How many Glucose Tabs is enough? (T1D kids)

Parenting a D-Child
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This is purely anecdotal from years of observations with Liam…recently honed to perfection FOR US. I’m posting here in case other parents are wondering how many sugar pills are enough without overdoing it and causing never-ending roller coasters from highs to lows. Again, I know there are factors (I:C especially) that would make this not work for many, but for kids Liam’s age/size, this may be close.

So, I’ve been testing this for a year or so and below is what I’ve found FOR LIAM…I realize all people are different, including kids his age (7), but figured I’d post this info here anyway as it’s been super helpful to us.

So, here it is…

If Liam has less or equal too 1 unit IOB, he gets 2 Glucose tabs.
If he has between 1 and 2 units IOB, he still gets 2 Glucose tabs.
For anything over 2 units IOB, he gets that number of glucose tabs (rounded up).

…so, for instance,
If he has 4.69 units IOB, he would get 5 Glucose tabs.
If he has 3.15 units IOB, he would be 3 Glucose tabs.

Hopefully that makes sense. What that does is two things…

  1. It stops the double downs and/or fall.
  2. IN LIAM, it causes a nice leveling out without the ups and downs of having too many, or not enough and still going low.

Not saying this will work for anyone else, but it works like a charm in Liam so I thought I’d share with others in case you want to test it in your young one.

Also…an added bonus for us is that he understands the system…so now all I have to do is say “Liam, you need sugar pills please.” He’ll always say “How many?” (hoping I give him the answer)…instead; I say…“how many do you think you need” or “I trust your judgement”. He usually responds back quickly with the correct answer just looking for my confirmation. I tell him AWESOME job and he eats them and goes about his business.

Also, we usually give the glucose tabs when he’s around 110 and headed down still so that we don’t wait too long and still get a low. If you wait too long to give the glucose tabs they’ll still go low…the goal is to avoid the low but “land softly” and “level out” at or under 100 if possible. :slight_smile:

Hope it helps someone as much as it’s helped us.

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That’s interesting!

So you don’t use his BG number as a factor?

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Of course! I should have made that more clear…he is falling (fast, or trending down even if not fast) and is at or under 110. I said that in part of the writing, but it probably wasn’t as clear as it should have been. He doesn’t get them if he’s not falling and in fear of going low.

But his actual BG doesn’t play a part in deciding how many sugar pills he gets…it’s more about how much IOB he has because, for us, that’s the predictor of whether he could go low or not.

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So you’re describing your strategy to prevent a low. Do you have a glucose dosing strategy if Liam is actually low? (Which basically never occurs because of your hypervigilance, if I recall.)

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For us, the key is to cut it off before it happens. But he does go low on occasion. My strategy is “Fast in, Fast out”. Don’t care if he goes low or high…just don’t want him lingering around there for any longer than he needs too. When he’s sick that’s very challenging but usually what we do here prevents the lows and IF he does go low, the method we follow brings him right back out after 1 or 2 ticks most of the time. There are exceptions where his BGs are being stubborn, he has NO IOB and his BGs just decide…“Hey, I think i’ll hang out here for a while, in the danger zone…live dangerously.” During those times, our method is usually just give 2 more glucose tabs and check BGs again in 15 min (typical strategy most people here probably follow.)

And then there are times when the CGM swears he’s low for an hour, but he’s never low at all. Multiple finger sticks all through the “low” screams show he’s coasting nicely in the 70’s. Those are the ones that make me eye roll the Endo when she says with a CGM no one should ever go low…uhh…if the CGM isn’t accurate/correct then those “false lows” are unavoidable." During those times, we do nothing…we just let the CGM report what it’s going to report and give no extra sugar pills and when the CGM decides it wants to wise up, it comes back up.

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That’s silly. That’s like saying, “With a CGM, nobody should ever go high.” :roll_eyes:

With a CGM, diabetes doesn’t exist anymore, endo!

Also, with a CGM, kids always do all their chores and always make their bed! :joy:

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Yes! That’s why I eye-rolled and laughed out loud when she said that and even said that’s ridiculous. :smile: You know I’m not shy when it comes to …talking. She’s a great endo, but that told me everything I needed to know about whether she has any “practical” experience with Diabetes or whether it’s all book learned.

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With my 6yo daughter to prevent a low I usually use 2oz 2% milk and 2 wholewheat ritz crackers at around 75-85 reading. This also works in school – they usually treat at 90

To treat a low I use “transcend” glucose gel dispensed from a care touch syringe. Usually 3cc or 4cc and usually at 65-75

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LOL…without the cgm I have a lot less lows and highs because I never know about them, there a lots more with a cgm to tell me about them

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So true! If a tree falls in the forest and you don’t see it, did it actually ever fall? :laughing:

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@ClaudnDaye Thanks for posting this and your efforts to “science the crap out of it!” I know it’s about kids more than adults, but it’s interesting to hear “when” others start to treat a suspected low onset. I’m only in this a year so still learning. I’ve read about those that like to hover around 85-90; I don’t have that skill set. I’ve found once I’m on a slow glide slope down past 100, I continue that direction. I set my low alert to 80 to hopefully catch it, but if not still wander to 70/65 (one occasion to 47) because I’m focused on the task at hand. I’m thinking of upping that alert to 85. Any type of effort involved, mowing the grass (gas mower, very small yard) or blowing leaves (back pack blower) can accentuates the effect and because I’m focused I miss the lightheaded/brain fog as a warning sign. Fortunately, my wife sees, walks out and hands me tabs or asks how I’m feeling. Anyway, thanks for the info!

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@EdD Interesting use of milk! I’ve always read about how much sugar is in the stuff. I never acquired the taste for it, except to put on my regular large morning bowl of Cheerios; sadly, those are no more (those and Vanilla Wafers probably moved me down the T1 path more quickly!). Ref the Transcend: I received sample packs from somewhere, cherry and orange I think; there is absolutely no chance of me cheating and just swallowing that stuff, truly thought it was awful tasting, yet most tabs I don’t mind and kind of enjoy, particularly (much to my wife’s chagrin) the “grape” flavor, though raspberry and orange are OK.

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WE do calibrate our # of carbs in low treatments based on IOB, but we calculate how much insulin would be active in the next hour and then how many carbs would be needed to soak that up assuming a 4 hour DIA.
So if he has 2 units of IOB, we’d give enough glucose tabs to soak up 0.5 units of insulin – so about two glucose tabs.

But since we started using Control-IQ we’ve been letting some steep drops play out and like magic he sort of stabilizes at 75 and then starts rising. He’s been taking fewer low treatments over the past 6 weeks, which is pretty good because he hates all sweet things.

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Also, with a CGM, kids always do all their chores and always make their bed! :joy:

@Eric, do you have the inside track on when this magical CGM is coming out? I need it ASAP!!!

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@TiaG, I think @ClaudnDaye’s endo has the inside scoop on this magical CGM!

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Can confirm that with the CGM lots we have received this effect is still not present. Perhaps it is limited to a few lots that get shipped every once in a while.

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@TomH - I only have experience with my daughter but there are a few other things that help her before activities assuming she is reading around 100. These are probably for 30mins active time
Any sort of yogurt - she uses chobani tubes
2-4 chunks of pineapple - frozen, fresh or canned - this will kick her up fairly quickly
half or a quarter of a granola bar or even half a fun size snickers occasionally

There some other things I could try but have not - for example a bagel with nutella cut into 8 pieces and maybe give one before activity and one at half time.

For activities like soccer I bring gatorade, G2 and water - depending on her BG she can have one or other. She usually sips G2 (half sugar of Gatorade)

I don’t end up using the gel much usually just if she is out of routine e.g. birthday party. Gel is easiest for her at night - I really don’t have to wake her, just shoot it into her cheek. it doesnt take much. she has never liked the tabs or glucose drink

you could try GU gels if you are receptive to the gel texture - but it would probably be sticky and messy

Ed

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Smarties are the same ingredients as glucose tablets (look at the nutritional labels) and 1/10 the cost. I buy 5 pound bags from Amazon.

When I go below 70, I eat three rolls and 30 minutes later I am back to the low 100’s. (Your mileage may vary).

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