Blood sugar control after Hyp

[Broomey]

Interesting to hear how effectively, people treat hypos without BG going sky high post-episode. I’ve been T1 since 1981 and when I’m good, I’ll treat low BG (<4) with small carton of fruit juice. Sometimes this is enough to keep BG below 10 the following day but sometimes I seem to bounce back to mid-high teens. I’ve grown to understand that controlling T1 diabetes is never an exact science and that 1+1 can sometimes = 15! Any thoughts comments or observations would be welcome please.

 

[Paulbreen]

Hi Broomey and welcome, I used to suffer with the bounce back a lot in my younger days. Now I will eat something like 1 or 2 jelly baby’s if I’m around 4.5 and dropping quickly and just ride it out, 3.8 is my hypo level and most of the time everything comes right without a major hypo event. It sounds Theke the carton of juice is too much glucose for the event, maybe try a half of one. You could also try glucose tablets they have 5 or 10 grams of carbs so you can calculate what gets you right again.
Please tell us more about your diabetic story like what insulin regimen you are on a1c number, stuff like that, you’ll get more useful feedback from the other members from the more info you give them

 

[Broomey]

Thanks Paul. Will update my profile. Levemir, Fiasp and Libre Sensor with a current Hba1C of 7.4. I tend to have the bounce back when I drop too low - ironically 3.8 is about my hypo level as well. The Libre helps as when I’m in the 4s I will have something to eat but it’s so frustrating that when you’re dropping low there is sometimes nothing you can do to stop the inevitable bounce back (sounds like a Government COVID loan scheme!). I’m proud to be in ‘good” health some 39 years on and it’s a condition which you never feel able to completely crack.

 

[Pumper_Sue]

Thanks Paul. Will update my profile. Levemir, Fiasp and Libre Sensor with a current Hba1C of 7.4. I tend to have the bounce back when I drop too low - ironically 3.8 is about my hypo level as well. The Libre helps as when I’m in the 4s I will have something to eat but it’s so frustrating that when you’re dropping low there is sometimes nothing you can do to stop the inevitable bounce back (sounds like a Government COVID loan scheme!). I’m proud to be in ‘good” health some 39 years on and it’s a condition which you never feel able to completely crack.

Have you tried treating a low at 5 on your libre? As you know the libre is at least 15 mins behind a finger stick so perhaps try a couple of JB's at 5 and see if that helps. You also might find it's the Fiasp causing the problems with the dump as I've noticed before I can drop to 4 and sit there for ages before it creeps up again with no help, but if I treat that 4 then I will end up higher than I want to be.

 

[Broomey]

Thanks Sue. 55 years! That’s fantastic. Still got someway to go to catch up with you.

 

[rebrascora]

The only time I have bounce back is if I don't treat it straight away. If I am mid 3s or above I will just have one or two jelly babies or a couple of dried apricots or prunes. If I am lower then I will have 3 jelly babies and lower than 3 I use 3xGlucose Tablets. I rarely go above 8. But I follow a low carb way of eating so hypos are usually just minor events where I have done more exercise than my Basal dose had catered for or mistimed my breakfast a bit.
The odd bounce back I have experienced are when I went to bed after exercise with no evening Levemir and levels dropped below 3.9 not long before my alarm was due to go off and I decided not to treat it because there was no appreciable active insulin in my system but after an hour my liver decided it needed to step in because I hadn't dealt with it. I had a rotten hypo hangover that morning!

 

[Broomey]

Thanks Barbara. All of this is really insightful and just goes to show how different our bodies are and how, despite having the commonality of this really frustrating condition, we all have different approaches and ways of dealing with the challenges which come our way. It can be such an unforgiving condition.

 

[rebrascora]

My digestive system is very fast with carbs of any sort so I can be pretty confident that whatever I take, if it isn't enough and I need to take some more, it will work in plenty of time.... but again that is because with using just small boluses I can never be more than 1 unit wrong so my hypo treatments reflect that both in a more relaxed approach and staged treatment phases for them.
Sometimes I will feel it at 4.2 and head one off, sometimes I can get down to 3.5, particularly if I am sedentary and focusing on something.... and then there are the occasions when you feel it, but you are busy doing something and "just want to get this finished and then I will deal with it" moments when you know you are probably pushing your luck a bit. Having the Libre and those "I'll deal with it when I'm finished this" hypos making a mess of your stats discourages you from letting them happen... or so I find... particularly if my TIR stats are really good and I want to keep them that way.... I sometimes see it more like a video game and if I have a really good score I don't want to jeopardize it!

 

[helli]

@Broomey have you experimented to see what impact a Caron on fruit juice will have on your blood sugars?
When you are stable (and not hypo), with no bolus on board, try drinking a carton of juice without insulin and watch your blood sugars rise.
I just wonder if you are over treating your hypo.
I use GlucoTabs and have learnt I tablet raises my blood sugars by 1 mol/l so dose according to how low my hypo is rather than the usual recommended 15g fast acting and 15g slow acting carbs.

 

[Paulbreen]

Thanks Paul. Will update my profile. Levemir, Fiasp and Libre Sensor with a current Hba1C of 7.4. I tend to have the bounce back when I drop too low - ironically 3.8 is about my hypo level as well. The Libre helps as when I’m in the 4s I will have something to eat but it’s so frustrating that when you’re dropping low there is sometimes nothing you can do to stop the inevitable bounce back (sounds like a Government COVID loan scheme!). I’m proud to be in ‘good” health some 39 years on and it’s a condition which you never feel able to completely crack.

I’m the same, I have 40+ years of it and it’s changing all the time, I’m pumping now and sort of have it sorted but I still get curved ball now and then. Have you heard go the Maio Maio, it’s a transmitter you put next to libre and it connects to an app on your phone so instead of you scanning the libre with your reader the phone will ping you when your BG starts to fall so you catch the hypo long before it happens, google it, it may help you.
Fiasp might also be an issue, some people find it’s like cracking walnuts with a sledgehammer

 

[SB2015]

Welcome to the forum @Broomey

Hypo treatment is very varied as you have already seen. I prefer to use JBs as I am able to control the amount I use, whereas a juice carton once open is more of a problem, so the temptation is to go for the lot. I pick up hypos at around 4.2 BG, and depending on the arrows on my Libre I will treat it at 5 with a straight downward arrow, or at 4.5 with a gentle down. I do find that in general the Libre helps me to head off the more severe hypos. However if out for a day of walking I do get caught out if I forget to check.

If I go below 3 then I do find juice is good at home, or three JBs when out and about. Above a BG if 3 I tend to reduce the amounts of JBs accordingly. The hardest bit I find is having to wait. I now set an alarm for 15 min, otherwise there is a temptation to overtreat the hypo.

 

[nonethewiser]

Interesting to hear how effectively, people treat hypos without BG going sky high post-episode. I’ve been T1 since 1981 and when I’m good, I’ll treat low BG (<4) with small carton of fruit juice. Sometimes this is enough to keep BG below 10 the following day but sometimes I seem to bounce back to mid-high teens. I’ve grown to understand that controlling T1 diabetes is never an exact science and that 1+1 can sometimes = 15! Any thoughts comments or observations would be welcome please.

Biggest factor for me is how much bolus is still in circulation, it determines how many tabs I take or to eat follow up starchy carbs.

So might be couple tabs for hypo 4 hours or so after meal, then again 3 tabs oat bar/slice of toast within 2 hours of meal, all depends.

 

[Lucyr]

If a whole carton makes you go high, have you tried say half a carton for milder hypos/when in low 4s to head it off early?

 

[Broomey]

I’m the same, I have 40+ years of it and it’s changing all the time, I’m pumping now and sort of have it sorted but I still get curved ball now and then. Have you heard go the Maio Maio, it’s a transmitter you put next to libre and it connects to an app on your phone so instead of you scanning the libre with your reader the phone will ping you when your BG starts to fall so you catch the hypo long before it happens, google it, it may help you.
Fiasp might also be an issue, some people find it’s like cracking walnuts with a sledgehammer

Paul
Thanks for this. I’ve been researching the maio maio which looks interesting, it also led me to the latest update on Libre Sensor 2 - see attached link, which suggests we should be talking to our consultants from January to request an upgrade. https://diabetestimes.co.uk/freestyle-libre-2-system-gets-nhs-drug-tariff-approval/

 

[Paulbreen]

Hi mate I have had the libre 2 for over a year, I live in Germany so things are a little different here about getting the latest equipment, there is not much difference from the libre 1 and the libre 2, the libre 3 is out here and that would to be the one to go for, google that one. I sort of left the libre in 2019 to start using a pump with a CGM loop system which works pretty well, not an artificial Pancreas yet but getting closer

 

[trophywench]

I'm picking up my replacement new pump on January 7th so hoping they'll be ready to swap me over to Libre 2 there and then! (However - who knows! Just live in hope, eh!)

 

[rebrascora]

Have to say, I'm not bothered about Libre 2. I used to worry about night time hypos but I've had quite a few recently and all easily dealt with, so that fear has dissipated and I no longer feel the need for alarms and as with any alarm there is a % of erroneous activations so not sure there is much to gain for me.
The Libre 3 being smaller might interest me as, since my weight loss and my arms becoming smaller but more muscular I find the Libre starts lifting at the edges during the second week and can become dislodged more easily, especially as I do a lot of physical work with my arms.
I am just so thankful though to have the Libre on prescription because it is an amazing bit of kit. The only thing I hate is all the associated plastic waste and that would be the big thing which would discourage me from having a pump... although my control is now back up to being 93% in target with MDI, so can't really see much benefit in a pump when I have got things back on track again.

 

[mikeyB]

I used to overshoot a lot early in my diabetes career, but I've long since learned how many jelly babies will move my BG up. So if I wake on a LO notice from the Libre (lees than 2.2, i first check its not an acute drop on the trace from lying on the sensor - it's fairly easy to spot those, then take 4 JBs and go back to sleep, knowing that it will take me up to around 6.0. The problem generally is that the feeling of being hypo is like the Libre - it takes time to fade.

 

[Paulbreen]

I'm picking up my replacement new pump on January 7th so hoping they'll be ready to swap me over to Libre 2 there and then! (However - who knows! Just live in hope, eh!)

Hi Barbara The 2 has alarms but you still have to physically scan it to get them, the 3 transmits to your phone every 5 mins so you get alarms when they happen not an hour later when you scan, I really can’t understand the reason for the 2 because it’s no better than the 1 because you still have to get your scanner or phone out and scan it the same way as you do with the 1
The 3 will change your world because it’s active and not passive

 

[Paulbreen]

Hi Barbara The 2 has alarms but you still have to physically scan it to get them, the 3 transmits to your phone every 5 mins so you get alarms when they happen not an hour later when you scan, I really can’t understand the reason for the 2 because it’s no better than the 1 because you still have to get your scanner or phone out and scan it the same way as you do with the 1
The 3 will change your world because it’s active and not passive

Haha I’m sorry I sent that to the wrong lady but I think it’s applicable to both of you anyway I was trying to say
The functionality of the 2 is not a big step over the 1 but the 3 is a giant leap in comparison to the 1 & 2