Post hypo advice please

[pippaandben]

I have good hypo awareness and use the 15g and 15 minute test rule. If less than 1mmol change then another 15g fast acting. Once more than 1mmol change then slow acting snack.

Then what? For my next meal do I bolus as normal - or is it dependant on the length of time after the slow carb snack ie if within 2 hours take less insulin?
I have had massive rebounds up to 13 or 18 but my diabetes dietician has explained the muscle and liver release of glucose (she also takes the Dafne course so have had my second 1 hour 1:1 with her, after taking the Desmond course last summer with her before moving onto insulin). I think I have been very lucky in that repsect.

I am having problems in coping with good weather gardening/painting etc which is causing me to drop to low 4s and high 3s. Things which I had never considered as "exercise". Do I carb up beforehand? I tried sipping juice when mowing the lawn yesterday with no symptoms but then an hour after finishing went down to 3.5 with the sweats and shakes. As I only started MDI in January I have not had this problem before.

 

[everydayupsanddowns]

I can only offer my own experience - not what might (or might not) work for you.

It didn't take me long to stop having the suggested 'follow up' carbs after a hypo. I would *always* end up in the high teens whenever I had a snack following a hypo. Without the snack it seemed much easier to come up 'into range' and then just stay there.

I've not routinely 'followed up' a hypo for over 20 years. What I do need to bear in mind though, is what caused the dip in the first place, and how fast and how far I went down. Occasionally I will re-treat and/or have a biscuit, but only under certain circumstances where I feel that a further fall in BGs is likely.

You are not the only one who finds gardening/DIY means you need a bunch of extra carbs! And yes, I do find it helpful to eat a little something before/during (and/or set a TBR to reduce active insulin).

All I can suggest is that you just experiment and see what works for you most of the time. Treat the hypo with 15:15 but try dropping the snack a few times and see what happens... Experiment with amount and distribution before/during/after of extra carbs where activity is involved and kinda work out a couple of 'rules of thumb' that seem to give decent results 🙂

 

[Redkite]

Hi pippaandben,

Are you on fixed doses or do you adjust your insulin yourself (assuming the latter as you've mentioned DAFNE)? If you're planning an activity which you know causes your levels to run low (for you, gardening in the sunshine!), you could make a slight reduction in your insulin dose at the meal beforehand. I would treat it like any other planned exercise, and experiment with suitable carb snacks (without insulin). 🙂

 

[pippaandben]

Hi pippaandben,

Are you on fixed doses or do you adjust your insulin yourself (assuming the latter as you've mentioned DAFNE)? If you're planning an activity which you know causes your levels to run low (for you, gardening in the sunshine!), you could make a slight reduction in your insulin dose at the meal beforehand. I would treat it like any other planned exercise, and experiment with suitable carb snacks (without insulin). 🙂

Redkite - I am on 1:12 carb ratio after starting on 1:10 4 months ago. My basal is 6 units am and evening. I correct at 1unit to 3mmol. I do not have any other planned exercise - that is the problem!!! LOL

 

[Redkite]

Redkite - I am on 1:12 carb ratio after starting on 1:10 4 months ago. My basal is 6 units am and evening. I correct at 1unit to 3mmol. I do not have any other planned exercise - that is the problem!!! LOL

I can identify with that!!

If you are gardening/painting every day and are consistently in the 3's and 4's, you may need to reduce your morning basal. If the gardening etc is ad hoc, it's best to either have a snack beforehand or reduce your insulin at the meal before you start gardening. Maybe ask your DSN what would be an appropriate reduction to try.

Personally I prefer getting out the garden chair and having a cuppa to actually doing any gardening, but that's probably why I'm losing a battle with weeds and unruly shrubs!! 😉

 

[Northerner]

Gardening is one activity guaranteed to drop my levels! Yesterday, knowing I planned to do some digging and chopping after lunch I reduced my lunchtime insulin and checked after 2 hours (an hour in the garden) - my level was at 4.4! I topped up with a jelly baby and that seemed to be enough to keep my levels steady until teatime. Like Mike, I rarely have a follow-up snack these days, I just keep an eye on my levels and top up again if necessary. I also don't routinely treat a hypo with 15g carbs as usually this would be too much for me - if I am in the mid-3s then usually just 5g is sufficient, low-3s maybe 10g. In time you will build up an intuition for what is appropriate according to when you injected, what you have been doing, how long to your next meal etc. 🙂