La Principessa has a new face in her group, another soon-to-be fifth-grader who has diabetes. She slept over last night, she gives herself an insulin shot every day (Madame is perfectly appalled, of course), does her own Accu-Chek, and apparently it’s okay for her to eat marshmallows. She said her mom lets her have 3 marshmallows when she sleeps over at someone’s house. She’s allowed to ingest corn syrup?
I thought diabetics, especially juvenile onset diabetics, were allowed no sugar whatsoever, except for the naturally occurring sugars in fruits and fruit juices. So what gives?
Also, should I start keeping sugar-free pop and Kool-Aid and stuff around for this kid, or is she able to manage her diet well enough that she can drink Kool-Aid and regular pop? Regular Nestle’s Quik has a lot of sugar in it–should I get some Nutrasweet Quik? When Madame informed me that we were expecting a diabetic for supper, I left the grape jelly out of the spaghetti sauce. Did I need to do that? Grape jelly doesn’t count as “naturally occurring sugar”, it’s just sucrose.
I want her to be safe, but I don’t want to embarrass her by making a Big Deal out of this. Obviously she’s very comfortable with her lifestyle, but I don’t want her to be the only one who doesn’t get cookies because they all have sugar in them.
The Cat Who Walks Alone used to have a little friend who told us that her mom said that she couldn’t have sugar, because it made her too “hyper”. So for several years I faithfully stocked up on diet this and that, until one day I saw the little friend drinking a can of regular 7-up. I said, “I thought you couldn’t have regular pop,” and she said, “Oh, my mom says I can have 7-up, because it’s made with fructose, and fructose isn’t sugar.” I said, “Um…” and stopped buying special stuff for the little friend, who didn’t seem any more hyper to me when drinking regular Quik instead of Nutrasweet.
So this sugar deal is nothing new to me, but diabetes is considerably more serious than “my mom says I get too hyper”.
Also, can somebody give me a quick 25-words-or-less on “when to call 911”? It’s called “insulin shock”, yes? Would she pass out cold, or just start acting strange, or what? Is it better to call 911 or her parents? Is time of the essence or is there some leeway?
While I don’t have much experience with diabetes – especially the juvenile onset variety – I do have a special-needs kid (my 13 year old has CP) so I know a little about dealing with this question (“How do I handle a special-needs kid house guest?”) from the other side. If I were you I would call the kid’s mom and ask her what the parameters are. Say just what you said here – that you don’t want to embarrass the girl by making a big deal in front of the other kids, but you want to be sure she is safe. The mom will be able to tell you what the kid allowed to have and how to recognise and deal with an insulin problem. In my experience this is the best way to deal with these situations. BTW, kudos to you for being so conscientious!
The human body breaks all carbohydrates down into glucose which is then used by the body for energy. Simple sugars (fructose etc.) all convert to glucose pretty quickly. Complex carbohydrates (bread, pasta, etc.) also convert to glucose quickly. The body will not react differently to high levels of glucose in the blood due to natural sugars, artificial sugars, or easily broken down carbs. (e.g. don’t worry about the grape jelly in the pasta sauce, the pasta can cause hyperglycemia just as easily.)
I wouldn’t worry too much about your daughter’s buddy. She monitors her blood sugar, and probably knows what it feels like when her blood sugar is too high, and hopefully adjusts her diet accordingly. I realize that she is only in fifth grade, but for her it is a matter of survival, and she is probably more responsible than the average fifth grader in this area.
These are much more complicated questions than you probably realize.
First things first. “Juvenile onset” is now referred to as “type 1” or “insulin-dependent” diabetes. The name was changed because plenty of adults develop it. I was diagnosed with it when I was 37 years old.
A person with Type 1 diabetes must take insulin because his or her pancreas either makes no insulin, or not enough insulin. Insulin is needed by the body to allow the sugar produced by all food to be turned into fuel ( insulin “negotiates” the transfer of sugars to the blood cells). If the amount of insulin is insufficient, all the calories and energy in those sugars are simply passed in the urine, and the body receives no nourishment. Without insulin, a diabetic can literally starve to death, even while eating plenty.
As to your sugar situation - all food you eat is turned into sugar by the body. Sugar provides the energy to run the body. While watching out for unnecessary sugar is important for diabetics, watching carbohydrate intake is more important. Some carbs for instance, can raise the blood sugar very quickly, and back down very slowly. The goal in managing diabetes is to avoid these situations. In your spaghetti sauce example, the amount of spaghetti eaten is probably of more concern than grape jelly in the sauce.
This is all too involved for this forum, and I am only giving a very light overview. There are many sources of info on the net. Just search on “diabetes”. Make sure that concern yourself with “type 1” diabetes.
Last, on “insulin shock”. Diabetics call this “going hypo” or hypoglycemic. It’s like “anti-diabetes” - when the imbalance between insulin and sugar favors insulin the blood sugar level can drop dangerously low. This can lead to coma.
Some people begin to shake or act drunk as their sugar level drops, but this stage doesn’t always occur. Anytime there is any question, do a blood test. If it’s very low, administer fast acting sugar (apple juice, Coca-Cola, etc). If you can’t get the level to rise back to normal, get to the hospital. And anytime consciousness is lost call 911.
Depends on her level of control - I can eat chocolate cake since my control is 1) exceptional mostly, and 2) I know what I’m doing. I have a real hard time with a 5th grader doing these things, as almost NO adult diabetics are smart enoungh to do the things I do. Oh, my last 3 H1Ac’s, because I just know someone will flame me, were 6.5, 5.5, and 6.0.
Overall, 3 marshmallows are no big deal. The things at play here are - 1, the calories involved, 2, the speed at which the sugar enters the bloodstream, and 3) the refinedness of the sugar. The calories are relatively low, and if she has good control then she has accounted for the speed of the sugar, OR is on a schedule that accounts for it.
See above, with my chocolate cake example. IMO though, being a diabetic for 19 years and living with an Internal Med doc, about 99% of diabeteics should NOT be eating any refined sugars, at least in large quantities.
Like I said - I doubt very highly a 5th grader is controlling her diabetes well enought to tolerate non-diet stuff, no matter how well-intentioned or informed. Sugar free pop, kool-aid, are great though - give her gallons of the stuff if she wants. Remember though, that the Nestle quik has lots of calories from the milk itself.
Most jellies have large amounts of sugar added to them. But the real issue is - how much would she have actually got? A teaspoon over an entire dinner? Don’t even worry about it. The three things are refinedness, quantity, and speed of intake. In this case, the quantity and speed of intake are very low I would imagine.
The way to embarass a diabetic is to call attention to it IMO. If you give cookies out, try to give her something else, like Doritos (assuming that it’s time for her to have a snack). Odds are she’s somewhat used to that by now.
Well, I and many others have their own opinions on whether or not sugar makes kids “hyper”. IMO it’s much more an excuse of bad parenting, but I will not debate this here.
Exactly. One is a real, FATAL illness, and the other is…oh, never mind.
You MUST have her bring, or get yourself, a Glucagon shot kit. It MAY save her life if she really goes crashing. Giving a Glucagon shot looks scary, but it’s easy and you cannot hurt her by giving it if not needed - you cannot overdose with a Glucagon shot or damage her in any way.
The signs of mild insulin reaction include sweating, irritability, trembling, headache. She should test immediately. Normally, in a mild reaction her sugar will be 50-60. Give her non-diet pop, about 1-2 cans, and test again every 15-20 minutes until it goes up. If she has glucaose tablets, she should take one or two.
Moderate insulin reaction has symptoms of lethargy, slurred or broken speach, low responsiveness to questions. She may not be able to test her own sugar - you should do this for her. In this case, it will probably be from 20-50. You should try to give her several glucose tablets if she can eat them, and non-diet pop as well. If not, give a Glucagon shot at once. Wait 10 minutes. If not very better, call 911.
For a bad insulin reaction, symptoms are convulsions, uconsciousness, and (gulp) death. Give a Glucagon shot FIRST, call 911 second. Best to do both at once. Glucagon does save lives, and it’s basically the first thing the paramedics will do anyways.
Hope this helps some. Remember - if she’s going to be a frequent guest, insist on a Glucagon kit being there. And you could stock up on a couple rolls of glucose tablets yourself - they’re about $1.00 a roll.
If you have more specific questions, please write me also if you wish.
Just read again DDG, and saw that you wanted 25-words or less. Sorry, but it’s too serious to fit it into that short of space. Remember - Glucagon. I stress this because 2 other diabetics or close relatives of diabetics on this board have pooh-poohed the use of Glucagon. Don’t take my word for it (life saved by Glucagon twice), ask a doctor, or look on the web.
And I don’t care who I offend - a diabetic without Glucagon is being irresponsible.
"Everyone who uses insulin should have a Glucagon Emergency Kit for Diabetic Insulin Reaction on hand at all times to counteract severe hypoglycemia that causes loss of consciousness, or if sugar cannot be given. The glucagon kit should be stored where all the family members know where to find it. Storage temperatures should be under 90 degrees F (28 degrees C).
Never give food to a person with diabetes who is unconscious from hypoglycemia. Always inject glucagon, or arrange for the person to obtain intravenous glucose.
Glucagon, like insulin, must be injected. Within the glucagon kit are a syringe pre-filled with a liquid
and a vial of powdered glucagon. You prepare the glucagon for injection immediately before use by following the instructions that are included with the glucagon kit. In general, small children (under 20 kg, or 44 pounds) are given 1/2 cc (half the syringe), while older children and adults are given 1cc (the entire syringe). In kids, some authorities advise using 1/2 cc to start with, then giving the other 1/2 about 20 minutes later if needed. This method can lessen the rebound hyperglycemia that usually ensues after use of glucagon. There is no danger of overdose, however. Injection is given in a large muscle, such as the buttocks, thigh or arm. (The needle on the syringe is usually larger than those on insulin syringes.)
Glucagon can cause vomiting, so be sure to place the person on his or her side prior to injecting so they do not choke. After injecting glucagon, follow with food once the person regains consciousness and is able to swallow.
In the United States, the glucagon kit is dispensed by presecription only."
On a related note - it is incredibly easy to follow the instructions and inject. I mean, these kits are made for the average person to do. Injecting is not that hard to convince yourself to do, when the alternative is coma or death.
Also, I personally wouldn’t quibble over the dose in the person is in danger - I’d rather give the whole shot - that’s what my doctor SO says as well. Better to have sugar that’s a bit too high than not give enough to bring it up and risk extending the damage. The very short term high blood sugar from this instance will not hurt her.
Just to add my 2 cents about glucagon – Its a great drug, but not the end all save to hypoglycemic reaction
In NM glucagon is a second line drug for paramedics and EMT’s – The first line drug is still D50 – dextrose 50%. Basicall its 25 grams of sugar in 50cc of water. We are supposed to attempt to get an IV and give D50 before we use glucagon.
This is because glucagon works by releasing sugar from the liver – if for some reasion there is no or very little sugar stored in the liver there wont be as good as a reaction to the injection of the drug. Also repeted dosages of the drug are less effective
So, in short, have her check her BGL often, help keep her sugar up, and if anything happens call 911, and worry about getting her sugar up after we are on the way.
Implying, of course, that my information is inaccurate. So please ignore everything I posted above DDG.
And I agree that “The first line drug is still D50 – dextrose 50%.”, but unlike Glucagon, that cannot be given by DDG at her house before paramedics arrive. And you’re right - it’s possible it might have limited effectiveness due to the liver function. My post should have been more clear as to call 911 and give the shot at the same time, or as soon as possible.
Handy – Medicine is my chosen career – if you doubt my information on D50 and Glucagon feel free to ask any doctor or paramedic, they will give you the same info
as far as giving the glucagon before the paramedics arrive, its great if you have it, but sense it is available only from a doctor your not likely to get any. And the time that it is going to buy you is not likely going to make much of a difference – if ya had done nothing and just called 911, the person would have most likely survived anyway.
note there is not absolute in the above paragraph, medicine is a fickle thing
It wasn’t always prescription-only in Kansas, and in the first post I said that the little girl most likely should already have it herself. I was wrong in saying that DDG could buy it herself - I forgot it’s prescription-only in most places. But surely the girl must have her own…?
Depends on response time. Where my Mom lives the response time for MedAct is > 10-15 minutes under normal conditions, and one time it was nearly 25 minutes. It all depends on where you live, and the situation. Plus, here in KC we’ve had a couple scandals lately where 911 dispatches were “lost”, and NO paramedics dispatched.
Given that medicine is fickle, why not give it anyways, since it is still the recommended treatment and the “standard of care” for non-professional first aid? Even though it’s not perfect, and even though paramedics need to be there to give advanced care? It really sounds like what you are saying is “don’t bother, just wait for the paramedics”. I never meant not to call 911 immediately, and I never meant that Glucagon replaces the need for professional help in a true emergency. But it really seems like you are really against giving Glucagon. I know a few paramedics myself through my Doc SO who agree 100% with my position.
Am I simply reading too much into what you are saying? I must be misinterpreting you, and if so I am truly sorry.
I mean, do you agree with me that one SHOULD try to have Glucagon available, that it SHOULD be given ASAP in an emergency?
I havent personally run on any calls with a diabetic that carried there own glucagon, but then again I have my own drugs so I dont look too hard for theirs…
In NM glucagon is by prescription only, so that’s where my experience comes from.
What I am trying to say is that while the diabetic having their own glucagon is a good thing, and that in a rural area it might damn well save their life if the response time is 15-20 minutes, but at the same time the people you really need are the paramedics.
basically the same thing you are, just not as well
duck duck goose, on the snack frount if you are uncomfortable with giving your guest marshmellows, might i suggest sugarless candy. there are sugarless hard candies, chocolates, and cookies that you could stock up on, i see them in supermarkets all the time. they don’t look any diffrent from the ones with sugar and taste okay, even your non diabetic guests may like them. be a bit careful with the chocolate more that a few pieces can cause “the runs.” the hard candy and the chocolate taste the best though, the cookies are a bit “chalky” unless a bakery in your area makes them fresh.
crystal light makes a good line of sugarless drinks, again this could be served to all without going into “the this is special stuff only for our special guest” thing.
Anthracite, let me preface this by saying that I don’t know anything about diabetes and I am not saying that you are wrong about anything. What I am saying is that some things in your posts are directly contrary to things I thought I knew about diabetes and I am going to point these things out in an effort to fight my ignorance and not yours.
My first question is about refined sugar. Are there any facts that support you opinion that, “about 99% of diabeteics should NOT be eating any refined sugars”? It was my understanding that the amount of sugar in a food was not nearly as important as the glycemic index of that food. According to this site sucrose has less impact on blood sugar than things like white bread and instant rice, among other things.
My second question is about hyperglycemia. How dangerous is it? All the posts seem to be discussing diabetic coma due to hypoglycemia. One thing I read said that without insulin a diabetic would eliminate blood sugar via urination instead of using it for energy. I couldn’t find much about potential ill effects of hyperglycemia. I don’t doubt that there are ill effects. I just don’t know what they are.
I’m oversimplifying things on purpose. Yes, white rice can really spike the blood sugar, as can many pastas. White rice causes be to at least double my insulin dose. But refined sugars spike it much faster, and are harder to account for in real life. It is easier to adjust for things like rice, et al than to adjust for things that go into the bloodstream very quickly. I tried to limit my response to the OP, which dealt with refined sugars.
Hyperglycemia has several short-term effects, such as ketoacidosis, which is really nasty and can be tricky to correct back in children - there is a risk of going too far the other way. Keto makes you sick, but is unlikely to kill you or cause permanent injury in an aware diabetic who corrects for it properly.
Even if you don’t go as far as keto, you still have short term effects of nausea, vomiting, weakness, general feeling of “unease”, backaches, bloody urine, etc. These are short term effects, and in themselves are not life threatening. The primary problems of high blood sugar are long-term and cumulative.
These include kidney damage, blindness (retinopathy), neuropathy, blood vessel damage, heart disease, much greater risk of infections, dermal ulcers, strokes, and, eventually, death.
The “facts” that support my opinion are anecdotal purely. I know a lot of diabetics, and as an Internal Med doc my SO treats MANY diabetics. The general exposure of us both suggests that the majority of diabetics do not control themselves well enough to risk with fast acting sugars, or as you add, foods with a high glycemic index. I’m sure Handy will something to say about this…
FTR, I have by far the lowest H1Ac of anyone my age as a complete, Type 1 diabetic for 19+ years. My one score of “5.5” makes me almost ranked as “nondiabetic” IIRC. Most people I know have scores of 10-14 consistantly. And yes, I know the H1Ac is not a perfect measure of control, but it’s a commonly accepted one nonetheless.
If you know diabetics that can eat chocolate cake and rice pudding without trouble, hey, more power to them. I’m just saying that from DDG’s perspective, she should not assume that the little girl is likely to be in extraordinary control.
As far as hyperglcyemia goes, it is a life threat due to the large ammount of suger that is excreated in the urine. Remember that all of your blood goes through your kidneys at some point of time. When all of the extra sugar that cannot be absorbed because of the lack of insulin gets dumped into the urine by simple graidents (less in the urea output than in the blood). this causes the urea to be hypertonic compaired to the fluid it is being pulled out of. This action causes water that would be normally recovered from the Urea to be left in the urea. This urea goes to the bladder and is then excreated. Any prolonged hyperglycemia quickly leads to dehydration
Ketones get envolved because the body cannot use sugar as an energy source, so it begins to breakdown fat to use for energy. this breakdown causes the release of keytones. These keytones are very acidic, and have a large effect on blood pH. That is why when a diabetic is in ketoacidosis you can smell the keytones, the body is blowing them off to get rid of the acid.
Anthracite & kinoons, Im not implying your information is incorrect, just that a lot of medical questions get asked here about all sorts of things & people should spend the time to find out if it’s right.