why didnt my sugar level go up after a hypo

[rgarcha]

Hi
Im new to pumping, and recently i got my basal rate on target. For two days everything was going great, my levels stayed between 4 - 9 mmols, and then suddenly out of the blue, for no apparent reason, i started to go low. My levels first dropped to 3.4, and my CGM alarm start buzzing, so as normal, i take my glucose tablets, and had a sandwich, hoping this should sort my levels to normal range.

But that wasnt the case, my levels droped further lower to 2.4, this was 10 mins later, i waited a further 5 mins thinking that the glucose tablets and food ive eaten should start kicking in. But instead, they dropped again to 1.7, at this point, i was feeling very faint and i cant remember much, but my partner said, he had to disconnect my pump, and start giving me glucose drink, because i wasnt responding to food.

The only time my levels start to rise very slowly, was a good 40 mins later from the time my alarm buzzed on the CGM. The lowest my bg went to was 1.2mmols, the medics arrived and gave the glucose injection, and slowly the levels went up, and i start to wake up.

I just wanted to know even, when ive taken so much glucose, and had food, and done everything correct, why did my levels still dropped? also i didnt do anything to prompt the drop in the first place, why did they drop?
Has this every happened to anyone else?
Any information would be great. Thankyou

Rav

 

[cugila]

Hi Rav.

I think one of the problems that is obvious here is the way you dealt with your hypo ? I am not a pumper, so can only guess that in some way you may have been getting too much Insulin in the first place, hence the hypo levels. If that was the case then stop the source of the Insulin or adjust it whilst dealing with the hypo. I do know how to treat a hypo though, I've had quite a few myself.

The correct way to deal with a hypo is to, as you rightly did, consume some fast acting carbs, 2-3 GlucoTabs or Lucozade etc. Rapidly absorbed into the system. No sandwiches ! After around 15 mins test again, if still low or dropping then you need more glucose, repeat this every 15 mins until a more normal level is reached. I have sometimes ended up taking about 5-6 glucotabs (24g carbs) AND a big slug of Lucozade to get back up from levels which for me are abnormal using this method.

Only THEN would you have a carby snack to stabilise the levels. A sandwich is not going to have any effect for probably around an hour so is of no use whatsoever in quickly treating a hypo. It is something to have when the levels are back to normal ! It is slow acting only.

Hope that gives some help to you for next time. There will be a next time I'm sure. Hypo's are like buses, there's always another along pretty soon....... :wink:

 

[hanadr]

Rav
I'd contact the care team and get the pump checked. I disagree with Cugila on the sandwiches. My T1 husband has used them to deal with hypos many times over the last 35 years. They may not be the ideal treatment, but they should work. Glucose has a GI of 100 and should work almost immediately. White bread is GI 70 and therefore shouldn't be much slower.
Hana

 

[noblehead]

Hi Rav,

I too don't use a pump, but could it have been possible that your pump may have inadvertently given you insulin whilst hypo? My reason for asking is that you kept dropping further even after you treated with glucose tablets.

Good advice by Cugila regarding treating hypo's and testing thereafter, but bear in mind that gluco-tabs are only 4g of carbs each, I find I need at least 3-4 tabs when falling 3.5 or below.

Regards

Nigel

 

[noblehead]

Hana,

The advice is to treat with fast-acting glucose..

Nigel

 

[cugila]

Rav
I'd contact the care team and get the pump checked. I disagree with Cugila on the sandwiches. My T1 husband has used them to deal with hypos many times over the last 35 years. They may not be the ideal treatment, but they should work. Glucose has a GI of 100 and should work almost immediately. White bread is GI 70 and therefore shouldn't be much slower.
Hana

Hana.

THAT might be your method of treating a Hypo....it is NOT the standard recommended method for treatment of a hypo, what I quoted is. So you are disagreeing with medical opinion, not me !

It is not my personal opinion, which would have little relevance when informing someone of the correct way to deal with a hypo. There are still people around who think having a Mars Bar is the right treatment for a hypo. It also depends on the severity of the hypo, just being a bit low,
3.9 say, a sandwich might suffice, at the levels the OP mentions they are as much use as the proverbial 'chocolate teapot !' :shock: I stand by my advice to the OP !!

Nigel.
Thank you for your input. You are perfectly correct. Misinformation can be dangerous !!

 

[Fujifilm]

I also agree with Cugila, sandwiches only after you have sorted the hypo problem.

I do not use a pump but have had hypos where the BG has continued to drop even though i was chucking sugar down my neck like no tomorrow but like the others have said if your BG goes too low you need to stop the insulin (pump) until you have it sorted out. Get the BG going in the right direction before starting it again.

.

 

[cugila]

Glucose has a GI of 100 and should work almost immediately. White bread is GI 70 and therefore shouldn't be much slower.
Hana

Hana.
You may know much about low carbing, but I think you need to study a bit more about the Glycaemic Index and the Glycaemic Load which is very relevant here. It's a trap many people fall into with GI and the oft forgotten GL. They are both things that should be looked at together.

Glucose as you say is 100 on the GI. Correct.
White Bread is also as you say around 70 on the GI. (I haven't looked it up BTW, I trust you) Correct.

You need to also consider the Glycaemic Load when talking about Carbohydrates and the effects, not just the Glycaemic Index. That would be misleading.

What you have failed to appreciate is that the thing that makes a big difference to the effect is that
Glucose is extremely high GL therefore acts virtually instantly because it is absorbed rapidly.

White Bread however is very low on the GL rating. Hence it is much much more slowly absorbed, so would be useless for a quick acting carbohydrate. It is just simply a slow acting carbohydrate hence the reason we tend to advise those who eat bread to test at 2 hrs or more, because that is usually when the peak cuts in. Not instantly as with Glucose.

I can recommend the Collins Gem GI and GL Books as they explain the idea quite simply. Easy to understand. There is also a book by Patrick Holford called, The Low GL Diet Bible which has some good explanations in it. Not a fan of some of his theories though, the basics are good.

Does Dr Bernstein have anything to say about this perhaps......

 

[hanadr]

Noblehead and Cugila
I write from EXPERIENCE. I know that sandwiches DO work for correcting hypos, because I've seen and done it hundreds of times over 35 years.
Does either of you have as much experience of this as I do?. It doesn't matter what the "Right" way is as long as the way works.
I can assure you it does. Bread is a FAST carb. digested in the mouth in minutes if not seconds.
I am beginning to think that some people just wait to see what I write and then contradict. This is just plain childish. Yes glucotabs are the ideal, but what do you do if there are none to hand? Does either of you suffer from insulin induced hypos on a regular basis?
My T1 husband REFUSES absolutely to use glucotabs( says they taste foul). I'd like you to try to persuade all 6feet3inches and 17 stone of him that YOU are right, when he is in a hypo.
HE WON'T use glucose tabs, MIGHT use Lucozade and WILL use a sandwich. I for one am not going to debabte the point with a man of his size and strength, when he's havinga hypo and a bad temper with it.
I offer help and you snipe at me.
Hana

 

[catherinecherub]

Han,
I don't think anyone is sniping at you.

The anecdotal evidence you use about your husband's personal hypo's may work for him but that does not mean it is going to work for others. Surely the correct way is the best information to give out?
There are plenty of posters on this forum who have had a curt reply from you at times when you do not agree with them.

Catherine.

 

[CarbsRok]

y

 

[cugila]

Hana.
I too write from my own experience. I personally have suffered many hypo's so I too know what I am talking about. Have you ever experienced a bad hypo Hana, I mean personally. Do YOU really know what it feels like ? How awful they can be. 'Helping' hubby is NOT the same as actually experiencing one......that's what you have NO experience of, if all your other posts are correct ??
Listen to the other members, you have got this badly wrong Hana.

Does either of you suffer from insulin induced hypos on a regular basis?

A hypo is a hypo whether it is Insulin induced or not. I suffer from them regularly. Do you Hana ?

You have seen the responses, yet still you persist in believing that YOU are right. Just for once Hana, stop and think about what you are posting here. Analyse the content, apply a conclusion. Impartially ?

There is a clear rule on this forum that we do not knowingly deliver mis-information to anybody. If I did I would apologise and I would also correct it publicly. I have done previously. I don't always get it right......but this one.......in your words....I AM RIGHT !

So Hana, nobody is sniping at you.....we are just pointing out your error and avoiding the
mis-information being passed on to other members. In just the same way that you stated that I was wrong, I have pointed out to you that YOU were wrong in advising a new member that bread would be the way to go to treat a hypo. If your husband cannot handle a little GlucoTab, then he needs to find alternatives. I use dextrose tabs which come in several fruit flavours. Very nice tasting.

Bread will never be a fast acting carbohydrate whoever thinks it is !

I think the posts that followed bear out my point. I hope that you have learned something here Hana, nobody is always right ! Whatever experience they may have.

 

[kegstore]

Going back to the OP...

Rav, are your bg readings from sensor or meter? And also, where is your sensor sited? The "maximum" 20 minute delay in sensor readings depends very much on where your sensor is located, and can be "off" quite alarmingly. Certainly my experience. CGM is not a catch-all solution, but it should help most of the time. Feel free to PM me if you want - I've had CGM full time for a while now, so happy to help out if you need.

And the bread thing, I agree (from my experience) with Hana - for ME, white bread is actually quite a rapid hypo cure, certainly faster than other things commonly used.

 

[CarbsRok]

y

 

[jopar]

Rav

A bit of a nasty experience there for you...

I see that you are very new to pumping, so it would at this stage be difficult to give a clear why, as it could be one of several factors Such as

Need to change basal settings as too much insulin being delivered..
Could be a bolus problems, (I suspect you'll still on the basic bolus) so you've bolused all insulin needed to cover your food, insulin kicks in but not quite the food.. Time and experience will guide you to best bolus to use for what type of meal etc..

Dealing with an hypo when using a insulin pump is slightly different than dealing with a hypo on MDI..

Firstly always use FAST acting carbs keep checking, and take more FAST acting carbs until your blood sugar returns to normal.. This is where it differes for the insulin pumper, there should be no need to turn your pump off, you migh how ever choose to use the TBR to lower the basal delivery for an hour or so.. In theory once again unlike MDI there should be no need to eat a slow carb snack to prevent a futher hypo, but I do sometimes find I pefer to eat something, then check my BG about 1/2 later then bolus for what I've eaten adjusting if necessary for the BG if it's lowish, or just bolus using a multiwave bolus... But again this comes with time and experience of using the pump.

Sandwiches, biscutes, cakes etc eaten before your blood glucose levels have returned to normal or to use them to treat an hypo can put the diaebtic in very serious danger, as the blood sugar levels will continual to drop until the carbs start to asorb into the system.. Of cause if for any reason an FAST acting carb isn't available then an highly sweeten food, piece of cake, biscute is the next best alternitive...

Hana

I do not blame anybody taking a snip at you, because the information you give is incorrect and very very dangerous indeed, you say it's from your experience, if this is so then yoru experinece should be screaming at you that you do not know anything that could possibly help a diaebtic at all..

Not only am I a T1 diabetic with 21 years of experience, my husband is also a T1 diabetic with over 30 years experience of diabetes... My husband became a diabetic at the same time as yours did, so would have faced the same regimes and treatments... But one does have to ask, how come your husband has many many complications and have landed himself in hospital on nurmious occassions, one not being very long ago, when suffering a hypo cut his foot, which ended up infected and came very close to losing his foot!

My husband has faired very differently, he had a glitch with one eye 10 years ago, which treatment recieved sorted but otherwise has never been hospitlised for his diabetes since he was first dianosed why back in the 70's

There is one reason for this, it's called self-management and complete uderstanding of the condition that we both live with (I don't have complications either)

Strange thing Hanna you spout on about this self management, the benefits of Bernstien and the extreme low carb diet.. But by what you post you either do not pratice what you preach or in fact you haven't after all these years understood diabetes is all about and still don't...

Your preaching is dangerous, as well if you advice from as you say your experience then your husband health highly suggests that this advice is dangerous, as it hasn't done him any favours what so ever has it?

 

[Fujifilm]

I think if we need to establish the different hypo states here, if we are talking hypo as in sugar levels have gradually dropped a bit and you are feeling slightly hypo a snack such as a sandwich is going to be OK but the OP did say that sugar levels kept dropping. So the sandwich was never going to stop this quick enough.

From experience as a type 1, I feel different from feeling hypo where my sugar levels have gradually dropped because I have missed a meal or been a bit energetic or something and a sandwhich or biscuit will replenish this level.

To feeling hypo because of a rapid drop such as over medication. I feel the levels dropping and can tell you without testing that they are dropping very quick, before now I have had a full big bottle of lucozade and even then known the levels were still dropping. A sandwhich would firstly have taken too long to eat, secondly not worked fast enough.

I think most of us who have had diabetes a while know the difference between gradual drop and rapid drop. New members might not have experienced this yet.

Hanadr, I am sure you have all best intentions with your postings but sometimes need to think about what you are saying because you are not always as right as you think you are. (I sound like my wife) :lol:

.

 

[noblehead]

Hana,

Experience: I have been insulin dependant for the last 27 years, and in this time have experienced many up's and down's of living life with diabetes. In this time I have had more than my fair share of hypo's, being type 1 on insulin it is inevitable.

You accuse me of being childish for correcting a post you have written telling someone that the way to treat a hypo is by eating bread! mmmmm...........ask any doctor, diabetes specialist or any other experienced diabetic how you should treat a hypo, you will find that the answer will be fast acting glucose, such as lucozade or glucose gel/tabs. Bread is not digested in seconds, it takes time for it to break down and turn to glucose, time a person having a hypo doesn't have.

I do not wish to contradict anyone on this forum. Since joining the forum I have learnt many things that my 27 years hadn't uncovered. I now have my diabetes under control, following advice on this forum and working closely with my healthcare professionals. Experience has taught me that not all you read on the internet or diabetes discussion boards are true, and one should be careful of what advice is taken on board. Where advice is sought on a potentially life-threatening condition, such as hypo's, it is wise to offer the mainstream advice as opposed to personal preference.

As for treating your husband's hypo's, if both you and your husband are happy with this method, that's fine, just refrain from passing on this unappropriate method to others.

Best wishes for 2010

Nigel

 

[phoenix]

I had a slightly less scary but similar incident the other day which also taught me to stick to conventional treatment particularly when the drop is caused by too much bolus insulin.
I have a fair number of mild hypos mostly caused by exercise which I can treat very easily with a single dextrose tablet or less conventionally (but nicer) with a couple of pieces of pepermint aero.
The other evening though I had one caused (I think) because I hadn't absorbed the food I'd eaten - I had diarrhea
a piece of aero at 3.5 didn't do the trick, after that I reverted to the 15gms of dextrose tablets every 15 minutes It took me over an hour with a lowest measurement of 2.4mmol before I got above 4. Even then I woke during the night back down at 3.5.
This was one time when I should have used a liquid source of glucose but didn't think of that until later.
I did remind husband about the glucagon kit in the fridge.
If you haven't got on it's certainly worth asking your doctor for one,

 

[rgarcha]

hi all,
I like to thank all that replied, and for the advise that has been given, i didnt expect that the way i treated my hypo would cause such a debate, i hope that my post didnt offend anyone.
To start with ive been a t1 for 26 years now, and recently in the last 2 - 3 years or so my control was off the scales, with a hba1c at 11.5%, hence the reason i was offered the pump. Also i had no hypo awarness, which added to to the problem, so i was offered the CGM as well, at the same time.
In the past i always treated my hypo's by first taking glucose tablets (3 - 4 tablets), and then checking my bg about 5 mins later and if still going low, i just top up with a another tablet, and check again, and then eat a high carb meal such as a white bread sandwich, as i did that day. Before i was on the pump, this method worked great for me, and i had no problems with this at all, untill yetsterday. I just didnt take the reading from my CGM as im aware that they can be out by 20 mins or so, so i also done my bg testing as i use do before.
Anyway i contacted my diabetic nurse, who thinks it might just be my basal rate is still off line, and needs alot of adjusting, as ive only been on the pump for 2 weeks, so im still have a long way to go, untill i'm perfect.
My main concern was, that no matter how much glucose ive taken, my levels still kept falling, so for this reason alone my diabetic nurse has faxed my GP, requesting that they perscribe asap the glucose injection, im not sure what the medical name is. Which ive just collected about hour ago, from the chemist.
It is still a worry, why this happened, but once the holiday period is over, im sure that further investigation will be done, to find the cause. I keep everyone posted with the out come. In the mean time, every one have a HAPPY NEW YEAR!!!

 

[cugila]

HI Rav.

NOBODY has been offended. It has been an Educational experience........for some.

Happy and Healthy New Year to you too.