Preventing and treating hypoglycemia

Preventing hypoglycemia may be time-consuming, but it's possible and entirely worth the effort! Even if prevention doesn't work and your child still has episodes of hypoglycemia, you can treat it in several different ways, as you find out in the following sections.

Preventing hypoglycemia

The best way to prevent hypoglycemia is to be constantly aware of your child's blood glucose. Meters are being developed that can measure glucose every five minutes and beep if it falls below a set level. (See Chapter 7 for more on these meters and for general information on measuring blood glucose.) Unfortunately, these meters haven't been perfected quite yet, so it's still necessary to stick your child multiple times a day in order to know his blood glucose. But even periodic testing doesn't get around the problem of not knowing your child's glucose for seven to eight hours while he sleeps (unless you set your alarm to wake you for an occasional middle-of-the-night test).

When your child is asleep, he may be unaware of developing hypoglycemia, and you certainly aren't watching him to pick up the cues. One way to avoid hypoglycemia during sleep is to give the child a bedtime snack containing a slowly absorbed source of carbohydrate. Unfortunately, the best food for this purpose, raw cornstarch, isn't very tasty. Even better (or worse!), it needs to be eaten cold to preserve the slow uptake of glucose. Here's a rough guide for how much cornstarch will help your child (or you) fend off hypoglycemia overnight:

^ A 50-pound child needs about 4 tablespoons of raw cornstarch. ^ A 100-pound child or adult needs 7 tablespoons of raw cornstarch. ^ A 150-pound adult needs 10 tablespoons of raw cornstarch.

And here are a couple of ways to make cornstarch somewhat appetizing for your child:

^ Dissolve raw cornstarch in a glass of milk.

^ Ditch the raw cornstarch for a snack called Extend Bar. It contains only 5 g of uncooked cornstarch, considerably less than the recommended 30 g, but children find it more palatable than the raw stuff. A study in Diabetes Research and Clinical Practice in September 2001 showed that Extend Bar kept the nighttime blood glucose in a non-hypoglycemic range when eaten by adults at bedtime. (The study results with adults indicate that Extend Bars are an effective option for children.) You can buy Extend Bars at some drugstores or order them online at www.extendbar.com; visit the Web site for more information.

Another way to minimize the occurrence of hypoglycemia is to keep as regular a schedule for your child as you possibly can. If he wakes up at around the same time, eats at around the same time, eats around the same amount of carbohydrates, and exercises around the same amount each day, you'll know how much insulin to give him. Very few people can do this because life intervenes with parties, travel to different time zones, meals eaten away from home, and sleeping late on the weekends. But fear not; I explain how to live well with type 1 diabetes in Part IV.

Adjusting insulin amounts for hypoglycemia

If you're unable to prevent hypoglycemia outright, one thing that you can do to treat it is know which insulin is most responsible for the blood glucose at a given time. If hypoglycemia occurs during that time, you can adjust the insulin down slowly (1 to 2 units a day, and then don't change it again for three to five days) until the hypoglycemia subsides.

Table 4-1 shows you which insulin — rapid-acting or long-acting — is active at certain times of day, assuming that you use the standard therapy of three shots of rapid-acting insulin or three doses of inhaled insulin before meals and one or two shots of long-acting insulin in the morning or both morning and evening.

Table 4-1 Making Adjustments to Insulin Activity

When Hypoglycemia Relation to Meal Insulin Type of Insulin to Change Occurs

Before breakfast None Long-acting

After breakfast

Pre-breakfast shot

Rapid-acting

Before lunch

None

Long-acting

After lunch

Pre-lunch shot

Rapid-acting

Before dinner

None

Long-acting

After dinner

Pre-dinner

Rapid-acting

Bedtime

None

Long-acting

Middle of the night None Long-acting

Middle of the night None Long-acting

You can see from Table 4-1 that, in general, rapid-acting insulin is responsible for blood glucose for the first couple of hours after meals, whereas long-acting insulin is responsible for all blood glucose the rest of the time. For example, if your child becomes hypoglycemic at about 9 a.m. most mornings, around two hours after breakfast, you need to reduce his pre-breakfast rapid-acting insulin If the hypoglycemia comes on around 11 p.m., around four hours after dinner, then he's getting too much basal insulin (see Chapter 10 for an explanation of basal insulin).

Unfortunately, things aren't always so clear-cut. Your child may have hypo-glycemia one day and hyperglycemia at the same time the next day even if you do everything the same way. In the final analysis, you may have to go back to that old standby, trial and error.

Using a glucose meter with a memory that you can download to a computer data management system is essential in recognizing patterns in your blood glucose. Among other things, the computer can show you all the tests during a given time period, indicating whether your child's glucose levels are typically high or low at that time. Your child's doctor should have this capability. (If you want to be able to download this information yourself, call the meter manufacturer using the 800 number on the meter.)

Trying other helpful tips to treat all severity levels

Some of the practices I recommend here for treating hypoglycemia may seem obvious, but they'll come in handy when your mind goes blank in the middle of a hypoglycemic episode happening to your son or daughter (or to you, if you're the patient). Most of these tips work for treating mild or moderate hypoglycemia (the last one is for severe hypoglycemia):

i Glucose tablets, which contain 4 g of glucose and are available over-the-counter, are usually the best way to treat mild to moderate hypoglycemia; two to four tablets is enough for most children and adults. More than that will cause hyperglycemia and you'll be tempted to give rapid-acting insulin to treat it, creating a vicious circle.

If your child has trouble swallowing, give him honey instead of glucose tablets. One teaspoon of honey is about 5 g of glucose, so you need about 3 teaspoons to give the equivalent of three to four glucose tablets.

i Don't push large quantities of food into the child. The result will be a high rather than a normal blood glucose. A piece of fruit may be all that's needed.

i Giving your child 1K cups of orange juice effectively raises the blood glucose back to the normal range of 90 to 100 mg/dl. Cartons of juice may be a convenient way to have a quick and satisfying source of glucose to treat hypoglycemia. A cup of apple juice or lemon-lime soda both work as well and may be used when glucose tablets aren't available.

i Always check the blood glucose 20 minutes after treating the hypoglycemia and give another treatment if the level remains below 100 mg/dl.

i Keep the child quiet and inactive for 15 to 30 minutes after the reaction. Activity tends to lower the blood glucose again.

i Use a prescription glucagon emergency shot for an unconscious child who has severe hypoglycemia. Just make sure that the glucagon hasn't expired.

If the child doesn't wake up in 10 to 15 minutes even though his blood glucose is normal, call 911.

Diabetes 2

Diabetes 2

Diabetes is a disease that affects the way your body uses food. Normally, your body converts sugars, starches and other foods into a form of sugar called glucose. Your body uses glucose for fuel. The cells receive the glucose through the bloodstream. They then use insulin a hormone made by the pancreas to absorb the glucose, convert it into energy, and either use it or store it for later use. Learn more...

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