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]

Hi JJ's Mom,

I too am a mother of a child living with diabetes.  My son was diagnosed at the age of 3.  He is now 9-1/2 years old.

before I give my input, I need to clarify that i am not a medical professional, so this is NOT inplace of medical advice.  I am giving my input based on my knowledge and personal experience.

Also, I apologize for the delay in my response to your post.

I am sorry that you are having a difficult time right now.  Being a mother of a child who has diabetes can be scary and cause anxiety..I know.  At times, I sleep with my son because I worry he will go low during the night.  

You may have already heard of the Honeymoon Period, but I thought I would add this.  This could possibly be what your son is going through / experiencing.

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.

You may have already done these things, but I am trying to put myself in your shoes and tell you what I would do since we both have son's who have diabetes.

If I was going through this with my son, I would:
a) Make an appointment with his Endocrinologist (I would bring a copy of my son's insulin schedule with me just to have it handy)

b)bring his logbook so his doc can see certain times of the day / night that he has lows, so he can see if there is a certain pattern and then make adjustments to the insulin accordingly.

You have probably done these things already.  If you schedule another appointment, possibly request the person on the diabetes team whom you are most comfortable with.  

Low blood sugars are scary.  I would say that since your son has had so many episodes including one where he lost consciousness, the dose is to high for him right now, but, that is for you to discuss with his Endocrinologist.

Remember, you are his Mother and you need to go with your gut feeling.

I keep a couple of those little gel frosting tubes on my son's night table.  If I ever test him while he is asleep and is low, I can squirt some frosting into the side of his mouth and grab a small juice box (the 15 gram one:) and gently wake him and although he is half asleep, as long as I put the straw up to his mouth and say, honey, you are low, drink a little, he will.  The gel frostings come in handy!

Although it has been 18 months since JJ was diagnosed, I have a sneaking suspiscion that he might be experiencing the honeymoom phase.

Sorry that I cannot provide answers to all of your questions.

This link (below) might be helpful:
http://www.peacehealth.org/kbase/topic/major/uq2734/course.htm

My heart goes out to you.  Please talk to your son's endo about possibly lowering J's does a little more if he continues to have these terrible lows.

Keep us informed and check back as others will post comments for you.

[JDRF-Team-LRS]

JJs mom,
It's so frightening when youngsters are hypo since they really can't yet feel it coming on and verbalize their needs.  I'm not a physician and am relieved that you've got calls in to your team.  

As a long-time diabetic, I'm thinking about this along the lines of what I would do if *I* were experiencing the types of hypos your little is.  I would certainly do as you have done -- cut out or provide minimal insulin.  The short term effects of potentially running high seem easier to handle than the lows.

I'm sure that it takes our bodies several days or longer to recover from severe lows.  Our liver needs to rebuild its store of glycogen in order to help deal with a future low -- and that rebuilding takes a while.  For that reason, we often experience "clusters" of hypos because our built-in defenses against bottoming-out have been sapped by the previous hypo.  I hope I've explained it well enuf to be understood.

I also want to tell you that hiccups are expected even tho' we may go weeks or months without anything serious happening.  It's one of the tough issues with DM -- things do happen.

I'd liek to recommend taht you study up on hypos and one of the best resources I've found is the JDRF website (www.jdrf.org).  On the top left of the screen, select RESEARCH and then type hypoglycemia in the search box.  There were over 100 articles that discussion prevention techniques and research aimed at understanding them better, too.

Will you check in again and let us know how things go?  I'm sure you'll get more responses, too.