First (near) hypo

[MollyBolt]

As some of you know, I was recently diagnosed with T1 and also managed to catch a chest infection whilst I was in hospital with DKA. My blood sugar numbers have been swinging fairly significantly recently and the diabetes team told me on Friday that I should anticipate feeling like I was having a hypo above 4 (given they’ve been so high). With my chest infection a bit better, I was just out on a gentle walk along a canal (far less strenuous than I used to do, not least for being entirely flat) and then noticed I felt quite hot and a bit light headed. I tested myself and was at 4.6, which is the lowest I’ve been since being diagnosed. Given this, I took 3 jelly babies and my blood sugar went up. But because I was in the middle of nowhere I couldn’t think what to do after other than continue on with the walk, albeit feeling a bit grim. I have four questions:

1. It seems weird that a gentle walk would be sufficient exercise to push my blood sugar down (it was 6.7 immediately before the walk). Could it be related to the fact that it’s quite hot and humid (though not that bad - I’m in the south of England)? Or should I expect even gentle exercise to have this effect?
2. Should I do something different before a walk the next time? Have a snack? Take less insulin?
3. Should I also be carrying something other than jelly babies with me? I was musing on biscuits or a Graze flapjack.
4. Is it normal to feel a bit crappy afterwards?

 

[Thebearcametoo]

Everyone reacts differently to the heat with some diabetics going low and some going high so over time you’ll get to know which way you go.

Exercise can be difficult to predict as something like walking seems gentle but you’re using your big muscles and the way glucose gets into the cells is either by insulin opening the door with a key or muscles forcing it through the cell barriers so many diabetics find that even gentle exercise using big muscles can bring them low (whereas high intensity exercise can actually make them high at the time).

WRT how to prepare for a walk or other exercise. If you notice a pattern of going low then if you’re eating within about an hour of activity you can reduce your bolus (most fast acting insulin peaks at about an hour). Otherwise you could have a 15g slow carb snack before you exercise or have some juice or glucose rich drink to have whilst doing it. Having things like bananas to snack as you go. So slower carbs before or faster carbs whilst doing it.

For treatments. Rest whilst treating a hypo (or near hypo). If you’re still feeling hypo even when coming up keep resting until you feel well. Once you’re coming up again have a slow carb snack if you have it with you or if not you can have some more fast carbs just to keep you higher until you’re somewhere safe. The lotus biscuits snack packs are great as they’re small and self contained. Things like Nakd bars or other fruit and nut bars are also easy to carry around.


Right now you’re still in the gathering data phase so don’t try to overthink it too much.

 

[everydayupsanddowns]

Sorry to hear about your near-hypo symptoms @MollyBolt

Some sound suggestions from @rebrascora already, but here are my observations / experiences over the years

1. It seems weird that a gentle walk would be sufficient exercise to push my blood sugar down (it was 6.7 immediately before the walk). Could it be related to the fact that it’s quite hot and humid (though not that bad - I’m in the south of England)? Or should I expect even gentle exercise to have this effect?

It certainly can do for me. Especially in warmer weather (warmer temperatures can increase blood flow and make you more sensitive to insulin. Often I’m surprised how much prep / precautionary carbs I can need for even quite modest walks. It also can have a big impact when my last meal was and how much ‘insulin on board’ is still acting. Meal insulins can continue to act for approx 5 hours after injecting, tailing off after 2hrs-ish - but activity can give those ‘dregs’ a real second wind.

2. Should I do something different before a walk the next time? Have a snack? Take less insulin?

Certainly worth considering if you begin to spot a pattern emerging. Eg if you walk to work, and go low during that walk, you might artificially reduce your breakfast ratio on work days. Or have some additional fast carbs en-route.

3. Should I also be carrying something other than jelly babies with me? I was musing on biscuits or a Graze flapjack.

Some find this helps. I’ve never been much of a follow-upper. I just retreat if I start to dip again.

4. Is it normal to feel a bit crappy afterwards?

Unfortunately yes.

Hypo warning symptoms are the result of a big splurge of hormones, and a ‘hypo hangover’ can be the price paid.

But

The body and brain tries to learn from these events. To change and adapt to ‘do better’ next time. So you may find that the full-on reaction more likely to give rise to feelings of grim-ness start to get reserved only for nastier lows, and you’ll just get some lighter gnawing symptoms in the low 4s or high 3s.

Don’t be deceived though. You need to treat those milder symptoms urgently, and not expose yourself to those levels too often - or else your body will ‘reset’ the glucose thermostat to a lower level again. Which is how impaired awareness of hypoglycaemia can gradually emerge.

 

[Inka]

I take Dextro glucose tablets out with me @MollyBolt Depending on the length and difficulty of the walk, I also take a Lift Glucose Shot or 150ml can of proper sugar Coke. This is good for fierce drops. I then take extra carbs like flapjack, cereal bars, dried fruit, biscuits or whatever.

The drop from 6.7 to 4.6 sounds normal. If you do the same walk again, you could experiment with eating some top up glucose/carbs before; eating some glucose as you walk; or doing both. Later on as you learn more, you can also look at reducing your bolus for the meal before your walk.

Everything needs planning and thinking about with Type 1. You can’t do anything without thought (and yes, it’s extremely tedious). Always take hypo treatments and snacks with you and always take lots more than you think you’ll need. Even things like supermarket shopping or walking around the shops browsing can cause blood sugar to drop.

 

[SimonP]

If you start running low during low intensity exercise, then doing something harder (like a sprint or two) will cause your liver to release glucose. I know it sounds weird, but it is actually a recommended method to treat a low intensity exercise-induced hypo (see here: https://extod.org/ I'll dig out the right link if you can't find it.)

Obviously if you've been exercising lots before this low intensity exercise (e.g. the walk to the car after a marathon) then this won't work as you liver hasn't got anything else to give.

I also tend to go low when going for a gentle walk (especially school drop off), but a ride will keep me reasonably stable as it's more effort so more hepatic glucose being generated.

I'd eat a snack beforehand, a biscuit or an apple or something similar, especially if you have any IoB from a previous meal/snack.

 

[MollyBolt]

Thanks so much for the above. Really striking that everyday I find a new thing that’s a bit different / complicated about T1. I really appreciate you all helping me through it. Ironically I would have said before this that I was quite a planner and v organised - but T1 practicalities are quite a thing.

 

[SB2015]

Good morning @MollyBolt

T1 practicalities do indeed need to be taken account of, but your strengths in planning and organisation will be out to good use.

Like you I was surprised at how small amounts of exercise, or just walking into town (20 min) , or gardening would impact my glucose levels. It is all a case of trial and improvement, and spotting patterns in what we do. You are already thinking along those lines and spotting possible causes and changes that you can make.

There are lots of factors that we need to take account of and I do find that weather impacts mmy absorption of insulin. On a warmer day I find some extra glucose is needed for a walk. We take Wurthers Origninals with us and use them to drip feed, without any extra insulin for them. Other times I find I need a slower release snack before I set off. An excuse for a coffee and cake! (Perhaps with half the normal dose of insulin) lots of variables and an excellent source of brain gym for each of us.

 

[JJay]

Towpath walking is my most frequent exercise as we live very close to the Grand Union and having a dodgy knee means I can’t do much more than gentle! Yes, the heat can have quite an effect on BG and I’ve been surprised how quickly it can drop even from a post-lunch 9 or 10.

Being so close I’ve often had to fight the urge to head straight for home when experiencing a hypo, but instead I make myself stop, take my JBs or similar, and wait for 15 minutes before moving on or back. Can’t usually find a seat but at least the scenery is great! I also carry a couple of Kind bars and have one as a follow up.

 

[Proud to be erratic]

This is a terrific question @@MollyBolt and has generated some terrific answers.

Several expressing similar responses but in different ways (I hope that doesn't read as nonsense!). But @JJay your point about fighting the urge to head for home and instead making yourself stop, treat, wait 15 mins before moving on or back is very real for me. I've done both and while I did get home, the resultant hypo was deeper, stronger and consequently worse than it might have been if I'd done the sensible thing AND that consequence ended up taking more of my time and used more of my valuable (& increasingly scarce) brain power in then regaining that (mythical) control.

In my opinion this thread should be pinned somewhere prominent. It is so pertinent to those of us vulnerable to going hypo.