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Dr Hive - Blood sugar of 40


ktgrok
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I posted the other day about DD8 waking up shaky, slow speech, etc. She had a stomach virus and hadn't eaten. I gave her some soda and some candy and after a while she was better. 

 

Well, she still has the stomach virus. She vomited again sunday night, and yesterday her stomach hurt still, so we went back to just clear fluids. I did make sure to keep giving her sprite/ginger ale etc, rather than just water. She was feeling pretty good last night, a heating pad helped her stomach, and more zofran. This morning I went to check on her and she was shaky again, although able to speak clearly. Very weak. I found my glucometer from when I was pregnant and used it...and her blood sugar was 40!!!

 

I've given her honey, half a pack of smarties candy, and some sprite. She's still pretty pale, and shaky. Going to get the rest of the sprite in her and then recheck. 

 

Anything I need to know here? I will be telling her doctor, and I am thinking I may be checking at some random intervals once she's well to see if there is something going on other than just being sick. 

 

And is there a chance I won't be able to get it up at home and need to take her in? (her stomach doesn't hurt she says, so she can eat now. She just had a cracker too.)

 

Update: She's not getting above 50, but....my strips are old. I just saw that they are supposed to be used within 3 months of opening and it's been over a year. Although I checked myself and it said 87, so that seems accurate. But individual strips might be off I guess. I also might have had wet hands with that last one...but I hate to stick her again. 

She's acting normal now, maybe a bit weak but that's expected with a stomach bug. But chatting and eating. So going to watch her. Going to get new strips, and maybe do a few late night or first thing AM checks for a few days. 

Edited by ktgrok
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Is she dehydrated? (Dark scant urine, circles around eyes, sunken looking, skin on back of hand "tents" when pinched and stays tented.)

 

That is a low level. If she can eat, try to get a little protein in her. Peanut butter on a whole wheat cracker or toast maybe? The sugar will raise her blood glucose temporarily, but it can cause a crash back down. The protein keeps it more stable.

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Update: She's not getting above 50, but....my strips are old. I just saw that they are supposed to be used within 3 months of opening and it's been over a year. Although I checked myself and it said 87, so that seems accurate. But individual strips might be off I guess. I also might have had wet hands with that last one...but I hate to stick her again. 

She's acting normal now, maybe a bit weak but that's expected with a stomach bug. But chatting and eating. So going to watch her. Going to get new strips, and maybe do a few late night or first thing AM checks for a few days. 

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My mother is has been a nurse for close to 30 years, and she says that what you are describing is not normal, even for a sick child. She says that having the blood sugar dip isn't normal and indicates something is going on. She also says that if you've done everything you've said and it hasn't come back up to at least the 60-70 range then you should take the child to the doctor/urgent care/ER NOW, don't wait for it to dip more.

 

Hope everything works out.

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That is really low, and especially since it isn't rebounding, I would be more concerned. I would want her seen by an MD today. PCP, Urgent Care, ER..somebody who can examine her, do a controlled blood sugar test (verified accurate monitor/strips) and do some basic blood work.

 

((((Hugs))))) hope it turns out to be nothing. It is scary when our littles are sick and we don't know what is wrong.

Edited by Tap
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​My adult son has hypoglycemia....when his blood sugar crashes, he needs protein. Just consuming sugar does not bring it up. 

 

With a consistent blood sugar that low, I'd be taking her in. Just to see what the doctor got when he checks it.

When my son's gets that low, he feels like he is having a heart attack so it does get our attention. 

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So, just got back on the computer. She's now laughing, playing, and acting 100 percent normal. Chatting non stop, jumping up and down, etc. 

 

I've never been so happy to see her being normal, lol. 

 

Ugh, I hate to go into the doctor's office at this point, they are SO full of germs right now. 

 

Would you go to the pediatrician (long waiting time, probably germier, would probably see nurse practitioner but might see pediatrician) or nurse practitioner at the family practice doctor? I like the nurse practitioner there but do not like the doctor there. Quicker to get in usually, I'm guessing less germs because they see way fewer children, but also going to be less versed in pediatrics. 

 

Other option is urgent care, there is a pediatric one nearby that will be open later this afternoon (opens at 4pm I think and is open until 11pm), but that is likely FULL of germs, higher cost, etc. But it is pediatric. But would definitely be seen today.)

 

Or, get new test strips and see where she is right now. (and regardless, I'm getting some glucose gel or tabs right away) 

 

She hasn't had protein in days because of the stomach bug, just carbs and yesterday just liquids. Will work on getting those in today, probably some turkey breast or something. 

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If she's playing, I would get new strips.  But I would monitor her carefully for hypoglycemia.  Actually I'd monitor her for awhile anyway.  Those extreme lows can sometimes come with swings in the other direction as well.  If her sugar is up to normal the doctors can't do anything for her.  But they would give you advice to monitor her and to give her sugar in some form plus protein if it happens again.  They do need to note it in the chart if it is repeated, though. 

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I have hypoglycemic tendencies (as in I haven’t been formally diagnosed by an endocrinologist but that’s what my family nurse practitioner calls it). When my sugar drops I eat a peanut butter and jelly sandwich. The jelly and carbs from the bread get the blood sugar levels up and the protein from the peanut butter keeps it steady. I also keep glucose tabs and hard candy with me at all times (the glucose tabs are good for in the car because they don’t melt or anything like that)

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I have hypoglycemic episodes where my BG drops into the 50s, but it always comes right back up again if I eat sugar. I have to be careful to consume protein/fat with everything - so no plain juice, bagels, etc. I'd probably buy a new glucometer at target or somewhere just to be sure your strips are right. 

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That is way too low, Katie. Too low, as in, seizure range. I wouldn’t let her sleep (or at least sleep with her) with it going that low until she’s been seen by a dr.

(((Hugs)))

Even if new strips show normal I'm going to set alarms to check her tonight

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I have hypoglycemic episodes where my BG drops into the 50s, but it always comes right back up again if I eat sugar. I have to be careful to consume protein/fat with everything - so no plain juice, bagels, etc. I'd probably buy a new glucometer at target or somewhere just to be sure your strips are right. 

 

And then, if you're like me, you will trend down again once that sugar wears off. I always have to pair high glycemic foods with fat or protein or it's ugly later.

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Katie, FWIW, I cannot do clear liquids when I am ill unless I have had good blood sugar control preceding the illness and it's short-lived.  I understand that there is an aspiration risk, but I have had scary blood sugars (40s) when I had hyperemesis (either pregnancy or norovirus).  If she's truly not keeping anything else down, and she's had two episodes of low blood sugars---I'd call in to her ped, and I'd be charting her sugars for the next couple of weeks. 

 

I tend to dip just before an illness as well, or when stressed.  If her body is feeling stressed from the flu (likely), she is probably dumping more sugars naturally and just a little more volatile. 

 

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So she ate the half sandwich I gave her, apple slices, and later a single chicken nugget (white meat, home baked). She also had a cookie later. Going to do some more chicken and some noodles with butter for dinner. Will (on the advice of a friend with a type 1 kid) check post meal levels at 1 and 2 hours after eating to see if they spike up at all, and will check, at minimum, a fasting level in the morning. Then take all that info and call the doctor.

 

No frequent urination or thirst, but she has had a history of irritability over the past several months to a year, although better lately, that I chalked up to start of puberty hormones. But it is effected by diet. And she has a history of sleep issues including nightmares and sleep walking which I'm reading can be connected to low blood sugar at night. 

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Yeah, a constant reading of 40-50 would have me taking her with me to the drugstore, buying new strips, testing her with the strip at the store or in the parking lot, and then proceeding either to urgent care or home depending on the result.

 

When I had GD my fasting sugars were regularly 60-65 and I was miserable.  I couldn't think, I couldn't move, I couldn't wake up, it was awful.  I had no idea there was a lower boundary to ideal blood sugar - my ob-gyn just said stay under 90 and never asked again.

 

So glad she's back to something stable again.  I'd keep an eye on it for a few weeks anyway.

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Yeah, a constant reading of 40-50 would have me taking her with me to the drugstore, buying new strips, testing her with the strip at the store or in the parking lot, and then proceeding either to urgent care or home depending on the result.

 

When I had GD my fasting sugars were regularly 60-65 and I was miserable. I couldn't think, I couldn't move, I couldn't wake up, it was awful. I had no idea there was a lower boundary to ideal blood sugar - my ob-gyn just said stay under 90 and never asked again.

 

So glad she's back to something stable again. I'd keep an eye on it for a few weeks anyway.

What a crappy handling of GDM. Did they not have you show them a log of your readings? Were you on diabetes meds?
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I wasn't on meds, they just said:

 

You have GD, here is a printout showing you what to eat, eat that and take your blood sugar 4x/day.  Fasting should be under 90 and post-prandial should be under 140 (I think it was 140, might have been 120.  I was welllllll under all the time).

 

Then at subsequent appts, they'd say on rare occasion "is your fasting under 90?" and I'd say, "yep, but I'm exhausted constantly" and they'd say that's normal, you're pregnant.

 

eta: got rid of a bunch of stuff because it was just complaining and a side-track :)

Edited by eternalsummer
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Young children can function at much lower bg's than adults. Dd could tell me, at bg 28, that she might need to have her sugar checked now, rather than later.

 

Glucometers have a tolerance of 15% or 15 mg/dL in over 95% of trials.

 

And of course they are used by babies and children. How on earth do you treat a Type 1 diabetic child if you don’t have any idea what their bg is?!? You are certainly not taking them to a lab 4-8 times a day for an absolutely accurate bg!

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Yep... I can't fathom how some people can eat a bowl of sugary cereal and then still be okay 4 hours later!  I would have to refuse to go somewhere if there was no food allowed. It's annoying!

 

 

And then, if you're like me, you will trend down again once that sugar wears off. I always have to pair high glycemic foods with fat or protein or it's ugly later.

 

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Ktgrok, it was probably a one off due to the flu. If you google hypoglycemia it will list the flu (or similar virus) as a cause for one time episodes.

 

 

Sent from my iPhone using Tapatalk

 

That's what I'm reading too. I will check her a few more times, but I'm less worried now. 

 

I will, however, be heavy on the Zofran and keep her eating if possible when she has another illness!

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Should this happen again I have 2 pieces of advice:  at least contact your pediatrician and discuss it with him/her, and, in addition to giving her sweets give her some protein (like peanut butter).  Only giving her sweets will raise her blood glucose, but send it crashing back down, the protein will help keep it up.

 

I'm glad she is feeling better.  No matter what, I would definitely let her pediatrician know this has happened.   Even with the wrong reading on the glucose monitor, her symptoms are definitely hypoglycemic and her provider needs to know (yes, she was sick, but I would still let him/her know).

 

The problem was she was too nauseated to eat protein - I think that's how we got in that situation. 

 

Normally, yes. 

 

And yes, will absolutely let the doctor know. 

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