Early on, I used to go in and look at him, just to make sure his chest was rising and falling. My knowledge, after discharge from the hospital, was enough to tell me that I could make a mistake with serious consequences. I knew what I didn't yet know, the experience I was lacking. It made my heart race, my hands shake, ice water fill my veins. The greatest fear of parents of T1D kids is the "dead in bed" syndrome or finding the child unresponsive.
I was reading yesterday:
In studies of insulin-induced hypoglycemia in monkeys, 5–6 hours of blood glucose concentrations of less than 20 mg/dl were required for the regular production of neurological damage; the average blood glucose level was 13 mg/dl. Fortunately, hypoglycemia of that magnitude and duration occurs rarely in people with diabetes.
Five or six hours of low blood sugar for neurological damage. Well, now you know why I don't sleep. I don't 100% trust technology and I do check his BG at night. Extended hours of low BG are dangerous. So, I am losing sleep over lows, but I'm no longer putting a mirror under his nose to see if he fogs it up.
Plasma glucose concentrations of less than 18 mg/dl occur occasionally in people with diabetes, and dying brain cells, presumably neurons, have been reported following episodes of hypoglycemiaat plasma glucose levels of 30–35 mg/dl — but not following episodes of hypoglycemia at plasma glucose levels of 45 mg/dl — in rats. Thus, it could be reasoned that these categories are not binary and that there is a continuous spectrum with increasing risk of neuronal death at progressively lower plasma glucose concentrations. Nonetheless, seemingly complete recovery follows the vast majority of episodes of clinical hypoglycemia.
How low is damaging?
With the CGM and Sugar Surfing, we're able to head off most all lows, rarely dipping below the high 50s, which are followed by a "seemingly complete recovery".
So while I'd like you to see me as a superwoman complete with cape and juice box in hand, the life saving efforts are more boring and long term. Day to day tweaking insulin ratios, assessing data, figuring out meal plans, pushing exercise. The dangers of high A1C and high BG are more likely to lead to complications and death than low BG.
Had an endocrinologist appointment yesterday. A1C was 5.9, down from five months ago at 6.1. Obviously, the good doctor had not looked at William's chart because he asked if we'd ever considered getting a CGM (continuous glucose monitor). I almost snorted. William has used one since 3 months post diagnosis, 2.5 years. Yeah, don't think we could have achieved lower A1Cs without it.
Key actions for William:
- Becoming more comfortable with lower numbers (Note: William is 14 years old and numbers we are comfortable with are in part due to his age/maturity. I know everyone will have different comfort levels based on size and age.)
- A tighter range for his target: right now at 70 - 160 mg/dL
- Pre-bolus (if in normal BG range) 15 minutes before eating or longer if high
- Not treating numbers in the 70s if steady and awake
- Lower sleeping target: around 100s if steady, but won't treat until lower 80s and that is just so I can get some sleep.
- Lowering the amount of complex carbs, e.g. rice, noodles, gluten free bread. Still eats them, but in smaller quantity
- LDN: can't prove it, not recommending it, but I'm seeing smoother numbers. Just saying.
- Gluten-free and limited dairy
- Probiotics, Vitamin D, and other supplements
Disclaimer; Nothing you read on my blog is intended as medical advice. If you have questions about your medical care, please consult a doctor, I am not a medical professional and do not offer this as advice but only my own thoughts for our own situation.