weird hypo?

[Northerner]

Patricia,
Its little wonder we get confused isnt it? I think you have to go with your own instincts a lot of the time - i have sent Alex to bed on 7 before and he has been fine - but i think i will now make sure he has milk if he is under 8! Are you a member of the other childrens forum - i am - its great - we are all meeting up over bank holiday - 35 familes all with a type 1 diabetic child! There are spaces left if your interested! Bev🙂

Are you taking catering sized buckets of insulin with you?🙂

Just to add to the debate about high/low - I was told to keep my range between 4-7. 3.5-4.0 is 'low' and needs a couple of jelly babies, below 3.5 I have jelly babies and a biscuit. Symptoms appear irregularly - sometimes I can feel them above 4.0, usually when hungry, but sometimes I have nothing until things drop below 2.5. Nothing's straightforward!😱

 

[Adrienne]

A glucose level below 3.0mmol/l indicates hypoglycaemia.

Some people experience symptoms when their blood sugar level is higher than this ? eg at 4.0mmol/l. (Therefore 'four is the floor' for blood glucose levels.)

Hypos can't be detected with urine tests for glucose.
****************************************************************************************


Adrienne, it seems we are both wrong! So a hypo is 3 or under, but they say its 4 to be on the safe side! I wish there werent so many contradictions with diabetes care- it seems different consultants tell us different things - so its pot luck!Bev

Hi

I can't agree with this at all in the slightest. These glucometers we use are not brilliant at low levels and are all slightly 'out'. So a reading of 3.0 could actually mean a true reading of 2.6 or 3.5. This is the problem. The One Touch meters always come out on top as being the most accurate but you just don't know. You cannot wait until 3.0 to call it a hypo, this website is wrong. A hypo or low is under 4.0. For a non diabetic a reading of 3.0 is just about passable but I would be worried at that as well if it was reoccurring.

I have read the link you posted and I also don't agree with another bit this bloke has written :

"How is hypoglycaemia treated?


Mild hypoglycaemia is treated by drinking or eating about 10-20g sugar, eg in the form of sweetened juice, milk or glucose tablets.


In the case of a more serious hypo, an ambulance should be called. The paramedic will then give glucose intravenously or glucagon (GlucaGen) (a glucose-increasing hormone) is injected into a muscle, or into the fatty tissue under the skin."

Where in any of that are the rules that should be followed. He seems to have missed out a normal hypo ie one where you treat it with lucozade or coke or any other quick acting sugar. Milk is rubbish as hypo treatment, it isn't quick enough unless you mix Maxijul with it. For many fruit juice is also not quick enough. He is saying that I presume 3.0 to 4.0 is milk and so milk or whatever is ok and anything under 3.0 is classed as severe and an ambulance needs to be called and glucagon administered. Oh dear.

Anyone can give glucagon, you don't need to call an ambulance to do that. If you use the glucagon you should then call and ambulance as vomitting and more hypos can follow and you cannot use glucagon again until the liver replenishes ie minimum of 24 hours later.

I just think these things are so misleading.

A hypo is under 4.0. You can get mild hypos which is the ones I mentioned before where you learn work out how much quick acting you actually need ie half a small can of coke or 2 glucose tablets. You can get the worse hypos, ie lower than 3.5 where you need more coke or whatever and then you can get the hypos where fits happen. Fits are not always jerky things. My daughter always used to have the still, staring fits as if passing in and out of a coma, they are all still fits. I was lucky and could use coke. I did have to use the glucagon once last year.

Sorry to disagree again Bev, there is too much conflicting evidence out there from professionals. 4.0 and under is a hypo for a diabetic person.

Take care

 

[Adrienne]

This is all interesting...My 13 yr old is discovering that he seems to really notice some hypos, but not others. For instance, yesterday he went to 2.7 just before lunch, but had barely noticed it. Day before he went to 3.5 and felt *terrible*. Seems to vary, perhaps according to what kind of hypo? The pre-lunch one for instance may be partly from hunger, so doesn't feel as desperate? Whereas the other was in the middle of lessons so was maybe dropping fast? He usually notices something at about 3.8 though, registers it as 'feeling low'.

He is also discovering that it's easy to 'overtreat' a hypo for him. If he has a hypo, treats it according to what we've been told, he will usually end up sailing to 11 or 13, which means he's battling all day on some kind of see-saw. He's also beginning to feel more comfortable just having a snack (before bed) or one glucose tab (if before a meal), when low (as long as not v low of course).

Adrienne, is your daughter on a pump? NICE guidelines are very clear for lack of hypo awareness, aren't they?

Hi Patricia

Yes the guidelines are clear and it sounds like your son definitely qualifies. Is is on a pump or are you thinking about one? My daughter is pumping and it is life changing, I recommend it all the way as would my daughter who is 9 next week.

Have you looked at the website www.childrenwithdiabetesuk.org It will tell you all sorts of interesting stuff that will help with diabetes in children.

The email group is particularly great that Bev has mentioned, Bev is now part of the massive 'family' on the email group, we have one serious bond that we all share and we all 'speak' the same language when so many of our non diabetic friends don't 'get it' at all.

Let me know if you need any more info on pumping and I'll do what I can. 🙂

 

[Patricia]

Adrienne, thanks. Yes I know the site and forum BUT can't seem to get on it properly. Don't want the blow by blow emails because I can't keep track of my work stuff with them coming in, and may not want to read them all. How can I sign up for the 'thread' page, so I can see what's happening?

We are pursuing a pump for E like mad, and it now looks certain -- but when is the question. We are awaiting PCT funding approval. Our local clinic has no capacity until the new year, but one of the big ones close to us does and wants to help. SO looks promising.

Interested to hear that even E's irregular episodes of 'not knowing' seem enough for NICE. We don't anticipate a problem anyway, BUT we are in clinic at end of April, and may be useful to point out these episodes beforehand.

Glad to hear pump is life-changing. We really long for the day. Managing a growing child, hormones, the whole lot, is so very challenging at times, and we anticipate the pump making things so much more manageable for us and for him.As well as healthier, of course.

Thanks for everything. Would appreciate advice about joining the group....

 

[Adrienne]

Adrienne, thanks. Yes I know the site and forum BUT can't seem to get on it properly. Don't want the blow by blow emails because I can't keep track of my work stuff with them coming in, and may not want to read them all. How can I sign up for the 'thread' page, so I can see what's happening?

We are pursuing a pump for E like mad, and it now looks certain -- but when is the question. We are awaiting PCT funding approval. Our local clinic has no capacity until the new year, but one of the big ones close to us does and wants to help. SO looks promising.

Interested to hear that even E's irregular episodes of 'not knowing' seem enough for NICE. We don't anticipate a problem anyway, BUT we are in clinic at end of April, and may be useful to point out these episodes beforehand.

Glad to hear pump is life-changing. We really long for the day. Managing a growing child, hormones, the whole lot, is so very challenging at times, and we anticipate the pump making things so much more manageable for us and for him.As well as healthier, of course.

Thanks for everything. Would appreciate advice about joining the group....

Great news. All I can do is email the 'boss' lady of the email group and I can give her your email address and she can sign you up. I'll ask her to make it so you only receive the daily digest. There are loads of emails and you will have to delete loads if you received them all. Some I don't read and just delete. It's worth it though. You will get more help with pumping and stuff as well. I think I can private message you through here so I'll get that a go and get your email address from you that way.

 

[Adrienne]

Here we go, got some info : This is taken from an American site and they use mg/dl instead of mmol. THe numbers they use have mmol in () and are odd numbers because they use whole mg/dl numbers. ie they use 120 mg/dl (6.7 mmol) so we would use 7.0 mmol which is infact 126 mg/dl. They use 70 mg/dl as hypo (3.9 mmol) where we would use 4.0 mmol which is 72 mg/dl.

"Hypoglycemia

Hypoglycemia (low blood sugar) is an emergency that must be treated immediately. Without treatment, a low blood sugar may progress to unconsciousness and convulsions.

The risk of low blood sugars can be reduced by:

Providing extra snacks for extra activity (consult exercise guide and/or dietitian)
Eating immediately after taking insulin if the blood sugar is less than 100 mg/dl (5.5 mmol/l)
Eating an extra snack of carbohydrate and protein if the blood sugar is less than 120 mg/dl (6.7 mmol/l) at bedtime
Replacing carbohydrates in the meal plan with things like regular pop, regular popsicles on sick days
Using an insulin pump or Lantus instead of a traditional Regular/NPH insulin regimen

Treatment should be given whenever the blood sugar drops below 70 mg/dl (3.9 mmol/l) or symptoms are present. "


There is also a table on how to treat hypos with ideas which is quite good, you can find it at :

http://www.childrenwithdiabetes.com:80/d_0n_020.htm

Hope this helps and clarifies things a bit.

 

[Admin]

In reply to the original post by Tracey about not getting symptoms - like Patricia's son - I vary all the time. Sometimes 3.5 can make me feel really weird - other times I have been below 2 and felt absolutely fine. No rhyme or reason or idea why - hence regular testing. At the end of the day - I am not really bothered about what the intricacies are of what counts for a hypo and what doesn't or .5 readings - I know how my body works which is different to everyone elses - we all have our own levels - and I know that I quite often treat them differently depending on circumstances. For me, there is no standard.

The hardest thing I find is stopping myself from shoving too much in! I, like many others, if I am particularly low get the overwhelming need to eat...and eat! It is your bodies natural way of saying Help! I need energy - unfortunately as a type 1 your body does not then say - woah! enough! insulin needed! we have to do that for ourselves! If I do do this I just then give myself some insulin to compensate. Though over the years I have trained myself to mostly not do this! Occasionally I indulge it though!!

 

[Adrienne]

Sounds like you have it sorted Admin, I hope my daughter does when she is older as well.

My biggest worry is when consultants say if not symptoms then no hypo. People tend to believe consultants, especially newly diagnosed people. What Patricia's son may have experienced is a big drop and that could have made him feel hypo.

Do you know I feel awful about writing all this stuff because I have absolutely no idea what it feels like. I don't know how you feel and I don't know what a hypo or hyper feels like. I just hope I help some other parents.

 

[bev]

I think this is where its obviously hugely different for the person with diabetes and the carer of someone with diabetes. As a parent, we have to go on what a meter is telling us! I have no idea by looking at Alex whether he is 2.5 or 4 so it is probably more important for a parent to 'know' what the exact levels are and then treat appropriately. The issue here is that we are being given different advice depending where we get the stats from! Bev

 

[Admin]

I know what you mean Bev - it is a case of living and learning - I am still learning after 35 years! as research/theories develop! (For instance in the 1980's it was decided there was no need to carb count - as advised by Diabetes UK! I never followed this and always continued to carb count as to me that made so much more sense and couldn't rationalise their thought process at all). As you go along - both you and Alex will get a greater sense of what works and what doesn't. I read a lot of stuff that people swear by and I think is bunkum and vice versa!! I do believe in being informed - but don't take anything that is written about diabetes as gospel.

Adrienne - don't feel bad! All contributions and experiences are valid and help people learn whether good or bad! Oh! And FYI - there is no standard to how a hypo feels either! LOL! But not starting that debate agiain as some people got upset xx

 

[Copepod]

try estimating level before testing

Only thing I'd add is that it is worth trying to "fix" a memory of what each blood glucose level feels like (to the person directly affected) - I find it best to try to estimate my blood glucose level before testing, whether expecting a low / regular / high level. Even each level can feel different, and I'm sure that feelings change, particularly through adolescence (I didn't have diabetes as a teenager, but everything else feels odd then!) Sure, it's expecting a lot of an 11 year old, and it's not perfect, but it is worth trying - and a way of Alex developing his management of his diabetes. He could write his estimate in a different colour pen or new column in his record book.

 

[Adrienne]

Hi

We play that game. I generally, when I remember, ask my daughter what she thinks she is and we both try and guess as sometimes I may be able to guess from her mood (thats what I like to think anyway!). Its a good idea.

 

[bev]

Copepod,
Good idea - i will give it a try! It would certainly make Alex more aware of 'extreme' lows and just low perhaps!🙂Bev

 

[sofaraway]

"there is no generally accepted definition of hypoglycaemia, although most would accept a laboratory venous blood glucose below 2.5 mmol/l as indisputably hypoglycaemic. for practical purposes in a person with diabetes on glucose lowering treatment, it is a finger prick blood glucose level below 4mmol"

Diabetes the complete guide by Dr Rowan Hillson

this might be where your Dr got he 2.5 thing from Bev.

Tracy- no harm in mentioning it. I would keep a close eye on this, as you know people with hypo unawreness are not allowed to drive. Might be one of those one off unexplainable things, but if it's a patternt hen it will need to be addressed

 

[Patricia]

I think trying to guess levels before pricking is a good idea too -- E is coming up with this himself. Sometimes though he says he has absolutely no idea whether he is high or low -- all he knows is that he feels rough. Both have at times made him feel sick, and both seem to cause a loss of concentration. So if it's not clear cut, he struggles...

Admin, I'm rather reassured to hear that sometimes you know and sometimes you don't so clearly, also that symptoms vary. We have certainly found this. What is clearer to E is a sense sometimes that *dropping* is happening, like in the middle of the lesson. Whereas before a meal...he's just waiting to eat, and it's usually not plummeting...?

Anyway. So good to read all of this. Many thanks.

 

[tracey w]

Sounds like you have it sorted Admin, I hope my daughter does when she is older as well.

My biggest worry is when consultants say if not symptoms then no hypo. People tend to believe consultants, especially newly diagnosed people. What Patricia's son may have experienced is a big drop and that could have made him feel hypo.

Do you know I feel awful about writing all this stuff because I have absolutely no idea what it feels like. I don't know how you feel and I don't know what a hypo or hyper feels like. I just hope I help some other parents.

well i saw my consultant today and he definately did not say i did not have a hypo because of no symptoms!!! In fact he was very concerned that i was so low and felt nothing. A hypo in my book is anything below 4 whether you have symptoms or not. as others have said we seem to get symptoms sometimes, at higher levels and for some reason occasionally no symtoms at lower levels. i have been 1.9 with no symptoms before!!

Also we do get to know just how much to treat, for me i use dextrose tabs and give between 1 - 4 depending how low i am, always follow with long acting carbs. if just before a meal i will still take dextrose, eat and then give insulin. For you concerned parents i think your children will find their own way, if not already of how to treat and whats needed. i understand is difficult for you. but i think you need to take info on net with a pinch of salt sometimes as they are all so contradictory. Personally i have found other peoples experience and advice on this site invaluable on gaining knowledge of my condition.

stef you are not ignorant, just new as we once were. i did not know what basal and bolus meant before i went on it! Although you threw me a little talking about basil? he he

 

[tracey w]

"there is no generally accepted definition of hypoglycaemia, although most would accept a laboratory venous blood glucose below 2.5 mmol/l as indisputably hypoglycaemic. for practical purposes in a person with diabetes on glucose lowering treatment, it is a finger prick blood glucose level below 4mmol"

Diabetes the complete guide by Dr Rowan Hillson

this might be where your Dr got he 2.5 thing from Bev.

Tracy- no harm in mentioning it. I would keep a close eye on this, as you know people with hypo unawreness are not allowed to drive. Might be one of those one off unexplainable things, but if it's a patternt hen it will need to be addressed

hoping a one off as not happened before. I did feel a bit pale yesterday so maybe i was just a bit off colour? Always testing though, would be terrible if i could not drive. But i would always put safety, mine and others first.

 

[tracey w]

Tracey, it sounds like you are experiencing what I've been going through lately - getting unexpected low readings all the time. I reduced my bolus injections to try and match things up, but it took a while and I always seemed to be underestimating just how much to reduce by! Finally seem to have got some sort of control. I have also reduced my basal by 10% and on the whole this seems to be about right, although I was 4.1 this morning which is lower than the 5.x I've had for the past few days.

All you can do is try your best - hope things settle down for you soon!🙂

thanks, am ok today. have you thought of a pump? My consultant said unexpected hypos fit the criteria, and you have been getting these often recently.

 

[kojack]

Pleased to hear that you are better today Tracey.
I think we all have unexplained glitches which are made worse by trying to find the reason.

Sounds as if you have a caring consultant. That's great. What a pity the same standards are not countrywide.

 

[Steff]

glad your better today tracey x