Twins Always Take Care of Each Other!

Thursday, April 11, 2013

Hypoglycemia Unawareness

Hypoglycemia Unawareness is a state in which a person does not feel or recognize the symptoms of hypoglycemia. 

As type 1 diabetic patients age with the disease, it is suggested that this may contribute to some of the cause: neuropathy and desensitization to hypoglycemia are just a couple of reasons. 

But what about the kids? From the medical professionals and parents I have interacted with, it is not uncommon for children to experience this unawareness. 

Case in point:

All is well in the house tonight until... CRASH!

And would our D-girl know to tell us? Was she feeling poorly?
You guessed it! NOPE! She slid all the way down to 49 and holding steady and felt perfectly fine and playing with her sister until the continuous blood glucose monitor (CGM) alarmed giving us our warning that trouble was brewing. Now, you know the mind of a child, right? As soon as the alarm sounded and she knew she was low, THEN she felt poorly and needed treatment :-) It is kind of when you get a paper cut and it doesn't really hurt that bad until you look at it and see how deep that sucker is and WOW! Then it really hurts! 

That being said, I don't know how we ever survived without a CGM in our lives. I remember before we got it that I was reluctant because she is a small child and isn't it enough that she has to wear an insulin pump? Poor kid, right? All of this stuff she has to carry around. BUT, this CGM has given us so much control over her T1D. 

We have been able to make more educated corrections to her insulin dosages. We have caught highs and lows FASTER and been able to treat them faster. We have been able to live with the comfort of knowing that she is protected because we know that this little piece of technology is watching over her day and night.

SPEAKING OF NIGHT! I don't know about any other T1D child or family, but personally our experience has been (and I suspect others as well) that the overnights are the most unpredictable and difficult to control sometimes. When I see the graphs on the CGM now, I cannot believe that we lived for the two years after diagnosis without a CGM because yes we would get up in the middle of the night and test. But that test once in the middle of the night only gives you one data point. It does not show you the entire picture!

Perfect example - here is a photo from this week:

You will see that she went to bed well within range.

Started creeping up...and up...and up!

If I had NOT had a CGM and only tested her once in the middle of the night, I may have bolused once and assumed that her number would come back down. Or perhaps if I would have only tested right before midnight the number would not have been that bad (as it was on it's way up) and would have gone to sleep not realizing how terrible the numbers would get AFTER I had fallen asleep.

By midnight she was well over target and stayed there the entire night. No matter how many times I tested and bolused, she was up there. 

Now, remember, this is the middle of the night and you aren't exactly using 100% of your brain power. Although, after you do this for a few years, the habit and ritual kick in and you know the patterns of your child's body. But even patterns don't even hold true every time. I would have SWORN I would have needed a site change on this. High all night - bolused several times - and the insulin could have been whisked away by magic unicorns for all the good it was doing! But THEN, wouldn't you know, just as it is time to wake up for the day... wait for it... YEP! The number finally starts coming down into target range!!! 

If you read my blog the other day "Hedging My Bets" you would start to think that someone out there is trying to have a little fun with me, right?! 

But the CGM has been a WONDERFUL tool in saving us from this unawareness. I think maybe kids are just too busy "being kids" to stop and pay attention to their symptoms until it is too late sometimes. I am not saying that she never recognizes her symptoms. She can - sometimes. Other times, not so much. 

I am most thankful for the opportunity to use this technology. Anything to keep her safer and healthier makes me happy. I will most happily give up my sleep every night for a healthy child (although a good night's sleep every once in a while sure is a nice treat!)

Thanks for reading!