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Dextro tabs & Hypos - How many tabs?

Discussion in 'Diabetes Discussions' started by miahara, Mar 16, 2019.

  1. miahara

    miahara Type 2 · Well-Known Member

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    I've just started on insulin so need an easily carried hypo booster. I've bought some "Dextro Energy" tablets, but finding it hard to estimate how many tabs to take to manage a hypo. Can anyone enlighten me please?

    Dave
     
  2. Scott-C

    Scott-C Type 1 · Well-Known Member

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    Hi, @miahara , I'm speaking from a T1 point of view here, but the biology of hypos is broadly similar whatever the type.

    As a very general rule, the starting point is that 10g raises bg by about 2 to 3, but this varies between individuals, so you'll need to figure out your own numbers.

    Each dextrotab is about 3g.

    Hypos differ in severity and speed of onset. A lot depends on how much insulin you've got on board (iob) and where it is in it's 3 to 5 hour active life span.

    For example, if I only have a very small amount of iob towards the end of activity, and I'm gently nudging into hypo land, then a single 3g dextrotab will be usually be enough to just nudge back up.

    Whereas if I've got, say, 5u iob peaking at about 2 hrs after injection and dropping me rapidly, that's a different situation entirely, and I'd probably be looking at 10 to 15g, about 3 to 5 tabs, and in some cases more - it can depend on how much food I've eaten and the rate at which it's being absorbed: if I reckon that the carb content is going to be in stream shortly, I'll tail back the tab correction so as not to overshoot.

    The main thing to keep in mind is that the dividing line between a decent 4.5 to 5 and sub-4 hypo is quite a narrow line, so, if you're managing well, a few hypos are inevitable. The flip-side of it being a narrow line is that, even though a bad hypo can be very scary and confusing, a few dextrotabs will sort it out.

    Boots do small bottles of Glucojuice, about £1.50 for 15g. Keep a few of those for emergencies, they fit into a jacket pocket easily - if things are looking really bad, they get in stream very, very quickly.

    There's always a temptation to over-treat and eat too much, which will leave you too high and then you need to inject again to bring it back down which can get messy and unstable.

    It's probably safer to overtreat when you're starting out just to be on the safe side, but the general rule is 10g, wait 10 to 15 mins to let the glucose get in stream, test to see how it looks, and another 10g if too low.

    As time goes by, you'll be able to nuance that general rule to fit the circumstances - it's astonishing how effective a single 3g tab can be with mild, slow hypos.

    Many people make the mistake of eating till they feel better, but that ignores the fact that it takes about 10 mins for the tab to get in stream, so eating till you feel better tends to overtreat.

    I think some meters let you enter bolus amounts so you can track iob. The libre reader does too, even if you're not using a sensor (use the cheat code CAA1C in the professional options settings to start the Active Insulin Indicator - a gingerbread man icon appears on screen after you enter the bolus amount, click it to show the number). If you're on android, xDrip+, a free cgm app, will also show iob even if you're not using it as cgm :https://github.com/NightscoutFoundation/xDrip/releases

    Good luck and don't panic!
     
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  3. miahara

    miahara Type 2 · Well-Known Member

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    Hi @Scott-C ! Many thanks for your very comprehensive and helpful reply. I just started with a basal 5 units yesterday which will be adjusted upwards over the next few days. The DSN reckons I'll have to move to basal plus bolus though. One thing on the plus side is that she said I'd qualify for a CGM.
    Got a steep learning curve ahead. I've copied and printed you post so I can read it at my leisure.
    Thanks once again!
    Dave
     
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