Preparing for first hypo

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Reptile

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Relationship to Diabetes
Type 2
I've never had one but understand that gliclazide makes them possible.

I have some questions for the more experienced please:

Should I know by the way I feel and take action or must I confirm with a test?

I've bought a couple of small bottles of lucasade, a large snickers, and prepared several little tuppaware boxes with five jelly babies. Am I on the right track with these?

I've seen glucose gels advertised. Would these be better than the above?

Many thanks in advance for your wisdom.
 
That must be distressing knowing that it's possible to happen but not knowing what it's going to be like. I'm sure that some of those who take gliclazide will be along soon to advise.
 
Hi @Reptile I’m Type 1 and have had plenty of hypos. It sounds like you’ve prepared well. The crucial thing is to make sure you have your hypo treatments near to hand and to take them with you when you go out. I like Dextro tablets and always take a packet with me. I also keep a packet by my bed, in my bag, in my coat pocket, etc. I also like the little 150ml cans of Coca Cola. If you’ve bought Lucozade just double-check it has a good amount of sugar in because they’ve reformulated it 😡 Some varieties have very little sugar at all. That’s why I swapped to Coke.

You don’t have to test if you’re sure it’s a hypo, but if it’s early days for you you might want to test to confirm it is, or test out of interest. If you’re about to drive, you should always test and not get behind the wheel until your blood sugar has returned to normal and until you’re safe to drive. If you have a bad hypo, always treat first and then test after.
 
I have only ever used Jelly babies, dextrose tablets or more recently "Fizzy worms". I just don't find it convenient to carry drinks around with me all the time and fizzy drinks would be my last choice, but that is just personal as I can't drink fizzy stuff fast. I also find that just 1 or 2 jelly babies or glucose tablets of Fizzy worms is enough to treat a hypo for me most of the time. 3 JBs or tablets would be what I would consider 15g carbs, which would be the standard hypo treatment.
The general rule of 15 is often quoted ie 15g fast acting carbs to treat a hypo and finger prick again in 15mins to check and then treat again with another 15g fast acting carbs if you haven't come up above 4. If the first treatment worked, then it is sometimes recommended to have 10-15g slower acting carbs to stabilize your levels... something like a digestive biscuit.

Chocolate is usually not advised to treat a hypo because the fat slows down the absorption of the carbs. There is also quite a bit of protein, fat and fibre in peanuts so again, that would slow down the effect of the sugar.

Yes, I always test first because sometimes I have similar symptoms when my BG levels are high as I do when they are low, so it is important to test before treating and carry your test kit with you all the time.

There are a huge array of hypo symptoms and they can be quite individual and they can vary from one hypo to another although usually there will be similarities. You do usually have a decent amount of time to treat a hypo so testing before treating will not cause a dangerous delay... providing you have your test kit on you and not several miles away!
Your first hypos are also likely to be false hypos if your levels have been running high for a while so again, whilst you might feel totally shocking as your levels suddenly drop to 4 or 5 you wouldn't want to be eating 5 Jelly Babies in that situation as it will just push your levels back up again, even though you will likely want to eat the whole packet! Hypos can really make you ravenously hungry until you learn to manage them, so having small portioned hypo treatments can help to stop the yoyoing of going low, eating too much and going too high.

Good luck. Hopefully you won't suffer any hypos but if you do, the key thing is to be prepared and you are clearly tackling that now.. And be reassured, they do get easier to manage and much less traumatic than the first few.
 
When I was on Gliclazide, I did not always have the same symptoms of my hypos. So I would advise you check. I also used Glucose tablets.
 
As others have said, test first, so you can increase your confidence of what they feel like, and use the 15g and 15 minutes rule: take 15g of something fast acting (like jelly babies) and wait 15 minutes and then check again.
 
As others have said, you seem well prepared, @Reptile.
Be aware that chocolate is not good to treat a hypo and the fat in it will slow down the absorption of the sugars. So the large snickers will not bring your levels back up quickly.
 
helli said:
As others have said, you seem well prepared, @Reptile.
Be aware that chocolate is not good to treat a hypo and the fat in it will slow down the absorption of the sugars. So the large snickers will not bring your levels back up quickly.
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..... and probably take you way too high later
 
Many thanks for the carefully written advice. This is really a tremendous help and I very much appreciate the time and thought.

I have little boxes of 10 (not 5) jelly babies on the coffee table, bedside table, car, and coat pocket. I have a 250 ml bottle of lucasade containing 21.3 grams of glucose in the car and another in the fridge. I'll dump the snickers bar.

I'm getting a bit apprehensive as my readings are getting good but therefore quite close to the hypo line. Dinner is a bit behind schedule but I'm coming in at 5.1 now and also have 80mg of gliclazide to take. I'll probably take the gliclazide after dinner tonight. Tonight's dinner also has some carbs in the form of modest portions of green and red lentils and pearl barley.

Next time I order strips from Diabetics Supplies I'll order some glucose chews and gels and ask my wife to test them. She's not diabetic but can identify how quickly the chews dissolve and how it all tastes.

I'll also get some digestive biscuits.

I feel a bit like an alcoholic in withdrawal who's putting bottles of vodka in all the most accessible places...
 
Reptile said:
I'll also get some digestive biscuits.
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What are these for?
Like the snickers, digestives contain fat so are not fast acting carbs and not suitable for treating hypos.

Next time I order strips from Diabetics Supplies I'll order some glucose chews and gels and ask my wife to test them. She's not diabetic but can identify how quickly the chews dissolve and how it all tastes

The gels taste like washing up liquid … or at least what I expect washing up liquid to taste like. For many of us treating our diabetes with insulin, they re an absolute last resort. They work very fast but you have to be pretty low and feeling pretty bad to tolerate them.
I use Lift tablets. They describe themselves as “chewable” but I think of them as chalky crunch. I like them because they come in plastic tubes. Dextrose are common but they come in paper wrapping which does not weather well.
 
Digestives were mentioned 'upstream' in the thread as slower acting carbs to take once the hypo is resolved with very fast acting glucose sources. Something to prevent falling back into hypo soon after the initial recovery.
 
Reptile said:
Digestives were mentioned 'upstream' in the thread as slower acting carbs to take once the hypo is resolved with very fast acting glucose sources. Something to prevent falling back into hypo soon after the initial recovery.
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That is what someone treating their diabetes with insulin would eat but I am not sure they are needed when you are treated with glycazide. I would check with your diabetes team/nurse if this is necessary rather than eating unnecessary carbs.
Sorry, I only have experience of insulin (as, I assume @Bruce Stephens does as a fellow Type 1) and it is different.
 
Thanks, will do, of course. Hopefully I won't be having too many hypos. I just want to be prepared. Thanks to all the responses on this thread, I feel much better prepared than I was.
 
It might be helpful for you to know that absorption of glucose starts in the mouth, so swishing your drink around your mouth before swallowing or chewing your jelly babies or glucose tablets well will often work quicker than getting it into your stomach asap.

Generally there is a decent amount of time to act, so don't panic too much if you have a hypo. One of the symptoms some of us experience is a need to finish whatever we are doing before we go and test/treat a hypo. It is part of the brain's function slowing down and wanting to focus on just one thing and even though we can feel that we are hypo, our focus sometimes continues on the job in hand because we can't prioritize leaving this job and doing what is actually essential. ie testing and treating the hypo. I have often had this problem but eventually I get a grip and head off to test. It can be well over 10-15 mins before I get it into my head that testing and treating is more important but I have never needed assistance from anyone, so it is not a case of having seconds to act or you will lose consciousness or anything like that but the longer you delay, the more likely the risk of losing hypo awareness in the future. I am certainly not recommending delaying treatment but just trying to reassure you that you should have plenty of time to comfortably deal with it if you hypo. In the early days I used to ring someone close to me and tell them where I was and what was happening and perhaps stay on the line to them until my levels came back up and I found that reassuring until I had more confidence in dealing with them.
Great to hear that you are getting some nice in range readings, although I can understand your anxiety. It is normal to be scared of the unknown but don't worry too much. I have about 5-6 hypos a week these days but they are only very minor ones and usually I just take my hypo treatment and then carry on with what I was doing. I had one yesterday whilst out horse riding and apart from stopping to dig some fizzy snakes out of my bag and chew on them, I was able to carry on.
 
PS. I love that you are going to use your wife as a food tester. I hope you will be warning her that the gel tastes horrid!

As regards Glucose/dextrose tablet, most large supermarkets stock them and will likely be cheaper than a specialist diabetes website. Certainly my local Morrison's sell both Lift tablets in a variety of flavours (raspberry one is best in my opinion) and Dextro Energy tablets. The orange Lift are naff but the orange Dextrose are OK.
 
I appreciate your practical advice, particularly regarding having time to test, and taking time to chew before swallowing.

I'm not a panicker as a rule but this was shaping up to be an exception.
 
@rebrascora I do all the cooking so my wife has an interest in keeping me going. She's enjoying very low carb at the moment...

Thanks for the Supermarket tip.
 
Do be careful with "very low carb" and gliclazide.
I see your most recent HbA1c was 102. When was that?
I am just wondering if you are being a bit hard on your body by trying to reduce your levels too quickly. Very low carb eating is a powerful tool in lowering BG levels and then adding in full dose Metformin and particularly 120mg Gliclazide could be a bit much all at once. Just wondering if your doc knows you are following a low carb way of eating and if the medication has been graded in slowly to assess how you are responding and over what sort of timescale.
It may be that you are like me and the gliclazide does nothing because your pancreas isn't producing much/any insulin, in which case there should be no concen about hypos just perhaps not being able to get levels down into range all the time but if you are a true Type 2 then the Glic together with low carb could be heavy handed.

It might be better to increase your carb intake slightly (at least initially) to slow the rate of reduction as well as give the extra insulin the Glic (hopefully) triggers, something to work on.

Most Type 2s are able to produce plenty of insulin but their body has become insulin resistant and started to ignore the normal amount, so extra is needed to push the surplus glucose into the cells. If you significantly reduce the amount of carbs you are eating, there is usually no need for increased insulin, because there isn't much excess glucose to remove, so stimulating the pancreas to produce more when it is not necessary, becomes too much. Many GPs have no idea how effective a low carb diet can be at reducing BG levels so might not realize that the combination of that with the medication might be too much.

Just my thoughts. Go steady and let us now how you get on!
 
Thanks for the advice. I mentioned low carb to the GP and the Clinical Pharmacologist (at the GP surgery) and they didn't seem too concerned but I take your point that they may not appreciate how powerful it is.

My attitude is always maximum force. Use a sledge hammer to squash a pea...

I'll keep a close eye on numbers (doing loads of tests every day), and if I start edging towards hypos, I'll reduce the gliclazide and call the doc to discuss.

Low carb is the only diet I can loose weight and maintain on. I've done it before for about 18 months and my HbA1c was below that of an average non- diabetic. I suspect I won't achieve that now but I want to get as close as possible. I don't want to be eating carbs to process the prescribed dose of glicklazide. I want to take just enough gliclazide to keep my blood glucose under control while eating low carb. (Why can't Pharma companies dream up friendlier names than glicklazide, how about diabetter?)

At the moment, I'm still waking with 8.5 ish and hitting 9ish in the early afternoon. Still a way to go...

It's possible that my pancreas has packed up. It's being investigated...

Thanks for your thoughtful consideration. I'll keep the forum posted.

BTW, the day I joined I felt awful: high glucose, blurred vision, quite fearful and heading towards depression. Not a place I want to re-visit. Today, I feel so much better and in control.

Thanks Diabetes UK!
 
Reptile said:
Thanks for the advice. I mentioned low carb to the GP and the Clinical Pharmacologist (at the GP surgery) and they didn't seem too concerned but I take your point that they may not appreciate how powerful it is.

My attitude is always maximum force. Use a sledge hammer to squash a pea...

I'll keep a close eye on numbers (doing loads of tests every day), and if I start edging towards hypos, I'll reduce the gliclazide and call the doc to discuss.

Low carb is the only diet I can loose weight and maintain on. I've done it before for about 18 months and my HbA1c was below that of an average non- diabetic. I suspect I won't achieve that now but I want to get as close as possible. I don't want to be eating carbs to process the prescribed dose of glicklazide. I want to take just enough gliclazide to keep my blood glucose under control while eating low carb. (Why can't Pharma companies dream up friendlier names than glicklazide, how about diabetter?)

At the moment, I'm still waking with 8.5 ish and hitting 9ish in the early afternoon. Still a way to go...

It's possible that my pancreas has packed up. It's being investigated...

Thanks for your thoughtful consideration. I'll keep the forum posted.

BTW, the day I joined I felt awful: high glucose, blurred vision, quite fearful and heading towards depression. Not a place I want to re-visit. Today, I feel so much better and in control.

Thanks Diabetes UK!
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If your levels are 8.5-9 and you aren’t injecting insulin then your pancreas is definitely producing insulin and hasn’t ‘packed up’. If your pancreas wasn’t producing insulin your levels would be far higher.
 
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