At what point do you stop treating a hypo?

[sgm14]

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?

 

[grantg]

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

 

[sgm14]

I note u said libre said low. Just so aware supposed to fingerprick blood glucose check..

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.

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.

 

[Hopeful34]

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.

 

[EllieM]

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 .....

 

[grantg]

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.

https://www.freestyle.abbott/content/dam/adc/freestyle/countries/us-en/documents/get-started-guide-FSL2-Plus.pdf

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.

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.