Hypo unawareness and bringing BGLs back up over target

[thewestiesmum]

With hypo unawareness are you supposed to bring your BGLs back up quickly by treating with your normal amount of hypo treatment or slowly by taking small amounts of hypo treatment?

My target range was 5-8mmol but now for a few weeks it's 6-10mmol. Every time I go into the 4s or 5s I've been taking just a small amount of hypo treatment at a time and sometimes it's taking 2 or 3 attempts to bring my BGLs back up into target.

 

[dancer]

If it takes 2 or 3 attempts of small amounts, I would just give the normal amount of hypo treatment. I presume the lows aren't cosistent, otherwise I'd be reducing the appropriate insulin.

 

[JMK1954]

I have lost hypo warning symptoms in the past , but got them back by keeping BS test levels higher. Don't hesitate to use your normal amount of fast-acting carbs to correct a hypo. You are just prolonging the hypo by not hitting it hard with enough glucose straight away. In your current situation, this is counter-productive.

 

[Juicyj]

With hypo unawareness are you supposed to bring your BGLs back up quickly by treating with your normal amount of hypo treatment or slowly by taking small amounts of hypo treatment?

My target range was 5-8mmol but now for a few weeks it's 6-10mmol. Every time I go into the 4s or 5s I've been taking just a small amount of hypo treatment at a time and sometimes it's taking 2 or 3 attempts to bring my BGLs back up into target.

Hi it's not how you treat a hypo that should change, it's how you manage your blood glucose levels on an ongoing basis.

Regardless of hypo awareness all hypo's should be treated with fast acting glucose and around 15g of carb, or 3 glucotabs.

You should run your levels higher to bring your hypo awareness back over time, so avoiding hypos is vital, but speak to your Diabetic team to discuss your longer term plan and what levels they feel are right for you to bring your awareness back.

At the moment the way you are managing your hypos is going to make it harder to bring back your hypo awareness.

 

[thewestiesmum]

If it takes 2 or 3 attempts of small amounts, I would just give the normal amount of hypo treatment. I presume the lows aren't cosistent, otherwise I'd be reducing the appropriate insulin.

Thanks for your reply. It is sometimes taking 2 or 3 attempts of small amounts. Regarding the consistency and also when I've had 2 or 3 attemps with small amounts of dextrose I've posted some pictures of the last couple of days for you to have a look at....

7:30 SG 4.8 didn't hear the low glucose alarm go off which is another problem re the alarms.
BG 4.5 finger prick. Had 3 dextro tablets which got me to 6.3 SG and BG 6.5.


18:30 SG 5.3
BG 5.2
had 2 dextro tablets.
18:48 SG 4.4
BG 5.5
had another 1/2 dextro tablet
22:43 SG 5.8
BG 5.7
had 1 and 1/2 dextrose tablets.

 

[thewestiesmum]

I have lost hypo warning symptoms in the past , but got them back by keeping BS test levels higher. Don't hesitate to use your normal amount of fast-acting carbs to correct a hypo. You are just prolonging the hypo by not hitting it hard with enough glucose straight away. In your current situation, this is counter-productive.

Thanks for your reply.
I'm not going hypo apart from just 2 in the last couple of days - I'm going below the bottom number of my target and treating it as though it's a hypo which I thought you should do in these situations. I think I may just treat these just below targets with my normal amount of fast- acting carbs from now on. I would normally have 4 dextro if I was hypo in the 3s.

 

[thewestiesmum]

Hi it's not how you treat a hypo that should change, it's how you manage your blood glucose levels on an ongoing basis.

Regardless of hypo awareness all hypo's should be treated with fast acting glucose and around 15g of carb, or 3 glucotabs.

You should run your levels higher to bring your hypo awareness back over time, so avoiding hypos is vital, but speak to your Diabetic team to discuss your longer term plan and what levels they feel are right for you to bring your awareness back.

At the moment the way you are managing your hypos is going to make it harder to bring back your hypo awareness.

Thank you for your reply.
Thanks for saying about the "regardless of hypo awareness....." I'm going to go back to treating these lows with my normal amount of dextro tablets which is usually around 4 for me.

Re "at the moment the way you are managing your hypos" please can you say a bit more about how you think I'm managing them? Do you mean by having the small amounts of fast-acting carbs?

 

[dancer]

Thanks for your reply. It is sometimes taking 2 or 3 attempts of small amounts. Regarding the consistency and also when I've had 2 or 3 attemps with small amounts of dextrose I've posted some pictures of the last couple of days for you to have a look at....

7:30 SG 4.8 didn't hear the low glucose alarm go off which is another problem re the alarms.
BG 4.5 finger prick. Had 3 dextro tablets which got me to 6.3 SG and BG 6.5.
View attachment 52730

18:30 SG 5.3
BG 5.2
had 2 dextro tablets.
18:48 SG 4.4
BG 5.5
had another 1/2 dextro tablet
22:43 SG 5.8
BG 5.7
had 1 and 1/2 dextrose tablets.
View attachment 52731

View attachment 52733

@mum2westiesGill to regain hypo awareness, you should try to avoid hypos for several weeks/months. If you consistently have hypos at the same time(s) of day you should reduce the appropriate insulin. E.g. If you are low for a few days when you waken in morning, your evening basal should be changed. You should look for patterns so that you can avoid being below your new target range.
Also, if you are high with ketones, only correct to the upper end of your target which is 10. For instance, if your BG is 22, you want to reduce it by 12, so use your correction factor to take the correct amount of insulin for that that reduction.

 

[Juicyj]

Thank you for your reply.
Thanks for saying about the "regardless of hypo awareness....." I'm going to go back to treating these lows with my normal amount of dextro tablets which is usually around 4 for me.

Re "at the moment the way you are managing your hypos" please can you say a bit more about how you think I'm managing them? Do you mean by having the small amounts of fast-acting carbs?

Yes as your delaying the recovery by not treating it correctly, unsure why you were treating it with small amounts of fast acting carbs ?

 

[JMK1954]

If the bottom of your target range is 6 mml as you say, you are going to have to eat more/ reduce your insulin in order to avoid a drop to below 6 mml. It really is that simple. The whole series of test results you have posted, together with the info that you have been taking inadequate amounts of fast-acting carbs to sort things quickly, shows this.

I know it is difficult to avoid a hypo for weeks, but you are making it more difficult for yourself than it should be. You can make much finer adjustments to the situation by adjusting carb intake than by adjusting insulin. You could start with an extra 5g at any meal where a drop to below 6 mml at any time before the next meal has occurred on the previous day. You seem to be trying to keep your BS as low as possible, when this is not the object of the exercise. You should be prepared to accept a test result of up to 10 mml in order to hit this problem on the head quickly. You were not given a range of 6 to 10 mml for fun. We all need warning symptoms to avoid accidents, loss of driving licence, ending up in A and E etc etc. It shouldn't be that difficult to sort this out.

 

[thewestiesmum]

Yes as your delaying the recovery by not treating it correctly, unsure why you were treating it with small amounts of fast acting carbs ?

Someone suggested to me to have small amounts to bring my levels up slowly but my usual way of treating an actual hypo ie in the 3s would be to have a bigger amount of fast acting carbs such as 4 dextrose and mostly that would bring me back to my previous target of 5-8mmol.

In future while I'm trying to deal with the hypo unawareness and my target of 6-10mmol if I drop into the 5s or 4s I'm going to be taking my usual 4 dextrose to bring it up quickly.

 

[thewestiesmum]

If the bottom of your target range is 6 mml as you say, you are going to have to eat more/ reduce your insulin in order to avoid a drop to below 6 mml. It really is that simple. The whole series of test results you have posted, together with the info that you have been taking inadequate amounts of fast-acting carbs to sort things quickly, shows this.

I know it is difficult to avoid a hypo for weeks, but you are making it more difficult for yourself than it should be. You can make much finer adjustments to the situation by adjusting carb intake than by adjusting insulin. You could start with an extra 5g at any meal where a drop to below 6 mml at any time before the next meal has occurred on the previous day. You seem to be trying to keep your BS as low as possible, when this is not the object of the exercise. You should be prepared to accept a test result of up to 10 mml in order to hit this problem on the head quickly. You were not given a range of 6 to 10 mml for fun. We all need warning symptoms to avoid accidents, loss of driving licence, ending up in A and E etc etc. It shouldn't be that difficult to sort this out.

So if I do this "You could start with an extra 5g at any meal where a drop to below 6 mml at any time before the next meal has occurred on the previous day". I match my insulin to carbs so if I take 5g of carbs off so I'm injecting for 5g less of carbs. If I see that for example on Monday before lunch I've dropped to below 6mmol then on Tuesday lunchtime I would reduce the carb amount by 5g. If on the Tuesday lunchtime I had dropped to below 6mmol I guess I would treat the below 6mmol and also reduce the carbs by 5g? Also for how long would I have the reduced 5g for? Would it just be the one day at lunchtime?

 

[JMK1954]

I wasn't suggesting adjusting your insulin - just eating more !!!!!! (I count carbs as well and have done for the last 58 years, since being diagnosed aged 10.) If you want your BS test results higher, you need more carbs or less insulin. Eat extra. Don't take extra insulin for the extra carb, just the amount normal for you at this meal.
Say you are below 6mml mid-afternoon Monday. On Tuesday, you could try eating 5g or 7g or 10g carbs extra at lunch. Make a point of testing before the time of the drop the day before. Note the result. Did you eat enough to stay above 6 mml ? If you did, you've learned something. You need more carbs for that amount of insulin, or less insulin.
Look, I don't have medical qualifications. I am just making a suggestion for the sort of thing I would try in your position, based on my experience.

There was very probably something wrong with your carb to insulin ratio at times for you to end up hypo so often that you lost warning symptoms in the first place. I would not be using the same, possibly questionable ratio to drop your insulin. I would eat some extra carbs if I were you and note the results. If your levels do not drop as low as before, it was the right move. You may need to eat an extra 7g or 10g every day at this time until you have proved what is required to keep above 6 mml. It's not forever. You can consult your DSN about adjusting your insulin for the longer term once you have an idea what is going on. A few days should make a difference if you are very careful and test before significant exercise.
I really hope this is helpful. I can't imagine why anybody would think it was a good idea to get yourself out of this situation slowly. Did you get any suggestions from the medics as to how you should set about staying above 6 mml ? Thry don't seem to have given you useful advice.

 

[Hopeful34]

The idea is to stop you dropping to below 6, so if:
Monday you drop to below 6 after breakfast and before lunch
Tuesday add 5g extra carbs to breakfast to see if you can stop the drop to below 6 before lunch.
If that works, continue adding the 5g extra carbs every day to your breakfast.

If you still drop to below 6 before lunch, try adding 10g extra carbs to your breakfast to stop you dropping to below 6 before your lunch

 

[dancer]

@mum2westiesGill try to find patterns to when you are below target. For instance if you are below 6 after lunch on Tuesday but not the rest of the week, it's not a pattern so you wouldn't eat 5g extra carbs for every lunch, you'd only react to the low on that one day. Your aim is to avoid falling below target. Everyone is different, so the "extra" 5g carbs might not be enough for you. Obviously, if there is a pattern you would reduce your insulin for that meal every day.

If you have been carefully, trying to avoid high BGs for years, your new target could go against the grain, but it is for your own good. You just have to accept this change to avoid hypos. Remember, it's not really a case of eating more. You will actually eat the same amount but take less insulin for your meal.