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Dealing with Hypos - treat first, measure later

tim2000s said:
I've noticed a consistent theme amongst forum members with regards to Hypos, and I find it disturbing.

It seems to me that many people feel the onset of a hypo and then rush off to find a meter to test, before doing anything to treat it. I was taught, and believe, that the most important thing to do in the case of feeling a hypo is treat it first, measure it later. It is imperative to get the glucose into your system ahead of worrying about where it actually is.

While there has been a consistent trend of diabetics using the internet to aim for lower blood glucose levels in the "normal" range to reduce the risk of complications (which I don't disagree with, and is something I too strive to achieve), it is still important to let this advice go out of the window when dealing with a hypo.

The basic point is - Always treat the hypo first, before worrying about whether it is a 3.9 or a 2.1. You'll be far better off if you do and you reduce the risk of a more severe hypo by not delaying the treatment.
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I Tend to get Mild Hypo Symptoms around my mid 4's which provides me plenty of time to test, as sometime the mild hypo symtoms are very similar to hyper or some times i just feel werid and test. if i get strong symtoms Shakes/Sweats then yes i eat first ask questions later
 
My first reaction when feeling a hypo is to make sure I have the glucose tablets within reach - I mean without having to stand up. I then test and treat accordingly. I think the time it takes to actually test (1 minute or so) is extremely minimal and unlikely to make a difference with my treatment. Speaking from own experience.
 
It is daft when you think about it, but gp's and dsn have always told me test first then treat if necessary. However I am normally chomping down my "fixer" as I'm testing, I have been caught out a few times by false hypos though and felt a bit silly holding glucose tablets in my hand
 
I wonder if Type 1s get worse hypos than LADAs? I'm always a little surprised at the severity of some members' hypos, how quickly they need to react and how much sugar they need to correct them. I feel a hypo pretty early on usually and try to test before correcting as usually mine are in the 3s and I need about 6g carb - 1 jelly baby! I can think pretty clearly. If my BG has gone into the 2s though, I prefer to use a few sips of Coke or orange juice to raise it quicker. On the whole, my BG stays pretty still and I have loads of time to sort out how to react, so testing first is a no-brainer.

Smidge
 
I was always taught to test first and then treat the hypo accordingly. Although I don't always test first :)
 
I also test first and have no desire to change that - it only takes a few seconds and there have been countless times I've felt hypo and actually had a perfectly normal BS. Especially when I'm stressed at work - it's a similar feeling for me. As long as you have your sugar source right next to you I can't see why you can't spare a few seconds to test and check your levels first?
 
I automatically test first. However, this enables me never to go high afterwards. I balance my glucose intake to the readings I get for hypo's.
 
For myself, my hypo awareness started to become a tiny bit variable once I changed from animal insulin over to human and then to analogue.
Nowadays, the sign of an impending hypo is finding it a great effort to walk ok and keep up with other people. I tend to get stiff legs which if I dont do anything about, I will start to stagger and not be able to communicate very well. My OH always knows when I start to look low as he can tell by the way I am standing and by the way I am holding my arms. This tends to happen before the true hypo symptoms come about. Infuriating.....but thrre you are. There was a time when I used to argue with him but as he was always correct, I gave up and just had some food and bg tested afterwzrds only to confirm my OHs observation... If sitting down, I will just not be able to concentrate very well on watching tv and start staring into space and eventually fall asleep. Sometimes my brain prompts me to wake up and I question why I feel so tired and go and bg test and usually eat something. Having a pump has helped a lot as my OH is more at ease now and doesnt worry about me like he used to, especially when I found myself trying to achieve my GPs recommendation of an a1c of 6.5%.
 
it all depends on the hypo.............

is it a slowly manifesting, expected one.........

or a quickly manifesting, unexpected one.......

I have regular hypos, 2 or 3 a week, but they are expected......(before next meal etc...)

so going by that my main approach is to test first, then treat......

what is right? who knows............some people are really quite scared of hypos and others are not.........
 
well, maybe expected is the wrong word..............

but if your basal is bang on and fine tuned with the pump and your carb count and insulin carb ratios are also finely tuned with the pump..........running late and having to run for the train might bring on a hypo..............

that's the scenario I am describing, and so, yeah, a hypo just before my dinner can be prepared for..........
 
My consistent hypo signs can also be the signs I get at higher levels eg 7-9mmol/l:
  • Tiredness/sluggishness
  • Yawning
  • Teary eyes
  • Wanting/almost needing to bit the inside of my lips/cheeks
I will test because, often enough, a suspected low can turn out to be a high. Treat a high with sugar and then you're having to do a correction dose later on and that, in my case, introduces a larger risk of a severe hypo.

The exception to me testing first -which only takes 60 seconds- is if I'm worried I may be dropping quickly, such as having a faster beating heart. In those cases, I'll treat first and test soon after.

If one is prone to severe hypos, I'd go with your advice of treating then testing.

Luckily severe hypos are a very rare occurrence to me and I'd struggle to remember how long ago the last one was. A number of years of years now.

Ed
 
After reading the accounts from different people. I'm of an open mind... As long as your capable of sorting it out yourself? Then do what works..

Me? I'm from the old days of peeing in a chemistry set.. "If you feel funny? Eat." Even with the pee sticks a hypo would cause colourblindness, thus matching the colour chart. ;)
I'm still fully hypo aware. Which even wakes me.. Plain & simple I feel "stoned"... I'm never wrong.

So I eat first.. Testing with a meter within the first 5/10 minutes while I drink or chew on something gives me a gestimation with respect to "lag". A reading of for instance 2.5 or 3.6 Maybe the lowest point I dropped 20 minutes ago? Or where I was 15 minutes back before it dropped further..
"Testing first" & getting a 4mmol may not seem that urgent but the reality of the BS at that moment may be lower due to that lag. I get the sugar down first.

I read a fair few posts on hypos where the testing is every 5 minutes & the BS don't go up fast enough... Some mention the BS even drops a little further & they panic & end up "over treating"..? "Lag"..

However accurate the meter is.. It's a "time machine".. You still need a little instinct. ;)
 
novorapidboi26 said:
well, maybe expected is the wrong word..............

but if your basal is bang on and fine tuned with the pump and your carb count and insulin carb ratios are also finely tuned with the pump..........running late and having to run for the train might bring on a hypo..............

that's the scenario I am describing, and so, yeah, a hypo just before my dinner can be prepared for..........
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If you know this is to be expected why don't you just have 10g of carb?
 
Agree with @iHs with tiredness. Now I'm back to being so active tiredness onset is a hypo warning..
 
Jaylee said:
After reading the accounts from different people. I'm of an open mind... As long as your capable of sorting it out yourself? Then do what works..

Me? I'm from the old days of peeing in a chemistry set.. "If you feel funny? Eat." Even with the pee sticks a hypo would cause colourblindness, thus matching the colour chart. ;)
I'm still fully hypo aware. Which even wakes me.. Plain & simple I feel "stoned"... I'm never wrong.

So I eat first.. Testing with a meter within the first 5/10 minutes while I drink or chew on something gives me a gestimation with respect to "lag". A reading of for instance 2.5 or 3.6 Maybe the lowest point I dropped 20 minutes ago? Or where I was 15 minutes back before it dropped further..
"Testing first" & getting a 4mmol may not seem that urgent but the reality of the BS at that moment may be lower due to that lag. I get the sugar down first.

I read a fair few posts on hypos where the testing is every 5 minutes & the BS don't go up fast enough... Some mention the BS even drops a little further & they panic & end up "over treating"..? "Lag"..

However accurate the meter is.. It's a "time machine".. You still need a little instinct. ;)
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Probably those who were diagnosed 30 or more years ago were told to treat first as we didn't have access to a bg meter so there was any way of testing, the old Clinitest kits and pee sticks only show glucose when bg levels were over 10 mmol if I remember right.
 
noblehead said:
Probably those who were diagnosed 30 or more years ago were told to treat first as we didn't have access to a bg meter so there was any way of testing, the old Clinitest kits and pee sticks only show glucose when bg levels were over 10 mmol if I remember right.
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Yep the old methods were pointless you had to be aware of hypos back then....
 
I test first if possible, if the situation does not seem severe, but treating the hypo is always a higher priority than measuring it, if push comes to shove. It's definitely valuable to measure it with a meter, whenever that can be done safely
 
Actually a good reason to always treat first is that our judgement is often impaired during a hypo so we shouldn't be taking complicated decisions about what to do. An automatic procedure, drilled in by habit, is safest.

Using a meter immediately after taking on some glucose will probably give the same measurement as before.
 
So here's the corollary of the original question:

Let's say you experience hypo symptoms and you test first. You meter shows you 4.3, but you have clear symptoms. What do you do next?

Personally, I've already treated at this point, but given the margin for error on that test reading is 15%, your 4.3 is just as likely to be 3.6....
 
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