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At what point do you stop treating a hypo?

S

sgm14

Well-Known Member
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309
When I was first diagnosed, I was told to treat a hypo by taking 20g of fast acting carbs (like jelly babies) and check 20 minutes later and if still low take another 20g and repeat every 20 minutes until back in range. And then to take around 20g of slow acting carbs to make sure your BS doesn't fall back down again.

That basically works out as 1g for every minute you are low.

So last week I had a pretty bad hypo (must have been a lantus low) and spent quite a bit of time LO (<=2.2) and it was over 100 minutes before my figures went back in range and during that period I took 115g of fast acting carbs.

Not surprisingly about 90 minutes later (after a few sensor errors) my Libre came back HI (>= 27.8) and stayed HI for nearly 2 hours and it was about 5 hours later before I came back down below 10.

Was wondering what other people do situations like this?
 
I note u said libre said low. Just so aware supposed to fingerprick blood glucose check... If blood glucose low treat I was also told to follow up if no food shortly to follow up with snack of some more complex carbs which would help to stabilise levels a little better. It's essential for blood check as cgm is not always fully accurate libre and dexcom both have that marked in the instructions. I have sent a few cgms back which read low in past when wasn't. There is not a point if time when not to treat low, can have honeymoon period in some circumstances where ratios may need altered if happens a few times speak to your diabetic care team for guidance
 
grantg said:
I note u said libre said low. Just so aware supposed to fingerprick blood glucose check..
Click to expand...
That was Abbott's recommendation for the Libre 1, but they changed it for the Libre 2 and now they say

Finger pricks are required if your glucose readings and alarms do not match symptoms or expectations.
Click to expand...

In this case symptoms definitely matched up and I didn't need my Libre1 to tell me I was very,very low.

The accuracy of the libre seems to vary greatly from person to person and I have usually found it very accurate. When I got my first Libre1 I used to follow the guidelines and do a finger prick confirmation before treating a low, but after about a year I decided it was just wasting test stripes.
 
I always check low cgm readings with a finger prick test as cgm's can give a lower reading than blood, and also I find they take a lot longer to start the upward trend during/after a hypo. Blood tests give a clearer indication of how much hypo treatment to take, and when to stop.

Without finger prick tests, it's much easier to over-treat a hypo, and get a really high sugar level as a result.
 
Lows can be hard to treat, particularly lantus lows. Once you get to the point where the cgm says "LO" you just want it to go higher. But once I'm lower than 3.4 I get my glucometer out and test every couple of minutes, just to see how low I'm going and whether the level is starting to go up. (I use a dexcom which only gives you a level every 5 minutes, so combine that with the cgm lag and it isn't much good for extreme lows). I have managed to have my meter read LO as well, so at that point I just knock back the carbs.

I think a rebound is almost inevitable once you go below 2, but you can reduce it by relying on a glucometer once you are very low....

I got a couple of lantus lows and I improved things by splitting the dose. But I still had too many lows.

My then team put me on a pump because of issues with lows - I haven't had any serious lows since .....
 
sgm14 said:
That was Abbott's recommendation for the Libre 1, but they changed it for the Libre 2 and now they say

In this case symptoms definitely matched up and I didn't need my Libre1 to tell me I was very,very low.

The accuracy of the libre seems to vary greatly from person to person and I have usually found it very accurate. When I got my first Libre1 I used to follow the guidelines and do a finger prick confirmation before treating a low, but after about a year I decided it was just wasting test stripes.
Click to expand...


page 2:
§The Libre app and the FreeStyle Libre 2 reader have similar but not identical features. Fingersticks are
required for treatment decisions when you see Check Blood Glucose symbol and when your glucose alarms
and readings from the system do not match symptoms or expectations.
Click to expand...

I'm pretty bad with needles, yet will check when low/high. small print. would agree accuracy can vary from person to person. I've also had a few dud sensors reading low which had to send back, after speaking to abbotts, although in general they are fairly 'consistantly' out for me. hopefully that helps. I wouldnt worry about 'wasting' test strips.

dsn has confirmed should always check against both highs and lows, saying they are more accurate within 'usual ranges'.

presume p14 is where get but see small print which listed above.: †Fingersticks are required if your glucose alarms and readings do not match symptoms or when you see Check Blood Glucose symbol during the first twelve hour

p16 also reiterates to check against fingerstick before treatment decisions.

speak to your diabetic team if unsure. if uk test strips for t1 are prescribed and should be free.
 
sgm14 said:
When I was first diagnosed, I was told to treat a hypo by taking 20g of fast acting carbs (like jelly babies) and check 20 minutes later and if still low take another 20g and repeat every 20 minutes until back in range. And then to take around 20g of slow acting carbs to make sure your BS doesn't fall back down again.

That basically works out as 1g for every minute you are low.

So last week I had a pretty bad hypo (must have been a lantus low) and spent quite a bit of time LO (<=2.2) and it was over 100 minutes before my figures went back in range and during that period I took 115g of fast acting carbs.

Not surprisingly about 90 minutes later (after a few sensor errors) my Libre came back HI (>= 27.8) and stayed HI for nearly 2 hours and it was about 5 hours later before I came back down below 10.

Was wondering what other people do situations like this?
Click to expand...
I was advised by my endo team to take liquids that are faster acting to treat the lows initially, so a small glass of orange juice/grape juice may be faster than your jelly babies. Not always possible of course but might help.
 
Teuchterabroad said:
so a small glass of orange juice/grape juice may be faster than your jelly babies.
Click to expand...
Interesting . Have you tried it and does it work faster ?

AFAIK orange juice has a medium GI value and hence I would have thought it would be slower. I have taken it a few times but certainly not noticed or thought of it as being as fast as jelly babies.
 
I always check with a glucose meter if my CGM reads low even if I am symptomatic, most CGM companies say you don’t need to when symptoms match the given result but in the past I sometimes think my body reacts to the result on the screen and I get phantom low feelings, I also still feel symptomatic with lows when I’ve given something for them and come back into range
 
sgm14 said:
Interesting . Have you tried it and does it work faster ?

AFAIK orange juice has a medium GI value and hence I would have thought it would be slower. I have taken it a few times but certainly not noticed or thought of it as being as fast as jelly babies.
Click to expand...
Good question. Tried it, yes. Faster, well I haven't pitched one directly against the other, but when I've resorted to sweets in the absence of juice (or coke) I would say that I get a quicker return to normal.

Edited by mods to remove forum rule breach B10 using AI generated info
 
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These days I don’t get actual hypos , you know the ones when you eat the contents of the fridge and any other chocolate cupboard in the house . I have set my low alarm on my Libre to 4.1. I know that it reads about 1 point high . When it goes off I take a mini can of Coke Cola and an energy gel ( like the ones the cyclists use )I never go actual hypo and even though my sugars to climb initially they do settle back down after a hour or so. The energy gels are really quick acting so much so that I don’t get the irritating lo blood sugar alarm as the Libre waits to catch up. My last H1bac was 53 so must be doing something right.
 
I treat a low once with zero sugar monster, yes it worked as I have Cushings syndrome. Caffeine kicked the cortisol and liver dumped glucose straight back in
 
I am not trying to argue against anything you may have been told by your medical team but I find that 15g of carbs is adequate.
For this I am a huge fan of Glucojuice (now renamed Lift). Each small 60ml bottle contains 15g of glucose so I can rip the top off and neck the whole bottle quite easily.
I have also drunk 1/2 bottle just to head off a hypo when I'm aware that my CGM is heading downwards.
As stated by others - your body absorbs liquids more quickly than solids so bear that in mind when your heading to 2mmol and need a rapid fix. I always keep 1 in the car now.
Glucojuice (Lift) is available from Amazon in cartons of 12 and have also seen them sold singularly in Boots.
 
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For me it’s pending on what caused the hypo? Misjudgment with basal around 5 or 10g of fast acting followed by 10g of slower carb (like a digestive biscuit.) incase of a recurrence in the hour?
If fast acting insulin is on board? A nudge with 5 or 10gs of fast acting will suffice.
The official line on treating a low is overkill in my world & can send me too far in the opposite direction..

Should it happen If I’m doing a gig? In the form of a drink? Hard to chew & sing..
 
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