The 2012 International Children with Diabetes Conference — Friends for Life (Continued)
5. Accurate carb counting. Since fiber does not raise blood glucose, Mr. Scheiner recommended subtracting 100% of fiber if it's over five grams. However, patients should only subtract 50% of the carbs in sugar alcohols, as these still raise blood sugar.
6. Be aware of delayed-onset hypoglycemia. Following high-intensity exercise or extended-duration activity, delayed-onset hypoglycemia may occur up to 24 hours later. Mr. Scheiner recommended reducing basal insulin for 8-12 hours, eating snacks that are low on the glycemic index (e.g., peanut butter, grapefruit, yogurt), and reducing mealtime boluses.
7. Adjust properly for alcohol. Drinking alcohol should be accompanied by a reduction in basal insulin. Alcohol reduces the liver's output of glucose, and it is the liver's output of glucose the necessitates basal insulin in the first place.
8. Frequently monitor. Mr. Scheiner stated, "The longer you go between blood glucose checks, the greater the risk of hypoglycemia."
9. Keep good records. To help prevent lows in the first place, it's important to understand what's causing them. Mr. Scheiner recommended keeping tracks of carbs, insulin, activity, and emotional levels. In his view, the key is to review every 7-10 days and look for patterns. Harkening back to earlier in his talk, he defines problem areas as times of the day where more than 10% of glucose readings are below target range.
10. Treat hypoglycemia properly. Mr. Scheiner recommended checking blood glucose first, treating with the proper amount of high glycemic index foods (e.g. glucose tablets, dry cereal, pretzels, graham crackers, vanilla wafers, jelly beans, Gatorade, anything with dextrose as the first ingredient), and rechecking blood glucose in 15 minutes.
A. Body size makes a big difference in treating hypoglycemia. Larger individuals need more carbs to correct blood sugar compared to smaller individuals. Mr. Scheiner displayed a comprehensive table with recommendations based on glucose level and body weight — for example, the table showed that someone under 40 pounds needs approximately eight grams of carbs to correct a blood glucose in the 50-59 mg/dl range, while someone over 220 pounds needs approximately 30 grams of carbs. These general guidelines are a good starting point and should be adapted over time with experience.
B. By using a CGM, treatment for hypoglycemia can be altered based on trend arrows. Mr. Scheiner suggested increasing carb consumption by up to 50% when a low blood glucose reading is accompanied by a downward CGM trend arrow. Conversely, carb consumption should be decreased for an increasing trend arrow.
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