Author Topic: Teenager dealing with "lows"  (Read 2231 times)

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Offline Remmer

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Teenager dealing with "lows"
« on: 17 May 2015, 03:22:04 PM »
Hi all, a bit of advice my 14 daughter, has had diabetes 1 for nearly 2 years. She has do date been treating her lows with Lucozade, however I have have concerns with this as although it fixes the situation quickly, I can't help but feel it that a more steady alternative would be better for her levels (ie something that takes her level up but not quite to erratic if that makes sense) I am also worried that lucozade cannot be a healthy option for her teeth. So just some advice on alternatives to lucozade. We do have the glucose tabs, a friend has also suggested one of the miniature cans of coke combined with a cereal bar?, any suggestions? Thanks in advance..... :)

Offline sedge

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Re: Teenager dealing with "lows"
« Reply #1 on: 17 May 2015, 04:55:50 PM »
Well you don't have to drink as much Lucozade as Coke to get to 15grams of carb, do you?  90ml of Lucozade as against 150ml of Coke.  That's because there is Glucose in the first and not in the second.  So anyway - having to drink more of it will be worse for teeth !

It's personal choice - but why would she also need a cereal bar after the 15g carb in the drink anyway?  I think following up with slow carb is a good idea if you are going to take exercise - or you're a YOUNG child - but for adults, it shouldn't really be necessary.  And she's almost an adult, isn't she?

The hypo rule is consume 15g fast acting carb, re-test in 15 mins.  If it isn't well on the way up, re-treat.  If she's been hypo for a while - or is VERY low before treating - then that's when the liver will help out by piling its contents into the bloodstream and giving us a mega-high level.  If she FEELS hypo but is over 4 when she tests - still treat, because feeling hypo at over 4 is a sign your BG is plummeting quickly - so untreated you very soon will be under - well under! -the magic 4.
Jenny

T1 DX 1972, pumping Novorapid 24/05/11

HbA1c - 7/07 8.7, 1/08 7.8, 9/08 8.4, 3/09 7.3, 7/09 7.2, 12/09 7.3, 11/10 8.1, 2/11 8.6, 9/11 6.5 2/12 6.4  5/12 50/6.7  11/12 52/6.9  01/13 46/6.4  06/16 46/6.4  12/16 45/6.4

Offline Lucy

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Re: Teenager dealing with "lows"
« Reply #2 on: 17 May 2015, 05:06:12 PM »
It's personal choice - but why would she also need a cereal bar after the 15g carb in the drink anyway?

Because whatever got you down below 4 is probably still working. I have always been told to have slow carbs after the fast. I thought everyone was told to do that, unless the next meal is soon?


Remmer: how many lows is she having? If its enough that the amount of lucozade she's getting through is concerning for her teeth then perhaps there are some insulin tweaks that could help reduce the amount of lows?
Type: Lucy. A1C 44 / 6.0% Jan17.
Lantus, Victoza and Apidra. Metformin XR, Bisoprolol (for SVT). Dexcom G4 with xdrip and nightscout.

Offline Remmer

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Re: Teenager dealing with "lows"
« Reply #3 on: 17 May 2015, 05:12:50 PM »
She is not having lots of lows, I was really seeking an alternative to lucozade. What would suggest would be a good slow carb from experience?

Offline Lucy

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Re: Teenager dealing with "lows"
« Reply #4 on: 17 May 2015, 06:17:28 PM »
She is not having lots of lows, I was really seeking an alternative to lucozade. What would suggest would be a good slow carb from experience?

I find bananas quite good actually, if i'm at home, or milk. Can't really carry those around with you though. Sometimes use a little tub of dried fruit for slow carbs, and have some to stop me dipping low.
Type: Lucy. A1C 44 / 6.0% Jan17.
Lantus, Victoza and Apidra. Metformin XR, Bisoprolol (for SVT). Dexcom G4 with xdrip and nightscout.

Offline Pattidevans

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Re: Teenager dealing with "lows"
« Reply #5 on: 17 May 2015, 07:06:25 PM »
Hi Remmer

I use Lucozade tabs because I can control the number of tabs I eat, whereas I would be hopeless with a bottle of Lucozade and probably drink far too much.  I find the tabs bring me up quickly, but the effect can be equally as quick wearing off sometimes.  Being on a pump I can, however, put on a lower temporary basal rate to see me over the next hour or so.  If she's on injections and it's within the time the insulin is still working she may need something slower acting to prop her up until the insulin dose is spent.  Poundland do boxes of 5 Weetabix cereal bars that are 12.1g each.  Alternatively they do boxes of 6 peanut tracker bars that are 14g each.  As they are individually wrapped they are easy to carry around & don't melt like Twix bars or some other chocolatey things.  You can of course get them in other supermarkets but at twice the price.  She also might need some slow carb if she's low due to exercise because sometimes you end up with the exercise affect carrying on for some while.

Yesterday I had a long walk on the coastal path which was a bit up and down, so more of an effort than walking on the level on a road. Half way we stopped for a cuppa at a beach cafe and I was marginally low, so I got to eat an ice cream  :) which propped me up for the walk back.  However, the effects of the walk lasted well into the night.  These sort of situations are the ones that need some slower carb sometimes.
Patti


Type 1.  Mis-diagnosed T2 May 2003, finally had CPeptide test 15/7/11 and proper diagnosis 1/9/11.  Now pumping Apidra with Roche Spirit Combo pump. Hba1c 6.1 April 2016.


© 2015 Patti Evans

Offline Liam

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Re: Teenager dealing with "lows"
« Reply #6 on: 17 May 2015, 07:58:55 PM »
I like Patti use tabs (gluco tabs) as while I find liquid a little bit faster I have a hard time judging how much to use. Like Patti I often lower my basal on my pump but it depends what else is happening around the low.
DX Type I 1994.    Novorapid Animas Vibe pump
HbA1c 3/10 10.2%, 7/10 8.1%, 12/10 7.5%.
2/11 7.8%, 8/11 8.6% 9/11 8.3%.
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4/13 63 (7.9%) 6/13 59 (7.5%)
1/14 71 (8.6%) 7/14 59 (7.5%) 11/14 (6.7%)
3/15 56 (7.3%) 12/15 49 (6.6%)
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Offline Remmer

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Re: Teenager dealing with "lows"
« Reply #7 on: 17 May 2015, 08:52:07 PM »
Thanks all, great help as always

Offline nytquill17

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Re: Teenager dealing with "lows"
« Reply #8 on: 17 May 2015, 09:57:27 PM »
Just wanted to throw out, for people lurking, that it is VERY hard to control what you eat while you are low or feeling low because it does affect your cognition (reasoning and judgment) and a lot of the chemical messages being sent are of a very primal nature, i.e. eat now or die! So I think it's more productive to do what you're doing, Remmer - look at ways to externally restrict the amount of carb one is likely to eat, by using prepackaged foods and things with easy-to-determine portion sizes. As opposed to trying to "get" the person to have more self-control while low.

Another thing to remember is that BGs are more likely to be erratic after a low, even an appropriately treated one, than they would have been without one. A low sets in motion certain chemical responses in the body that can affect BGs for some time afterwards, particularly if the liver gets involved. Unfortunately from the outside we don't have any good way to know if the liver has gotten involved or not, so we have to always assume that it might have. A liver dump can cause a high BG following the low, even if the person treated with only the minimum carbs necessary. And it may lead to more low BGs in the hours that follow, particularly if the person tries to correct for the original liver dump high with insulin.

Two things follow from this; one is that it's important not to jump straight to pointing the finger at overtreating just because a person has a high BG following a low - the body after a low is an unstable environment for up to 24 hours after the fact. The second is that unless you are 110% sure that a high BG after a low one is down to overtreating (like, okay, if I've eaten three tortillas, five spoons of peanut butter, two apples and a Pop Tart and am now at 21.something it's probably safe to correct a little, lol!) it shouldn't be corrected for at all and if you ARE going to correct a post-low high you should work out what you would normally give and then only give about half that.

What people use to treat lows is down to personal choice, what are you looking for - speed of digestion, degree of perishability, degree of portability, taste/texture questions, etc. For me I want my hypo remedy to fit in a pocket (so I can go for a walk without carrying a bag), not be affected by heat or cold, relatively long shelf life so I don't have to replace it if I don't need it for a long time, and to be palatable but ideally not taste SO good that I will be tempted to eat it just because. Kind of a tall order! I gravitate towards pre-packaged fruit leather, but I've been told such a thing is less available in the UK. Here in Canada it's called Fruit-To-Go and it's just about perfect. Before that I used to use those little fun-sized boxes of raisins but they don't exactly have a slim profile. I do also use Dextabs (but I find the tubes are so large that fitting them in a small bag or pocket is tricky). I've tried the hypo gels and found them disgusting (others swear by them though so don't go just by me!) I don't like liquids because then you have to carry the bottle around plus it's hard to dose out. But if I'm out and about and find I'm low, it's fine stopping in a shop to get a Coke or a juice or something!

I think from my own experience and from others I've heard on the forum that slow carb is overhyped for treating hypos. But it all depends on the situation, too - how much insulin is still on board, is there activity coming up, how far away is the next meal (or the last one!), do you often have hypos that are difficult to treat and require lots of carb or are you more likely to just need a little carb "top-up" to correct minor wobbles? So the official advice is 15g/15 min., repeat as needed and follow up with slow carb, and that will definitely keep you safe in all situations, i.e. you can't go wrong with it in terms of treating the low. However in terms of maintaining appropriate levels after the low, it isn't always what is necessary in a given situation and can sometimes be overkill. It's really down to how good the person is at noticing their lows (if there is a chance you might not notice that you are still hypo/hypo again and need to re-treat, best to err on the side of caution), and at sizing up their situation and knowing what their body is typically like (including whether it's unpredictable and not "typically like" anything much) to figure out what exactly is needed.
T1 DX 1995
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"I suppose anyone can fall," said Shasta.
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Offline Pattidevans

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Re: Teenager dealing with "lows"
« Reply #9 on: 17 May 2015, 11:28:24 PM »
Oh... I forgot.. this might help too!
http://diatribe.org/issues/55/thinking-like-a-pancreas

Really good article from Gary Scheiner of "Think like a Pancreas" author
Patti


Type 1.  Mis-diagnosed T2 May 2003, finally had CPeptide test 15/7/11 and proper diagnosis 1/9/11.  Now pumping Apidra with Roche Spirit Combo pump. Hba1c 6.1 April 2016.


© 2015 Patti Evans

Offline Venomous

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Re: Teenager dealing with "lows"
« Reply #10 on: 30 June 2015, 07:16:13 PM »
The problem I have had with trying to treat a hypo with a slower "healthy" alternative is by the time you've eaten it and then tested, if you're still going low after you've finished the slower option, when you then treat with the faster alternative, it takes a while longer to be absorbed because you've already filled up with the slower option and it somewhat blocks the action of the faster remedy. Also a hypo feels emotionally "panicky" so if the diabetic is used to treating him/herself with something specific if you then prevent them from doing that even whilst providing them with an alternative it may feel to them even more frightening in their (slightly) confused state.

I would say if she wants to drink lucozade why not let her, just limit the amount she is taking to treat for it. I do remember a hospital nurse trying to force me to have glucose tabs and being ready to fight her rather than swallow them lol, that's what you're dealing with, a confused and yes primal response.

I have a nice routine we use when I am hypo, I drink a specific amount of orange juice which we have worked out has the correct amount of sugar in. We turn on a fan (cold air cools me and calms my panicked feelings) and my husband gives me a cool slightly wet flannel to wipe my face and neck as the hypo begins to subside. I often feel *HOT* when I'm hypo so hubby will take me starting to feel chilly as a sign the hypo is subsiding. Hubby says if I am hypo enough to be antagonistic and reject the idea of drinking the OJ when I need it then I'm usually below 2.5ish and need it more than ever.

Alternatively if we're going to bed and I'm lower than 5.0 hubby is uncomfortable to go to sleep in case I hypo in the night so I'll drink a small glass of milk which is usually slower carb and fatty enough to keep me stable preferably or does sometimes produce a small slow rise followed by a slower drop still within normal range.
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