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Type 1s on mdi who use a pen - how do you treat a hypo which is just before a meal?

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mum2westiesGill

mum2westiesGill

Well-Known Member
Relationship to Diabetes
Type 1
Type 1s on mdi who use a pen

how do you treat a hypo which is just before a meal?

when would you inject for the meal?

Am I correct that you would inject for only the carbs in the meal?
 
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I use a syringe not a pen, but it works the same way. Yes I inject after the meal allowing a little time for the BG to start to go up.

No I do NOT inject for the carbs in the meal. I use the correction factor that I use to reduce a high BG to reduce the amount of insulin that I use. I use the insulin calculated for the carbs less a correction. This way BG should get back to the desired value.
 
I think Gill possibly means, do you include the carbs you used to treat the hypo when you jab for the meal. The answer to that is no - you ignore those carbs entirely right now. It's the same using a pump too, cos you still have to calculate the carbs in the meal and bolus for them. But I agree with Leon and would on that occasion not worry about bolusing before eating - eat now, make 100% certain how many carbs I ate (might not fancy eating all of it having just consumed hypo treatment carbs) - and then jab after I ate it.
 
Well "just before a meal" I would not use any hypo treatment at all. The meal would treat the hypo, that is why the insulin dose should be reduced. I might, if very low, change the meal slightly to include some quick acting carbs early in the proceedings. I would count these as part of the meal for insulin calculation.

It does not seem right to me to treat to raise BG then take insulin to bring it down because you have eaten food which will bring it up.

The method I describe was recommended by UCH London on their web site.

I would stress that one should NEVER inject quick acting insulin when hypo
 
My approach of a pump is just the same as it was on MDI.

Treat the hypo as normal - take 15g or fast acting carbs with NO insulin to cover these). The purpose of these carbs is to raise my BG, so I don’t need insulin to balance them.

Inject for the carbs in the meal. I need insulin to balance these carbs so that my BG doesn't go too high. Rather than follow-up carbs to treat the hypo I might tell the bolus adviser that I am eating 10g fewer carbs than I actually am, so that I get a slightly smaller dose.

I certainly wouldn’t prebolus for the meal, and may even decide to inject after eating (to give the food a bit of a head start), depending on what I thought had caused the hypo.

I find it helpful to think about the purpose of any carbs or insulin I am considering in order to decide whether the carbs I am eating need insulin. eg

  • My BG is too low / hypo - take carbs with no insulin
  • My BG is a little low - take carbs with less insulin than normal
  • My BG is in a good range - if I eat carbs I need to balance them with insulin
  • My BG is too high - I need extra insulin on top of the insulin that is balancing any carbs I might be eating (a correction dose)
Try separating out the correction carbs, correction insulin, and meal insulin+carbs in your mind

correction carbs - to raise BG, no insulin needed
meal carbs - aiming to balance BG, carbs and insulin need to match
correction insulin - to lower BG, no carbs eaten for this

🙂
 
everydayupsanddowns said:
My approach of a pump is just the same as it was on MDI.

Treat the hypo as normal - take 15g or fast acting carbs with NO insulin to cover these). The purpose of these carbs is to raise my BG, so I don’t need insulin to balance them.

Inject for the carbs in the meal. I need insulin to balance these carbs so that my BG doesn't go too high. Rather than follow-up carbs to treat the hypo I might tell the bolus adviser that I am eating 10g fewer carbs than I actually am, so that I get a slightly smaller dose.

I certainly wouldn’t prebolus for the meal, and may even decide to inject after eating (to give the food a bit of a head start), depending on what I thought had caused the hypo.

I find it helpful to think about the purpose of any carbs or insulin I am considering in order to decide whether the carbs I am eating need insulin. eg

  • My BG is too low / hypo - take carbs with no insulin
  • My BG is a little low - take carbs with less insulin than normal
  • My BG is in a good range - if I eat carbs I need to balance them with insulin
  • My BG is too high - I need extra insulin on top of the insulin that is balancing any carbs I might be eating (a correction dose)
Try separating out the correction carbs, correction insulin, and meal insulin+carbs in your mind

correction carbs - to raise BG, no insulin needed
meal carbs - aiming to balance BG, carbs and insulin need to match
correction insulin - to lower BG, no carbs eaten for this

🙂
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Thank you so much for this 🙂
 
I have been reading this thread with interest, I know what I’d do on a pump but that doesn’t help when you don’t use a pump lol
but @everydayupsanddowns is right, you can apply the same theory!

When my daughter was younger she had quite a lot of hypos and it occurred to me that if we were about to eat it seems daft her sitting there eating sweets and then waiting 15 minutes while her dinner is going cold and then hitting her with more insulin, if there are carbs in the meal they can be used to treat the hypo. So I got that I’d just let her eat her dinner but tell the pump that she was eating 10g less and put the insulin on an extended bolus for an hour or so to give her blood sugar time to come up again. Assuming that there were enough carbs in the meal of course! Depending on how low she was I’d sometimes give her 3 jelly babies as well. On pens you could do a similar thing, you can’t do the extended bolus but you could inject after you’d eaten instead of before.
 
everydayupsanddowns said:
I certainly wouldn’t prebolus for the meal, and may even decide to inject after eating
Click to expand...
If you decide to inject after eating which is what I do if eating out or having a takeaway would you get your bolus advice from the last test you did ie before the meal which is what I have to do on MySugr because
"log entries may not be older than 15 minutes in order for the Bolus calculator to use them"
 
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mum2westiesGill said:
If you decide to inject after eating which is what I do if eating out or having a takeaway would you get your bolus advice from the last test you did ie before the meal which is what I have to do on MySugr because
"log entries may not be older than 15 minutes in order for the Bolus calculator to use them"
Click to expand...
If you’re eating after a hypo you don’t need to take correction insulin so your bg before the meal isn’t needed. Just bolus for the carbs.
 
Lucyr said:
If you’re eating after a hypo you don’t need to take correction insulin so your bg before the meal isn’t needed. Just bolus for the carbs.
Click to expand...
The bg from before the meal would already be on the MySugr App from when I would've tested to see if my bg is back to a normal level after the hypo.

To just bolus for the carbs would I just enter the carb amount in to MySugr app?
 
mum2westiesGill said:
The bg from before the meal would already be on the MySugr App from when I would've tested to see if my bg is back to a normal level after the hypo.

To just bolus for the carbs would I just enter the carb amount in to MySugr app?
Click to expand...
Yes
 
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This thread is now closed. Please contact Anna DUK, Ieva DUK or everydayupsanddowns if you would like it re-opened.
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