Hypo advice needed

[DancingStar]

Fortunately I don't get hypos very often. When I do get one I eat 5 jelly babies, wait 20 minutes, retest & then eat 5 more etc, retest etc until my glucose level is above 4. I feel awful when I'm having a hypo - today I couldn't get the test strip into the reader because I felt so light headed & shakey. It takes me a long time to recover from hypo & I generally feel very sleepy & need to sleep afterwards.

I need advice & opinions about how long it takes blood glucose to go up to a decent level. Today I started at 2.3 which went up to 2.7 with 5 jelly babies so I had a very small (100ml?) can of cola which took glucose to 3.2 after 15 minutes then 5 more jelly babies. The whole time I had that horrible light head, shaky feeling, and hypos really affect my thinking. I had a text message from my sister & couldn't make head or tail of it.

I retested my blood glucose two hours later and it was 19.8 (eeek).

My questions, after all my rambling are:
How quickly do you come out of a hypo after eating glucose? Is it normal for glucose level to go up quite slowly? Do you think I should wait longer after eating the jelly babies & testing? I panic a bit, I think, because it feels like I'm going to pass out.

Is it usual for glucose level to go high after hypo?
How can I come out of hypo without making subsequent blood glucose go so high?

Still waiting to be approved for Libre so it's all finger pricking for me atm.

 

[Lily123]

I think you may be over treating your hypos. We all are different and need what we need though so you never know.

Jelly babies are 21 carbs per 4 sweets. That works out at roughly 5 carbs a sweet. The 10 that you had would be around 50 carbs plus a small can of coke (150ml are the standard small) which is 16 carbs. That adds up to 66 carbs. I think that’s why you are getting the rebound high.

What were you doing before this hypo occured?

 

[Bruce Stephens]

My questions, after all my rambling are:
How quickly do you come out of a hypo after eating glucose?

It depends partly on what you mean by "out of a hypo". Almost always once I've eaten enough then after 15-30 minutes I'm technically not hypo, but it doesn't necessarily feel that way. If your BG goes very low it can be hours before you feel normal again. That's one of the many benefits of a CGM: we can catch an approaching low nice and early, before we feel anything at all.

As @Lily123 says, the highs are surely because you're over treating the lows.

 

[pawprint91]

I also agree about overtreating the lows- however, if I get a low after eating (usually related to the insulin I’ve had with food), I find that if I eat a hypo treatment such as jelly babies, I can be eating lots before I see an improvement, as you describe above. I find that unless I have an empty stomach (such as 4+hours after a meal, or the middle of the night), I need a fluid hypo treatment such as coke or juice to bring me back up fast. I presume this is because the solid sugar such as JBs just “sits” on top of the food already in my stomach - and is digested eventually (say half hour to an hour later) but would then also cause a rebound high for me. If I have coke or juice I guess it is absorbed around the food a lot quicker and I usually come up faster but without going so high. This might just be me and my digestive system, but thought I’d share!

 

[Bruce Stephens]

If I have coke or juice I guess it is absorbed around the food a lot quicker and I usually come up faster but without going so high.

Yes, drinking something at the same time can help even with JBs. Or so it feels, anyway. (And the lunchbox sized boxes of fruit juices are about the recommended size: 15-20g of carbs. They can be a bit fiddly to open and stick the straw into, so be aware of that if you sometimes get nastier hypos.)

 

[Thebearcametoo]

With my kid the first aim is to stop the drop so if after 15 minutes he’s stabilised and isn’t dropping further I am more cautious about treating so I may either wait another 5 minutes or give 5-10g carbs and then retest after 15 minutes. Some hypos take longer to resolve so as long as the BG is stable and not dropping further we try to be patient. If you’re on injections and not pump then having a slower carb snack of around 15g once you’re above 4 is a good idea.

With the example you’ve given from today I would have probably not done the 5 jelly babies at the end but waited another 10-15 minutes and retested and if necessary give a small amount of fast carbs then. It sounds like it was a rough hypo and it may be that the Coke (because it’s liquid) would have worked faster so it might be good to have that first if you can when you’re that low.

 

[Bloden]

I always rely on orange juice to get me out of a hypo quickly - and stop me from overtreating! JBs, glucose tablets, etc just take too long to bring me up again.

Having a Libre’ll let you know you’re going low, so that you can react before you’re fully hypo. My low alert is set to 4.8 so I avoid most hypos these days. I hope you get approval ASAP.

 

[Lucyr]

Why did you wait 2 hours before testing again after a 3.2 and with lower readings before that? Important to stick to the 15 rule when treating hypos. 15-20g carb, wait 15minutes before retesting. Repeat until bg above 4. Don’t stop testing with fingerprick readings until you’re above 4.

It sounds like you’re having more than 15g carbs at a time and not repeating the process until your levels are safe.

 

[everydayupsanddowns]

Sorry to hear you’ve been having some nasty lows that have taken a bit more to get back up out of.

I also find full-sugar drinks are quickest for me - though they are getting weaker and weaker and there are few which are actually ‘full sugar’ any more.

I tend to base my first hypo treatment on the level of the low, and whether I have got any ‘insulin on board’.

So a gentle nudge down to 3.7 doesn’t need the same level of treatment as a 2.7 with 2u IOB.

 

[rebrascora]

It might be useful to bear in mind that glucose will actually absorb through the mouth quicker than in the stomach, particularly as @pawprint91 mentioned, if it is a hypo after you have eaten a meal, so chewing the JBs well before you swallow or swishing the full sugar cola or juice around in your mouth should bring your levels up faster than swallowing quickly.
I also agree with @Thebearcametoo, that stopping to drop is the first thing to look for and take comfort from and go more cautiously with hypo treatments after that to try to avoid overtreating.
I rarely need more than 2 JBs, so eating 5 seems like a massive amount let alone 2x5 JBs plus some cola, so it really doesn't surprise me at all that your BG hit 19 afterwards. I can totally understand why you would panic though and it is really difficult to be restrained when your body is crying out for more. Gradually you become more confident that the treatment will work and how or which treatments work best for you and once you gain more confidence, you panic less and also your adrenaline response reduces, so it all becomes a lot easier to manage.

 

[Spathiphyllum]

I always rely on orange juice to get me out of a hypo quickly - and stop me from overtreating! JBs, glucose tablets, etc just take too long to bring me up again.

Having a Libre’ll let you know you’re going low, so that you can react before you’re fully hypo. My low alert is set to 4.8 so I avoid most hypos these days. I hope you get approval ASAP.

Yes, you definitely need a Libre (or other CGM) asap!

And agree with Bloden and Pawprint-- juice is the way to go. It is absorbed much more quickly than jelly babies or glucose tablets or anything similar. Also, I've read that fructose, as in juice, is particularly quickly converted to glucose. I use apple juice.

Also agree with Bruce about "the lunchbox sized boxes of fruit juices are about the recommended size" but "can be a bit fiddly to open and stick the straw into" if you're really hypo. I keep scissors in a particular drawer in my kitchen-- sewing scissors with bright orange handles, so easy to find even when hypo; just snip off a corner of the juice box and glug it!

For me, juice will take effect within about 15 minutes, and then I top up with something a tiny bit slower-- but not too slow-- to digest. I use corn thins, because they digest fairly quickly and each one is only 4g, so it's easy to calibrate and not overcorrect.

Once you have your Libre, it will be much, much easier! You can set the 'low glucose' alarm to somewhere in the 4s, so you can give yourself just a little top-up before you go hypo.

For a real-life example: I sing in a choir, and have a Libre. This evening, during rehearsal, I hit 4.3 with a downward arrow. Immediately had a small box of juice-- I keep a stash in rehearsal room-- 12g carbs. (Rest of the choir know I'm T1 so understand if I suddenly sit down and start slurping juice!) 15 minutes later, 4.4 and upward arrow; snarfed a corn thin immediately before service (stash of them in rehearsal room too), 4g carbs. 20 mins later, 5.8 with a level arrow, so I knew I was out of the woods; got through service fine.

So, basically: use hypo treatments that take effect fast; start with a small amount; test every 15-20 minutes; and top up with small amounts until you're in the clear. And fingers crossed you get your Libre soon!

 

[helli]

Bear in mind that Libre can take much longer to report a hypo recovery. Therefore, it is recommended to continue to test with finger pricks to detect when to stop treating.
The value in Libre is not in the hypo recovery but in stopping them in the first place.

 

[Spathiphyllum]

Bear in mind that Libre can take much longer to report a hypo recovery. Therefore, it is recommended to continue to test with finger pricks to detect when to stop treating.
The value in Libre is not in the hypo recovery but in stopping them in the first place.

Yes indeed, on both points. Specifically on the first-- if I'm at home, I always check actual blood when dealing with or recovering from a hypo. (Just can't bring myself to carry blood-test gear with me everywhere, along with all my other paraphernalia; maybe I should!)

 

[pawprint91]

(Just can't bring myself to carry blood-test gear with me everywhere, along with all my other paraphernalia; maybe I should!)

I do, frustrating as it is - one “error” message from Libre about having to wait and scan again in 10 mins and you are left with no idea what your bg is!

 

[Lucyr]

Just can't bring myself to carry blood-test gear with me everywhere, along with all my other paraphernalia; maybe I should

You should since need to use fingerpricks for hypos, highs, unexpected libre readings or issues, and have to always have it with you for driving

 

[helli]

Just can't bring myself to carry blood-test gear with me everywhere, along with all my other paraphernalia; maybe I should!

I know exactly how you feel.
For me, it depends how long I am out for.
My full paraphernalia stays at home if I pop to the shops or a quick gym session but will always come with me if I am out for a few hours or more.
And, I believe, if you drive, you must carry finger prick meter. Luckily many things - gym, shops, ... are within walking distance for me.

To reduce space taken by paraphernalia, I chuck the meter cases as soon as I get them. A pot of strips, pricker and meter can easily fit in a small pocket unlike the chunky case.

 

[Spathiphyllum]

I know exactly how you feel.
For me, it depends how long I am out for.
My full paraphernalia stays at home if I pop to the shops or a quick gym session but will always come with me if I am out for a few hours or more.
And, I believe, if you drive, you must carry finger prick meter. Luckily many things - gym, shops, ... are within walking distance for me.

To reduce space taken by paraphernalia, I chuck the meter cases as soon as I get them. A pot of strips, pricker and meter can easily fit in a small pocket unlike the chunky case.

Thanks, Helli! Fortunately, I don't drive; and fortunately, like you, most of what I need is within walking distance.

But of course I do often go out for a few hours or more, and had been thinking 'prob should take blood meter just in case, groan ...' So the idea of chucking the chunky meter case is brilliant.

I can prepare a mini-bag of strips and mini-bag of lancets and put them and spare pricker in a very small bag; then, when I'll be going out for a while, just add meter and toss in handbag or coat pocket.

 

[Lucyr]

I can prepare a mini-bag of strips and mini-bag of lancets and put them and spare pricker in a very small bag;

I think the strips need to stay in the pot to keep them dry etc? No need to bother packing lancets though.

 

[Tdm]

I think the strips need to stay in the pot to keep them dry etc? No need to bother packing lancets though.

Yes, i found a couple of escaped strips and popped them back in the pot. I knew when i found them...they all read around 3

 

[Robin]

I think the strips need to stay in the pot to keep them dry etc? No need to bother packing lancets though.

If like me you get the strips that fit the Libre reader, they come individually wrapped, so I can always just put a strip of 5 into a pocket.
They're not usually on the normal first line prescribing list, though, I was lucky in that when I started getting the Libre prescribed, the hospital told the GP to prescribe that brand, and they did!