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Posted 9 months ago
Is it better for a child with type 1 diabetes to have glucose control as tight as possible without hypoglycemia, or is it usual care to have daily readings in the 300s and cover with insulin?
9 months ago
How ironic that it as an RN asking this question. I remember my mother running Benedict's tests on my urine specimens EVERY NIGHT until I was 7 or more years old. I had some understanding of what sugar levels meant, but I do know that I that m there was a lot of orange and maybe some yellow or green test tubes and only an occasional navy blue test tube. Blood sugar control was NOT tight, and my mother had enough medical background with only 3 semesters of medical school to understand that STRICT blood sugar control was NOT a good thing for ME. That is WHY she refused to send me to a diabetes camp across Lake Pontchartrain when I was a teenager. The Benedict's tests were replaced by Clinitests of urine. I was almost 30 and a half years old when I was given my first blood sugar meter when I was leaving the hospital after a hysterectomy, NOT complete... The oncologist saw no reason to remove the ovaries of a 30-year-old woman... Large benign ovarian tumor... In Europe, they would have removed the tumor. Yes, I can still be brittle. Yet here I am alive and kicking after MORE THAN 60 YEARS. Tight glucose control probably IS NOT good for type 1 diabetic children, no matter what the current medical paradigm may be. I actually felt quite insulted when a nurse practitioner told me I was OVER controlled because my A1C was 6.0 on September 15, 2015.
I speak ONLY for myself, not for all type 1 diabetic children, because now I am well pas menopause and am old enough to be a grandmother and probably be YOUR grandmother OR grandmother.
Blood sugar spikes after eating are a NORMAL part of metabolism for EVERYONE. HOW LONG is it going to take before the medical professionals UNDERSTAND that and START teaching it. EVERY diabetic is an individual and is unique.
Update: Covering with insulin may not be a good idea. There are risks when you over-control anything, and covering with insulin may make the type 1 diabetic child more brittle. There are different types of insulin, and not everyone is insulin resistant. A 1.2 unit of fast-acting insulin When I first went onto human RNA insulin could mean the difference between low blood sugar episodes and be a little bit high. I may not be quite as insulin sensitive as I was 19 years ago, but sometimes I am not taking quite as much fast-acting insulin as I would have before that last doctor's appointment. . The Np told me to stop taking Novolog at bedtime, Sorry, but I am not eliminating the bedtime snack, and that means taking fast-acting insulin to cover the carbohydrate in that snack. Blood sugar spikes ARE NORMAL. The only difference with type diabetics type 1 diabetics is their beta cells no longer produce insulin-like non-diabetics beta cells, so the insulin has to come from somewhere.
Different types of insulin have different action times. When I was 7 years old I went onto semilente and ultralente mixture. ultralente has a 36 yo 48 periods of action. Semilente and ultralente insulin may no longer be made, those were beef and pork insulins and Eli Lilly got rid of their herds of cattle and pigs in m the Mid-late 1980s. that was when my parents hauled me out of bed early in the morning, like warm, tested my urine, because this was BEFORE blood sugar meters, and I if blood sugar was low. I had some kind of snack, and that was WITH a bedtime snack. My CURRENT diabetes dor toles me pre-meal blood sugar or below should ideally be around 200 mg / dcl, but not lower than 100mg/DCL.
The obsession with keeping blood sugar levels CONSTANTLY normal CAN BACKFIRE. I was almost SCOLDED by a nurse practitioner when my A1C was 6.0 less than a month ago... I am over-controlled. according to her, and my closest friend who is an M.D. and a type 2 diabetic herself Agreed with NP.
I've been on a sliding scale for how much insulin I take my entire life because my parents, specifically my mother, had the medical background to do that My father was medical school FACULTY. he TAUGHT my doctor's. I was taking my own insulin and deciding how much insulin to take AND MIXING by the time I was 14 years old. The parents of most diabetic children often don't have that type of background. Some do, but not money. Don't "fiddle with your diabetic child's insulin dosage WITHOUT talking to the child's doctor. I am NOT on an insulin pump, and I don't have much desire to be put on an insulin pump.
I am NOT a health care professional. Talk to your child's doctor if you are the parent of a diabetic child. EVERY diabetic is DIFFERENT. a somewhat high blood sugar IS NOT going to mean your child will have an early death.
9 months ago
blood sugar closest to normal for as long as possible is always best. But remember that your doctor's answer to this question will be affected by other factors:
* Doctor's confidence in his patients' ability to comply with instructions (over the course of his career). If a doctor sees that most of his patients can't or won't comply with difficult diet and monitoring instructions, he will modify his instructions to something he sees as more likely to be complied with, even if it's not the best for the patient.
* Doctor's confidence in YOUR ability to comply with instructions. Same as above, but will involve a doctor's opinion of your ability, willingness, and skill to undertake the long-term monitoring of your daughter, and hers to take over when she can.
* Whatever studies the doctor has read lately, most of which seem to be measuring long-term the effects of tighter vs. looser diabetic control, but even their tighter controls tend to be much looser than is healthy. The conclusion these studies generally reach is that there's not much difference. My conclusion might be that all these studies stop short of actual tight blood glucose control. For actual tight control and its results, you may find the work of diabetic journalist Jenny Ruhl helpful. Although she concentrates on type-2 diabetes, her blood sugar monitoring tips and diet tips are even more important for type-1.
* and of course, 'do no harm". If the high blood sugar does harm the long term, but the doctor isn't sure of your ability to avoid an immediately dangerous hypo incident, the doctor must advise you to keep blood sugar high.
9 months ago
It’s not unusual to have blood sugar readings in the 300s, particularly with children given the impact that hormones and illnesses have on BG. However, blood sugar readings in the 300 are ALWAYS a problem.
At around 240 you run the risk of your body going into ketosis. This is where your body begins metabolizing its own fat for sugar because cells aren’t getting energy. As ketosis continues your body begins to produce ketones and eventually you can slip into Diabetic ketoacidosis (DKA) which usually means a trip to the emergency room.
Additionally, a consistent BG of over 200 is going to involve some level of cell death. The results might not be apparent for years, but eventually, it rears its head. Frequently in the eyes and feet
9 months ago
It is better for the child to have good control over their diabetes, rather than allow them to eat themselves into DKA and hope that insulin is going to fix it. It is not usual care to have blood sugars in the 300s, and wild swings in blood sugar levels aren't healthy.
Diabetes can be a disabling, even fatal disease. However, it doesn't have to be. When you aren't maintaining good control of your diabetes, you're doing damage to your body. Over time, this can lead to blindness, increased risk of infection, nerve damage in the extremities, and kidney failure; and they may ultimately need to have limbs amputated, long-term dialysis. Complications of diabetes can become life-threatening.
If you're having trouble regulating your child's diet and/or their diabetes, you need to talk to their doctor and potentially pursue a dietician who can help you develop a diet plan that will help to keep blood sugar levels within a reasonable range.
9 months ago
The higher the blood glucose over 120, and the longer it stays there, and the more often it goes there, the more damage is accruing to major systems in her body. My father died of diabetes complications and it was just awful. Eyes go blind, kidneys shut down, you lose limbs.
Confer with her doctor, certainly, but don't allow wild swings of her blood glucose for the sake of her long term health.
9 months ago
Is it better for a child with type 1 diabetes to have glucose control as tight as possible without hypoglycemia
It is better for any diabetic. In general, risk of slight hypoglycemia is considered acceptable.
or is it usual care to have daily readings in the 300s and cover with insulin?
That is not “usual care”, that’s appallingly inadequate management of the disease, bordering on neglect.
If your physician told you that this blood sugar level is acceptable, get rid of him and find a doctor who actually knows a damn thing about diabetes instead of putting your child’s life at risk.
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