Newly Diagnosed Child Diabetic

[StephenMacInnes]

Hi, I have had diabetes for 30 years and my 9 year old daughter has just been diagnosed with diabetes.

Here is a situation which occurs often. My daughter had a blood suger of 7.5 mmol last night, I gave her 2 units of levemir (background insulin) and no short acting insulin. For dinner she had pasta with sausagesa and brocolli, grapes and a mars bar ice cream. 2 hours later she was up at 20 mmol then it started to come down quite fast, so when it was at 10 mmol she had 2 slices of toast with butter, it continued to fall and she was at 4 mmol an hour later, she was given a carton of apple juice and some sweets to bring her back up, it did not rise so she was given lucozade and more sweets, I checked later at 1am and it was 7.1 and climbing. At 4am it was down at 2.9 and then I gave her more sugar to get her out of the low glucose range.

I just don't understand how consuming all of the carbs and sugar whilst only having background insulin can the blood sugards free fall like that. Morning and lunchtimes work like they should in terms of matching insulin to the food she eats.

I understand there is a honeymoon period were my daughter is producing her own insulin but can this happen at only certain parts of the day? I don't want her to be constantly having sugary drinks and sweets but at the moment it is necessary.

Does anyone have any similar experiences they can share and what was done to avoid this.

Thanks,

 

[rebrascora]

Hi and welcome.
So sorry to hear of your daughter's diagnosis but at least you have a bit of a head start on non-diabetic parents in knowing the basics. I can't begin to imagine how heart breaking it must be to have to give your child daily injection.

Are you giving her a split dose of Levemir ie some in the morning and some at night? If so, how many units in the morning? If you only give her Levemir at night then it might be worth discussing changing it to the morning instead with your daughters team and to be honest you really should be taking this problem up with them anyway... that is what they are there for.
I find if I am active through the day, Levemir disproportionately takes me down at night. I have currently had to stop all evening Levemir and still need to get my BG up to 9 or 10 before bed to keep from hypoing, but I still need 16 units in the morning to keep my daytime levels right. If your daughter is running about and active through the day or doing sports then this may be the cause of her evening lows. Going up as high as 20 and then down into hypos must be making her feel pretty shocking. I certainly think that the honeymoon period will be adding to the problem, but best to speak to her team about a strategy to tackle it. Using bolus insulin for the meal and no Levemir might be a better option to prevent that high happening.
Do you have half unit pens for her as that is something else which might be helpful when such small doses are having a big impact. Hopefully other parents will be along to offer their advice and support.

 

[everydayupsanddowns]

Sorry to hear about your daughter's diagnosis. It must have been heartbreaking to see that unfolding having lived with it yourself.

I guess at least you had a lot of insight into the ins and outs of T1 from the start. Though it sounds like that comes along with some extra frustrations where your daughter's T1 plays to completely different rules to yours

I don't have and experience of T1 in childhood as I was in my early 20s when I was diagnosed, but I've heard other members over the years talking about a frustrating honeymoon period of 'stuttering' and sometimes quite unhelpful insulin addition

I wonder too whether there might be something related to 'reactive hypoglycaemia' where her remaining beta cells might be being prodded into over-enthusiastic action by the high levels? That is a complete guess, but in non-Ds I think the glucose regulation responses can be triggered by glucose variation.

Do lean on your paeds team so their insight too. They will have seen all sorts of different experiences over the years and may well have a variety of strategies to try? A good Paed DSN is worth their weight in gold.

You might also want to get hold of Ragnar Hanas's book Type 1 Diabetes in Children Adolescents and Young People too. Many members over the years have found it filled in a lot of blanks.

 

[Thebearcametoo]

I wonder if giving some novorapid to match the food so there’s less of a spike and the honeymoon dump of insulin doesn’t happen may be better. Maybe no basal for the evening but some bolus. I would definitely chat with your team though those night time lows aren’t safe. Don’t guess at it. Talk to the paed team as they have way more experience than us as they deal with way more kids.

How many carbs was that meal? I would guess a lot but obviously I don’t know what the portion sizes are. We found that in the early months limiting the carbs to around 60g per meal stopped the cycle of spikes then hypos but for us it was about balancing bolus as she always needed insulin with food. And some foods including pasta would make her spike more than others but it was a bit of trial and error as to which ones it was (she was fine with pizza which a lot of people struggle with).