Good morning, my husband was recently diagnosed with T1. He has been increasing his insulin slowly and last night had his first experience of a hypo - not very low at 4.3 but he was feeling very odd. I’m sure everyone is slightly different and he will find what works for him, but is there a quick guide somewhere to hypo treatment with timings so that we can make a sheet for advice to friends and colleagues? He rang 111 for advice as he wasn’t sure whether he should be taking his basal dose while low (it was his usual dose time) and whether he should be increasing it as advised. Thank you!
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Hypo advice
- Thread starter Pandy8
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Windy
Well-Known Member
- Relationship to Diabetes
- Type 2
Morning @Pandy8 I'm not a type 1 or on insulin, but used to be a first aider at work. One of my workmates was on insulin and used to keep a small tube of glucose in her desk drawer. I was meant to get her to have some of that if she was low blood sugar.
There's much more comprehensive information on this site Hypos.
My understanding is that insulin brings your blood sugar down, so if he's low, I'd have thought that that would make him more hypo? I'm sure the more knowledgable members of the forum will be able to give you much better advice than me.
Best wishes, Sarah
There's much more comprehensive information on this site Hypos.
My understanding is that insulin brings your blood sugar down, so if he's low, I'd have thought that that would make him more hypo? I'm sure the more knowledgable members of the forum will be able to give you much better advice than me.
Best wishes, Sarah
@Windy beat me to the same link 🙂
The important thing is that your husband should always keep hypo treatment with or near him. This could be in his desk at work, in his car, with his insulin, ....
Regarding basal insulin - this is slow acting and will not have an impact on hypos so should still be taken. Personally, I would wait until I had recovered. from the hypo but still take it. As basal doses are usually stable, I cannot advise whether to increase it or not. I think I would hold off the increase to see what happens for the next day and, then, if no further hypos (and still too high levels most of the day) increase the basal ... but I am not a doctor.
The other important thing which I did not see mentioned in the Hypo page is to treat it as a learning opportunity. I find it very useful to review the last hour or so and try to work out why I had a hypo and decide what I could do differently in the future. The obvious reason is because I took too much bolus insulin but was this because I incorrectly carb counted (or had a smaller meal if I was on fixed doses) or because I undertook some vigorous exercise, for example.
The important thing is that your husband should always keep hypo treatment with or near him. This could be in his desk at work, in his car, with his insulin, ....
Regarding basal insulin - this is slow acting and will not have an impact on hypos so should still be taken. Personally, I would wait until I had recovered. from the hypo but still take it. As basal doses are usually stable, I cannot advise whether to increase it or not. I think I would hold off the increase to see what happens for the next day and, then, if no further hypos (and still too high levels most of the day) increase the basal ... but I am not a doctor.
The other important thing which I did not see mentioned in the Hypo page is to treat it as a learning opportunity. I find it very useful to review the last hour or so and try to work out why I had a hypo and decide what I could do differently in the future. The obvious reason is because I took too much bolus insulin but was this because I incorrectly carb counted (or had a smaller meal if I was on fixed doses) or because I undertook some vigorous exercise, for example.
Robin
Well-Known Member
- Relationship to Diabetes
- Type 1
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- She/Her
That’s a good link that @Windy has put up. Yes, the general rule is 15g fast acting carb (I personally use jelly babies, but the examples in the link are all good). It helps to weigh out little packets of 15g and keep them handy (especially one by the bed in case of a night time low).
Then wait 15 minutes and retest. If still low, rinse and repeat. If all Ok, the advice is to have some longer acting carbs, but experience will tell you if this is necessary. If it was just a miscalculation of your insulin, you may not need anything morel If it was because you’d been doing strenuous exercise, you may continue to drop.
Your husband may be feeling his hypos sooner at the moment if his body has got used to having higher levels before starting insulin, this will settle down.
The hardest things I found were to wait the 15 minutes to see if my levels were coming up, and to resist eating the whole fridge - the body sends out strong hunger signals.
Edit. Helli types faster than I do!
Then wait 15 minutes and retest. If still low, rinse and repeat. If all Ok, the advice is to have some longer acting carbs, but experience will tell you if this is necessary. If it was just a miscalculation of your insulin, you may not need anything morel If it was because you’d been doing strenuous exercise, you may continue to drop.
Your husband may be feeling his hypos sooner at the moment if his body has got used to having higher levels before starting insulin, this will settle down.
The hardest things I found were to wait the 15 minutes to see if my levels were coming up, and to resist eating the whole fridge - the body sends out strong hunger signals.
Edit. Helli types faster than I do!
Sally71
Well-Known Member
- Relationship to Diabetes
- Parent
You can get “hypo rebound”, where your liver responds to the hypo by chucking out glucose reserves into the blood stream, and this is too much on top of your hypo treatment. Unfortunately in type 1s this reaction is not very reliable so you always have to treat the hypo and assume that your liver is not going to step in and help you! It might also be that you didn’t really need the toast, or that one piece would have been enough. These things you will learn from experience though, everybody is different and every day is different and what worked last time might not work so well the next time! You will get more confident though as time goes on.
Thanks very much. Perhaps this is what happened. Who knows? ! It was his first hypo experience, so there is plenty of learning to do. He had carefully counted his carbs at supper and gave exactly the right amount of insulin, but he wondered if a large amount of olive oil in with the potatoes had slowed release down so the novorapid just didn’t coincide with BG rise. Is it usual to work all these things out from the internet or do the diabetes teams usually give you a bit of training?
@Pandy8 did your husband take his basal insulin? You said you were unsure whether to take it or not. If he missed it, this would lead to a rise as there is no background insulin to manage the glucose that constantly drips from his liver.
Unfortunately, there is no "exactly right amount of insulin". With so much that can affect our levels and the carb levels in food all being estimates and needing to round up (or down) the dose to while or half units, there is a lot of approximation going on with insulin dosing. For me it just was an incredibly clever thing a working body is.
As to whether it is usual to work these things out yourself, it varies but as we are all different our diabetes teams can only give us suggestions and things to look out for.
That said, they should have told you how to manage a hypo. This is too important to rely on someone to read up on the internet.
Unfortunately, there is no "exactly right amount of insulin". With so much that can affect our levels and the carb levels in food all being estimates and needing to round up (or down) the dose to while or half units, there is a lot of approximation going on with insulin dosing. For me it just was an incredibly clever thing a working body is.
As to whether it is usual to work these things out yourself, it varies but as we are all different our diabetes teams can only give us suggestions and things to look out for.
That said, they should have told you how to manage a hypo. This is too important to rely on someone to read up on the internet.
Yes, he did take it. I dare say the team wasn’t expecting him to go low yet. I hope he is speaking to them today. They must have said something as he had the jelly babies ready, but I’m thinking of the written protocols we use for T1 kids at school. We both would have liked that in the middle of the night! Would be useful to have something similar, but not sure if it’s too individual to be a generic thing?
- Relationship to Diabetes
- Type 1
- Pronouns
- He/Him
The most basic seems to be the ‘15 rule’ that @Robin mentioned
- Take 15g of fast-acting carbs
- Wait 15 minutes
- Check BG
- If still <4.0mmol/L start again at 1
Others here have also been recommended not to administer correction doses after a hypo (because of the likelihood of further hypos following).
There’s some general guidance around treating hypos here if it helps:
What is a hypo (hypoglycaemia)?
A hypo is when your blood sugar level, also called blood glucose level, drops too low. This is usually below 4mmol/l. A hypo, also called hypoglycaemia, can happen quickly. So it’s important to always have hypo treatments with you. It's also important to know what the signs are and how to treat...
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