What would you do: "glucose going down" at start of a meal

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TwilightMidna

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Hi all,

Just to warn you, there's lots of questions in this post !

I'm curious to know what more seasoned diabetics on insulin would have done in the following situation. Today as I sat down for lunch my FreeStyle Libre read as 5.3 and my finger prick read as 5.6. Around five minutes into my lunch the Libre had a diagonal downwards arrow, said "blood glucose going low" and was reading as 4.4. I was a bit scared as I haven't had a hypo yet... As I had a nectarine on my plate I decided to eat that first (instead of last as I had intended) and then carry on with the rest of my lunch. The Libre didn't read any lower than 4.4 and started to go up a while afterwards.

What would you have done in that situation? Or is this a bit of a non-event that I'm overthinking?

This also got me (over)thinking - what would you do if you sat down to eat and your blood sugar was under 4, and for some reason you had only just noticed? Would you take some fast acting carbs and wait for 15 minutes, then if above 4 have your meal? Would you still bolus for that meal? I'm only on basal insulin at the moment but adding bolus on Friday, all being well.

Lots of questions, I know. Appreciate any insights!
 
Hi - I would of done exactly the same as you regarding your lunch. If I sit down to eat and my bg is in the low side I eat my meal, check my blood once I've finished and then inject. If my bg is lower than 3.5 I usually have a sugary drink - I fine that works quickly and still lets me enjoy my meal without feeling stuffed!
 
Sounds like you handled it perfectly @TwilightMidna
My only concern would have been if the fibre in the nectarine had slowed the release of the glucose from it a bit or the nectarine wasn't quite as sweet as you might have hoped, meaning there was less glucose readily available. I just had a similar situation with my lunch. For some reason I have become more insulin sensitive the last few days and Fiasp is kicking in faster than normal. I was 5.2 with a downward sloping arrow when I started my meal which was corned beef hash. I thought the carbs would release quickly enough as my body is usually pretty fast at digesting stuff and insulin slow but mid meal I got the low alarm at 4.2 with a downward sloping arrow, followed by a 4.0 with a vertical downward arrow and had to eat a Jelly Baby mid meal and then just carry on eating. I have finished the meal now and Libre is showing my level as 3.5 with a sloping downward arrow but a finger prick says I am 5.6, so all good. Libre will eventually realize that it exaggerated the situation and may not even show any red on my graph when it sorts itself out despite several readings suggesting I was below 3.9. Generally Libre reads lower than a finger prick, so I don't worry if it shows that I have dropped into the red a bit.

If I am under 4 and just about to have a meal, I have 1 JB and then eat the meal straight away and probably eat the carbier elements of the meal first. I certainly don't delay the meal. I do however chew that JB really well before I start the meal because it will absorb faster through the cells inside my mouth than a couple of chews and swallowing it and then dumping a load of slower releasing food on top of it in my stomach. You could do the same by having some orange juice before the meal and swilling it around your mouth a bit before you swallow and then eat the meal.
If I was somehow really low like 3.0 before the meal, then I would probably have 2 JBs and then the meal, but I personally still would not wait, but then I know how I respond pretty well, so I am confident that 1 or 2 JBs will do the job.

Yes, just as I thought, Libre now says I am 4.9 and stable and there is no red on the graph and it doesn't even touch the line. Libre is such a drama queen sometimes! 🙄
 
It may not always be possible but I try to avoid this situation. With Libre (or other CGM), I check my BG (including the direction of trend) at least 30 minutes before I plan to sit down to eat. If my levels are in the low 5s or 4s and heading downhill, I will have a single GlucoTab (or Jelly Baby or hypo treatment of choice). This way, they should be ok when I sit down to eat and take my insulin as usual.
Some people go a step further and set their low alarm at 5.0 and treat with a fraction of a hypo treatment at any time of the day regardless how soon mealtime is.
 
Yep, if I was dropping I’d eat something fast-acting. It’s happened to me before a number of times. I just have a Dextro or two. You can’t enjoy your meal if you’re going low or worried about dropping further. I don’t think you’re overthinking it. I think you’re being sensibly cautious 🙂
 
Thank you all for sharing, I really appreciate it. It’s reassuring to hear what you would all do in this situation. Hopefully I won’t get so worried next time and I think I’ll feel better prepared having heard everyone’s experiences with this.

@rebrascora that’s a good point about the fibre! I have noticed that the Libre tends to read a bit low sometimes, although I didn’t double check with a finger prick this time as it was above 4 and my hands were covered in food haha. I suppose it’s better than it exaggerates these lower numbers a bit so we can catch them earlier!

Thanks again to you all. This forum is such a help!! <3
 
TwilightMidna said:
Today as I sat down for lunch my FreeStyle Libre read as 5.3 and my finger prick read as 5.6. Around five minutes into my lunch the Libre had a diagonal downwards arrow, said "blood glucose going low" and was reading as 4.4. I was a bit scared as I haven't had a hypo yet... As I had a nectarine on my plate I decided to eat that first (instead of last as I had intended) and then carry on with the rest of my lunch. The Libre didn't read any lower than 4.4 and started to go up a while afterwards.

What would you have done in that situation? Or is this a bit of a non-event that I'm overthinking?
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I wouldn’t have fingerpricked as well as tested, and would have just cancelled the alarm and ate my lunch as normal. If I started to feel ill I would have fingerpricked.
 
TwilightMidna said:
what would you do if you sat down to eat and your blood sugar was under 4, and for some reason you had only just noticed? Would you take some fast acting carbs and wait for 15 minutes, then if above 4 have your meal? Would you still bolus for that meal? I'm only on basal insulin at the moment but adding bolus on Friday, all being well.
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High 3s and feeling fine I’d just eat my meal. Low 3s or 2s I’d fingerprick and have a glass of juice then my meal straight away. If I felt sick I’d delay my meal.
 
Thankfully it doesn't happen often but would just eat some glucose first or if seriously low something like small can of coke.
 
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