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Question:

From America OnLine:

My 12 year old daughter has had diabetes for just six months and we are getting used to the routine. We are having a problem with her not being able to recognize a true low blood sugar from a high blood sugar. It sounds odd but she will get panicky and anxious and say she is getting low when in fact she is well over 250.

She knows the true feeling of a low and has experienced several bad true lows since being diagnosed. She is terrified of that low feeling and complains also of being sensitive to crowds, noise and dim lighting.

She is bright and has a great attitude about her condition but these erratic blood sugars and false lows are causing some major problems.

Have you heard a similar story before or do you have any advice?

Answer:

It is common and very understandable to have a lot of anxiety, especially over hypoglycemia, in the months just after diagnosis. It almost always subsides as familiarity and control increases. One reason that she may have had especial problems is that during the 'honeymoon' period there may have been what is called a delay in 'first phase insulin release'. What this means is that residual insulin is released into the blood stream, not immediately in response to a rise in glucose level; but some time later. This can lead to unpredictable hypoglycemia, which subsides after all insulin has ceased.

There are two steps you can take to help your daughter. The first is to encourage her to test whenever she feels 'odd' irrespective of symptoms. This will teach her to relate feelings to actual blood sugar level. You may need to talk to her school to facilitate doing blood sugars there. Personally I have been very sceptical about the ability to tell high from low blood sugar levels on the basis of how you feel. It is often used as an excuse not to carry out actual measurements and small children especially have been known to feel 'low' when they pass by Baskin Robbins! At best it is very unreliable

Anyway lots of blood sugars at this stage. The second task is to identify if and when real low blood sugars occur and with the help of her doctor to readjust insulin levels and snacks appropriately. It would be important for example to set the alarm clock and do a few blood sugars at 2:00 A.M. and to do enough bedtime blood sugars to keep blood sugars at that time above 110 mg/dl, supplement the snack if they are below that point. Make sure that school lunches are not a problem and that they are not sometimes being skipped. Finally vigorous exercise can lead to low blood sugars. The lows can occur at different times in different individuals, sometimes at the end of the game, sometimes that evening and sometimes before bed. The timing is fortunately consistent in any one person; but you need to find out when it is most likely to occur.

If there is a medical social worker in her diabetes team, you might like to talk to her. Sometimes help is needed to unravel these problems if they don't go away.

DO'B

Original posting 15 Mar 97

  
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Last Updated: Tuesday April 06, 2010 15:08:54
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