Hypos

[Newbie777]

Thanks I am not sure if I had genuine hypos now or just low BG, but each time I did my eyesight was bit blurry.

I am now showing 5.3 CGM and 6.3 on the strip, but have only taken one glicizide today.

I need to stop the hpos ASAP, don't mind if I go a hit higher on BG, am at home with my wife and kids but sometimes am away from on my own, so will not take chances with getting an Hypo. Just need a bit if stability with my BG and work out what medicines to use and wht to get rid of.

So will have some beans on toast with cheese, 2 slices and some chips and will take my 500mg metformin, too hopefully enough done so as not to get hypo and I don't mind the BG a bit raised at the moment so a BG read of less than 8 tomorrow. Morning would be great.

 

[Inka]

What is a hypo (hypoglycaemia)?

A hypo is when your blood sugar level, also called blood glucose level, drops too low. This is usually below 4mmol/l. A hypo, also called hypoglycaemia, can happen quickly. So it’s important to always have hypo treatments with you. It's also important to know what the signs are and how to treat...

www.diabetes.org.uk

Sorry just seen this now, oh OK, then I will eat the dextrose tablets 5 of them and a biscuit or the gel and a biscuit, will be trial and error, but will get it right

Depending on your blood sugar, 2 or 3 Dextro should work ok. You mention your blood sugar ‘takes a long time’ to come back up after your hypo treatment, but 15 mins is normal. Keep testing if you feel worried, but it does take around 10-15 mins to see a rise, and even then that might not be the full rise.

 

[rebrascora]

You mention your blood sugar ‘takes a long time’ to come back up after your hypo treatment, but 15 mins is normal.

I am guessing this may be because @Newbie777 has been relying on Libre which has a delay when levels are changing direction rather than finger pricking or it may be because they have been eating an apple first or a combination of the two.

If only taking Gliclazide in the morning then the chances of a real nocturnal hypo are very low.

Beans on toast with chips is a pretty carb rich meal! Carbs in the bread, carbs in the beans and carbs in the chips.

 

[Newbie777]

I am guessing this may be because @Newbie777 has been relying on Libre which has a delay when levels are changing direction rather than finger pricking or it may be because they have been eating an apple first or a combination of the two.

If only taking Gliclazide in the morning then the chances of a real nocturnal hypo are very low.

Beans on toast with chips is a pretty carb rich meal! Carbs in the bread, carbs in the beans and carbs in the chips.

Yes I have been too reliant on Libre.

After a hour of eating my CGM Is 7.7 and test strip is 8.5, so another hour to go.

Sorry the bread was seeded and 4.8g carbs per slice but the beans and the fries are high carbs.

I think I may have the solution now, but it does mean I stick to 4 different medicines for Diabetes.

1x 100mg Canagaflorzin before breakfast
1x 80mg Glicizide before breakfast
1 500mg Metfomin with breakfast.
1 x 5mg Trajenta with food at lunchtime.
1x 500mg Metformin with food at tea time.

Hopefully, this may give me slightly raised BG which is fine as I will be going gym starting tomorrow.

Will use test strip when CGM alarm is showing 5.0 and getting lower, then if it is hypo will have the glucose gel and biscuit and will use the test strip after 15 minutes until normalised.

Key to this working is if BG levels dropping by small amount in 1 hour and then a very small amount tonight, otherwise will need to have one or two biscuits tonight before bed and monitor at night and early motning, like I said will be happy if my BG is on the slightly high side

 

[Leadinglights]

Yes I have been too reliant on Libre.

After a hour of eating my CGM Is 7.7 and test strip is 8.5, so another hour to go.

Sorry the bread was seeded and 4.8g carbs per slice but the beans and the fries are high carbs.

I think I may have the solution now, but it does mean I stick to 4 different medicines for Diabetes.

1x 100mg Canagaflorzin before breakfast
1x 80mg Glicizide before breakfast
1 500mg Metfomin with breakfast.
1 x 5mg Trajenta with food at lunchtime.
1x 500mg Metformin with food at tea time.

Hopefully, this may give me slightly raised BG which is fine as I will be going gym starting tomorrow.

Will use test strip when CGM alarm is showing 5.0 and getting lower, then if it is hypo will have the glucose gel and biscuit and will use the test strip after 15 minutes until normalised.

Key to this working is if BG levels dropping by small amount in 1 hour and then a very small amount tonight, otherwise will need to have one or two biscuits tonight before bed and monitor at night and early motning, like I said will be happy if my BG is on the slightly high side

That is good you have a plan and see how it works out, the best thing is not to change too many things at once if it is not quite right after trying the same for a few days.
It might be better to delay the gym for a few days to see how your new plan works.
You could always go and see as they would usually want to do a assessment and introduction before you start on an exercise program, best to start gently and build up if you haven't done any exercise in a while.

 

[Newbie777]

Thank you, yes I agree.

I have the membership for 10 months now and used to go every 3 days, doing CV stuff and then low resistance weights on upper body and then next time on my legs, trust me I dont really exert myself, typical Northerner very laid back.

 

[Newbie777]

Gwttubg ready for bed not good news, cgm 5.4 and rest strip 6.3... Damn can see this dropping more at night/early.morning

Thinking will have some white bread two pieces with butter now and check throughout the morning.

BTW the reads 2 hours after food was 10. 0 test strip and 8.8 cgm.

 

[Leadinglights]

Gwttubg ready for bed not good news, cgm 5.4 and rest strip 6.3... Damn can see this dropping more at night/early.morning

Thinking will have some white bread two pieces with butter now and check throughout the morning.

BTW the reads 2 hours after food was 10. 0 test strip and 8.8 cgm.

It almost feels like you need to go back to the drawing board with the medications as if you are newly diagnosed where you might be started on metformin and make dietary changes which you seem to be doing anyway and closely monitor what happens with those low carb meals.
It would be worth asking for a complete medication review given you are struggling with fluctuating highs and lows. Though if you di have a higher carb meal as you said you were going to then 10 / 8.8 which is really 9 would be likely. Those 2 reading are essentially the same and within the accuracy of both devices.

 

[rebrascora]

Why are you having white bread at bedtime? 6.3 is a perfectly good number.... a normal number. Yes it has dropped from 9 -10 2 hours after your meal, but it is supposed to do that. It should not continue to drop but stabilize at these normal levels.
One slice of white bread is going to be about 17g carbs, so 2 slices is over 30g carbs.
They generally suggest when you start on insulin that 10g carbs will raise your BG by about 3mmols, so 30g carbs could raise your levels as much as 9mmols, so if you add 9 and 6.3 you are looking at mid teens which is not a healthy level and your body and particularly your kidneys, will have to work during the night to try to bring those levels down. A single jelly baby which is about 5g carbs will likely raise your levels by about 1.5 mmols, so that would take your 6.3 up to about 7.8mmols. That is still slightly higher than a normal person, but isn't going to cause your body nearly so much of a problem as 2 slices of toast or even just one slice. I know you are worrying about hypos but you are counteracting all the medication you are taking by then eating bread to push your levels higher.

It would be different if you were on insulin, but you are not and the only medication which could potentially cause you to hypo is the gliclazide but you took that in the morning before breakfast, so it should be gone.

 

[Proud to be erratic]

Can you provide a reference for this as it is contrary to my experience and what I have read?

@helli, that is not my experience. We regularly tell each other that we are all different and I suspect that you and I have very different fitness levels. In former years I have been extremely fit, alas in the last 5 years I'm now constrained more than I like by health issues (and age).

My references would be from my personal experiences in the last 4 years and supported by various articles I read during 2021 and through into 2022. At that time, with my newly provided CGM (Libre 2), I was trying to make sense of how to adjust my bolus doses to accommodate forthcoming exercise and activity. Before that time I knew nothing about insulin dependence and on MDI with only FPs I was really roller coastering from some deep and lengthy hypos rapidly into hypers in the 20s. That "before CGM" period was pretty miserable at times.

The DUK online T1 Conference in the autumn in (I think) 2022 further informed me; a particular speaker gave his presentation on Exercise and Activity. I have the notes I scribbled down at the time - but these are still in storage (due final release for good behaviour, next week). But they may not see daylight for several weeks; so much else to be unpacked and placed.

In my experience, a full on cardio work out significantly reduces my BG.

And in my experience a full on Cardio workout is as intense as I can manage these days. This will (does) quickly raise my BG significantly; it does eventually drop (crash usually unless I anticipate it properly), but I attribute that speed of fall directly to my total pancreatectomy and consequent brittleness of my D.

Steady walking works best for me and I can happily walk most of a day. That gives me a degree of control (ie reasonable BG management); I still need to adjust my bolus dosing for such days and can often make a 75% reduction of bolus for that post activity meal. Mowing my own and my daughter's lawns (a few houses away and hers is on 3 levels) is my equivalent of a full gym workout; I invariably regret taking that on, since it just plays havoc with my BG management.

However my intention in that post was to encourage @Newbie777 to return to some exercise and fitness training as soon as practical for him. And to not overdo that exercise after many months away from the gym. It may well be I could have added to those particular words with "this works well for me". However, having read my post again I think my immediate subsequent sentence:
"Once again I caveat my remarks: we are all different and what works for one person may not work for another"
goes some way towards that objective.

This has been a relatively fast moving thread, with now 50 posts in some 30 hrs and I've had to erode my beauty sleep to get this reply to you, before I step away for a while and look to where (and how) we are going to stow everything coming out of storage on Monday! At the very least in the coming weeks there will be multiple "Hanging Committees" needed to be commissioned, for the final detailed approvals of each picture's next resting place. Busy weeks ahead.

 

[Newbie777]

Why are you having white bread at bedtime? 6.3 is a perfectly good number.... a normal number. Yes it has dropped from 9 -10 2 hours after your meal, but it is supposed to do that. It should not continue to drop but stabilize at these normal levels.
One slice of white bread is going to be about 17g carbs, so 2 slices is over 30g carbs.
They generally suggest when you start on insulin that 10g carbs will raise your BG by about 3mmols, so 30g carbs could raise your levels as much as 9mmols, so if you add 9 and 6.3 you are looking at mid teens which is not a healthy level and your body and particularly your kidneys, will have to work during the night to try to bring those levels down. A single jelly baby which is about 5g carbs will likely raise your levels by about 1.5 mmols, so that would take your 6.3 up to about 7.8mmols. That is still slightly higher than a normal person, but isn't going to cause your body nearly so much of a problem as 2 slices of toast or even just one slice. I know you are worrying about hypos but you are counteracting all the medication you are taking by then eating bread to push your levels higher.

It would be different if you were on insulin, but you are not and the only medication which could potentially cause you to hypo is the gliclazide but you took that in the morning before breakfast, so it should be gone.

Yes I wrongly thought may go hypo even though only took one Glicizide in the morning! Oops.

Rightly so my BG was high this morning so 11.0 with the strip and 10.7 on the CGM.

Now will try Plan B.

Usual breakfast, so lowish carbs, like boiked egg my cereal or high life bread.

The change now is lunch time. I will now focus on a higher carb meal, jacket potato with tuna, curry with almond flour chapati, haddock with batter, beans on toast. Thin is an important step for me.

Evening meal will be lower carb higher protein.

Will carry on with nuts as snacks as well as strawberries, blueberries with Greek yogurt.

1 hour before bed will check my BG with strip, if it is below 5.5, I will have an apple, otherwise am good.
Will also see if I can get hold of a Diabetic specialist dietician.

For now I wwill stick to 1000mg Metformin, 80mg Glicizide, 5mg Trajenta and 100mg Canagilflozin.

Will monitor my meds for a few weeks to stabilise everything, worst case scenario may need add Glicizide, best case scenario may go off Trajenta,either way will seek medical advice BEFORE I do anything.

Good news, I went to the Gym this morning, very light 30 minutes.So 3 times a week to start off with., may need to increase my carbs if my workouts get intense but it is more likely for pigs to fly. Lol

I also have my Hba 1c blood test on Monday and my last one was 117! so hoping for 70 or below ideally, but if it is higher know am on the right path.

I have tried taking the good advice from everyone here and I am grateful., thank you.

I think also our bodies and tolerances and medical conditions are all different and so what works on one person may not work on another, but the key thing is to listen, try, adapt and change in a controlled manner.

In hindsight I should have looked after my BG years back and have made mistakes, but I am now looking forward and have experience behind me and will try not to make the same mistakes.

Inetesring thread and comments thank you all.

 

[Newbie777]

@helli, that is not my experience. We regularly tell each other that we are all different and I suspect that you and I have very different fitness levels. In former years I have been extremely fit, alas in the last 5 years I'm now constrained more than I like by health issues (and age).

My references would be from my personal experiences in the last 4 years and supported by various articles I read during 2021 and through into 2022. At that time, with my newly provided CGM (Libre 2), I was trying to make sense of how to adjust my bolus doses to accommodate forthcoming exercise and activity. Before that time I knew nothing about insulin dependence and on MDI with only FPs I was really roller coastering from some deep and lengthy hypos rapidly into hypers in the 20s. That "before CGM" period was pretty miserable at times.

The DUK online T1 Conference in the autumn in (I think) 2022 further informed me; a particular speaker gave his presentation on Exercise and Activity. I have the notes I scribbled down at the time - but these are still in storage (due final release for good behaviour, next week). But they may not see daylight for several weeks; so much else to be unpacked and placed.

And in my experience a full on Cardio workout is as intense as I can manage these days. This will (does) quickly raise my BG significantly; it does eventually drop (crash usually unless I anticipate it properly), but I attribute that speed of fall directly to my total pancreatectomy and consequent brittleness of my D.

Steady walking works best for me and I can happily walk most of a day. That gives me a degree of control (ie reasonable BG management); I still need to adjust my bolus dosing for such days and can often make a 75% reduction of bolus for that post activity meal. Mowing my own and my daughter's lawns (a few houses away and hers is on 3 levels) is my equivalent of a full gym workout; I invariably regret taking that on, since it just plays havoc with my BG management.

However my intention in that post was to encourage @Newbie777 to return to some exercise and fitness training as soon as practical for him. And to not overdo that exercise after many months away from the gym. It may well be I could have added to those particular words with "this works well for me". However, having read my post again I think my immediate subsequent sentence:
"Once again I caveat my remarks: we are all different and what works for one person may not work for another"
goes some way towards that objective.

This has been a relatively fast moving thread, with now 50 posts in some 30 hrs and I've had to erode my beauty sleep to get this reply to you, before I step away for a while and look to where (and how) we are going to stow everything coming out of storage on Monday! At the very least in the coming weeks there will be multiple "Hanging Committees" needed to be commissioned, for the final detailed approvals of each picture's next resting place. Busy weeks ahead.

Thanks and started this morning going to gym and will do regularly, slowly at first

 

[SB2015]

You are working through systematically which is good, as it is difficult to sort issues if changing many things at a time. Well done.

With regard to low BG I know that when I first had hypos (below 3.5) it was so easy to overdose on quick carbs, and also very hard to wait the normal 15 min for my levels to rise. I stick to using quick acting carbs such as jelly babies, and these are easier to limit. If I use biscuits or other things containing fat the rise will take longer. For a full on hypo I will use three JBs then wait …. If you over treat a hypo it may well be that your body is then releasing insulin in response and causing the ups and downs.

If your body is used to having higher glucose levels you will feel weird at normal levels (5 - 7). It takes some getting used to.

Keep going with the step by step approach.

 

[Newbie777]

Thank you very much, yes it is true I used to feel weird getting reads of 5 to 7, as my fastinh reads were always 10 to 14!

Am not supposed to have jelly beans as they have gelatine, but I do have the dextrose tablets and now have the hypo kit with the gels.

I need to quickly sort out the hypo bit as that will hinder my work life balance, as I work away from home.

Also I have learnt that Libre is not accurate and so I may have been panicking prematurely

 

[Leadinglights]

Thank you very much, yes it is true I used to feel weird getting reads of 5 to 7, as my fastinh reads were always 10 to 14!

Am not supposed to have jelly beans as they have gelatine, but I do have the dextrose tablets and now have the hypo kit with the gels.

I need to quickly sort out the hypo bit as that will hinder my work life balance, as I work away from home.

Also I have learnt that Libre is not accurate and so I may have been panicking prematurely

I'm pretty sure you can get gelatine free jelly babies or jelly beans but check if they still have about 5g carbs each.

 

[rebrascora]

Glucose tablets are of course fine and many people just use those for hypos so no reason why you shouldn't continue with them. Some of us just find jelly babies cheaper and more easily sourced, ie most corner shops sell them

 

[Newbie777]

I'm pretty sure you can get gelatine free jelly babies or jelly beans but check if they still have about 5g carbs each.

Thank you, where there is a will there is a way

 

[Newbie777]

Glucose tablets are of course fine and many people just use those for hypos so no reason why you shouldn't continue with them. Some of us just find jelly babies cheaper and more easily sourced, ie most corner shops sell them

Yes I agree but I am hoping that I need to use them soon 🙂

 

[rebrascora]

Yes I agree but I am hoping that I need to use them soon 🙂

I am assuming you mean "DON'T need to use them soon"

 

[Newbie777]

Oops sorry