Hypo recovery .... how many carbs do you need to eat?

[JontyW]

TODAY'S QUESTION:- Hypo recovery eating carbs.....
I see many references to others who, when they have a hypo, eat "everything in the fridge".

During 46 yrs as a T1 I have NEVER experienced this, and so just eat 10g to 15g fast acting carbs and never feel either hungry or the need to keep on eating.

So am I the only one who feels like this? Let us what you or your child normally does, and if you feel really hungry & so eat a lot, why do you think that is?

 

[Pumper_Sue]

Hi Jonty, I'm the same as you 99% of the time, have had one or two episodes where I have dropped like a bomb so felt the need to eat for England.

 

[Sally71]

Hi Jonty, we also stick to the "15 carbs, wait 15 mins, test again" rule, there can sometimes though be a bit of a time lag between the blood sugar returning to normal and the brain feeling better! E.g. One evening daughter announced that she was wobbly, tested 2.1, ate 3 glucotabs and waited 20 mins I think rather than 15. Retest was 6-ish so all OK but she was still feeling dreadful and complaining that she needed more sugar. We ignored her and didn't give her any - REALLY hard when you are a parent!! - and 10 minutes after that she had perked up again and was back to normal. If we'd given in she'd have been sky high, she really felt as if she was still low though when she wasn't. Maybe that's why some people feel like they need to eat more?
Also Pumper Sue is right that I think the speed of the drop makes a difference too!

 

[JontyW]

Thank you for your valuable inputs. I have posted this on two FB groups and got 'similar' feedback in that it depends on the speed of the drop.

So why is the drop so fast in some instances? Perhaps this is due to hypo unawareness and so no action is taken soon enough for what ever reason?

What else can cause a rapid drop?

 

[Robin]

Two things can make me drop rapidly. Miscalculating insulin, so I've still got Insulin on board when I've run out of carbs to digest, and shovelling snow! ( Well, any unexpected arduous exercise, in fact, I assume my body gets ahead of my basal, and the rate that my liver can pump out some glucose)

 

[Northerner]

Thank you for your valuable inputs. I have posted this on two FB groups and got 'similar' feedback in that it depends on the speed of the drop.

So why is the drop so fast in some instances? Perhaps this is due to hypo unawareness and so no action is taken soon enough for what ever reason?

What else can cause a rapid drop?

I treat according to how I feel and what the level of hypo is/how much insulin I am likely to still have circulating. So, a 3,8 before a meal will get one jelly baby, but a 3.8 two hours after injecting will get three jelly babies and a bag of crisps! 🙂 The 'eat everything' experience has happened for me with a rapid fall or a night hypo. I don't think rapid drops are due to lack of awareness, in me at least, as I have symptoms usually, just that sometimes the drop is so rapid that you either get the symptoms all at once or just after you've tested (what I call a Schroedinger hypo - one that only manifests symptoms when you observe the number! 😱) Rapid drops are rare for me and generally unfathomable - possibly due to a sudden, uneven absorption of insulin, or perhaps my pancreas (which still produces insulin - I'm weird!) deciding to spring into life 🙂

 

[JontyW]

What about the need to eat 10-15g slow acting carbs after recovery? Many seem to think that this is the normal recommendation, when in actual fact I believe it is should be related to 'when your next meal is'?

What do YOU do?

 

[Northerner]

What about the need to eat 10-15g slow acting carbs after recovery? Many seem to think that this is the normal recommendation, when in actual fact I believe it is should be related to 'when your next meal is'?

What do YOU do?

Not for me, I treat according to what I perceive I need to cover the drop and any remaining circulating insulin. I believe that the 'modern' recommendation is that you don't need to follow up with slow-acting carbs as a matter of course, although not all HCPs have caught up with this.

 

[Sally71]

On a pump you definitely don't need to follow up the sugar with more substantial carbs, this is because the basal is much more finely tuned to your individual requirements. We were on MDI for such a short time that I don't know what the current advice is for that!

 

[JontyW]

Regarding the slow acting carbs, this is what the official line from Diabetes UK is ..

"Some people may need to follow this treatment with a snack of 15–20g of slower-acting carbohydrate to prevent their blood glucose levels getting low again. This snack could be a sandwich, piece of fruit, cereal or some biscuits and milk – or even your next meal, if it’s due."

So the key point here, which many HCPs often forget, is 'how soon to your next meal'. The training course booklet for my area states ...
"once above 4, if you are not due a meal within 1 hr, eat a slow release carb e.g.a piece of fruit or digestive biscuit"

 

[Northerner]

Have to say, I wouldn't regard either a piece of fruit or a digestive biscuit (or indeed cereal or any other type of biscuit) as a 'slow-release carb', what nonsense 😱 You can't apply a strict rule to something like this, the answer of what to eat is determined by experience - you may apply the rule the first time, but then having seen the effect never apply the 'rule' again. I see it as a guideline for the uninitiated. 🙂

 

[Pumper_Sue]

Thank you for your valuable inputs. I have posted this on two FB groups and got 'similar' feedback in that it depends on the speed of the drop.

So why is the drop so fast in some instances? Perhaps this is due to hypo unawareness and so no action is taken soon enough for what ever reason?

What else can cause a rapid drop?

Sudden or prolonged exercise without something to eat before you start can cause a sudden drop. IT's nothing what so ever about being hypo unaware.

 

[AlisonM]

As a LADA my pancreas can suddenly start pumping insulin into the system, though as time goes on, this is more rare. There's no way of predicting when it will happen and when it does, my BGs can drop frighteningly fast and I'm in deep trouble. If I realise what's happening I do the 15:15 and keep my fingers crossed, if not I can end up stuffing as much carb into my body as I can to try and get my numbers back up. I have a sliding scale (snort) I use. If jelly babies don't do it, try coke or juice. If that doesn't work try toast and jam or banana toastie and, if that doesn't work hit the chip shop. If chips don't work, I'm stuffed.

 

[stephknits]

In the day time I treat with fast acting and no other carbs. At night I do eat a bi suite or whatever as well cos I want to go back to sleep and don't want to hang around wondering if I might go low again.

 

[AlisonM]

Have to say, I wouldn't regard either a piece of fruit or a digestive biscuit (or indeed cereal or any other type of biscuit) as a 'slow-release carb', what nonsense 😱 You can't apply a strict rule to something like this, the answer of what to eat is determined by experience - you may apply the rule the first time, but then having seen the effect never apply the 'rule' again. I see it as a guideline for the uninitiated. 🙂

Agreed. Real life doesn't work to any schedule or programme and we do what we must to 'manage' our diabetes as best we can. All while trying to avoid the pitfalls placed in our way by Murphy and the Diabetes Fairy.

 

[trophywench]

Really - it all depends on what caused the hypo, doesn't it? Cos eg when you have a pocket of unknown stored insulin decide to 'let go' - they can go on for hours! eg Just after I started pumping I felt a bit low actually at my D clinic appointment one afternoon. So I swigged some Lucozade, waited tested, still under 3, swigged some more, waited tested, then thought I better tell my DSN so I did - since by that time I'd finished the half bottle of Luc in my handbag. She produced another bottle out of their fridge, and I'd drunk half a bottle of that, and eaten some biscuits they happened to have in a drawer (she went rummaging for them not me I hasten to add) and it was turned 6 o'clock - two and a half hours later! - when my BG had reached over 4 so she would allow me to leave - knowing I'd driven myself there that day!

I could have done with the contents of the fridge - or preferably the bread bin and the open jars of jam etc TBH - that time! Other times, esp pumping - a swift swig is quite enough.

But - I say again - it doesn't matter really, as long as you treat it and you are OK again - EXCEPT that you need to be able to identify, afterwards, EXACTLY what happened every time in an effort to avoid that happening ever again, and to identify the best method, for you, of treating 'that type' of hypo - seeing that most of em are caused by User Error LOL

I should say that the pocket of insulin letting go, is the only possible explanation of that event, as far as both I and my DSN could fathom when we dissected it between us a couple of days later. I knew about the possibility in theory (something my lot teach us about in the carb counting course) but she had actually seen it happen before me and wasn't phased. Had it not been for her staying and sorting me out, as there is no A&E at St Cross - they would probably have had to ambulance me to UHCW Walsgrave, along the M6 in the rush hour!

 

[JontyW]

Northerner .. re your comment ..."I wouldn't regard either a piece of fruit or a digestive biscuit (or indeed cereal or any other type of biscuit) as a 'slow-release carb', what nonsense"

This is what the Diabetes UK website states..."This snack could be a sandwich, piece of fruit, cereal or some biscuits and milk ", and I agree with your comment.

However if you look up the carbs & sugar of these products using My Supermarket some (digestive bisc, cornflakes, sandwich) clearly are 'slow release' since the % sugar content is very low ..
Slow release
=========
Digestive biscuit/100g: carbs 63g sugar 17g = 27%
Cornflakes/100g: carbs 84g sugar 8g = 10%
White bread (sandwich) /100g: carbs 46g sugar 3.8g = 8%

Fast release:-
=========
Banana/100g: carbs 23g sugar 21g = 91%
S/Skimmed milk/100g: carbs 5g sugar 5g = 100%

 

[Northerner]

Digestive biscuit/100g: carbs 63g sugar 17g = 27%
Cornflakes/100g: carbs 84g sugar 8g = 10%
White bread (sandwich) /100g: carbs 46g sugar 3.8g = 8%

Hi Jonty, my contention is that, regardless of sugar content (unless it's zero!), the carb in these items is not 'slow-release', it will hit your levels as fast as a jelly baby would. 😱 In fact, white bread has a higher glycaemic index than table sugar, since the carb needs one less chemical process to convert to glucose than sugar, and raise levels. Sugar content alone is not the issue, it's the GI of the carbs as a whole. 'Slow-release' might be a slice of Burgen S&L bread with peanut butter spread, or Burgen S&L cheese on toast (where the fat and seeds slow the release) - I often have these if hypo before bed to keep levels up whilst sleeping 🙂

 

[KookyCat]

I don't get the munchies when hypo, exact opposite as it happens, I tend to feel very sick, so it's jelly babies for me, then more jelly babies if I don't come back up. I'm very moderate with insulin though so it's unlikely I'd have a very resistant hypo. The only time I've followed up with 15g of extra carb and felt extreme hunger was back when I was on mixed insulin and i'd gone down to 1.6 very rapidly and knew I was still falling (I get different hypo signals for a rapid drop). I actually had 5 gluco tabs, followed by a full American muffin, a latte and then a biscuit, 20 minutes after that I'd managed to get to 6.2, an hour later 5.3 and then back down to 3.9 before lunch.

If I ever do follow up with extra carb I go for oat biscuits and peanut butter, like Stephknits I'd only do that at night and I got low GI to make sure it keeps on giving!

 

[JontyW]

Many thanks for all your interesting feedback! Two last points ......

1) Here is a interesting article posted on one of the FB sites which explains more about how the body & brain reacts to varying levels of BG...
http://tmedweb.tulane.edu/pharmwiki/doku.php/hypoglycemia

2) Many of the responses have mentioned about 'insulin on board' as a major feature of how they treat the hypo, and particularly for the extra slow acting carbs.
- from these it appears that the hypo occurs within just a 'few' hours e.g.when there is still bolus unused. But for this to happen you must have made a big miscalculation of either carbs or bolus, or had some unplanned exercise
- since starting accurate carb counting 3 yrs ago, this has 'never' been the case for me, since recording all my carbs & bolus data in a spreadsheet which I analysis for a few minutes each morning. So I know what my ratios and recovery factors are and check them every month or so.
- So I contend that if you are in good control, then unexpected hypos should only occur very rarely. From the extensive feedback I've got from this & other groups it would appear that the few who claim that 15g/10min works for them (like me) & no need to have to take extra carbs, are generally under very good BG control as shown by good HbA1c & very few hypos.
- although we are all different, I still maintain that if more worked to the 'guidelines' (I use this word rather than 'rules') given, then less hypo problems would be experienced. Working to get better BG control overall is without doubt the key target.