When is a low....BAD?

Before you answer ALWAYS, let me give a scenerio:

You (or your child) is at a cool 105, 45 degrees down at the point your meal has been consumed…15 minutes later you see that your CGM is still showing down movement. Now you’re at…say 85. After 20 or 25 minutes your CGM says you’re even lower than that…say 60 or lower. So my question is…are you (or the child) really low…and by that I mean…are they in “dangerous territory” EVEN IF their BG is seriously reading say 60? You know that you’ve eaten X number of carbs Y number of minutes ago and you know that foods in your system being digested and that you have enough carbs to cover the amount of insulin you bolused yourself for.

So, in this situation would you consider the low bad?

There are times where our son is headed down and we treat him quickly enough (or he gets his schedule meal), but for whatever reason the carbs don’t kick in fast enough and he ends up going lower than we would ever want him to be…yet we know he’s consumed enough carbs to turn the corner on that low AND when he shows low on CGM and/or via finger prick, we know he’s already been corrected 15 or more minutes earlier so we don’t really think of that as a “true low”…hope this makes sense?

I know GI determines the speed that foods get processed also, so let’s just say for the sake of argument for this question that 99% of the time this specific food(s) that you are eating (or your child is eating) doesn’t cause you to go “low”. But that 1% of the time it acts differently.

Anyone have any input on this?

Short answer, with the existing data they can’t find a real problem other than inability to discern future low blood sugars, which is troubling when driving and doing other activities where blood sugar is critical.

Also, hypoglycemic events cause an impaired ability for the counter-regulatory responses in your body to work. So in the future your body won’t be able to to respond as well.

I would not call this a well studied area. So caveat emptor.

I guess my real question here is…even though finger pricks and CGM’s may SAY he’s low…is he really??? If he’s consumed a full meal 15 - 30 minutes earlier and I know he’s got carbs in his system…is he really even considered “low” in this instance…

A real low is a crashing blood sugar that takes you by surprise and makes you feel lousy… a steady 60 and not dropping doesn’t meet my definition of a real low

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if the finger sticks say he’s low, he’s probably low, assuming your meter is accurate. Dex is an other story – for us it overestimates the duration of the low by a good 10 to 15 minutes – especially if it was a bad one.

Now, that doesn’t mean the answer is to immediately give carbs… If he’s 60 I might wait another 5 minutes and retest. Different at 55 or 45…

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We had this situation yesterday. We made the mistake of prebolusing for a meal he usually devours…but then he had to go to the bathroom which took a while. Long story short he had a belly full of carbs but crashed down to 60 first…and then he slowly crept back up, +3, +3, +3, to 100. We didn’t treat because we figured the carbs already in his belly would work about as well as a treatment. If we gave him juice it’s possible we could have shortened the low duration by maybe 5 or 10 minutes – but it didn’t seem worth it given that it would likely cause a high later, which causes roller coastering.

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I read an interesting story a few months ago. This young woman (T1) had just had lunch with her friends. She walked out of the restaurant, and suddenly realized she was super low, couldn’t stand up, couldn’t walk. She had to sit down on the sidewalk right away and wait until she felt better. She was panicked because she had nobody with her, and there was nothing she could do: she had already eaten and she knew she had plenty of carbs in her system.

When you have already taken your carbs, there is really nothing else you can do until they kick in. But the low IS a low, no doubt about it – not when the CGM tells you so (often 15 mins late), but if the fingerstick tells you.

Over the past two months, we have had many lows, way too many. Most of them are due to the fact that we don’t take carbs early enough, and, by the time they kick in, my son is low:( We are working on it right now… But - these lows ARE low, and I’d much rather he didn’t have them, for the reason @Chris gave: your body does not react as well the next time around, and may progressively not sense the low.

Like @TiaG, we have noticed that the CGM often exaggerates the duration of lows.

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In this situation, I would define it as low until his meal starts to affect him. But you already treated the low with the meal. So you have to decide if waiting is best. What did he eat? How bad is he dropping. How much insulin did he take and how long ago? How quick will the meal hit.
These will always depend.

You can speed it up with a little juice. Or wait it out. You’re the best judge if it. Sometimes I have been faced with similar situations and actually took both insulin and food so that it would balance better in the long end.

When there is food on the way, those lows seem easier.

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I think being low is bad, but being low for an extended period of time is worse. I liken it to holding your breath. Probably not too harmful if it is for a very small amount of time (unless it is too low, of course).

We just had a weird situation yesterday. My son was at a cool 100 range. Ate dinner (pasta and some bread). We did not prebolus because this was a new meal and wasn’t sure if he would eat it (good thing we didn’t). Strangely he did not spike. He had no IOB. His BG actually started to slowly drop, so we gave him a few grapes and eventually a few gummies. Still no IOB. Then out of nowhere he plummeted with a Dex reading of 75↓↓. When we checked BG it was actually 45. He refused to drink the quick acting Mt. Dew because he said his tummy hurt, so we talked him into skim milk with hershey syrup and more gummies. With the glucagon on hand and countless finger-sticks later, we eventually got his BG up. Still no IOB and we had since suspended basal. This all came seemingly out of nowhere. I am convinced that it was due to a GI issue, but was totally unpredictable. He mentioned his tummy hurting in passing–but didn’t really stop him from playing or being his normal self. I think if he had been at school during this episode, it could have turned out much, much worse.


He may be getting a tummy bug?

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Quite possibly, but no real noticeable symptoms except for saying his tummy hurt in passing 1 time.

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It is similar situations, although with an older child it is easier to make him eat/drink, that have led us to being a bit more conservative in our approach. Also, being in school with hundreds of “poo flinging monkeys” ensures that my son gets sick more than anyone else (or so it seems). Every time we think we have it figured out, something else happens…

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