DSN email about my hypo and how to treat

[mum2westiesGill]

I emailed my DSN about my hypo last night 3.6 treated with 3x jbs - after 15 mins 3.3 treated with 3x more jbs - after 15 mins 3.6 treated with 3x more jbs after 15 mins 7.1 had a snack to stop me dropping

DSN reply


my reply


DSN reply


I always thought you should keep repeating the test every 15 mins until you reach a normal BG then if it's not a meal time have a snack to stop you dropping - am I correct with this info?

 

[Sally71]

Yes that is correct - 15g, wait 15mins, test again, keep repeating the cycle until you get a number within range, then on MDI I believe you should have a small snack of slower acting carbs to make sure you don’t drop again. Very annoying if you have to go several times round the cycle, but there isn’t anything else you can do - most hypos resolve after one dose of sugar, you don’t know until it happens which ones are going to be more persistent, so although it is tempting to eat extra sugar to speed things up that could easily send you too high. It is surprisingly easy to overtreat a hypo! And then rebounding between high and low is not very good for you at all!

Just put this one down to experience - sometimes they happen for no obvious reason. But if it starts happening every day then you might have to think about whether you need any insulin adjustments.

 

[Inka]

Yes, you should treat the hypo and then have some longer-lasting carbs if you’re not due to eat soon @mum2westiesGill Sometimes on a pump you don’t have to have the longer-lasting carb snack, but on injections I think it’s what’s advised.

 

[mum2westiesGill]

So if you don't mind me asking what do you think about what my DSN said? I'm thinking she's meaning I shouldn't have checked my BG 3 times before I had a snack to stop me dropping and I should consider having a snack after the first treatment?

 

[Sally71]

Oh I see, she thinks you should have had the snack after the first round of sugar. Don’t know about that I’m afraid, on a pump we don’t need the extra snack because the basal is more tightly controlled. I would have thought you should get back in range first though, hopefully some more people on MDI might be able to explain better! (We have been on a pump since 8 days after diagnosis so I don’t really remember the rules when using pens!)

 

[rebrascora]

To my mind Gill you followed the rules perfectly. You need fast acting carbs until you come up out of hypo, however many rounds of 15g and 15 min tests it takes to get above 4 and then the slower acting carbs to stabilise things after that, which is what you did and your morning reading is testament to the fact that you handled it perfectly, so I don't understand why the nurse would be criticizing what you did, unless she didn't read it properly. I assume your email to her was more to see if she could identify the reason for the hypo, not how you handled it, considering you did that by the book.
I would just ignore her comment.
With diabetes, hypos happen, even when we think we have done everything right. Pizza is also renowned for being tricky to bolus for and eating out even more so because you can only ever guestimate the carb content. Just put it down to experience and have a bit less insulin with it next time. My guess is that it was a thinner crust than whatever you used to estimate the carbs. Just as well you didn't bolus for it before the meal as you might have been in a worse pickle.

 

[everydayupsanddowns]

I always thought you should keep repeating the test every 15 mins until you reach a normal BG then if it's not a meal time have a snack to stop you dropping - am I correct with this info?

Yes.

I found it a little difficult to understand the reply, but I think @Sally71 is right - your DSN was possibly suggesting having the follow up snack earlier. I wonder if perhaps the ‘unrecovered’ hypo hadn’t quite been understood?

I have been told to avoid eating other things when treating a hypo so that the fast carbs don’t get mixed up with slower carbs and slowed down?

I think the recommended sequence is just as you did. 15min 15g fast carbs repeated until back above 4, then a follow-up snack if you usually need one.

 

[leonS]

Does this SDN speak English? I have no idea what she intends to say or what the advice it is that was given. Did she perhaps think that you had tested three times before taking any action?

You took exactly the right actions, and to prove this (I assume) just now you are OK.

 

[mum2westiesGill]

Did she perhaps think that you had tested three times before taking any action?

Thanks @leonS maybe she did think that - yes I tested three times
First test 3.6 - confirmed I was hypo - I took action and had 3x jbs and waited 15 minutes
Second test 3.3 - confirmed I was still hypo - I repeated the hypo action and 3x more jbs and waited again for 15 minutes
Third test 3.6 - still hypo - repeated hypo action and 3x more jbs and waited 15 minutes
Fourth test 7.1 - back to normal level so had snack to stop it dropping again

You took exactly the right actions,

Thank you!