Overtreating hypos

[Flower]

How do you manage not to overtreat hypos?

I completely panic thinking I am seconds away from disaster and over do my glucose intake. How do you remain calm waiting for glucose to kick in? Waiting 10 minutes before re testing seems like an age.

I've changed my first treatment to 3 jelly babies so I can be more controlled but I still find myself having extra glucose drinks just in case. My day yesterday involved 4 hypos and 4 rebound highs. I know glucose will work but I don't seem to be able to be rational about it.

 

[novorapidboi26]

I suppose it depends on how quick the hypo has came on as the symptoms can be quite severe.

So in the long run, you should try and get the hypos you will have to come on gradually, not that easy though, as none of us want hypos, never mind trying to engineer them...

When I over treat a hypo its purely a choice out of enjoyment, I do try and get some insulin in as well though.

For you I guess it just a case of learning over time that you will be OK, training your self to have only what is required to treat the hypo....


Your body will assist you, as long as your liver has a full stock of glucose....

 

[everydayupsanddowns]

It's very difficult. And you are righht... waiting those minutes to make sure everything is back on track can take an age.

The gluco-coaster is no fun at all

For me the bigger question for you to tackle is *why* you are having all those hypos. 4 in a day is a lot IMO. Was there something unusual about yesterday? If not are you now running an TBR to reduce your basal today until you can work out what is going on?

 

[Northerner]

How do you manage not to overtreat hypos?

I completely panic thinking I am seconds away from disaster and over do my glucose intake. How do you remain calm waiting for glucose to kick in? Waiting 10 minutes before re testing seems like an age.

I've changed my first treatment to 3 jelly babies so I can be more controlled but I still find myself having extra glucose drinks just in case. My day yesterday involved 4 hypos and 4 rebound highs. I know glucose will work but I don't seem to be able to be rational about it.

I tailor my treatments to the hypo. As suggested, some hypos come on quicker than others and these can have more severe symptoms. I try and take into account possible reasons for the hypo and likelihood it will go much lower. For example, if I find I am 3.7 five hours after my last injection then I will just have one jelly baby to increase my levels a little before my next meal. If, however, I suddenly find myself at 2.7 just 2 or three hours after my last injection then I will be fairly sure that I injected too much insulin, so will have 3 jelly babies. For a really bad hypo I will go for some coke/lucozade as this will act more quickly for me. For a fast-falling hypo I won't always wait 15 minutes before rechecking and treating again if I feel I need more. I'm reasonably well-disciplined though, and for me the aversion to high levels is greater than my aversion to lows, which I have proven to myself that the vast majority are simple and easy to treat.

I know this probably doesn't help you much, but just really saying that I have in my mind the scale of the hypo and what it will need to treat it, rather than every hypo being open-ended.

What levels are you normally at when you have hypos? Can you usually explain why you are having them?

 

[AlisonM]

I tend to treat in stages Flower, have a jelly baby or two and wait 10-15 minutes then test. If numbers come up, wait another 10-15 and test again. If they stay up, panic over.

I sometimes get persistent hypos when I struggle to keep my numbers off the floor, which means my BGs may come up a bit then fall again. That's when I tend to panic and go for something high carb like a slice of apple pie, a banana toastie or a few chips, that usually does it. I suspect the cause of the persistent hypos is the LADA effect. Sometimes, increasingly rarely, my pancreas works and I end up with too much insulin floating around... possibly.

 

[newbs]

I tend to treat in stages Flower, have a jelly baby or two and wait 10-15 minutes then test. If numbers come up, wait another 10-15 and test again. If they stay up, panic over.

I sometimes get persistent hypos when I struggle to keep my numbers off the floor, which means my BGs may come up a bit then fall again. That's when I tend to panic and go for something high carb like a slice of apple pie, a banana toastie or a few chips, that usually does it. I suspect the cause of the persistent hypos is the LADA effect. Sometimes, increasingly rarely, my pancreas works and I end up with too much insulin floating around... possibly.

Mmmm, a banana toastie - never tried that one but will be sure to very soon.

I tend to overtreat when my blood is very low and usually reach for a large slice of something tasty then ... but if it is a hypo in the 3s then I usually just treat with lucozade and a biscuit. My brother has always overtreated though, I think he just loves the chance to eat something he otherwise wouldn't .

 

[DeusXM]

I find the trick is careful measurement, distractions and "pretend" treating.

15g is usually enough to you on the straight and narrow again, so I try to treat the initial hypo with something that can be clearly counted and measured, such as 3 jelly babies or 4 glucotabs.

Once that's in, I then will try to distract myself for 15 minutes - I'll try to focus on a magazine or put News 24 on. The trick is to keep telling yourself you've treated the hypo and you just need to read to the end of the page before doing anything.

If you still have an overwhelming urge to eat and drink, make sure you've got things close to hand that won't raise your blood sugar. Sugar free jelly and squash can help fool your brain into thinking you're getting sugar whereas all you're getting is flavour and bulk. I also tend to graze on something like salami or biltong - basically, the point is to satisfy your body's urge to eat but without getting more glucose in.

All of this is easier said and done, of course. But this approach, when it does work, has saved me from panicking when treating sleep hypos - there's nothing worse than waking up in the teens after a 'nypo' and I have a stack of thumbed and food stained Private Eyes that have saved me from this!

 

[trophywench]

LOL

I have a very nice shot glass marked with a magic marker to the required level of Lucozade. Kept solely for that purpose and that's what I use.

It was a free one with Tabasco sauce and it has a 'lighted bomb' on it!

 

[Flower]

Thanks for the replies, it is a difficult area for me as I have no hypo awareness of my own and am completely reliant on cgm to alert me. As cgm uses interstitial glucose, the figure showing on my pump screen is lagging about 10 minutes behind my blood glucose. The time lag really comes into play with hypos as even once you have treated the hypo the figure displayed on the pump screen still indicates you are dropping. I should stop looking at the cgm results when hypo, focus on my meter instead and hide the lucozade and jelly babies to avoid over doing it.

 

[AlisonF]

Id agree with you re cgm - it takes far too long to show you starting to rise, I always use a blood test if I want reassurance than im going up.

I find the cgm very helpful though as I can see the speed of the hypo. If I see im dropping gentlyi can eat a little and give it time to work. If I have double down arrows and a legful of insulin on board im a little less relaxed! Do you react the same to all hypos? If so is it worth raising your low alarm so you're alerted earlier and have more time to react?

 

[Redkite]

Thanks for the replies, it is a difficult area for me as I have no hypo awareness of my own and am completely reliant on cgm to alert me. As cgm uses interstitial glucose, the figure showing on my pump screen is lagging about 10 minutes behind my blood glucose. The time lag really comes into play with hypos as even once you have treated the hypo the figure displayed on the pump screen still indicates you are dropping. I should stop looking at the cgm results when hypo, focus on my meter instead and hide the lucozade and jelly babies to avoid over doing it.

Just wondered - do you make use of the rate of change alerts with your sensors? My son only wears a sensor occasionally as we are not NHS funded, but they are so useful at preventing hypos - if he gets an alert for a steep drop (double arrows down) he would test his BG even if the sensor is showing one in the 6's or 7's, because chances are the true BG could already be in the low 4's. This way he can have a small snack and prevent an impending hypo.

 

[Flower]

I do use the rate of change alerts with the sensor and react to both single and double arrows down, I tend to suspend the pump rather than eat if I am still above 4, I'll start having some glucose instead. I seem to plummet through the 3s and am often in the high 2s when I test after a predicted low alarm. It's a balancing act to set the low alarm so that it isn't alerting when you are low 4s but still giving yourself enough time to react to hypos. I think some fun basal testing is in order to see if I can get a better grip on my hypos and stop the glucose rollercoaster.

 

[Northerner]

Good luck Flower, it must be very difficult when you have no hypo awareness.

 

[Redkite]

I do use the rate of change alerts with the sensor and react to both single and double arrows down, I tend to suspend the pump rather than eat if I am still above 4, I'll start having some glucose instead. I seem to plummet through the 3s and am often in the high 2s when I test after a predicted low alarm. It's a balancing act to set the low alarm so that it isn't alerting when you are low 4s but still giving yourself enough time to react to hypos. I think some fun basal testing is in order to see if I can get a better grip on my hypos and stop the glucose rollercoaster.

Oh I agree, it's tricky to set the threshold so that it isn't "nuisance alarming" all the time. In fact we turn them off at night for that reason, and only leave the low suspend on (I get up at 2/3am anyway to test him). The trouble with changing basal is that it needs a lead time, ie planning ahead, so if my son is on a downward trend but is still 5 or 6 mmol, I can set a reduced temp basal and all will be fine. But if he is in the 4's, the reduced temp can't prevent him dipping into hypo territory before the rise. I think there is a time lag of around an hour when you make basal changes, ie what the basal is at 10 affects what the BG will be at 11. So if in the low 4's he has to have carbs! Of course, if the insulin was going straight into the bloodstream like it would from a pancreas, there wouldn't be any time lag.

 

[Kim23]

Thanks for the replies, it is a difficult area for me as I have no hypo awareness of my own and am completely reliant on cgm to alert me. As cgm uses interstitial glucose, the figure showing on my pump screen is lagging about 10 minutes behind my blood glucose. The time lag really comes into play with hypos as even once you have treated the hypo the figure displayed on the pump screen still indicates you are dropping. I should stop looking at the cgm results when hypo, focus on my meter instead and hide the lucozade and jelly babies to avoid over doing it.

Hi Flower, just seeing ur comment about no awareness..are you on list for a hypo-alert dog? My best mate lost her symptoms a couple years ago and tbh both us didn't know that existed! She has had Toby a 3 yr Labrador for nearly 2 years now and he has given her so much confidence and comfort ass he found cgm with the time difference difficult to sort out xx