Post hypo advice please.

[pippaandben]

I have good hypo awareness and know what to do but am a little at a loss as to when I can bolus for meals after one - and do corrections.
Hopefully I am now past the stage of panicking and over treating and so far I have usually found a good reason for them.
Late yesterday afternoon when preparing our evening meal - veg on and fish cooking - I had one. Sweating profusely, palpitations, jelly legs. Tested within a couple of minutes. 2.4!! One bottle of glucojuice and 15 minutes later 5.8. 15 minutes again and 6.2. The reason was a lovely slice of cheesecake - I thought - which I treated myself to when shopping on my own and feeling down with with loads of schoolkids around acting stupid. Turned out to be more a creamy mousse so I had obviously over bolused for it.
Now after this half hour I am feeling fine - all symptoms gone, BS in normal range for me at a pre meal level.

1. Should I have bolus this meal - I didn't - too scared to. Should have been 6 units.

2. Do I bolus for mid evening snack say about 2+ hours later? I did a very exact count and under injected by half a unit with no correction which would usually have been a further unit

3. Should I have done basal which I usually do pre evening meal? I was too scared to again. I have 6 units am and the same pm

This morning my BS was 9.3 about 3-3.5 higher than normal so I know I did - or rather didn't do- the right thing. It seems perhaps I was right not to cover my meal as it was so close to the hypo and I should have covered the snack in full including correction as that would have given me the same as I have to give as a correction this morning.

My ratios at present are 1 unit for 12g and 1 unit for 3mmol blood sugars using a half unit pen for basal and bolus.Thoughts please.

 

[Northerner]

1. Should I have bolus this meal - I didn't - too scared to. Should have been 6 units.

2. Do I bolus for mid evening snack say about 2+ hours later? I did a very exact count and under injected by half a unit with no correction which would usually have been a further unit

3. Should I have done basal which I usually do pre evening meal? I was too scared to again. I have 6 units am and the same pm

This morning my BS was 9.3 about 3-3.5 higher than normal so I know I did - or rather didn't do- the right thing. It seems perhaps I was right not to cover my meal as it was so close to the hypo and I should have covered the snack in full including correction as that would have given me the same as I have to give as a correction this morning.

My ratios at present are 1 unit for 12g and 1 unit for 3mmol blood sugars using a half unit pen for basal and bolus.Thoughts please.

This has happened to me on occasions. Personally, once I have treated the hypo and got my levels back up to the 5s or 6s then I would just carry on as normal, bolusing for the meal and taking my basal as per usual, as long as I knew the cause of the hypo. If it was completely unexpected i.e. I thought I had done everything right, then I might be a little more cautious and lower my meal bolus, as it may have been due to an increased insulin sensitivity. 🙂

 

[pippaandben]

Thanks Northerner. I was wary about the meal as it would have meant injecting only an hour after the hypo so not sure if the increase would be maintained or drop back..
I now realise the basal would have been ok as it takes longer to have any affect, and should have done the snack and correction in full.
Perhaps being that close I should have done a one hour test after meal and done the correction then?

 

[Northerner]

Thanks Northerner. I was wary about the meal as it would have meant injecting only an hour after the hypo so not sure if the increase would be maintained or drop back..
I now realise the basal would have been ok as it takes longer to have any affect, and should have done the snack and correction in full.
Perhaps being that close I should have done a one hour test after meal and done the correction then?

Yes, I think that would have been a good idea as you can have stubborn hypos that may need extra treatment. I usually take into account when my last bolus was before the hypo, and whether I am likely to have much of that insulin still circulating - if it's 4 or 5 hours after then I know there will be far less likelihood of it falling again after treatment 🙂 Let's hope it's not something you have to think about very often! 🙂

 

[everydayupsanddowns]

Yes, I think that would have been a good idea as you can have stubborn hypos that may need extra treatment. I usually take into account when my last bolus was before the hypo, and whether I am likely to have much of that insulin still circulating - if it's 4 or 5 hours after then I know there will be far less likelihood of it falling again after treatment 🙂 Let's hope it's not something you have to think about very often! 🙂

Yup... that's pretty much what I do. Though to be honest it takes Novo(notvery)Rapid such an age to get going for me that I can quite happily dose while still hypo as long as I don't have lots of insulin sloshing about from earlier doses!

Your numbers suggest your approach wasn't too far off thought P&B 🙂

 

[trophywench]

On MDI the advice always was to NOT correct until the mealtime after next. ie ignore high pre prandial and just bolus as per normal, then leave it again until next pre-prandial.

In the case of hypoing when I am where you were, I'd have bolused proper amount but AFTER I ate. No correction as it wasn't a reliable pre-prandial BG.

Then when I fancied a snack later, would have corrected and bolused.

In the case of it being caused by prior 'exercise' I'd knock 20% off everything, basal, correction and bolus.

 

[pippaandben]

On MDI the advice always was to NOT correct until the mealtime after next. ie ignore high pre prandial and just bolus as per normal, then leave it again until next pre-prandial.

In the case of hypoing when I am where you were, I'd have bolused proper amount but AFTER I ate. No correction as it wasn't a reliable pre-prandial BG.

Then when I fancied a snack later, would have corrected and bolused.

In the case of it being caused by prior 'exercise' I'd knock 20% off everything, basal, correction and bolus.

That's great - thank you very much. I have now written down your advice in my hypo bag. Just when I thought I had it all sussed MrD throws you a googly. Still at least now I can hit him back.