hypo question

[astbury1]

Just had a hypo of 3.1 and no signs. Only checked coz cgm started beeping. Am I hypo unaware??????

Should I be concerned?

 

[Northerner]

Not necessarily. Some hypos that come on very slowly can leave you with little or no symptoms, it's the ones that fall quickly that can give the clearest messages. 3.1 is just a bit lower than a non-diabetic person might experience, and of course meters aren't totally accurate. If you get symptoms usually, I wouldn't worry about the occasional one that sneaks up on you. I've also discovered some hypos that only give symptoms when you test and see how low you are!

 

[astbury1]

Thanks for the reply. Got a shock! Glad I have the cgm. Ive been told at dafne not to correct a hypo....I'm sitting at 22....surely I shud correct this? Not sure how it went that high. Didn't eat loads

 

[Northerner]

Thanks for the reply. Got a shock! Glad I have the cgm. Ive been told at dafne not to correct a hypo....I'm sitting at 22....surely I shud correct this? Not sure how it went that high. Didn't eat loads

Personally I would definitely correct a 22 (I'm guessing you mean 'hyper' not hypo here), depending on when I ate and bolused. I think DAFNE does have some strange advice - I think you are told not to test between meals?

 

[astbury1]

Yeah they said if you go high after a hypo then not to correct it. I've left it and now 11 so maybe there is a good reason to it....yeah no testing inbetween meals. To stop you correcting and hypoing due to quick acting lasting up to 5 hours. I tend to come back into range after 5 hours. I've asked them to help with the peaks inbetween but they seem uninterested =-O

 

[Northerner]

Yeah they said if you go high after a hypo then not to correct it. I've left it and now 11 so maybe there is a good reason to it....yeah no testing inbetween meals. To stop you correcting and hypoing due to quick acting lasting up to 5 hours. I tend to come back into range after 5 hours. I've asked them to help with the peaks inbetween but they seem uninterested =-O

Something I (and many others) have found very good is bolusing some time before eating, in order to give the insulin a chance to get working. It's called 'fast-acting', but usually it doesn't work as fast as the food! Ironing out those peaks in between meals will really help to reduce your HbA1c. You do have to be cautious, of course, but I tarted off by injecting around 10-15 minutes before eating. Through lots of experimentation and testing I've now discovered that I can inject as much as an hour before eating breakfast, and between 30-40mins before lunch and tea. My post meal (one and two hour) readings are much, much better now. You need to find out what works for you, and also take into account the type of food you will be eating e.g. a fatty meal might raise your levels very slowly so you would need to inject closer to eating for something like that.

 

[Austin Mini]

Hi there. This CGM sounds very interesting where can you get one of these?

 

[astbury1]

Ha ha yeah my quick acting is as quick actinmg as a snail! Had another hypo before bed!!!!!! no idea why. Only thing I can think of is the cold weather.


Re CGM- I got my dexcom one from advanced theraputics online. They do a two week trial that you can send back if not happy!🙂

 

[Cleo]

Hi Andrea
I can sometimes detect hypos when I'm around 3.3 and sometimes I don't realise I'm having a hypo until I'm 2.7 - so it really depends . I think like northerner said - if overall you're hypo aware and the odd one sneaks up on you then I wouldn't worry about it. 🙂
I remember the nurses on Dafne saying not to correct after a hypo - fair enough if that works for some people but to be honest I just ignore that ! If I do have a hypo I just try to make sure I only have 15g of fast acting carbs and that way I avoid a rebound high. Does take alot of willpower though 🙂
And I've also found that injecting a bit before meals REALLY helps with post meal spikes. 😉
X

 

[bev]

Hi Andrea,

The more I hear about DAFNE the more it worries me.😱What is their reasoning for not testing inbetween meals? What do you take for a hypo? I am wondering why you went up to 22mmls - this isnt right? And not correcting such a high is not good advice either. I think perhaps DAFNE need updating - and have also heard they dont approve of CGM which is odd. And as for FA lasting 5 hours - how do they know that? Its different in everyone for example with my son its only 3 hours so if we followed their advice it would have a detrimental impact on his HBA1C. Not correcting highs inbetween meals will significantly impact too and would be wary of doing this. Why is it allright to be high for 4 or 5 hours after eating? We are told at our clinic that 1.5 to 2 hours after eating levels should be no more than 2mmols higher than pre-meal otherwise the ratio's are out.🙂Bev

 

[novorapidboi26]

DAFNE is designed for MDI and so in order to fully understand the action of each meal time bolus, testing in between meals is to be avoided. But this is only relevant when you are in training and also when you are evaluating your ratios.

When the ratios are good to go, of course testing in between meals is a good source of info.

Its been many years now since I done DAFNE, so I would hope they will now emphasise the fact that not testing in between meals is only relevant when considering a ratio change....

 

[Redkite]

DAFNE is designed for MDI and so in order to fully understand the action of each meal time bolus, testing in between meals is to be avoided. But this is only relevant when you are in training and also when you are evaluating your ratios.

When the ratios are good to go, of course testing in between meals is a good source of info.

Its been many years now since I done DAFNE, so I would hope they will now emphasise the fact that not testing in between meals is only relevant when considering a ratio change....

DAFNE is not available for parents of children with type 1, so we've had to educate ourselves! In my case I learnt from one of the best imo, the American Certified Diabetes Educator Gary Scheiner (who wrote "Think Like a Pancreas"). I've been to a number of his seminars, and his recommendations are that you MUST know what your BG is 2-3 hours after a meal in order to evaluate the bolus ratio for that meal. Rises and drops between that time and the next meal would be due to the action of basal insulin. Perhaps DAFNE is out of date and referring back to older insulins.....

 

[novorapidboi26]

DAFNE is not available for parents of children with type 1, so we've had to educate ourselves! In my case I learnt from one of the best imo, the American Certified Diabetes Educator Gary Scheiner (who wrote "Think Like a Pancreas"). I've been to a number of his seminars, and his recommendations are that you MUST know what your BG is 2-3 hours after a meal in order to evaluate the bolus ratio for that meal. Rises and drops between that time and the next meal would be due to the action of basal insulin. Perhaps DAFNE is out of date and referring back to older insulins.....

As I say DAFNE has moved on from when I done it in 2009 but its still relevant for people injecting with Levemir/Lantus/Novorapid/Humalog.

Pumping insulin is much different though. The behavior of the insulin delivered alone is in a totally different league.

I wasn't fighting the DAFNE movement or anything just explaining the logic behind their 'don't test between meals' idea.....🙂

Currently my understanding is that the spiking between meals is down to the timing of the insulin against the digestion of the food.

The insulin/carb ratio we use represents how many grams of carbs is processed by 1 unit of insulin.

 

[everydayupsanddowns]

I wasn't fighting the DAFNE movement or anything just explaining the logic behind their 'don't test between meals' idea.....🙂

Currently my understanding is that the spiking between meals is down to the timing of the insulin against the digestion of the food.

The insulin/carb ratio we use represents how many grams of carbs is processed by 1 unit of insulin.

I'm pretty sure that's right. I've not done DAFNE, but as far as I know they discourage post-meal testing as their research shows that many people over-react if they see a high level at 2 hours and don't necessarily take into account that they still have quite a bit of IOB which leads to the discouraging (and damaging) cycle of high followed by hypo followed by overcorrected high blah blah blah.

I'm not sure if it will be updated to include careful/cautious use of post-meal tests at some point.

I think it is easy for people here forget how far 'ahead of the curve' their insulin and dose adjustment strategies are in relation to many people who undertake DAFNE.

 

[bev]

Hi NRB,

Thanks for the clarificaton.🙂It makes more sense that this is done to check ratio's are correct. Hopefully they do encourage testing inbetween meals though once ratio's are understood?🙂Bev

 

[astbury1]

Hi Dafne doesnt like testing inbetween meals at all. Infact I went for a follow up yesterday and they just said they are only concerned with before eating and morning/bedtime. I explained that I peak high and they basically said that as long as it doesnt stay too high for long periods this is ok. They were more concerned with HBA1c being 7 and below. I explained that I wanted to get pregnant and the problems that I would have hitting the after meal targets and they said they would only really help when that time came. Quite frustrating really!😛

 

[novorapidboi26]

Hi NRB,

Thanks for the clarificaton.🙂It makes more sense that this is done to check ratio's are correct. Hopefully they do encourage testing inbetween meals though once ratio's are understood?🙂Bev

I hope they do now......

For me the mid meal testing was taking the control that on step further, and I suppose in order to keep everyone on a level playing field they advise not to do so.

After the course though, they were able to understand why I did it......