Hypos

[pawprint91]

Okay, so my DSN told me that if your basal is right, it should mean that you can go without eating and not hypo. I reduced it by a unit after finding that if I didn't snack between meals, I would often be hypo before my next one (breakfast aside). This reduction does seem to have stopped the hypos, but I now seem to be under 5 before meals if I don't snack. If my basal is correct, does this mean that despite being say, 4.8, I shouldn't drop into a hypo even if I didn't eat for another few hours? Or will it just carry on dropping? And do all the usual factors count here too? (Weather, exercise & activity levels, hydrations levels etc). Basically, I understand hypos happen when you're diabetic for many reasons, but should they really be few and far between (as the nurse made them sound they should be when saying if you didn't eat all day your basal should cover you)? I'm a bit confused!

 

[Robin]

The idea is, your basal should hold you steady even when you don’t eat. The reality however, is very different. Because so many things affect insulin uptake, and once basal insulin is in the system it can’t be taken out, we all have hypos occasionally. For example. My basal today should have held me steady, but I went horse riding, It was very hot, and I had to work quite hard (you’re not just a passenger on a horse!) so I had to have a few extra carbs to keep me from going low, because I’m more sensitive to the insulin in hot weather, and when taking exercise.

 

[helli]

I have very little to do with my surgery DSN because she focuses on type 2 and I have an annual review at the specialist diabetes clinic.
This year, she insisted on a telephone appointment. One of the questions she asked was whether I had ever had a hypo. My response was “Anyone with Type 1 who says they have never had a hypo is either lying or is running their levels high.”
In other words, if we care about managing our diabetes, we will experience some hypos. With the tools we have available today such as Libre which alarms when we near a hypo, the risk of hypos is reduced.
However, with so many things that can affect our levels, there is more than just getting our basal dose correct to avoid hypos.
Being under 5 and stable should not be a problem. But it depends what your starting level and whether you got your last bolus correct to say whether your levels would fall further, even if the weather was perfect, you did no exercise, had an amazing night’s sleep, no illness, taking no drugs, drinking no alcohol, …
With the correct basal, should hypos be few and far between? They will be less than if your basal dose was too high but the ”correct” basal dose one day may be different the next day. The ”correct” basal may even be different one hour to the next (this is the main point of a pump). Or the “correct” basal may be something your insulin pen cannot give you - my pump allows me to give myself a dose of 0.05 units.

So, with the best basal rate you can work out, never go anywhere without hypo treatment and, even if you don’t eat, keep an eye on your levels.

 

[Pumper_Sue]

Okay, so my DSN told me that if your basal is right, it should mean that you can go without eating and not hypo. I reduced it by a unit after finding that if I didn't snack between meals, I would often be hypo before my next one (breakfast aside). This reduction does seem to have stopped the hypos, but I now seem to be under 5 before meals if I don't snack. If my basal is correct, does this mean that despite being say, 4.8, I shouldn't drop into a hypo even if I didn't eat for another few hours? Or will it just carry on dropping? And do all the usual factors count here too? (Weather, exercise & activity levels, hydrations levels etc). Basically, I understand hypos happen when you're diabetic for many reasons, but should they really be few and far between (as the nurse made them sound they should be when saying if you didn't eat all day your basal should cover you)? I'm a bit confused!

Simple solution is to skip a meal and see what happens 🙂 It's called basal testing 🙂

 

[Inka]

I’d take that with a pinch of salt. Yes, if your basal is right you should, in theory, be able to go all day without eating. But - your body may ‘helpfully’ decide to pump out some glucose (because you haven’t eaten) or you might be more energetic than planned and need Dextro or a snack, or you might get hayfever which can send you high or low, or you might get stressed which - you guessed it - can send you high or low.

Even when I had the most perfect day of blood sugars on my pump with no meals at all due to circumstances, I still needed a few carbs of top-ups. So, to answer, your question, if you’re 4.8 and in the middle of something energetic, even food-shopping, you’ll probably need a few carbs. If you’re sitting still watching TV, personally I’d still have a small amount of carbs to push myself into the 5s or you could just sit and watch what your blood sugar does. But why bother/risk it when you could just have something to eat?

Hypos aren’t rare. If you control your blood sugar strictly, you’ll have hypos. It’s not a failing on your part. Obviously if you’re having lots, you need to get advice, but most people have a few regularly and ward them off with Dextro/carbs.

 

[pawprint91]

Simple solution is to skip a meal and see what happens 🙂 It's called basal testing 🙂

My nurse advised a version of this initially - have a meal with no carbs and see what happens. I did this and had to drop my basal - dropped it again when I was hypo before meals. Thank you for reminding me this is an option 🙂

 

[pawprint91]

Hypos aren’t rare. If you control your blood sugar strictly, you’ll have hypos. It’s not a failing on your part. Obviously if you’re having lots, you need to get advice, but most people have a few regularly and ward them off with Dextro/carbs.

This may be a silly question, but why does controlling your blood sugar strictly result in hypos? Is it because we're trying hard with our boluses etc and if we didn't bother we'd basically just be running high all the time?

 

[Inka]

This may be a silly question, but why does controlling your blood sugar strictly result in hypos? Is it because we're trying hard with our boluses etc and if we didn't bother we'd basically just be running high all the time?

Because if we try to keep our blood sugars tightly controlled within a small range, we’re almost guaranteed to have hypos. Ideally, you spot them before they happen and ward them off, but because the bottom of our ‘ideal tightly controlled range’ is so close to hypo territory, it’s pretty much a given. Years ago there was a trial (DCCT, I think) that tested if tight control reduced complications. They found tight control did - but also increased the risk of hypos.

 

[Pumper_Sue]

My nurse advised a version of this initially - have a meal with no carbs and see what happens. I did this and had to drop my basal - dropped it again when I was hypo before meals. Thank you for reminding me this is an option 🙂

It's a waste of time doing no carb meal as the fat and protein you eat will raise your blood sugars, why it's skip a meal time 🙂

 

[pawprint91]

It's a waste of time doing no carb meal as the fat and protein you eat will raise your blood sugars, why it's skip a meal time 🙂

Thank you - not sure if my stomach can take this without thinking my throat has been cut

Edit: Although google tells me fat and protein shouldn't raise blood sugars ... would they be doing so because of the lack of carbs in a carb free meal?

 

[Sally71]

Thank you - not sure if my stomach can take this without thinking my throat has been cut

Edit: Although google tells me fat and protein shouldn't raise blood sugars ... would they be doing so because of the lack of carbs in a carb free meal?

Probably. Some people actually have to give themselves insulin for protein if they aren’t eating carbs. I remember once trying to basal test my daughter, really fun trying to tell a 7 year old that they can’t eat anything all day, so we had a list of acceptable snacks - one scrambled egg, one frankfurter etc. These things are pure protein and are not supposed to raise your blood sugar, but every single time she ate one her blood sugar went up. Not by much, but it still ruined the test!

 

[Pumper_Sue]

Probably. Some people actually have to give themselves insulin for protein if they aren’t eating carbs. I remember once trying to basal test my daughter, really fun trying to tell a 7 year old that they can’t eat anything all day, so we had a list of acceptable snacks - one scrambled egg, one frankfurter etc. These things are pure protein and are not supposed to raise your blood sugar, but every single time she ate one her blood sugar went up. Not by much, but it still ruined the test!

I'm not sure but think it was Bev many years ago who said that she had to count eggs as if eating 4gms of carbs per egg. Would the info be in Bev's night in (food forum)

Only thing I have heard you can eat is sugar free jelly.

 

[Sally71]

I'm not sure but think it was Bev many years ago who said that she had to count eggs as if eating 4gms of carbs per egg. Would the info be in Bev's night in (food forum)

Only thing I have heard you can eat is sugar free jelly.

Yes because that’s basically just water with some colouring in We did have those too but she didn’t really like them. We find since then we rarely need to basal test, but when we do we do it properly!

 

[Pumper_Sue]

Yes because that’s basically just water with some colouring in We did have those too but she didn’t really like them. We find since then we rarely need to basal test, but when we do we do it properly!

They taste better if you add sugar free squash to them when making 🙂