Unexplained lows

[greenbayfan]

I'm a mom of a type 1 diabetic who was diagnosed 1 year ago (she's 9 years old). My kiddo is on lantis and novolog. She's stays within her normal range (80-180) most of the time when she's NOT in school. She was absolutely perfect nearly every time she tested during the summer...then school hit, and about 2 weeks into it she started dropping like CRAZY after lunch time. From everything I've read, stress tends to raise BS, as do hormones. We've basically stopped giving her insulin at lunch time. Regardless of whether she goes into lunch at 300 or at 150, about 1 1/2 to 2 hours after lunch she plummets. And I'm not talking into the 60s/70s...she plummets down to the 40s pretty regularly, and then she's stubborn coming back up. Oh, and did I mention we're giving her lunches that are right around 100 carbs??? That's a ton of carbs for a kid her age. We upped it, hoping that a big lunch would help...yeah, to no avail.  Her endocrinologist said the only explanation that he could come up with is that she could still be honeymooning, and maybe her body is just picking that time to produce insulin. I'd almost buy it, if it weren't for the fact that it doesn't happen on the weekend, and the entire 2 weeks of Christmas break she was perfect. It's absolutely insane. Sometimes it'll last for hours and she'll have juice after juice (or soda after soda), and it really never catches up with her.

[liz733]

Hello, I have had diabetes for 33 years, since I was 1 years old. I feel she may be taking to much insulin. Ask if you should lower the amount by 2 units. Maybe, she should take a mid afternoon snack such as crackers and cheese near the time she is having these low blood sugar attacks. Her school would probably allow her to go to the office and do this. When she is in low blood sugar it is important to give her carbs but also protein. Peanut butter, cheese a sandwhich would be best. The protien will help her long term and help stop her from going into low blood sugar again once the carbs have been used up by the body and will help stabalize her sugar readings. I hope this helps.

[KevinHarney]

Honeymooning is a slight possibility here but I would lean towards no and here is why.  

This is not consistant.  If she stays home it would be happening the same as when she is at school.  Also Christmas time she was fine and when back to school it was wrong again.  Usually for honeymooning general levels of Insulin are dropped for a while as your body uses the last little bits  that it is producing.  And generally it is not time specific during the day it is all the time.  And it certainly is not, reliant on whether she is at home or school which seems to be your case.

[KevinHarney]

Are you SURE that she is actually eating the lunch meal ?!?!?!?!?  This may be the case of a teenage girl trying to stay thin and diet by peer pressure.  Just a thought.

Also I would look closely at what happens in that 2-3 hours after lunch each day.  Perhaps a really bad subject for her causing stress or really mean classmate in one class causing stress.  These might be easily solved and cause the problem to go away if it is the stress instead.

[kraysmom]

I can relate to what is going on with your daughter.  My daughter, 16, who has been diabetic since she was 11, has the same problem.  She is a very rare diabetic because she does not produce enough cortisol at times and too much at other times.  It took 4 years for a specialist to figure this out.  Stress is the main problem.  She could be at home and do perfectly fine at times and then go to school and do not so good.  You may want to talk to your specialist and ask him or her about doing some blood tests when she is actually running low.  This will show them a lot.  If she is lacking certain hormones or if her body is producing insulin.  My daughter has "insulin binding antibodies" also.  This can only be detected when the sugar is low. I wouldn't take any of this sitting down because there is an answer if you fight for one.  Just for an example, my daughter has a pituitary suppression and also has the binding antibodies which is very, very rare for a child.  Go with your gut feeling on this, as that is usually right, and make the doctors answer you with blood tests.  I hope this helps and I hope I didn't worry you too much that it could be something underlying but I don't want anyone to go through 4 or 5 years of what my family has gone through if there is an answer. I am so vocal that the pediatrician hates to see me coming sometimes because I put them on the spot, but that is our job as parents!

[WindomEagle]

We have an 11 year old with a similar trend (low blood sugar at school compared to home).  There are a few things we found - look into any activity level differences compared to home vs. school and the accuracy of the carb count eaten vs. what was expected.  Our son uses a novalog pen so is on a sliding scale during the day and we ended up with much less insulin to carb at noon (at school) compared to the other times of day.  This helped with the lows in the afternoon at school but is not totally fixed the "problem" yet.  In general, he is more active at school (due to recess, moving around to different class rooms during the day and physical education) so found he needed less insulin to cover the carbs.  As he is also a picky eater, we are now very careful to make sure he eats what is there (either school lunch or one from home) - if he doesn't, he works with the school nurse to figure out any modifications that need to be made (cover what he didn't eat with a juice box or other carb snack).

Good luck - this was hard for us to get under control.  We have a daughter that is 15 and is also type I and does not have this problem.  Definitely something your diabetes doctor / educator can help out with as they will also have suggestions and should be aware of any changes made.

[greenbayfan]

Hi guys...
Thanks so much for the quick responses!

First, just to answer the couple of questions:  Kevin--yep, positive she's eating.  She's only 9, and of course is conscious of how she looks, but she's a pretty naturally thin girl.  She's also monitored by the nurse and the lunch monitors (they're aware of her diabetes and the crazy lows, so they're pretty much all over her) during the day, so I know she's getting the food down.  Also, since we're not giving her insulin, there's no real "reason" that she should drop from 350 to 45 even if she didn't eat, ya know?  It's just a nutty thing.  

I know she stresses about math a little bit...and I have a funny feeling that sitting next to the little guy that she has a huge crush on probably affects her as well.

JDRF--good to know that stress can actually cause lows in rare cases....I hadn't read that anywhere, so I'm so thankful for your personal experience in this!!!  I do think that she is having some hormone issues already...she definitely has a few telltale signs.

Kraysmom--thanks for your experience as well.  I will talk to her endocrinologist....I'm guessing if she's having a bad day I'd have plenty of time to get to the hospital and get a blood draw to check for some of those things.

WisdomEagle--yeah, we thought about the activity thing too, but she tends to be so active at home that I would wager she's much less active at school...altho she may play harder at recess for that short time than she does at home.  Who knows!  But she sometimes drops down before recess...it's all just a crazy thing.

I sure appreciate all the replies!  I have a couple more things to research, I guess!!!!  :)

[JDRF-VOL-SG]

This must be very frustrating for all of you. I think I agree with your endocrinologist. I have been a type 1 for 38 years, since childhood, along with my twin sister. Oddly enough, I tend to do what your daughter does when stimulated by things that cause either good or bad excitement. My twin does not. My insulin requirements are pretty small and all of my doctors have always believed that I must produce some insulin of my own when stressed (again, this is either good or bad stress). Now, you are correct that the adrenal hormones generally act as insulin blockers, and when adrenalin is produced, blood sugars usually go up. But in my case, I believe that when my body is stimulated, my pancreas may spurt out some of its own insulin, so my glucose levels drop instead of rising. When I get sick, the same thing happens, but not as noticeably. Most people find that their glucose levels rise when sick, so this is also different from the norm. The fact that her glucose levels are so easy to maintain in her ideal range when she is not in school would indicate to me that she must be producing some insulin of her own still, for most diabetic kids have numbers all over the place even when control is good.

At age 9, she is not into those puberty years when other hormones that can make glucose levels both rise and drop usually hit, but it is possible also that some hormonal changes are beginning at this age. Nowadays, girls tend to start showing signs of hormonal changes a little earlier than in previous decades. And not all of the female hormones cause blood sugar levels to rise. Usually, there is a rise, followed by a drop. In my case (not my sister's), every month I would have days of unexplained lows that coincided with my menstrual cycle. I have not read of any other woman doing this, but like your daughter, I would have days of just eating all day and my blood sugar would just stay on the borderline of normal.

All that being said, it sounds to me like you are being as proactive as you can and that you are treating it the best way. It is a tough situation, for it is not entirely predictable. You just have to watch for patterns so you can try to predict it as best as possible, and keep lots of carbs handy for her. She absolutely must have carbs in her backpack for school days. My bet is that in time, this will settle down some and her body will stop producing as much insulin. If she stays like me, with a permanent small ability to produce insulin, then it actually will help her in the long run, for I find it fairly easy to maintain good control as long as I never go anywhere without a couple of juice cans.