Adjusting Insulin Dose Post Hypo

[SHmano]

Hello there,

Whenever I Have a Hypo, the sugar levels rise after eating. It ranges from 350-450. How to treat the rise in the sugar level. Is it normal to take an increased fast acting insulin. This does bring my sugars to normal condition after 2 hours. Are there any drawbacks of treating the condition. Has anybody faced the similar situation. Any advice?

 

[Juicyj]

Hi @SHmano How are you treating your hypos ?

I tend to stick to 3 glucotabs only and then monitor every 10 mins until above 4, once I am on the way up then I leave it unless it was a bad hypo and so take 10g if carb on board too.

 

[Knikki]

All the time and I inject small amounts of insulin if my sugars start to climb to a number I'm not happy with, but everyone is differnet and will handle hypo's differently.

What are you eating to get the blood sugars that high and from how low are you treating it?

 

[alphabeta]

I smell something classic here! 5 AM hypos did the same for me and the reason is that I wake up not knowing where in Heavens I am and just go to the fridge and start eating bananas milk bread etc... until my sweat goes and I restore my sanity. I think I don't need to tell you my blood sugars next morning you figure it out
It seems that you are over-treating your hypos. For me, the best solution was to stick to a certain hypo treatment which is milk and few biscuits. I think this will help you avoid those nasty spikes. Anyway, the real question is why are you falling hypo in the first place?

 

[SHmano]

All the time and I inject small amounts of insulin if my sugars start to climb to a number I'm not happy with, but everyone is differnet and will handle hypo's differently.

What are you eating to get the blood sugars that high and from how low are you treating it?

My blood sugars go low as much as 30 and some times I faint and when I wake up two hours later, I eat regular food. The sugar level spikes. The reason for low sugars is I am scared of high sugars hence eat minimal food.

 

[SHmano]

I smell something classic here! 5 AM hypos did the same for me and the reason is that I wake up not knowing where in Heavens I am and just go to the fridge and start eating bananas milk bread etc... until my sweat goes and I restore my sanity. I think I don't need to tell you my blood sugars next morning you figure it out
It seems that you are over-treating your hypos. For me, the best solution was to stick to a certain hypo treatment which is milk and few biscuits. I think this will help you avoid those nasty spikes. Anyway, the real question is why are you falling hypo in the first place?

I have hypo because I am scared of eating, but the reverse happens.

 

[Knikki]

My blood sugars go low as much as 30 and some times I faint and when I wake up two hours later, I eat regular food. The sugar level spikes. The reason for low sugars is I am scared of high sugars hence eat minimal food.

30? That is low, I have hit that a few time but not fainted.

But you use a blood testing kit so you can monitor your levels?

Most of us do a ratio of 10 grams of carbs for one unit of insulin, so say you eat a bun with 30grms of carb then you would inject 3 units of insulin which...should...theoretically keep you on the straight and narrow, however that is just an example and we are all different in the way we react to insulin and hypos.

Your medical team should be able to advice you how to go about this plus there is lots of info online about it. But be a little wary as I think that here in the UK the amount of carbs in food displayed on packages might be different from where you are.

If you have had a bad hypo like that and then eating regular food plus add in the glygocon dump from the liver, I would expect you to climb, I would, but if it was me I would be checking my blood sugar levels every 30mins to 1 hour and if it started to get to an unaceptable level I would correct but only with small amounts of insulin.

That is how I do it and please bear in mind I am not medically qualified, just been a T1D a long time

You shouldn't be scared to eat, it is just a balance to get the right combo of insulin and the food intake you have. It is learning curve and takes some experimenting to get it to click.

Even after all the time I have had this I am still learning and still here and I have had this for over 50 years

 

[tim2000s]

My blood sugars go low as much as 30 and some times I faint and when I wake up two hours later, I eat regular food. The sugar level spikes. The reason for low sugars is I am scared of high sugars hence eat minimal food.

30mg/dl (1.7mmol/l) is considered to be a severe Hypo. First up, and I'm sure you're aware of this, you really should try and avoid getting this low as you're starting to get to a low enough level where brain damage may occur.

The other aspect of going this low is that it forces your body to physiologically react. This means that it produces glucagon to counter the low glucose level. When you go this low, your body continues to react to the hypo for up to 36 hours afterwards, producing glucagon and causing your liver to produce quite a lot of glucose. This is especially prevalent around food.

Unfortunately, due to this mechanism, it means you also need to be really careful about dosing insulin, as hormonal glucose production tends to be very reactive to insulin, so reducing levels requires careful management. What ever dosing you choose to do you'll need to monitor very carefully. The 48 hours after a severe hypo are the period in which subsequent hypos are most frequently observed. There's a knock on effect.

I'd strongly urge you to speak to your diabetes team about what's happening with you as it's a form of complication and also a health issue that could result in very serious side effects. I think you need to look at how you are giving yourself insulin for what you are eating, and what your overall insulin use looks like, as frequent lows like this are a problem.

 

[alphabeta]

I have hypo because I am scared of eating, but the reverse happens.

Well then reduce insulin, eat little and you will be fine but is that your best bet? If you are still below 18 your body needs food to grow unless you are trying to lose weight. Anyway, you should balance your insulin and food otherwise you will feel tired all the time, you will eventually find yourself scared of leaving the house in fear of a hypo, and it won't be generally good. Anyway, you have up to 180 mg/dL or 10 mmol/L as long as you keep it below, I don't see why this should be a problem. There are many steps that you can follow that can reduce the spike after eating: pre bolus, inject in upper arm or stomach for faster absorption, and lastly consider Fiasp which I believe is the fastest bolus in the market, but please pay attention to your sugar levels, sometimes you will find yourself going into unexplained high BGL but it happens... I once forgot my bolus for my lunch which was potatoes, bread, and chicken. I went to nap, woke up to a reading HI on my meter (>600 mg/dL). It did feel nasty but the next day I was okay. Do not be consumed by your thoughts. Stay safe.

 

[SHmano]

30? That is low, I have hit that a few time but not fainted.

But you use a blood testing kit so you can monitor your levels?

Most of us do a ratio of 10 grams of carbs for one unit of insulin, so say you eat a bun with 30grms of carb then you would inject 3 units of insulin which...should...theoretically keep you on the straight and narrow, however that is just an example and we are all different in the way we react to insulin and hypos.

Your medical team should be able to advice you how to go about this plus there is lots of info online about it. But be a little wary as I think that here in the UK the amount of carbs in food displayed on packages might be different from where you are.

If you have had a bad hypo like that and then eating regular food plus add in the glygocon dump from the liver, I would expect you to climb, I would, but if it was me I would be checking my blood sugar levels every 30mins to 1 hour and if it started to get to an unaceptable level I would correct but only with small amounts of insulin.

That is how I do it and please bear in mind I am not medically qualified, just been a T1D a long time

You shouldn't be scared to eat, it is just a balance to get the right combo of insulin and the food intake you have. It is learning curve and takes some experimenting to get it to click.

Even after all the time I have had this I am still learning and still here and I have had this for over 50 years

Sure will do it. Thank you for the wonderful reply. Thanks a lot

 

[SHmano]

Well then reduce insulin, eat little and you will be fine but is that your best bet? If you are still below 18 your body needs food to grow unless you are trying to lose weight. Anyway, you should balance your insulin and food otherwise you will feel tired all the time, you will eventually find yourself scared of leaving the house in fear of a hypo, and it won't be generally good. Anyway, you have up to 180 mg/dL or 10 mmol/L as long as you keep it below, I don't see why this should be a problem. There are many steps that you can follow that can reduce the spike after eating: pre bolus, inject in upper arm or stomach for faster absorption, and lastly consider Fiasp which I believe is the fastest bolus in the market, but please pay attention to your sugar levels, sometimes you will find yourself going into unexplained high BGL but it happens... I once forgot my bolus for my lunch which was potatoes, bread, and chicken. I went to nap, woke up to a reading HI on my meter (>600 mg/dL). It did feel nasty but the next day I was okay. Do not be consumed by your thoughts. Stay safe.

Yes what you quoted is right. I am scared of getting hypo while I am on the road. I will surely take your advice. I have started to check my sugar levels frequently and reduced the frequency of hypos. Thanks a lot.

 

[SHmano]

30mg/dl (1.7mmol/l) is considered to be a severe Hypo. First up, and I'm sure you're aware of this, you really should try and avoid getting this low as you're starting to get to a low enough level where brain damage may occur.

The other aspect of going this low is that it forces your body to physiologically react. This means that it produces glucagon to counter the low glucose level. When you go this low, your body continues to react to the hypo for up to 36 hours afterwards, producing glucagon and causing your liver to produce quite a lot of glucose. This is especially prevalent around food.

Unfortunately, due to this mechanism, it means you also need to be really careful about dosing insulin, as hormonal glucose production tends to be very reactive to insulin, so reducing levels requires careful management. What ever dosing you choose to do you'll need to monitor very carefully. The 48 hours after a severe hypo are the period in which subsequent hypos are most frequently observed. There's a knock on effect.

I'd strongly urge you to speak to your diabetes team about what's happening with you as it's a form of complication and also a health issue that could result in very serious side effects. I think you need to look at how you are giving yourself insulin for what you are eating, and what your overall insulin use looks like, as frequent lows like this are a problem.

Thanks a lot for the information. Have started to check sugar levels 2 hours after BF, Lunch, dinner and ensure to eat something. Love your reply.