Hypo corrections

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Lion2012

Lion2012

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Good morning guys.
Once again over sugared my son and gone from low to high instead of me just being patient
He hit a low after crashing having taken part in a football tournemant... The crash didn't happen until the following morning.... Unusual for my son usually crashes within three hours.
I have him 2 glucose tablets
After 10 minutes the arrow on the libre went from down to middle.... Then dropped again causing me to panic and give another glucose followed by a jaffa cake.
Then a couple of hours later sky high. Always a bloody delay :-(..
. I always panic when i see no sign of upwards motion and the big red down arrow.
Can i ask... What is the best way to be calm and treat hypo without over correcting.
I wanted him set for another game this eve and if i was patient and waited then i feel the spike wouldn't of happened. Graph attached
 

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Sorry to read about your continued issues.
The best way I find to be calm when treating hypos is not to use Libre for detecting recovery.
As all hypos must be checked with finger pricks (unless it is an obvious hypo with symptoms), so must the recovery.

CGM calculate blood sugars based on Interstitial Fluid Readings which are 10 to 15 minutes behind blood sugars. The algorithms use by the CGMs attempt to "predict" this delay by extrapolating the current curve. As a result, when the direction of the curve changes, the prediction will take 10 to 15 minutes to notice. Therefore, I completely ignore Libre when treating a hypo until I have recovered.

The usual advice is
- treat with fast acting glucose
- wait 15 minutes
- test again with finger pricker
- if still under 4, repeat the treatment, wait another 15 minutes and go round the loop until the finger prick is over 4.
- eat 10 - 15g of slow acting carbs.

(I also try to pay little attention to the arrows as they are based on only one or two readings and values fluctuate. It is better to look at the graphs rather than just the arrow.)
 
Well obviously I've only ever treated me - but I don't panic anyway. I just do something else for an hour to take my mind of whatever it is. I've always got something that needs reading. Then test my blood. Not interested in reading my Libre, because it shouldn't be used when BG is quickly changing, Abbott tell everyone it is unreliable then themselves - and certainly my clinic made sure I knew that fact.

We have told you this before.
 
helli said:
Sorry to read about your continued issues.
The best way I find to be calm when treating hypos is not to use Libre for detecting recovery.
As all hypos must be checked with finger pricks (unless it is an obvious hypo with symptoms), so must the recovery.

CGM calculate blood sugars based on Interstitial Fluid Readings which are 10 to 15 minutes behind blood sugars. The algorithms use by the CGMs attempt to "predict" this delay by extrapolating the current curve. As a result, when the direction of the curve changes, the prediction will take 10 to 15 minutes to notice. Therefore, I completely ignore Libre when treating a hypo until I have recovered.

The usual advice is
- treat with fast acting glucose
- wait 15 minutes
- test again with finger pricker
- if still under 4, repeat the treatment, wait another 15 minutes and go round the loop until the finger prick is over 4.
- eat 10 - 15g of slow acting carbs.

(I also try to pay little attention to the arrows as they are based on only one or two readings and values fluctuate. It is better to look at the graphs rather than just the arrow.)
Click to expand...
Thank you so much for this i do always use the finger prick when addressing hypos.. Try to anyway.
The issue i have with Leo is that his body does NOT react to the glucose as quick as he should hence why i panic. Example waiting 15 minutes just doesn't cut it and he can still be low... Then 2 hours later he's rocketed.... Sadly
 
trophywench said:
Well obviously I've only ever treated me - but I don't panic anyway. I just do something else for an hour to take my mind of whatever it is. I've always got something that needs reading. Then test my blood. Not interested in reading my Libre, because it shouldn't be used when BG is quickly changing, Abbott tell everyone it is unreliable then themselves - and certainly my clinic made sure I knew that fact.

We have told you this before.
Click to expand...
Single parent dealing with multiple conditions i am sure many people tell me many things that i do NOT absorb immediately. Thanks for that
 
Lion2012 said:
Thank you so much for this i do always use the finger prick when addressing hypos.. Try to anyway.
The issue i have with Leo is that his body does NOT react to the glucose as quick as he should hence why i panic. Example waiting 15 minutes just doesn't cut it and he can still be low... Then 2 hours later he's rocketed.... Sadly
Click to expand...
Have you tried changing his hypo treatment.
Some people find a drink like a carton of fruit juice or small can of coke works faster or glucogels.
The gels do not taste pleasant but are designed to work fast.

(Sorry if you have already tried these things. I know Leo has added complexities with CF.)
 
As long as he isn’t dropping further and further or exhibiting worsening symptoms then you don’t need to panic. My daughter has had some humdingers that have gone on for an hour, usually at bed time and the temptation to just shovel a load of sugar in so that we can all go back to bed is really hard to ignore! But you still stick to the rule - 15 grams, wait 15 minutes, test again, repeat the cycle until it goes above 4. They are the longest 15 minutes of your life and when you’re on the 3rd or 4th time round you do start to get a bit desperate. Hang in there though, it WILL come up again!
 
I read that fizzy drinks open the stomach sphincter faster, so maybe try coke- unfortunately they have taken a lot of sugar out of fizzy drinks. Or you could buy sugary squash (Sainsburys high juice is good) and add soda water. I also don't trust cgm when hypo- back up with finger pricks if it doesn't match how I feel.

Have been reading your posts but not commented yet, but I would really recommend a pump, I find it so useful after exercise. Sorry to hear your son has so many conditions to deal with. Puberty hormones won't help either!

Have got got a copy of Ragnar Hagnas book? I found it really useful, even as an adult.
 
helli said:
Have you tried changing his hypo treatment.
Some people find a drink like a carton of fruit juice or small can of coke works faster or glucogels.
The gels do not taste pleasant but are designed to work fast.

(Sorry if you have already tried these things. I know Leo has added complexities with CF.)
Click to expand...
Thank you 🙂... I changed from jelly babies to glucose tablets around 4 weeks ago ish... As the jelly babies were also sending him into orbit hours after sadly.
The fifteen minute wait just doesn't seem to work anymore.
He is now down for a tslim pump which we are just waiting for now. I am sure this will be a welcomed god send for us. And have been assured he cab detach when training and playing football which is great
 
Sally71 said:
As long as he isn’t dropping further and further or exhibiting worsening symptoms then you don’t need to panic. My daughter has had some humdingers that have gone on for an hour, usually at bed time and the temptation to just shovel a load of sugar in so that we can all go back to bed is really hard to ignore! But you still stick to the rule - 15 grams, wait 15 minutes, test again, repeat the cycle until it goes above 4. They are the longest 15 minutes of your life and when you’re on the 3rd or 4th time round you do start to get a bit desperate. Hang in there though, it WILL come up again!
Click to expand...
Thank you so much... Leo too is on a wait for his tslim.. I am hopeful this will keep him in range and stop all the huge swings top to bottom... Fingers crossed. And thank you again
 
Pigeon said:
I read that fizzy drinks open the stomach sphincter faster, so maybe try coke- unfortunately they have taken a lot of sugar out of fizzy drinks. Or you could buy sugary squash (Sainsburys high juice is good) and add soda water. I also don't trust cgm when hypo- back up with finger pricks if it doesn't match how I feel.

Have been reading your posts but not commented yet, but I would really recommend a pump, I find it so useful after exercise. Sorry to hear your son has so many conditions to deal with. Puberty hormones won't help either!

Have got got a copy of Ragnar Hagnas book? I found it really useful, even as an adult.
Click to expand...
Thank you so much for that for the advice... Leo is waiting on his tslim... Then next heat hopefully the omnipod 5... Which will be tubeless.
I am so hoping that this will keep him in range most of the time meaning his football will improve no end. He can disconnect apparently to play or train.
Thank you for the advice very much appreciated... I haven't heard of this book sadly
 
Ragnar Hanas

Type 1 Diabetes in Children, Adolescents and Young Adults Seventh Edition​


Sorry tried to get an Amazon link but couldn't work it out. It's brilliant, I learnt so much
 
Funnily enough re the fizzy comment - I always found that orange Lucozade worked very well for me. I choose orange for the simple reason I like the taste better than 'just' Lucozade. Bearing in mind the glucose starts being absorbed through the inside of the cheeks, it made sense to me, especially as I have much more difficulty chewing when hypo. However on the other hand - it still worked perfectly OK when it had gone flat - so I reckon it's more 'the insides of the cheeks' than the fizz !
 
Find when bg drops like a stone liquid glucose works fastest, those 150ml cans of full sugar coke are ideal.

Once bg back up have slow acting carb like oatbar to keep it from dropping later on.
 
Lion2012 said:
He is now down for a tslim pump which we are just waiting for now. I am sure this will be a welcomed god send for us. And have been assured he cab detach when training and playing football which is great
Click to expand...
Why would you want to detach the pump?
 
It is really helpful to chew solid hypo treatments well rather than a couple of chews and swallow to get the fastest response as the glucose is absorbed through the cells in the mouth. If you are panicking this may well be affecting your son and he may be just getting the hypo treatment down as quickly as possible.

You say that he takes hours to respond to hypo treatment but the graph shows that he responds very quickly as there is very little red on the graph so it may be your perception rather than the reality that he is hypo for long periods. Yes he hypoed again about an hour and a half later and that may be because his football has made him more sensitive to the Levemir but there is no indication (which is why reducing Levemir after exercise is helpful... he has come down from 20 since midnight which is a pretty steep descent if just Levemir was on board) ..... Or whether he had breakfast during this period too and bolus insulin was also at play with these hypos. It doesn't look like you log insulin and food on his Libre so it is difficult to know exactly what is happening. Not sure if you know how to do this but it will help Leo's team to understand what is going on if you do log each insulin dose and carbs on his Libre.
From the graphs you posted you seem to be treating the hypos really promptly and they are responding well, so it may be your panic which is skewing your perception of how long they take to respond and perhaps cauing you to over treat, or it may be Leo's liver responding to the hypo and pumping out some glucose to add to the hypo treatments you have given.

The best solution is to try to prevent the hypos perhaps by reducing the evening Levemir. Coming down from 20 to hypo overnight suggests evening dose is far too high in my opinion but your graph doesn't show if there are other Fiasp corrections at play during that time as well.
 
I find glucotabs with water work faster than sugar products when i have a bad hypo but donot last aslong and then you donot get such a high spike after .but if i can see sugar dropping quick before a hypo i use liquid sugar as glucotabs are quite expensive and difficult to buy where i live .
 
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I sympathise also as I can panic with double arrows heading down. I find nothing raises my blood sugar faster than coca cola and the 150 ml cans very useful. I usually down one, set the timer on my phone for 15 minutes and until that timer goes off I tell myself I can add no more sugar. Then if still crashing once the timer goes off, repeat. Don't always manage to do it that way, but it often works.
 
The best way to stop panicking is to have confidence that what you are doing is working and follow the rules about finger pricking ie. having fast acting carbs waiting 15 mins and finger pricking again.
You need to be methodical and disciplined about it and ignore the Libre during this period as it is not accurate. Nothing bad will happen during that 15 min period once he has carbs on board. Don't look at Libre if it is tempting you to over treat and don't give him slower acting carbs until his levels are above 4. Follow the 15 minute rule. If he isn't above 4 (finger prick only- ignore Libre) after 15 mins then give him another 2-3 glucose tablets and wait another 15 mins. Only give the slower acting carbs once he is above 4 at that 15 min check.

Personally I wonder if the Fiasp is causing some of your problems with these highs and lows and you are perhaps getting impatient with insulin corrections when his levels are high. Fiasp takes ages to work when levels are high.... But without knowing if and when you injected insulin it is hard to know for sure. The more info you input into Libre the easier it is to interpret what is happening and figure out solutions.

My questions would be.... Did you do any overnight corrections with Fiasp and if so when and how much.
Did you bolus for breakfast and if so, when? And did he have breakfast and if so when?
When did he inject his morning Levemir?
 
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