Woke this morning at 8am with a hypo, 3.9. I got up, had my normal breakfast of 1 Weetabix, tea and toast. I went back to bed and read till 9.30. I then took a reading, it was 17.7. I injected 8mls of Novorapid and took 1 metformin, my usual routine. I am still a bit shaky but otherwise OK. Did I do all the right things, or should I have done something different?
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Did i do right?
- Thread starter lynbrown
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paulliljeros
Well-Known Member
If I knew that I no longer had any insulin on board (i.e. more than 6 hours since my last bolus), then I would take the appropriate number of fast acting carbs to raise my BG (10g or 15g with a BG of 3.9 for me), and continue to take my insulin and eat breakfast as normal. It feels counter-intuitive, but the immediate carbs will raise my BG well before the insulin kicks in, and then breakfast will be back to the normal process.
By not taking the insulin as you normally do, you created the high BG peak, and this could have been avoided.
HTH, Paul
By not taking the insulin as you normally do, you created the high BG peak, and this could have been avoided.
HTH, Paul
@lynbrown If you are on a multiple daily injection regime, you should really adjust your meal time insulin based on your blood glucose levels and target. In your position I would have done the following because the glucose level wasn't very low:
Subtract current blood glucose from target blood glucose, e.g. 6 is target and current is 3.9. This gives 2.1.
The correction factor is the amount one unit of insulin drops the blood glucose level. Let's assume it is 1u to 3mmol/l.
Divide the difference from target by the correction bg, so 2.1/3 = 0.7
This gives the amount to reduce meal time insulin by. To be on the safe side I'd round that up to 1u and reduce the amount I would normally take before the meal by that 1u.
It's a bit more complex, but hugely avoids that spike that you saw. If I had woken up below 3.5, I would have done exactly as @paulliljeros has suggested and taken fast acting carbs first.
Subtract current blood glucose from target blood glucose, e.g. 6 is target and current is 3.9. This gives 2.1.
The correction factor is the amount one unit of insulin drops the blood glucose level. Let's assume it is 1u to 3mmol/l.
Divide the difference from target by the correction bg, so 2.1/3 = 0.7
This gives the amount to reduce meal time insulin by. To be on the safe side I'd round that up to 1u and reduce the amount I would normally take before the meal by that 1u.
It's a bit more complex, but hugely avoids that spike that you saw. If I had woken up below 3.5, I would have done exactly as @paulliljeros has suggested and taken fast acting carbs first.
Hi @lynbrown , for me, if I woke with 3.9, I wouldn't class that as a hypo. I would have had breakfast as normal but would have taken 1/2 a unit less insulin which would have taken me to around 5.4 once the insulin and carbs had finished doing what they do. Or if I wanted to play safe take a unit less which would take me to about 7. For me a unit of insulin drops me by about 3mmol/l, so taking 1/2 less raises by 1.5 ish, but this is only because I'm confident in how my body reacts and in my ratios. Normally if my sugars are good I would bolus a good half hour before eating breakfast, but in this case , with my sugars on the low side, I would bolus immediately before eating.
Aye, for taking my fast acting insulin, Novorapid in my case. Bolus for fast acting, Basal for the long acting (Lantus}
I an only say what I'd do, but in those circumstances I'd probably have something tiny to raise my blood glucose a little (I like to wake up around 5 or so) So maybe just half a glucose tablet or a jelly baby to boost me up to my normal starting place, then I'd inject as normal.
There are other ways of dealing with this as @tim2000s explains and I would probably do that sometimes too, but in the morning I go for simple : D
This is the Multiple Daily Injection regime (Also known as Basal/Bolus):
The injection with meals is known as a Bolus and the long acting is known as Basal. The blue lines are the fast acting, the white line is the slow acting and the grey area is the carbs.
The injection with meals is known as a Bolus and the long acting is known as Basal. The blue lines are the fast acting, the white line is the slow acting and the grey area is the carbs.
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@lynbrown, are you saying you didn't take your insulin with your breakfast? If so it's understandable that your bg levels would go into double figures 90 mins after.
Next time you could either have a Jelly Baby or two or just knock a unit off your insulin dose, I tend to bolus (inject) after eating if bg levels are around that level.
