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Rebound Hyperglycemia

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This thread is now closed. Please contact Anna DUK, Ieva DUK or everydayupsanddowns if you would like it re-opened.
Sprogladite

Sprogladite

Well-Known Member
Relationship to Diabetes
Type 1
I have recently been struggling in the heat with hypos either at the end of the day or first thing in the morning. I particularly struggle with the ones that happen in the evening as I have been forbidden by the DSN to go to bed on anything lower than an 8, which means quite often I am having to stay awake until 1am while treating these. For these hypos, it can take over two hours for my BGs to start to rise. However, when they do eventually rise, they then don't stop (presumably because I've been eating every 15 mins when my BG hasn't moved again) until I am very high. I had a LO hypo this morning, which has taken an hour and a half to come out of and now watching my sugars going up and up (currently 14.4 and rising). Is there any way to prevent this happening? Should I quit with the eating every 15 mins while low? What's the best way to deal with this?

All comments and advice welcome 🙂
 
BG now up to 17.0 :(
 
Oh heck. Look I know telling you not to got to sleep on any lower than 8 is good advise, but you really need to be given proper professional help.
You shouldn't have to but I'm afraid you need to keep on at them.
Hopefully others with more experience than me will be along soon.
 
Yes I am waiting for the DSN to call me back currently, problem is they don't always call you back! Down to 14.5 and have done lunch time injection + correction so hopefully that will sort me out, but I'd rather not go high again tonight if I can help it!
 
Are you using a Libre? It is not good at picking up rapid upward changes after a hypo. You need to find what picks up your BG most quickly - use Dextro Tabs. You will learn fairly quickly what amount of tabs bring you out of the hypo if you monitor it with fingerprick testing. I try not to eat food to correct a hypo, it's unpredictable, and you are always likely to overshoot.

Once you've learned how much glucose brings you out of the hypo, always use that amount, and don't be tempted to eat every 15 minutes to bring the BG up. It will be coming up with the glucose if you test. 15 minutes is the approximate time the Libre is behind a fingerprick.

As an example, I woke with 3.2 at around 5 this morning. I just took four Dextro tabs, and went back to sleep. No further checking. Woke at 7.30 with 6.2.
 
mikeyB said:
Are you using a Libre? It is not good at picking up rapid upward changes after a hypo. You need to find what picks up your BG most quickly - use Dextro Tabs. You will learn fairly quickly what amount of tabs bring you out of the hypo if you monitor it with fingerprick testing. I try not to eat food to correct a hypo, it's unpredictable, and you are always likely to overshoot.

Once you've learned how much glucose brings you out of the hypo, always use that amount, and don't be tempted to eat every 15 minutes to bring the BG up. It will be coming up with the glucose if you test. 15 minutes is the approximate time the Libre is behind a fingerprick.

As an example, I woke with 3.2 at around 5 this morning. I just took four Dextro tabs, and went back to sleep. No further checking. Woke at 7.30 with 6.2.
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I do use a Libre but I only use the finger pricker thingy when I'm having a hypo as I'm aware of the Libre's lag. I tend to treat hypos with fruit pastilles or coke - yesterday was fruit pastilles hence the term 'eating', I'm not scarfing down sandwiches or anything lol. However the one I had this morning I was going down, I started off at 3.9 and went all the way down to LO over an hour despite drinking my standard amount of coke (switched from lucozade so still learning what amount does it for me), I think because I walked to work in fairly high heat and had done a correction injection having woken on 17.0 - suspect the heat made me more sensitive to that and combined with heat and walking just did me in. I stopped with the coke as soon as my BGs started rising again. It was the fact I appeared to be dropping at an alarming rate that had me swigging a little bit more every 15 mins!
 
Sprogladite said:
I do use a Libre but I only use the finger pricker thingy when I'm having a hypo as I'm aware of the Libre's lag. I tend to treat hypos with fruit pastilles or coke - yesterday was fruit pastilles hence the term 'eating', I'm not scarfing down sandwiches or anything lol. However the one I had this morning I was going down, I started off at 3.9 and went all the way down to LO over an hour despite drinking my standard amount of coke (switched from lucozade so still learning what amount does it for me), I think because I walked to work in fairly high heat and had done a correction injection having woken on 17.0 - suspect the heat made me more sensitive to that and combined with heat and walking just did me in. I stopped with the coke as soon as my BGs started rising again. It was the fact I appeared to be dropping at an alarming rate that had me swigging a little bit more every 15 mins!
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Hi, is your basal insulin set correct? with all those hypos and difficulties getting it back up, could be too much basal?
 
Amity Island said:
Hi, is your basal insulin set correct? with all those hypos and difficulties getting it back up, could be too much basal?
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No it isn't, I've been on an ongoing quest to get my basal switched since February. It was finally switched from lantus to toujeo a few weeks ago and it has been better than lantus but still not good enough! Waiting to hear back from the dsn currently about what she recommends going forward 🙂
 
What about the amount of basal. Is there a chance that your dose may be too high?
 
khskel said:
What about the amount of basal. Is there a chance that your dose may be too high?
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I don't think so. I started off on 28, and have reduced down several times - now on 20 units and it seems the more I'm reducing the more problems I'm having. The dsn never called me back today so I'll have to wait to try again on Monday :(
 
Sprogladite said:
No it isn't, I've been on an ongoing quest to get my basal switched since February. It was finally switched from lantus to toujeo a few weeks ago and it has been better than lantus but still not good enough! Waiting to hear back from the dsn currently about what she recommends going forward 🙂
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Sorry to hear about that, I hope you get sorted quickly, must be a worry....I had probs with Lantus, now trying Tresiba, too early to say yet how it's working.
 
Chin up hun! I'll come down and insist they Tresiba test you! :D I can be quite persuasive! 😉 xxx
 
Amity Island said:
Sorry to hear about that, I hope you get sorted quickly, must be a worry....I had probs with Lantus, now trying Tresiba, too early to say yet how it's working.
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Thank you! Update - spoke to the DSN yesterday and have been switched to humulin i - first dose tonight and another one tomorrow morning. Hoping the split doses will give more flexibility. Fingers crossed! Hope this one works coz I'm flying out to America in 8 days and I don't want the whole trip to be spent worrying about the diabetes!!
 
Humulin I is an older insulin and you might find it peakier than Lantus/Toujeo.

Whichever basal you are on I would thoroughly recommend a series of fasting basal tests to help you work out the correct dose/splits. There's a link in the 'newbies' thread.
 
everydayupsanddowns said:
Humulin I is an older insulin and you might find it peakier than Lantus/Toujeo.

Whichever basal you are on I would thoroughly recommend a series of fasting basal tests to help you work out the correct dose/splits. There's a link in the 'newbies' thread.
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Hi @everydayupsanddowns, thanks for your comment. I have done more than my fair share of fasting basal tests this year so definitely familiar with the process lol. On both Lantus and Toujeo, my BGs would keep going down and down until I was in hypo territory - I never actually found a dose low enough for either of them that didn't result in night time hypos. I'm aware there are peaks with humulin i so I will keep an eye on that. I strongly suspect I will need a lower dose in the evening than in the morning, but it will be interesting to observe!
 
Hopefully the ability totals split dose will help. Lots of options for timings/splits. 12ish hours apart is common, but you may find different timings suit you.

Hopefully you can get it so that you are staying roughly level. TBH I've never needed as much as 20u for basal. My Total Daily Dose is not much above 28u at some points in the year, so in your shoes I'd just keep testing and reducing to try to get a level-ish line.
 
everydayupsanddowns said:
Hopefully the ability totals split dose will help. Lots of options for timings/splits. 12ish hours apart is common, but you may find different timings suit you.

Hopefully you can get it so that you are staying roughly level. TBH I've never needed as much as 20u for basal. My Total Daily Dose is not much above 28u at some points in the year, so in your shoes I'd just keep testing and reducing to try to get a level-ish line.
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Yes I'm starting with 12 hours and will adjust as necessary. The timing isn't ideal as I'm going to be away from the advice of the DSNs for two weeks while I'm away but hopefully it won't be too much of a big deal. I have alarms set to remind me to do the basal injections - paranoid I'm going to forget them lol. My TDD used to be as high as 70 but recently, with the basal dose reductions and the move from fixed doses to carb counting (started carb counting in March) this has gone down significantly. It was the carb counting that tipped me off my basal was wrong. At the moment with the most recent reductions my TDD is at around 38!

EDIT: should add, basal has been reduced again to 16, so splitting equally for now with 8u in evening and 8u in morning!
 
Lucy Honeychurch said:
Hope this works for you and have a great trip 🙂
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Thank you @Lucy Honeychurch, 5 days to go and counting! Lol.

Today is the first day I've been relatively stable, I think the Toujeo took a couple of days to get out of my system properly coz I had quite a few hypos over the weekend. No hypos yet today though and have been between 10 - 12 all day, with hardly any post prandial spike to show, which just confirms for me that my carb counting ratios are ok. Will see how it goes overnight and potentially start thinking about tinkering with dosages to bring me down in the day a little more. Hopefully only minor changes needed - but just realised I need new travel letters (again! Lol) because my old one says Toujeo on it! Will have to call the DSN tomorrow and see if she can do me a new one, otherwise I'll have to get one from the GP and pay for it. If they can even do it in time, they aren't what you would call 'efficient' LOL. Oh the joys 🙄
 
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