From Alta Loma, California, USA:
My six year old son has had type 1 for two years. Two days, ago his seven year old brother came to our bedroom at 6 am and said he was lying on his bedroom floor crying. My wife and I went and found him to be having what we thought was a nightmare. He was delirious, his eyes glazed and rolling about. He would kick and scream, then relax like being asleep, then speak like he was dreaming. We could not wake him and were very frightened. I tested his blood sugar, and he was 82 mg/dl [4.6 mmol/L]. He has been low and cranky in the past, and when given juice, he has come around. So my wife tried giving him juice. He would drink a little, then have a fit, then drink more. The whole time it was if he were still asleep. We were still very frightened because he wasn't coming around. My wife thought he had gone low in the night, gone into a coma, suffered brain damage then rebounded and was permanently brain damaged. We were both crying, my other son was very frightened. We drove to the emergency room. On the way, he vomited the juice.
He was admitted, slowly calmed down, but would not let anyone touch him. They put him on an IV. He vomited twice more. He had a small bruise on his back that we assumed he received when he fell on the floor. The doctor wanted x-rays of his chest, so four of us held him down. The doctor wanted a CT scan, but said that until he could lie still on his back, unrestrained, they couldn't do the test. Three hours and four injections(something to calm him} later, he had fallen asleep. When the aide came to transfer him to the CT room, he awoke, sat up said "hello", and was the sweetest thing. He didn't know where he was, and he had no recollection of anything, except vomiting in the hospital. Over the next 24-hour period, they did the CT scan, EEG, urine sample and observed him. All tests came back negative, and, because his sugar was 82 mg/dl [4.6 mmol/L] when we tested him, they didn't attribute it to his diabetes. Their diagnosis was night terrors. They hadn't heard of it lasting that long, but that was all they could think of to explain it.
I don't know what to think now. We are still very concerned. I hope it was not diabetes-related, but, now, I fear this poor little guy will have to deal with diabetes in his waking hours, and night terrors in his sleeping hours. Can you advise us as to what might have happened? Could it be night terrors? Is it possible to go into a diabetic coma and then rebound on your own?
I could write a book on the unfairness of a child having diabetes. Every holiday conceived by man revolves around sweets. Everyday at school snacktime, when the other kids have cookies and cake and ice cream, my son has his blah diabetic snack. Anything 50/50 has created for diabetics tastes like cardboard. I'm sorry to get off the main point of my question, but it feels good to get it off my chest.
I do not think that the episode that you describe was due to 'night terrors', rather it was almost certainly a severe hypoglycemic reaction. The fact that his blood sugar was 82 mg/dl [4.6 mmol/L] by the time it was done in no way negates this. It just means that the body's counterregulatory mechanisms had started to work. I think that it is unlikely that this episode will have any lasting effects, but you want to be very sure that it is not repeated. To do this, you will need to develop a detailed 24 hour profile of his blood sugars over a few days with particular attention to the effect of vigorous exercise or any diminution of food intake.
Once the pattern of blood sugars has been developed, I expect that you will see evidence of early morning low blood sugars. This will need some adjustment of insulin dose and timing and perhaps of type of insulin which needs to be coordinated with his doctor.
I suspect that 'blah' snacks have been a factor too, but you can avoid this by talking your dietitian diabetes team or by looking for help on the this web site. NiteBite bars may work for the bedtime snack.
Until all this gets sorted out, you need to keep monitoring early morning blood sugars and to make sure you become familiarised with the proper treatment of hypoglycemia.
Additional comments from Dr. Bill Quick:Your situation might well be clarified by monitoring sugar levels continuously for several days to try to sort out what's happening in more detail. See The Continuous Glucose Monitoring System.
[Editor's comment: Please do see your dietitian. It seems like the "diabetic snacks" issue is a big one for your child. These days, with carbohydrate counting, kids can fit any type of snack, including cookies and ice cream into their meal plan. In addition, there is now a new sweetener, Splenda (sucralose) available which not only can be substitutes one for one in recipes with sugar, but tastes like it too! There are several products which are, or soon will be, available that contain Splenda.
Denying treats to children is not only unnecessary, it is unhealthy. It is important that you learn how to incorporate them correctly into a meal plan. SS]
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