Severe hypoglycemia episode

[Annalise]

My 7-year-old son was diagnosed with Type 1 diabetes in early June 2003, and since then we have been extremely conscientious about keeping his glucose under control.  He is still in his honeymoon phase, so there have been a lot of fluctuations, which his endo says is normal.  This summer, my son is at day camp (not one for diabetics, but for regular kids), and the counselors have been excellent at following his snack and lunch schedule.  Plus my husband goes at noon every day to check his blood sugar.  My son got through camp last summer just fine, but yesterday he blacked out just as I arrived to pick him up.  The paramedics inserted a glucose IV and he came to, and we took him to the ER for observation.  My son is fine, but now, a day later,I am still very upset -- more so than when he was first diagnosed.  We have tried so hard to keep his diabetes under control (his A1Cs are always excellent)and then something like this happens.  I know that what happened yesterday wasn't anyone's fault, but I can't stop beating myself up about it. I hope there is less of a chance of this when his honeymoon ends.  Any words of advice? Comfort?  The doctor has lowered his insulin, of course, even though the morning dose had been working all summer, and we've pushed his carb count for meals and snacks to the high end of the range.

[JDRF-Team-sgg]

Unfortunately, I believe that many tightly controlled diabetics do have to be aware that severe hypoglycemia is always a possibility. Anything such as added excitement or activity can cause him to be more sensitive to the insulin he takes and also burn up more of his glucose so a low is possible. Frequent checking is the real safety net, and also, as he gets older, making sure he always has an emergency sugar with him for times when he may feel this coming on. It is NOT life-threatening if caught within a few hours of loss of consciousness, but is of course frightening to all involved.

Do you and your husband have a glucaon kit in the house? I believe that this is a MUST for all tightly-controlled diabetics, and it can save the added trauma of having to go to the emergency room. I have had my share of severe lows and it is just part of walking that tightrope of careful balance. If the HIGHS are kept pretty normal, any little mistake in judging activity or food can result in a pretty bad low.

My best advice you you is to make sure that when he is not in his normal routine, his glucose is checked every 3 hours instead of just at meal times. That way, a low is caught before it gets so severe that he is in danger of passing out and of course he will feel better when not walking around for hours in mild hypoglycemia if he is dropping. He feels fine once the sugar levels are back up to normal, so this is probably more scary to parents than to the child.

No, the danger of this happening has nothing to do with honeymoon phase, for once the honeymoon phase is over, he will be taking more insulin by injection and any mistakes in estimating activity can mean the same result. This does NOT mean that you should limit his activity, though. To offer comfort here, I have been insulin-dependent for 34 years and have played USTA tennis and even was a white water raft guide for a few years!

One must just be aware that this kind of severe low is possible and try to do practical things to prevent it from happening or catch it early if it does happen. The day camp workers should possibly be taught what to look for in the way of symptoms of hypoglycemia and be given permisison to give him a half cup of juice if he seems to need it.

[Annalise]

Thanks for your answer!  The camp has been great about his diabetes.  The counselors all carry juice boxes in their fanny packs and know the signs of hypoglycemia. Plus I found out yesterday that one of the counselors is an EMT, so I am going to take my son's school glucometer to keep at camp from now on.  We do have glucagon at home, but we also check him if there's the slighest indication he might be low.  That's what makes this such a scary disease.  The numbers can't go too high or risk long-term complications, yet there the dangers of going too low.

[JDRF Team SGG]

The real danger to most diabetics is when they tend to lose their warning symptoms of hypoglycemia. For years, doctors had no answer to this problem, and tightly controlled people who do tend to have lows (even if not severe) fairly frequently tended to become unaware of hypoglycemia. In this case, it does become more of a life-threatening issue, and of course as the diabetic child grows up and is driving, could be a threat to the lives of others. A few years ago a study was released that indicated that those warning symptoms can be brought back by doing a couple of things, and those things are important for parents to build into a regular routine in order to protect your child's warning symptoms of hypos.

First, if he has several lows in a short periiod of time and seems to be dropping lower before noticing or behaving oddly, then you should do as your doctor just arranged for -- raise those glucose levels for a period of 2 weeks, according to the study on hypoglycemia unawareness. The study indicated that this is the length of time needed for the body to return to normal with normal warnings if a pattern of lows has caused the symptoms to dissapear.

The second thing is to treat any low wtih the quickest possible glucose fix. I think this is probably the one that may change your habits the most -- the idea is to treat any low (even mild ones) ASAP before the body has  a chance to seek the emergency sugars stored in the liver. So, if your child is low just before a meal, don't just feed him quickly, but give him a half cup of juice to get some glucose in his system immediately and then feed him his normal meal minus the carbs in the juice. This keeps the body from going after emergency sugars during the hours it takes to digest normal foods. So the quick fix is the key here. If he is low, give him sports drink or juice rather than a cookie, which takes more time to digest even though it has sugar in it.

I personally can attest to the usefulness of the advice published in this study. Keeping his warnings healthy is very important to all of you. I have changed my reactions to lows, and the warnings that I had lost years ago are now back.

[steveman45]

Hi annalise, im not on the JDRF team, but, ive been a type one diabetic, for about the same time your son as been, i was diagnosed in june 3003 aswell, at the age of 15
Going low, to the point of going unconcious, is my biggest fear as a diabetic.  and ive asked plenty of questions on this forum regarding it.

When im out, with my friends or whoever, i always have 3 BD Glucose Tablets in my pocket, as well as a pack of Christie Cheese Nips Sandwiches,(which i can easily and discretly hide in my pockets) or something liek that in my other pocket, so when i have a low, i am able to notice it, tell my buddies im takin a leak, lol, then quickly eat a few of thsoe glucouse tablets,  and eat 2-4 cracker sandwiches, and im fine within a few minutes, and that holds me off for a while.

Your son is still young, 7, so that may be harder for him,and maybe its harder for him to reconize a low but i dono, but i recomnmed Glucose tablets, there small, and taste like candy, and are the size of a small candy, so it smuch easier then carrying around juice or something

Hopefully that helped you in some way, im still learing how to cope with this disease aswell, and hopefully, within the next 5-10 years, cell transplates will be perfected, and widley avaible, and we can rid ourselves of this tiresom, and horrible disease.

[steveman45]

Oh, and i thought id add somethign to my last post, i read somewhere, that the insulin pump, is the best choice for young children on the go, maybe you can look into that if you'd like.