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3K views 16 replies 7 participants last post by  justinervin85 
#1 ·
Most of the time I don't count how many grams of carbs is in my hypo treatment food, I just estimate usually (around 15 grams of fast acting carbs). My blood sugar goes up a little too high after this (usually around the 8-9 mmol/l range). Few questions...

1. Is the high reading after a hypo a sign that I could be over treating it? Usually the lows are not any lower than 3 mmol/l (sorry for using that unit, it's what we use in 'land down under' lol). Would I be better having 5-10 grams of fast acting carbs instead and see what happens?

Or

2. Could it be due to gluconeogenesis and my liver kicks in to raise my bsl? Does it take a LOT of excess protein for this to happen or can it happen if you just eat a tiny bit more protein then you should? I don't feel I eat a lot of protein, especially now when I rarely eat meat...

I would also like to hear how long after a hypo do you correct? I usually wait 2-3 hours after hypo to treat a high bsl. Is this correct method?
 
#2 ·
Other insulin users may have different views than mine, but I don't think you should treat a hypo with foods. The results tend to unpredictable and can lead to rollercoaster BG swings. For me the best option was glucose tablets. They're 4 or 5 grams of glucose each depending on the brand. I would take one tablet then wait 15 minutes and test BG. If it was stable (not going any lower) I'd wait another 15 minutes an test again. If I was still dropping though I'd take another tablet and wait the 15 minutes an test. This minimizes the chance of over correction and wild swings.

The only times I corrected hypos with actual food was when I used the wrong insulin or wrong correction factor. Those times I needed LOTS of carbs, quick!
 
#3 ·
As David says, food is too blunt an instrument for hypo management and glucose tablets much wiser.

Jenny Ruhl's website has this section - How to Treat Mild Hypos which describes a scientific approach including a table showing just how little glucose you need for a given body weight to bring your numbers up to sanity.

It is a counsel of perfection but, if you can get close to it, it gets the risk of roller coasting down quite substantially.
 
#4 · (Edited)
Thankyou, been really helpful. I am aware that glucose tends to work the most rapid at raising blood sugars. Due to gaining weight from hypos, I got into a strange mindset about it thinking "well if I'm going to go low I may as well make the extra I'm eating nutritious"..lol...
Like today I used hilo milk to treat it (thinking it being a liquid, it wouldn't take too much longer than glucose to absorb) - also since I had just woke up and hadn't eaten. Also since I am very sensitive to carbs in the morning. And because it wasn't a severe hypo (3.7 mmol). It actually worked in a fairly decent time- about 15-20 minutes. Probably due to all those factors I mentioned. But 250ml of milk raised it to 9.1 mmol/l. But you are both right, glucose tablets would be a much safer and more predictable bet.

Thanks for that link too John, have a few links from you bookmarked to read tonight. :D
 
#5 ·
A few things happen when you go low.

You experience an adrenaline response (the severity of which correlates with the severity of the low)

Cortisol is released (the amount of which correlates with the adrenaline response).

Endorphin levels increase (to help you cope with the shock of the adrenaline response).

So what does this tell us?

1. Hypoglycemic levels are seen as a fatal state of emergency by the body (the brain runs off of circulating blood glucose and is unable to store glucose so this is a very bad situation for the brain).

2. Adrenaline is released to give us a hyper injection of energy to correct our emergency state. Though this is short lasted (shocks the body into conscious action).

3. Cortisol is released to stimulate gluconeogenesis. But it has a rather nasty side effect that lingers. The counteraction of insulin effectiveness. This effect is supposed to be a therapeutic response. It allows your body to recover a stable level of glucose within the blood. But to diabetes patients who (not surprisingly) could panic and over treat their hypo state this could pose a rather nasty problem.

Ask any doctor that knows their stuff. Insulin treatment after a hypoglycemic state (whether immediately or after a period of time post hypoglycemic episode) will effectively nullify or decrease the effectiveness substantially of insulin treatment.

My doctor told me that after a hypoglycemic episode do not attempt any correction dosages until the next day. Just take insulin for what you eat. The extra insulin and the period of which it lasts or when parts of it will activate is too risky according to my endocrinologist. It's best to eat your meals and add a little extra correction to the meals. The meals you eat send a response to the brain letting you know things are getting better and the cortisol levels begin to deteriorate allowing for the effectiveness of the insulin to return to its original state.

At least according to him, and my own research and experiences, this seems to be the case.
 
#7 · (Edited)
Thankyou for telling me this. I have never actually heard of this before. I knew that some hormones were released...but I was told that if my level was high 3 hours after the hypo, then I can correct it. Is it still bad to give half the correction dose of insulin if your level goes up very high (3 hours after) or would you recommend to just leave it completely?
I find highs so uncomfortable :( so I try my hardest now not to let it go anywhere above 10 mmol/L.. Any more than that and I am seriously thirsty and irritable and my body temp seems to go up.

I actually have had THREE lows today (all above 3 mmol/l though). Though I know the reasons why. And I tend to have many hypos over the slightest things. So I think what you say may actually be what is happening to me....the correcting gets you into a cycle of hypos...
 
#6 ·
In my own experience, the "15 grams of carb to treat a low" rule is bad news. Yes, you should know how much 1 gram of carb increases your blood sugar and use that knowledge to appropriately treat hypos. Overtreating can lead to a yoyo pattern (overtreat low- end up high - overtreat high - go low....).

After lots of testing I found that 1 gram of carb increases my blood sugar by 6 to 9 points. Even for a low of 2 (37) which I had the other night, a single 4-gram glucose tablet is usually sufficient to get me back to my target range of 3.9 (70) to 5.6 (100). For mild lows in the 60s I usually eat a strawberry or small piece of apple. I hate the yo-yoing more than I hate the lows.

Jen
 
#8 ·
Should I get some glucose powder and do some experimenting? I've actually never done that before (testing to see how high 1g carb increases my blood sugar)...

I no longer buy glucose tablets to treat lows. We were using them up so quick we just gave up on buying them and decided to just use sugar or juice or milk. That plus I wasn't all too keen on the taste and so thought it wouldn't make a hell of a lot of difference. But I can see that I may as well try to recover the low as quickly as possible...except not over treat of course...

I can definitely relate to the frustration of yoyo bsl :/
These days...well easier said then done for many I guess, especially in the panic state...but I just stop myself from over treating by telling myself that in the end the temporary discomfort is better than hours of discomfort of blood sugar going through the roof.

Now I just need to figure out how much glucose to treat a low.
I found that 250ml of milk (12.6g carbs) was far too much to treat the low this morning due to the insulin sensitivity issue then. But the other two times, I had half a cup and probably could of done with a little more. So...yeah...sometimes it also depends on the time and how much exercise has been done, and how much insulin is still active (if you are pumping, it sometimes shows an estimate of the insulin still active). I love the pump for that reason...gives me more reassurance that I have treated my low adequately.
 
#11 ·
I know nothing, but should the focus maybe more pointed to avoiding the hypo to begin with? I would think not totally avoidable but if happening often, something should be changed to lessen the frequency.
 
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#12 ·
There are a few things you should get down pretty accurately to avoid BG swings. First you should figure out how much 1g of carbs will raise your BG (as stated above). Then you should figure out your Insulin to Carb ration. This means you should know how many carbs 1 unit of insulin will cover. Then you should figure out your insulin correction sensitivity. This means you should know how much 1 unit of insulin will lower your BG. The last thing, but very important, is you should figure out your true basal insulin. Your basal insulin should keep you stable when not eating. This means if you have your basal correct, you could go all day without eating and your BG should be fairy stable. Once you get these ratios down, you will be able to avoid most BG swings. You will not be able to completely avoid some minor swings, as many things affect BG, like exercise, stress, infection, etc. But your swings will be much less and certainly less severe. Getting these ratios accurate is not the easiest thing but a couple books that can help are Dr Bernstein's Diabetes Solution and Gary Scheiner's Think Like a Pancreas.
 
#13 ·
What I do in the rare occasion that I go low is I drink 1 measured cup of orange juice and a package of peanut butter crackers.

Always does the trick.

Unless my bg went to like 18mg/dl. Then I just don't care I'll empty the fridge lol (if you've ever been that low you'd find that panic does overtake you like that)
 
#17 ·
What I did for this was take a pre meal blood glucose level then ingest 10g of carbohydrates.

I monitored my bg every 30 minutes until the spike discontinued

Then subtracted my final bg with my pre meal bg to find the difference.

Then I divided that difference by 10 (the amount of carbs ingested)

That ought to tell you how much 1g of carbohydrates affects your overall glucose level.

Basically the formula I used was this:

Final BG level - Pre Meal BG level = Carbohydrate Spike

Carbohydrate Spike / Ingested Carbohydrates = Carb Sensitivity

I find that ingesting 10g of carbohydrates isn't going to throw your body out of whack so much that it makes this test dangerous but everyone is different.
 
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