Why the sudden onset hypoglycaemic trend in a 4 yr old type 1?

[J J's mom]

My 4 year old son was diagnosed with type 1 Diabetes 18 months ago, and we have very gradually gained better control over that period of time. 5 days ago he woke up with a reading of 3mmol/l (54mg/dl). I reduced his insulin slightly. He ate breakfast normally, and then went into a severe hypo 2 hours later, losing consciousness. His hypos have persisted for a few days now, and his daily insulin intake since then has ranged from nil to about one sixth of his usual requirements, and he is still experiencing frequent hypoglycaemia. He did vomit approx 12 hours after the first severe hypo, and had loose stools for a couple of days. I have been in touch with the Diabetes team, and we are monitoring him closely.
I was wondering what the reason for this sudden hypo state is, and when he is likely to kick back in and require his usual insulin? Will he grow properly during this time, and will the hypos be harming his brain or other organs? This is the first hiccup we have had since diagnosis. Any comments would be most welcome. Thankyou. J J's mom

[JDRF-Team-SS]

Hello again,

I am going to write a brief posting here (I have to test myson before I go to bed to make sure everything is a-okay:)in response to your comment: "people with Diabetes should always have a knowing/caring buddy around them at all times."

What you wrote (above) is very true and important in my opinion.  At school he has a buddy system.  A buddy walks with him to the restroom, as well as to the Health office to be tested.  Each year I have given a little talk and story to his classmates so they know they cannot catch diabetes and also understand why my son needs a buddy with him.

I relate to you mentioning that it feels like he has been diagnosed all over again.  My son just started on the insulin pump almost a month ago and at first I felt like that.  All of the emotions from when he was diagnosed came up.  I thought why are we doing this?  But now the pump has turned out to be something that works very well for my boy.  

I can also relate to "hypoglycemia unawareness."  My son, for a long time, has said I feel low and was low,...now sometimes he knows and other times, he says I feel weird, but he is unsure if he is low and then he tests and he is, so now I know the "I feel weird thing" is most likely a low:)

Well, to end my posting, I want you to know that in my city the JDRF "Walk to Cure Diabetes" is in October and I am going all out!  I have already created graphics for our team t-shirts.  This is the first year we will be having team t-shirts and I have family members and friends collecting donations.  Just keep thinking that there WILL be a CURE in our sons' lifetime!  
Well, I better go test my little sleeping boy:)


(Another helpful site: www.childrenwithdiabetes.com)

PS- my son already picked out a wife....LOL
he met her 4 yrs. ago at his camp for children with diabetes that he goes to every July.  They both hit it off and still are inseparable every year at camp! You never know.  At least she would understand!

[J J's mom]

Thanks again to all you wonderful people who are being such a great support! It's like having someone right there with you who has been there and understands.The fact that we are on near opposite sides of the globe doesn't seem to matter.Thanks too for the helpful links.

JJ's insulin requirements seem to be very gradually creeping up again, so we are going cautiously and keeping him a little on the high side until he is more settled.(Endo's suggestion)He is now having occasional higher readings again, but is still prone to hypos without being aware.He is looking a little skinnier than usual, but definately better in himself.

I was wondering, regarding the pump (SS's son) how much better the control is now,and whether hypos are an increased concern?? I have heard such good things about them, but they are still not widely available in most parts of New Zealand unless one has heaps of dollars! If it is going to minimise future complications then it has to be worth any sacrifice to use this kind of therapy, I guess.

Congratulations on your efforts for Diabetes "Walk to cure Diabetes", and thankyou so much for your efforts. I was interested to know what sort of cure there might be available apart from an artificial pancreas type device, since the islet cells have been destroyed or damaged with type 1 Diabetes?

It made me smile to see your son(SS)has picked himself a good wife already! Good on him! These medical camps can be great, but I've often wondered if it could sort of backfire longterm, in that people with similar genes for a condition are likely to team up and produce offspring with even greater susceptibility to the disease in question.Perhaps we should mix up several compatible conditions within the same camp?? :)(Intended as a light hearted comment, but it makes you think :) ).

Thanks again dm, SS, and LRS for your helpful feedback and support.

J J's mom

[jdrf team dm]

Dear JJ's mom,

I am so sorry that you and your son are going through such a difficult period. This disease can be so confusing with the balancing act that we need to go through. My son was diagnosed with type 1 at 8 and is now 27. You have recieved great advice from SS and LRS, but I wanted to address your fear for his future.

I have also had the same concerns, but would like to reassure you that in the 15 years as a volunteer with the Juvenile Diabetes Research Foundation, I have met many "super girlfriends and wives" and "super boyfriends and husbands" along with great friends that call me if they have not heard from him. They have my phone numbers and I have theirs. Many, many people with diabetes find their significant others and have long and successful marriages. While my son is not married yet, he has had terrific girlfriends that understood his diabetes and realized that this is a part of his life. I will never forget a question that was asked in this forum by the fiance of a young man with diabetes. She was a bit afraid, but after reading many comments and learning more about type 1, she came back and commented that while she has always embraced him, she has also learned to embrace his diabetes. This simple statement will stay with me forever.

I would also like you to understand that research is moving at a fast pace. I never give a timeline, but I am very hopeful that we are closer than ever with the breakthroughs that I have seen. This is only my personal opinion and I am not a physician or researcher, but I never give up hope that a cure is sooner than later.

JJ's mom, please let us know how you are doing. There is also additional help through the jdrf website that SS suggested for research (www.jdrf.org). You can also click on the Online Diabetes Support Team located on the left side to recieve one on one support from a member of our JDRF team. I look forward to hearing from you again and hope all goes well with your dear son.

dm

[J J's mom]

Hello again,

Thankyou for you helpful comments and hints. It seems as if this is the "honeymoon" period. I though that would be a good thing, but the increased sensitivity to insulin and change in requirements has made life even more of a challenge. It is like having a newly diagnosed diabetic child all over again, and having to relearn what his needs are. I wonder if this honeymoon period is happening now(after 18 months) because it is only very recently that we have gained significant control, and so it is only recently that his pancreas might have had a chance to recover a little. I actually find it a little frustrating. We were just making such good progress, and it's like having to start over.We are adjusting though, and I know we'll get the hang of things again.I could relate to the comment likening Diabetes control to controlling a natural disaster!! I'm not so worried now while JJ is young, but I'm already praying for a "super wife" for him when he is older!I think, ideally, people with Diabetes should always have a knowing/caring buddy around them at all times.

I think the advice you gave re: helping children to be "hypo aware" is excellent and important.I have tried to do likewise, and again we were getting good at it, but he seems to have lost that "awareness" again.

You sound like you have lovely kids, and their developing compassion is a great characteristic to have.

Thanks again for your replies.
J J's mom

[J J's mom]

From J J's mom.

Hi,
Thankyou so much for the comments from the team. I am really touched by the thought you have given to my question, and the heart behind your comments. Thankyou!
JJ's Endocronologist was in touch a few hours ago, and was ready to admit him to hosp. for observation, but I thought he was "turning the corner" so to speak, although I'm not so sure about that now. He is on a new sliding scale of insulin, and is only needing about a fifth or less today of his usual dosage, and has had only one hypo today(20 mins after his Endo rang!).I have been keeping a detailed log. Because I am a solo parent with five children,I am trying to avoid hospital admission unless it is really vital.

Re: Honeymoon period; I thought that normally occurred almost immediatly after diagnosis, and JJ has been diagnosed for 18 months now. Could this still be it though?

Thanks for the comments regarding post hypo clustering, and the body's need to rebuild resources. This makes sense. It was his most severe hypo yet, so I guess it has knocked him a bit.

One suggestion by a member of the local Diabetic team was that he may be suffering from an accumulative effect of too much long-acting insulin.Anyone else experienced this?

I do have my son sleep next to me so that I can be aware of his condition at any time, and I, too, find that he sips and sucks quite readily,the sweet drinks or glucose when he needs it during the night.I can so relate to that whispering in the ear to tell him that he is low, and watching him respond in his sleep.Diabetes might be a "game" we didn't want to play, but it sure draws us close to these precious little children.
Many thanks for your feedback. I appreciate it all.
J J's mom

[JDRF-Team-SS]

Hello again, JJ's Mom,

I am the mom who has a 9-1/2 year old who was diagnosed at the age of 3.  

I used to fill a little spill proof cup with gatorade and put it in the bed with him.  He had one of those car beds and there was a little space between the mattress and the plastic car frame and I would kind of wedge it in there and he knew it was there for him if he felt low during the night.  Of course I checked on him every time I woke up during the night.

Well, one night I peeked in on him and you know how little kids hug a stuffed animal in their sleep?  My son has holding his cup.  I almost cried.  That was his security blanket...his cup.

As far as the Honeymoon Period, what I posted before. (below) is some of the info. I found while searching.  You might hear different things as far as how long it could last depending on where you look or who you talk to.  It has been 6 1/2 years since my boy was diagnosed, but it feels like he has always been living with diabetes.
(Posted in my previous post)
Found While Searching:
Honeymoon Period
The period of time shortly after the diagnosis of Type 1 diabetes during which there is some restoration of insulin production and the blood sugar levels improve to normal, or near-normal, levels. Unfortunately, like other honeymoons, this diabetes honeymoon doesn't last forever; it may last for weeks, months, or occasionally, years
_______________________________________________________

Wow!  Five kids and a single parent.  Pat yourself on the back.  

I have a little tip that I have given to other moms who have children who were recently diagnosed.  (I know for JJ it has been 18 months)  If your son has problems recognizing when he is low... (I am not referring to when asleep at night, because I have tested my son in his sleep and he has been low and it did not awake him, I did) here is a suggestion:  When he is low during the day when you test, but he was unaware, say, honey, you are low right now, so whatever you are feeling that is low blood sugar and do this everytime.  (of course while you are giving him a juicebox, etc.:)  I did this with my son at the age of 3 figuring it was new to him and he might not recognize a low.

Please keep in touch.  Ihave tips for when he starts kindergarten.  (not that you even want to think about that now!)


My son had 2 lows today at school and the Health Aide (there is not a Nurse at school - only a district Nurse who pops by from time to time) is good about treating the low and then calling me.  Last year, we had times that she did not call me, so I had a long talk with the District Nurse and things have shaped up this year!!!

My son's Endo once said that "trying to control diabetes is like trying to control a natural disaster!"  

Please keep us informed about JJ.  We are all here for you.  Believe me, there are times that I still cry and it has been 6-1/2 years.

Hugs to you and your children.  

I can tell you that I believe our children living with diabetes are very special.  My son is extremely compassionate and concerned about others.  Imagine a fourth grader coming up to his sister who is a kindergartener and giving her a hug and a kiss on the cheek and saying have a nice rest of the day....that's my boy!