FUDiabetes

Request for help understanding a hypoglycemic event

Hi,

My 9-year-old son was diagnosed T1D 12 January after entering an emergency ward DKA. We could still be within the so-called honeymoon period. Some weeks ago we had a Freestyle Libre flash sensor gifted from a new friend, but on Thursday started with the Dexcom G6. I’m very happy, so far, with its accuracy.

At any rate, I’ve not seen something like this before, and wondered what those with more experience would think of what apparently happened last night.

To explain, my son was sleeping throughout. Coincidentally, I woke around 3am, a few minutes after this happened. A couple of minutes later, I saw my son’s levels on my iPad and woke him to give him some juice. Around 20 minutes later he dipped again (you can see the second dip to the right of the chart) and I gave him flavored milk.

There were no more events, but as I reviewed at the readings, I was surprised to see what had happened:

  1. The very sharp downturn. Nightscout reports the low reading as 39 BG, with the nearest earlier reading being 56 and -6 mg/dl.
  2. The very sharp upturn within the 5 minutes to the next Dexcom reading, rising at a rate of +47 mg/dl, to reach 87.

I was still asleep, and my son also, when this happened.

So, am I correct to imagine that his pancreas released glucagon, inducing the liver to release glucose into his blood?

If so, will this residual capacity deplete in the months ahead?

I’d be happy, also, to hear any other reflections others may have. Sleep is the thing that terrifies me the most.

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@ianrobertdouglas, I am on my phone so I have a hard time seeing exactly the event on the CGM. But I think that possibly what happened might have been a “pressure low.”

CGMs, when pushed down by a movement of the patient (if they sleep on it, or there is the weight of small arm on it) tend to indicate a sharp low. Often, it will go down sharply then you will lose the signal. When the pressure is released, you see the signal come right back.

We used to see a pressure low at least once a week or more. Then we roll our child off so as to free the sensor and the signal comes back.

Apologies if the event described gives more info on the pic that means I am inducing you in error here!

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Thank you, Michel.

That may well be what happened. When I came to him, he was sleeping on his left side, and again when I came to him the second time. The Dexcom is on his upper left arm, though we positioned it slightly behind, with sleeping positions in mind.

So if I understand it, pressure on that site could induce a downward low, while the pressure released could induce the sharp upward swing seen on the chart.

Good to know.

Thank you again.

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The pressure can totally induce the downwards low, but it comes back to what it was before when you release it. If you see further upward motion (to the right in the pic?), it would either be the carbs you gave it, or something else that may be a glucagon reaction. Sorry obout the limited screen access of my phone :slight_smile:

The right screen is when we were both sleeping, before discovery of this event.

What is interesting is that this apparent low (that might have been simply a pressure low) was followed by another, around 20-30 minutes later.

But that could have been a pressure low, too.

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Very common for us too: often I have to come to my boy two or three times in the same night in a short time to turn him over—then no problem for a week or two :slight_smile:

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I’m awake now because my partner had trending low BG tonight before I fell asleep, treated, and then a pressure low. And it takes a while to rebound. So I’m in the same boat. It’s really hard to find a good spot for the Dex that doesn’t get slept on!

I wish I had better advice but it’s the middle of the night and my brain is ready to sleep. :slightly_smiling_face: But I wanted to chime in on the pressure low likelihood.

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Without seeing the cgm numbers at the time involved, it is hard to say. (Numbers leading up to and after within a one hour span - not just the single cgm number at the time of the event)

The graph is pretty expanded so hard to see the details of the time in question.

Obviously a meter reading at the time would resolve many questions.

However the graph does not resemble the graph that we would get from a pressure low.

The second low definitely does not look like a pressure low at least the sort of pressure low and resulting graph that we would get.

Note - A cgm pressure low is quite unusual for us although it has and does happen on the rare occasion. The resulting graph which we would get is (from my point of view) blatantly obvious. Like so many other things, the way a pressure low impacts somebody and the resulting graph could certainly be different.

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Thank you.

If anyone has managed to capture a pressure low on a Spike screenshot, I’d love to see it.

I don’t immediately see a way to extract the raw numbers at the time of the episode, but I can list them here. Spaced at five minute intervals:

2.15 am - 74
2.20 am - 75
2.25 am - 68
2.30 am - 64
2.35 am - 62
2.40 am - 62
2.45 am - 56
2.50 am - 39
2.55 am - 87
3.00 am - 95
3.05 am - 95
3.10 am - 92 (Around here is when I woke my son for his first juice)
3.15 am - 91
3.20 am - 90
3.25 am - 88

I don’t know if this helps at all.

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I second this. If you’re getting up to give him juice anyway, would you consider using a meter to confirm the CGM reading? This is more my angle since I see so many discrepancies between CGM and finger stick but have not experienced any pressure lows that I’m aware of.

Although… looking at your numbers, I think that the 2:50 am 39 and 2:55 am 87 is suspicious. That’s a huge jump for a five minute span…

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Agreed. If I’d been more present of mind, I would have tested him with a fingerstick. Seeing this happen for the first time, the obvious just didn’t to occur to me.

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You’re gonna have to go a little easier on yourself. You’re going to learn these things for yourself, and then they’ll become second nature. You’re also going to learn what’s true for you and your son. If you look around, you’ll see people don’t always agree on things… not even “the obvious”. We’ll all respond to your questions based on our own experiences. Some stuff will work, and some won’t. So you’ll just chip away at it and find what’s good in your case.

And take good care of yourself. You can’t skip that part.

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Yes - the numbers make it much easier to look at.

I change my previous opinion. Based on these cgm numbers, at least this first event @ 2:50 AM does look like a pressure low.

Everything is easier in hindsight !!!

:smile:

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For what it’s worth, in addition to the pressure low possibility, I’ve found that the first twelve hours or so with a new G6 sensor can have a lot of this jumping around, especially false jumps low causing alarms to go off. So, if you had just put in a new sensor that could be what happened. However, if you’d had the same sensor for several days and it was accurate, then ignore this theory. I don’t find that the G6 goes off much once it’s gotten on track.

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Agreed with @TTnyc - I see a substantial improvement in the G6 sensor after the first 12 hours (post warm-up).

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Thank you. In this instance, it was the fourth night with the G6 onboard.

I’ll keep my eye on it, but chalk it up to a pressure low.

Part of my worry is that we remain in the “honeymoon” period and that things are going to become much more unstable sometime soon.

I guess we’ll just burn that bridge when we come to it.

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@ianrobertdouglas

One item I would question (if you don’t mind) is why an alarm was not sounded at something like 65.

Not to do any Monday Morning Quarterback fingerpointing or anything like that but more in terms of what can be done moving forward to make things better?

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For us, the honeymoon period was more difficult to manage than the time as we were exiting the honeymoon. During the honeymoon especially when you are getting “spurts” of insulin from the pancreas your dosing can be confused because you never really know how much his body is going to contribute. Once the pancreas stops adding to the equation it gets a bit easier.

With that said, teenage growth is real pain in the butt to deal with, so there is that to look forward to.

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I have a number of alarms set, but last night my son was sleeping with my wife while I slept in the other room because I’m coming down with flu. Neither she nor my son woke to the alarms, and I didn’t hear them from where I was. But I have a great Bluetooth mini-speaker on the way, so hopefully we’ll not have issues with unheard alarms soon.

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Yeah - not hearing alarms is a common issue. For this reason, that reason or the next reason.

All you can do is to analyze, figure out what the cause was and find a way to prevent that same issue from becoming a recurring theme.

Sounds like you are on top of it. You already recognized it, thought it through, and came up with a solution.

That is how it works !!!

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