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Best quick fix for hypo with tube feeding

M

Mungobean

Well-Known Member
Messages
88
Type of diabetes
Type 1
Treatment type
Insulin
Hi, I keep having hypos and the trouble is that I’m 99% tube fed, so I get into a bit of a cycle.

- hypo
- Try and eat carbs (more often than not I’m sick (hence the tube feeding), which doesn’t help.
- Try and get something down the tube - sugary water, a biscuit dissolved in water or some Fortisip.
- takes ages to get my BS up.
- Once it finally starts going up (after say 45 minutes), it then goes too high.

If I eat orally, I’m either sick or it sits in my stomach for days (Gastroparesis - my stomach doesn’t empty) so doesn’t tend to help much.

It seems to take ages to raise my sugar, I’m probably trying too many things because I’m panicking).
- Eventually I get my levels up, but then they seem to go whoosh quickly and they’re too high, so I’m then using the Novorapid.

If I try say just the sugary water, how long should I be leaving it, to take affect?
I can’t eat things like jelly babies - I can’t swallow them.

I’ve tried the diabetic nurse and the diabetes lead at the practice, but everyone seems to have decided that I’m ‘too complicated’ and so they don’t want to deal with me, because they don’t know what to do.

- but if I’m too complex for the experts, how am I meant to know what to do by myself, when I’m new to all of this?

Thanks in advance!
 
Mungobean said:
If I try say just the sugary water, how long should I be leaving it, to take affect?
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Hard to say, as the gastroparesis might mean it takes longer for the sugar to be absorbed. I do think sugary water is your best bet, it works faster than solids anyway, and because you can take it through your tube it might affect your nausea a bit less.

What I found very effective is undiluted cordial, it has a lot of sugar packed in very little volume, which could be useful in your case. It does taste horrible but this doesn't really matter if you can use your tube
Mungobean said:
Try and get something down the tube - sugary water, a biscuit dissolved in water or some Fortisip.
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The dissolved biscuits and Fortisip aren't very helpful for treating a hypo. They will get you up eventually, but it takes much longer than plain glucose because all the other stuff in it needs to be digested at the same time as the sugar. You don't want your body to have to do anything beside getting the glucose in your bloodstream!
 
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You can buy liquid glucose drinks, it’s a tiny bottle of 60ml? I think?
Or you can do tiny party cans of coke, or juice cartons? They are like the perfect size to not over do the carbs.
General rule is have 15g of carbs, but for me it is depending on level - at 3-4mmol I have 15g, anything under I have a bit more and taking into account any insulin left over from meal times, wait 15 mins, re test, still low? Do another round of 15. for some people they find they eat enough but they need to wait a bit longer.
 
The glucose drinks are called Lift and contain 15g of carbs. For me they work much quicker than sugar, or anything else for that matter.
 
Would something like glucogel work? It absorbs through your inner cheek so no need to swallow.
 
sleepster said:
Would something like glucogel work? It absorbs through your inner cheek so no need to swallow.
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Thanks. I have a bottle of glucogel, but I’m a bit wary of it! On the box, it says to read the enclosed leaflet to see how much to take, but when I look at the leaflet, it just says to use the required amount! I’ve had the little tubes of it before in hospital, and they just used to give me two, but this is an 80g bottle (containing 32g of glucose) and seems a lot to take I one go?
 
The Glucogel tubes are 25g of gel which gives 10g glucose. I use them if I go really low and the seem to work very quickly. As said above, you can absorb through your gums and cheeks.

HTH
 
"Lift" in the small bottles is glucose which acts quite a bit faster than sugars. I usually scoff a few jelly babies to ward off hypos, but if I'm needing a really fast fix I resort to "Lift".
 
I have a similar pattern.
Something triggers me to throw up > blood glucose drops like a rock > need to absorb glucose > eating/drinking glucose makes me throw up.
The best my doc (senior diabetes consultant in a hospital diabetes centre) has come up with is buccal (next to gum) antiemetic tablets. These mean I won't actually throw up, and if I take a liquid form of glucose, most of it is absorbed before it hits the stomach.

Other notes.
1) If you actually throw up, you're losing a huge amount of fluid, and your blood glucose will come down a little even by just drinking water.
2) Keep an eye on your ketones. High ketones, high bg and dehydration is a go-to-hospital mix.
3) Tube feeding is designed to put the food into the stomach. Ideally you want the glucose entering the blood before the stomach, so liquid and by mouth would be better if possible.
4) A last resort to raise bg is the glucagon pen. You should have one of these if you're on insulin anyway. Warning - it works once, then the liver needs time to restock.
5) Standard doses and timing. Alas, it's the old chestnut, everybody is different. I take about 15g glucose, wait ten minutes, and check my libre to see what's happening. If it's still going down I take another 15g, if it's level I eat a biscuit. Please bear in mind I take larger amounts of glucose because I'm hypo unaware.
6) My main glucose sources are honey (on the gums) if I'm still puking, Lucozade if I think I can keep it down.

You have my deepest sympathies for this horrible situation. If your medical team have said 'you're too complicated' for them, perhaps asking for a referral to a local hospital might be a good idea. (My GP openly says my diabetes is too complicated and she doesn't want to treat it. Which is fine, because she referred me to the best hospital team locally.)
 
Hi - either glucogels or Lift fast acting glucose juice shots are best.

How often are you going hypo and does your insulin dosing need adjusting ? is there a pattern to your hypos in regards to time of day ?

Can you get a Libre or Dexcom which will show you when your levels are starting to fall ?

I agree with @Seacrow ask to be referred - no one is too complicated for a specialist diabetes team.
 
miahara said:
"Lift" in the small bottles is glucose which acts quite a bit faster than sugars. I usually scoff a few jelly babies to ward off hypos, but if I'm needing a really fast fix I resort to "Lift".
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I'd like to see the poster try getting a couple of jelly babies down the tube.
 

My feed goes straight into my jejunum, so I think that will mean it gets absorbed quicker? I had an appointment with a consultant at 9am last Thursday, but they then rang me at 9:05 to say the consultant was off sick, so it will need to be rearranged. I hope they sort it before Christmas!
 
KK123 said:
I'd like to see the poster try getting a couple of jelly babies down the tube.
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It’s amazing what you can get down a JEJ if you try hard enough (I try not to explode the tubes,)
 
KK123 said:
I'd like to see the poster try getting a couple of jelly babies down the tube.
Click to expand...
I''m not the complete idiot you seem to think I am. My comment was intended to highlight the fact that 'Lift' , a liquid, is high in carbs and very rapidly absorbed. It's obvious jelly babies won't go down a tube - even this thicko comprehends that!!
 
I don't know which would be faster, it might even depend on whether your gastroparesis extends further into slow peristalsis in the intestines. Definitely something to ask a specialist doctor. Just in case you get a sudden appointment, have you made a written list of questions? I tend to come away from telephone 'chats' with a list of stuff I forgot to say.
 
miahara said:
I''m not the complete idiot you seem to think I am. My comment was intended to highlight the fact that 'Lift' , a liquid, is high in carbs and very rapidly absorbed. It's obvious jelly babies won't go down a tube - even this thicko comprehends that!!
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Ah, I think that little bit of light hearted humour fell flat, my apologies.
 
KK123 said:
Ah, I think that little bit of light hearted humour fell flat, my apologies.
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Every response is truly welcome, so thank you.
You really will be surprised at what can (I’m not saying should!) go down a tube. I hate the taste of jelly babies, even if I could swallow them; so I have been experimenting this morning. I have a syringe with a couple of chopped JB in water - and I am leaving it to see if it goes mushy enough to go down the tube when/if I need it later.
 
miahara said:
I''m not the complete idiot you seem to think I am. My comment was intended to highlight the fact that 'Lift' , a liquid, is high in carbs and very rapidly absorbed. It's obvious jelly babies won't go down a tube - even this thicko comprehends that!!
Click to expand...

Thank you for your response. I will let you know how I get on with my mushy jelly baby experiment; it’s all a case of whether or not it will dissolve in water and if it does dissolve, how long it takes. The drinks and gels, I never seem to have them, when I need them, so I am looking for readily available things, like the JBs. I have started a second lot, mixed with boiling water. It looks like some iffy kind of cryogenic lab here

A genuine question; are sugar coated jellies like Fizzy cola bottles as good as a JB or does the coating make them worse for you?
 
Can't say about the coated sweets, they're more likely to make me throw up so I avoid them.

Have you got a liquidiser, even one of the little hand held ones? The only time I was on an NG tube was pre-24 months, and my mother told me she would put half an adult portion of their dinner aside, liquidise most of it for the tube and let me chew on the rest. I don't know if jelly babies would liquidise, but maybe worth trying.
 
I doubt if Jelly Babies will disolve. Just out of curiousity this evening I thought I'd see if dextrose or glucose tablets would disolve so I popped one of each into a glass of warm water and even after an hour they hadn't disolved :-(
 
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