The RULE OF 15: If your blood glucose is 70 mg/dL (3.9mmol/L) or below, use the rule of 15 to treat hypoglycemia. Treat with 15 grams of rapid-acting carbohydrate. Check blood glucose in 15 minutes. If your blood glucose is still less than 70mg/dL, eat another 15 grams of rapid-acting carbohydrate and re-check blood glucose in 15 minutes. Repeat as needed until blood glucose is in goal range.
We all know about this rule. Who breaks it?
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| Memorial Day Parade 2012...The Essence Of "Joe" (Thank You Nikki) |
A couple of days ago...
A pause...then the heavy Joe breathing that I know as heavy Joe breathing because it seems he is always breathing heavily when he calls me from school.
"Yeah Joe."
(tears and a quivery voice were then heard) "Please mom. You have let me eat when I am like 68"
"56 is too low Joe. Wait for your number to come up."
"Please mom." (tears)
"Joe, put Mrs. School Nurse on the phone." (firm voice)
"Please mom." (tears)
"Joe, put Mrs. School Nurse on the phone." (firm voice)
"Please mom." (tears)
I explained that the 50s was just too low to go ahead and let Joe eat. I wanted Joe to wait 'til the fast acting sugar brought his number back to a safe range (greater than 70) before he ate his snack. He ended up missing snack time with his peers. He waited out his low in the Health Office, with the nurse...he ate 15 minutes or so after his buddies. Sucks. But it is life with "D". Rarely is a complaint voiced by Joe.
I am not sure if Joe's tears were out of frustration or due to the low. Most likely they were a product of both. When parenting a child with a chronic condition, restrictions and limitations are part of our day-in and out. Sure they are a part of everyday parenting of any child to keep them safe and to raise them to be a somewhat kind, caring, respectful human being. However, in our situation...the limitations and restrictions are present on yet another level. On a few levels actually...for safety~sake...and for guiding their self-management for the one day when they will be independent with this big time, high maintenance, laborious condition.
I have let Joe go ahead an eat when he has been in the mid to high 60s. After fast acting sugar has been consumed, he has sat down to eat. The bolus in this situation would be given after his meal is consumed..and/or an extended bolus may be executed. The 50s, while he is at school...and not under my watchful eye, was too low for me to acquiesce.
What is your cut-off low number? How do you manage it...delayed bolus...combo bolus...extended bolus...free carbs?
9 comments:
Reading this, I can hear the almost quiver in Joe's "please, Mom?"
That 15 minute wait is annoying when there's something else you want to do.
This is tough. If its snack or meal time, I usually let her go ahead and eat. She has something fast first. Then eats. One reason being that she get ravenous when low and if I make her wait she fills up on fast acting sugar and then won't eat real food. I don't get how a couple of packs of Smarties can fill you up- but t does. Go figure!
We don't follow the rule. I pretty much know how much carb she needs depending on her number. And what kind. Sometimes 15 would be way too much. Sometimes 15 isn't enough. And as for how I bolus the food... I usually keep an eye on Dex and test and as soon as I see her coming up I bolus for the meal.
It's what works for us. At least right now. That's one of the things that makes D so hard. Nothing is universal. You did what was right for Joe. And that's all you can do!!
I'm a rule follower! I would have done exactly what you did...then hung up the phone and cried. I hate D most when the kids are upset about something that D causes. Now my husband would've caved to the pleading and let her eat with her friends! But he's a big push over where his girls are concerned.
I might've let her go ahead and eat, because like Hallie's daughter, my DD might fill up on sugar when she's low, and won't eat real food. I would've bolused shortly after she ate (after asking all 6 kids to remind us so I don't forget!). But my DD is older (11). You did what was right for Joe and that's all you can do!
We too for now follow a similar rule as you...under 60 fast acting sugar is given. If he is in the mid to upper 60's he can go ahead and eat. I am sure I too will be in this same boat as you one day! It's hard to sometimes be that tuff mutha! xoxo
I've been breaking that rule since it became apparent that treating a low (at the time, anything under 90) with 15 grams of carbohydrate (at the time, a juice box) didn't usually bring up my blood sugar at all within 15 minutes, and that retreating with another 15 grams of carbohydrate typically landed my blood sugar in the upper 200s or lower 300s. That became clear after about three experiences with hypoglycemia.
Depending on how low I am and how long it's been since I've eaten, I initially treat with anywhere from 0 (if I'm above 60 and just ate and have that sort of stomach ache that means I'm experiencing slow digestion) to 20 grams (if I'm below 50) of carbohydrate, and do not re-treat in under 20 minutes.
We don't wait with Isaac, but TJ will wait. The main reason is that Isaac takes longer to come up, 15 minutes is never enough. So, if Isaac is between 50-70 he gets fast acting and if he can hold due to not being hungry than fine, but if he's starving I'll have him eat as long as the snack isn't high in fat if it is than it gets switched to something not high in fat. If we're out I just have him eat everything, check again at 10 minutes and then 20 minutes if his BG has risen we dose for the full carbs over 30 min. Now, if TJ is low he just eats something fast acting, waits and checks. He doesn't give insulin for the fast acting. He can handle the 15 grams of carbs to just bring up his BG, but Isaac ALWAYS needs insulin. Anyhow, I admire how you so calmly handle it with Joe, I'll be there someday and hope I am able to do what is best for Isaac without too much worry. Enjoy the end of the school year, summer is right around the corner :)
Depends on how she is trending that day and the day previous. For a 50 I would have given more sugar, about 25 grams upfront so I could be sure she would come up, then send her off to eat the snack with friends, check blodd sugar before bolusing for snack. So, in this case, it would be bolusing post-prandial. But each kid is different; we may have another low in an hour, but if given enough sugar, she will come up. Obviously, you have to go by your own experience. Feel bad for Joe; from reading your blog, he doesn't usually cry. It stinks he couldn't socialize with his friends and enjoy a simple snack. I'm sure you'll make it up for him. Do something extra fun another day just because he was so disappointed.
This is heartbreaking - We really admire how you handled this situation.
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