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Question:

From South Carolina, USA:

My daughter is 8, Type 1. Our concern is that she might go to sleep, have an insulin reaction, go into a coma, and either we find her dead or in a coma. What are the chances of this worst-case scenario happening? Has it ever happened before to your knowledge? My local provider says she's not 100% sure. Also, possibility of brain damage from coma--what % chance is there of this happening? Finally, blood sugar levels are erratic, being 120+ at night, 147 during the night, and 150+ in the morning---currently giving 1/2 unit fast acting and 7 units long acting in AM, 1/2 unit fast acting and 5 unit long acting in PM. Doesn't eat much more than 20 carbs for breakfast and 40-50 carbs for lunch or supper. What could be the problem?

Answer:

Fear of hypoglycemia is common in all parents of children who have diabetes. No one can guarantee that hypoglycemia will not occur during the night, but it sounds like you are doing a great job of preventing it from happening. Testing before bedtime, making sure she gets her bedtime snack, (some diabetes teams have guidelines for extra food to be added to snacks when blood sugars are below certain levels) and testing her during the night are all things to help prevent this from happening. If middle of the night lows become a problem, some physicians will move the shot of Intermediate acting insulin (like N or L) to bedtime so it does not peak in the middle of the night. This would be up to your physician, though!

As for her "erratic" blood glucose levels that you describe, there are several questions that need to be answered: What kind of target range are you going for (or what have you been told to do by your health care provider?) Also, some kids eat more at different times of the day than others, according to appetite, etc. Is this carb pattern what the dietitian worked out in collaboration with your doctor or diabetes nurse educator? If your daughter isn't under the care of an experienced pediatric diabetes team, you should ask for a referral to a nearby team.

JW

Original posting 11 Feb 98

  
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Last Updated: Tuesday April 06, 2010 15:08:56
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