Tuesday, May 11, 2010

Treating Lows

This is Day 2 of D-Blog Week created by the Diabetes Online Community. The second installment: Making Lows Go Away.

Lows are all very different, some creep up on you and hit you like a freight train. Some come on slowly and you only know they are there because your brain is processing things slowly. There are crashing lows and lows that just hang around without dropping. There are lows that are a result of a basal rate thats too high, and lows from over bolusing or counting carbs wrong for food or corrections given. Some lows allow you to continue on your merry way while treating, while others inflict horrid confusion, weakness, headaches, trembling and FEAR.

Another sucky kind of low are the ones that come after a high. You know the ones. The highs you've been correcting that dont budge, so you do what seems logical and over ride the pump suggestions bolusing MORE. Then you crash and end up cursing Diabetes. It really ticks you off. Its the worst of both worlds.

I personally have only had a few heart pounding lows over the past 4 years while sleeping. I'm a daytime low kind of girl. I think we all tend to over treat night time lows sometimes. Night time brings about a desperate need to ease our fears and stop the sweating and confusion during our sweet dreams. Juice is stashed in my dresser drawer along with glucose tablets and Glucagon. You never know.

Maddison tends to have alot of numbers that are lower than is safe for a sleeping child at night. "Drink Drink" is all I have to say to get Maddison sipping on juice straw all hours of the night. My goal of treating night time lows is to never have to wake my sleeping child. Thats why I choose juice at night for Maddie. If I wake Maddison up, she will then feel the low which sucks in itself. I also dont want Maddison to then be kept awake with needless worry of going back to sleep. If its a scary low (under 60) I may choose to grab the glucose tabs out of fear that she's dropping fast. You never know. Glucose tabs are also nice because they are only
4c....sometimes thats all it takes to bump up a low. Tabs also work fastest for us, probably because it is a dextrose sugar vs fructose. If Maddison is just trending low I reduce her basal to 0% for half an hour and recheck at that time. Trending lows also get some milk or PB for staying power. There is a very fine line between too many carbs for lows and not enough. Treatment of Maddies lows are pretty much based on the weekly trend or the activity level of the day.

Daytime lows for both Maddison and I are **typically** caught before they happen, because we ALWAYS try to check 2 hours after eating. The "active" insulin, or insulin still working to lower blood sugar after a meal, is tracked by the pump. THANK GOODNESS. THIS IS MOST IMPORTANT PART OF PUMPING FOR US! If you see me asking for Maddison's pump when she is low it is because the active insulin tells me how low she is likely about to go. There is a BIG difference between a low with no "active" insulin and a low with tons of insulin still working.

If a low is already here and crashing we choose 100% juice (not apple, too slow) tabs or a hidden candy stash. Skittles work well since I can find them in tiny holiday packets, they have 12c which usually does the trick. If we have an impending low that isnt here yet, we have a snack starting with fruit (or something high GI like pretzels) and reduce the insulin given with it to balance out the low.

The lows that tell your brain to cause intense hunger feelings are treated with some very filling food. A good balance of carbs, protein and healthy fats does the trick and assures your body you are replenishing the crashing blood sugars. There is nothing worse than the starvation feeling you sometimes get when you are low. Your body literally signals you to shovel in the food because your brain is being starved of the vital glucose it needs to survive. I never ignore that feeling. If my body says pour in the food, I do. (which is probably why I've gained weight) Then of course you will have to bolus back some insulin after the risk of the low has passed. Its all about balance my friends. Balance.


Wendy said...

Without the DOC, I would never have known why Addy seems like a stark raving food craving maniac sometimes when she's low/dropping.

I'm so thankful to have learned things like this...I have no idea what she feels so I need all the help I can get.

Since learning about the low-starvation feelings, I've been quick to allow her to have all the snacks she feels she needs after her quick sugar.

Thanks to IOB, I can just dial in the carbs and the pump will do the math, plus take into consideration her current blood sugar ... it's very effective for preventing the rebound.


What the heck is THAT?????

Tracy said...

Great post Kelly! I too treat all lows differently. It depends on what the low was caused by and how fast he is dropping, if he is still dropping more anyway.

Thanks for sharing!

Karen said...

I Love those holiday candy packs too! They're so handy. I wish they made more of them during the regular year!

I don't really get low at night too much either....but last year somehow my pump's date/time settings got messed up and I was getting a daytime basal instead of a nightime one! ahh. I woke up shaking and sweating....with a 22! Both my roomates left school for the weekend too! It was the scariest experience!

Hallie said...

I love reading your first hand view of it. It really helps me "get" what she is feeling. Avery's only low signal to us is "I'm Hungry!". Always. Lows suck!

Scott K. Johnson said...

GREAT post Kelly - you really nailed it on the lows and the urges to shovel in the food.

That balance is damn hard to find sometimes.