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Question: From Philadelphia, Pennsylvania, USA:
My daughter, who has type 1, uses Lantus and NovoLog for meals. This morning, she woke up to her alarm, tested her sugar and it was 36 mg/dl [2.0 mmol/L]. She ate a bowl of cereal, took no insulin went to work and started to feel sick. She tested again and her sugar was 411 mg/dl [28.8 mmol/L]. This was only one and a half hours later. What causes this to happen? This has happened before, too. Is it the liver releasing sugar because of the low?
Answer:
It is impossible to know exactly what caused the marked swings in blood glucose (sugar). Several possibilities come to mind immediately. The meter reading of 36 mg/dl [2.0 mmol/L] may not have been correct. The carbohydrate load from the cereal, milk, etc. may have been greater than required. The liver's glucose response to a low blood sugar is another possibility. There may have been a combination of these and other factors. We generally make the following recommendations to patients who require multiple doses of insulin.
- If the blood glucose meter requires coding, ensure that the meter code matches that of the strips.
- Ensure that strips have been stored properly, i.e., in the original container.
- Use calibration solution frequently (at least once for each container of strips).
- Ensure that strips and calibration solution have an unexpired date.
- Recheck any blood sugar value that is out of the ordinary.
- Do not use food to correct a blood glucose, rather use the 15,15,15 rule: If blood glucose is less than 80 mg/dl (DO NOT DRIVE!), take three glucose tablets (15 gm carbohydrates). Wait 15 minutes. Check blood glucose. If less than 110 mg/dl [6.1 mmol/L], take three more glucose tablets. Wait 15 minutes. Check blood glucose. Repeat this cycle until blood glucose is greater than 110 mg/dl [6.1 mmol/L].
DTQ-20071207085453
Original posting 16 Dec 2007
Posted to Hyperglycemia and DKA and Daily Care
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Last Updated: Tuesday April 06, 2010 15:10:16
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