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July 24, 1999


Question from Wyoming, USA:

I work in an institution catering to the Developmentally Disabled population. At present we have a 56 year old woman with Down's Syndrome who is a brittle Type 1 diabetic. Many times she bottoms out at 2 A.M. and her blood sugar range is usually < 10 to around 35. During the day, she goes off campus for work and is not monitored as closely as she would be on campus by the staff who normally work with her. The other problem we have had with her is that she becomes very hyperglycemic on the days she bottoms out with a range of 400-500. We are trying to implement a updated procedure and policy and I need your help. Since we are in a remote area and do not have any University Hospitals or centers for diabetes, it's difficult to update with the lack of resources available to us. Would you happen to have a standard procedure or protocol to follow with the latest updated innovations? If you could, I would appreciate it greatly.


It sounds like you have a real challenge to provide safe diabetes coverage for this woman, while allowing her to be as independent and productive as she can be. My hat is off to you.

Without knowing all of the circumstances of this person, I am wondering if she needs some adjustments in her insulin management. Consultation with her primary care provider would be a good idea to see if the roller coaster of highs and lows can be evened out. You don’t say how often these nighttime lows are taking place or what kind of insulin regimen she is on, but some changes in her management might be helpful.

I am also wondering if the lows are being overtreated, which is easy to do. Generally an insulin reaction can be successfully treated with 15-30 gm of carbohydrate (a rapidly absorbed source such as juice or soda), followed by testing in 15 to 30 minutes to determine the blood glucose level. This is appropriate if the person is conscious and able to cooperate. If it is more than 30 minutes until a meal, then a snack of carb/protein (such as cheese or peanut butter & crackers or a half of a sandwich) may be indicated.

Last but certainly not least, education is key to this process. It is important that the people in this woman’s world (work, home, friends) are educated in recognizing her symptoms and treating a low blood sugar. Since you are rural and don’t have a diabetes center near you, check for diabetes educators in your state who might be willing to work with you by phone or e-mail. I hope this helps you and gives you some ideas to work with this woman.