Hypos but dextrose working too slowly. Anyone experiencing same?

[ChrisLG]

I’m type 1 for 40 years, reasonably well-controlled, and with a more recent gastro condition. Recently had episodes where food isn’t digested/absorbed so no carbs entering the blood-stream...but the insulin injection is still acting and pushing down BG level. Responding with dextrose but that's also taking longer to be absorbed than previous. Anyone else managing this scenario or similar?

 

[Lucyr]

How well are you chewing the dextrose so that it’s absorbed in the mouth to get working quickest? Have you tried liquid carbs like Coke etc?

 

[everydayupsanddowns]

Is it gastroparesis (slow transit of food) that you might have @ChrisLG ? Or another gastro condition affecting food absorption like something needing PERT (enzyme replacement)

One member here @AJLang has been juggling diabetes and gastroparesis for many years.

 

[ChrisLG]

How well are you chewing the dextrose so that it’s absorbed in the mouth to get working quickest? Have you tried liquid carbs like Coke etc?

Using Dextrose Gel and liquid..so follows same digestive route. Also, glucogel for absorption through mouth cheek. Coke as well.... but they're all taking 15-20 minutes to work when previously it had been more like 5.

 

[everydayupsanddowns]

but they're all taking 15-20 minutes to work when previously it had been more like 5.

15 minutes would be closer to my expectation than 5.

The old 15-Rule of hypos that I was told soon after diagnosis. Take 15g of fast carbs and recheck in 15 minutes.

Even more-so if you are watching recovery on a sensor that may be lagging a further 10 minutes behind?

Maybe you've been lucky up until now with a super-speedy system, and it's now easing back to more like the rest of us?

 

[ChrisLG]

Is it gastroparesis (slow transit of food) that you might have @ChrisLG ? Or another gastro condition affecting food absorption like something needing PERT (enzyme replacement)

One member here @AJLang has been juggling diabetes and gastroparesis for many years.

Gastro consultant ruled out gastroparesis but confirmed eosinophilic oesophagitis...meant to be triggered by a food sensitivity and likely wheat (I'm still unsure, based on trial and error). That was 6 years ago and recent episodes of slow to act dextrose only in last month.

 

[ChrisLG]

15 minutes would be closer to my expectation than 5.

The old 15-Rule of hypos that I was told soon after diagnosis. Take 15g of fast carbs and recheck in 15 minutes.

Even more-so if you are watching recovery on a sensor that may be lagging a further 10 minutes behind?

Maybe you've been lucky up until now with a super-speedy system, and it's now easing back to more like the rest of us?

I agree. Thanks

 

[Satan’s little helper]

Hello. 15 or 25 minutes sound about right depending on how low I went? I can drop further before recovery using a BG meter within 5 minutes testing. My sensor will take much longer. Measuring interstitial fluid.

 

[Inka]

I’m type 1 for 40 years, reasonably well-controlled, and with a more recent gastro condition. Recently had episodes where food isn’t digested/absorbed so no carbs entering the blood-stream...but the insulin injection is still acting and pushing down BG level. Responding with dextrose but that's also taking longer to be absorbed than previous. Anyone else managing this scenario or similar?

Are you splitting your meal bolus? That would help reduce the hypos due to food absorption problems. Also, where are you injecting your bolus? Choose a slower site like buttocks maybe.

I always find Coke works faster than Dextro (I think it’s the caffeine and fizz). I also like the Lift Gluco shots, as they’re concentrated and fast too. Keeping a Dextro tablet chewed and in your cheek can work. I had to do this when I had Norovirus and hypos.

 

[Thebearcametoo]

What are you taking your BG reading with when thinking about timings? Don’t forget sensors are about 10 minutes behind finger pricks.

 

[helli]

What are you taking your BG reading with when thinking about timings? Don’t forget sensors are about 10 minutes behind finger pricks.

I think it is worth expanding up on this.
Interstitial fluid changes (what CGMs use to calculate BG) are about 10 to 15 minutes behind BG changes. The algorithm that some CGMs use to convert between the two attempts to take this into consideration and "predict" the current BG by extrapolating the trend in the BG graph. Most of the time, this is close enough. However, if the trend changed direction in the last 15 minutes such as when you are recovering from a hypo, the CGM reports a low for longer than a finger prick. And beyond your recovery.
Sometimes, when interstitial fluid "catches up", the CGM will make a correction to historical data and the lowest low (or highest high) will disappear.
I have also read others suggesting that the increase in blood glucose affects their interstitial fluid later - it's as if the glucose makes its way to the most critical parts of the body first and finally "fills up the interstitial fluid reservoir", again resulting in the CGM reporting the low for longer than it happens.

All this means that, while CGMs are fantastic pieces of kit, they are not perfect and far from ideal for checking hypo recovery. Today, there is no substitute for finger pricks in this situation.

 

[ChrisLG]

Are you splitting your meal bolus? That would help reduce the hypos due to food absorption problems. Also, where are you injecting your bolus? Choose a slower site like buttocks maybe.

I always find Coke works faster than Dextro (I think it’s the caffeine and fizz). I also like the Lift Gluco shots, as they’re concentrated and fast too. Keeping a Dextro tablet chewed and in your cheek can work. I had to do this when I had Norovirus and hypos.

Thanks - good suggestion to split meal bolus. Issue on whether it's Coke, dextro etc. all comes to the same thing..it feels like there's a blockage (although gastro consultant says there isn't one) but there must be slow absorption (whatever the cause) and that's also impacting absorption of fast-acting sugars.

 

[ChrisLG]

What are you taking your BG reading with when thinking about timings? Don’t forget sensors are about 10 minutes behind finger pricks.

What are you taking your BG reading with when thinking about timings? Don’t forget sensors are about 10 minutes behind finger pricks.

Following the guideline of using Libre Sensor until readings go south and then rely solely on glucometer. Latest episode I watched the glucometer stuck on 3.0 despite having consumed a sweetshop load of dextrose.

 

[ChrisLG]

I think it is worth expanding up on this.
Interstitial fluid changes (what CGMs use to calculate BG) are about 10 to 15 minutes behind BG changes. The algorithm that some CGMs use to convert between the two attempts to take this into consideration and "predict" the current BG by extrapolating the trend in the BG graph. Most of the time, this is close enough. However, if the trend changed direction in the last 15 minutes such as when you are recovering from a hypo, the CGM reports a low for longer than a finger prick. And beyond your recovery.
Sometimes, when interstitial fluid "catches up", the CGM will make a correction to historical data and the lowest low (or highest high) will disappear.
I have also read others suggesting that the increase in blood glucose affects their interstitial fluid later - it's as if the glucose makes its way to the most critical parts of the body first and finally "fills up the interstitial fluid reservoir", again resulting in the CGM reporting the low for longer than it happens.

All this means that, while CGMs are fantastic pieces of kit, they are not perfect and far from ideal for checking hypo recovery. Today, there is no substitute for finger pricks in this situation.

Thanks and agreed on no substitute for finger pricking

 

[rebrascora]

Could there be some problem in your mouth that you are not absorbing glucose there. A blockage lower down your GI tract should not impact your mouth absorption, which is usually the fastest way of raising levels. I am assuming there is no problem with Glucometer. Strips in date and not opened more than a month or whatever it is? Now that most of us have a CGM, test strips get used so much less frequently, that it is easy for them to go out of date.

 

[Inka]

Thanks - good suggestion to split meal bolus. Issue on whether it's Coke, dextro etc. all comes to the same thing..it feels like there's a blockage (although gastro consultant says there isn't one) but there must be slow absorption (whatever the cause) and that's also impacting absorption of fast-acting sugars.

I know you’ve had a problem diagnosed, but have you also had a recent coeliac screen. Undiagnosed coeliac disease can be a cause of hypos as the damaged gut can’t absorb food properly to match the insulin timing.

 

[ChrisLG]

I know you’ve had a problem diagnosed, but have you also had a recent coeliac screen. Undiagnosed coeliac disease can be a cause of hypos as the damaged gut can’t absorb food properly to match the insulin timing.

Thanks. Gastro consultant thinks its an intolerance (not allergy) to wheat which I've (mostly) excluded. However, some of these episodes have occurred following a wheat/gluten/dairy/egg free-meal.

 

[Inka]

I’ve had to exclude gluten/wheat too. It’s in lots of places you wouldn’t think. Also, I imagine it might take time for things to settle even after you’ve excluded it, so it could be that.

 

[ChrisLG]

Could there be some problem in your mouth that you are not absorbing glucose there. A blockage lower down your GI tract should not impact your mouth absorption, which is usually the fastest way of raising levels. I am assuming there is no problem with Glucometer. Strips in date and not opened more than a month or whatever it is? Now that most of us have a CGM, test strips get used so much less frequently, that it is easy for them to go out of date.

Thanks for your input. Recent investigations by gastro consultant and visit to dentist didn't identify any mouth issues. I'm interested in what has been said about glucose absorption through mouth...so can I ask contributors if it's the preferred route (I always thought it led to limited glucose uptake) as opposed to swallowing and ingestion. And yes re: expired strips. Been caught out many times over the year.

 

[ChrisLG]

I’ve had to exclude gluten/wheat too. It’s in lots of places you wouldn’t think. Also, I imagine it might take time for things to settle even after you’ve excluded it, so it could be that.

Thanks. May I ask if it created any difficulties in glucose absorption during low BG events before you excluded it?