Type 2 Help-Sugar Levels not going above 3.8mmol

Hi welcome

Do you have biscuits in the cupboard? a biscuit on the way to bed will bring her bg up, maybe too far but a little high is better than a little low at bedtime, Glic can cause hypos unfortunately. Sounds like you guys are doing a great job, well done!

To fix a hypo, you need fast acting carbs, ie. jelly babies etc, nothing keto, that’s the opposite of what she needs. If you have nothing else, a teaspoon of sugar will work or a sweet drink.

A hypo is below 3.5 mmol/l so she has been safe. I would recommend eating a small apple which will lift her blood sugar 2-3 mmol/l.

byeazucar said:

Her sugar then dropped drastically to 2.9mmol within 30-45 min. She then had some Keto chocolate and blueberries to try to stabilize it, however, we did not manage to go above 4.0 mmol.

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To get your blood glucose up you need glucose.
So sweets, sugar, syrup, things like that.
Please don't 'sit it out' for hours until dinner time!

ert said:

A hypo is below 3.5 mmol/l so she has been safe. I would recommend eating a small apple which will lift her blood sugar 2-3 mmol/l.

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The amount a small apple increases BG is different between people, you cannot know how much it will rise someone else.
She dropped to 2.9 on glucose lowering medication, which needs to be treated with fast acting carbs.

byeazucar said:

Hello everyone,

First post here so I try to be as good as I can. My wife has Diabetes Type 2, she is on Keto diet for several months and we monitor things pretty close on daily basis. She wears LibreFree2 as well as does a finger test now and then to ensure reads are correct. 95% of the time she is between 4.5 and 7.5 mmol.

She only takes Glycozide now and then as she is managing levels very well with diet. However, today her sugar was 7.0mmol after waking up and stayed that way for few hours, which is unusual and did not really follow her daily sugar level patterns (no major changes on diet) so she decided to take a Glycozide tablet (1). Her sugar then dropped drastically to 2.9mmol within 30-45 min. She then had some Keto chocolate and blueberries to try to stabilize it, however, we did not manage to go above 4.0 mmol.

After 2 hours we decided to have dinner, expecting levels to go back up. To our surprise, she is still on 3.8mmol (1.5 hours after a meal) and it is concerning me that her sugar levels are not increasing for so many hours despite food intake.

Anyone has experienced similar scenarios or can help me bring some light to it? I would not like to go bed with such levels. (I will definitely won't sleep monitoring her)

Thank you in advance,

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Hi,

Were these readings taken with the Libre. Or was a finger prick test taken too.?
In my experience the Libre can "lagg" when responding to a rise in BG from a low.. The meter will register BGs on the rise a good 20 minutes or so earlier?

What dose of Glic was the tablet? If it was 80mg then that is probably too strong for a keto user. It is available in 40mg dose (which I currently use) and a pill splitter could drop it to 20mg. Certainly, when I was going for keto I had to adjust my Glic doses and it is quite safe to split this med if needed. If she finds she needs a lower dose you will need to notify the doctor to get the scrip changed. I personally like using a small dose of Glic since it allows me to be more relaxed about my carb intake, and I am not currently aiming for keto, just low carb.

byeazucar said:

Perhaps Glycazide only in the morning could be the solution or maybe just to learn a better way to manage Down.

I love to hear always your opinions, I really absorb and enjoy all the useful information that is being shared here.

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This really needs a review with her health care provider, we cannot in any way advise on changing medication.

While a keto diet can be very, very helpful with diabetes, please remember a hypo is an emergency and it needs immediate treatment, which is glucose.
Do not try to treat a hypo with keto chocolate or blueberries, a hypo is serious.

Antje77 said:

The amount a small apple increases BG is different between people, you cannot know how much it will rise someone else.
She dropped to 2.9 on glucose lowering medication, which needs to be treated with fast acting carbs.

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The 2-3 blood sugar rise in mmol/l for a small apple (10 grams of carbohydrate) is in the DAFNE course handbook and recommended to everyone on my course by the DN who lead the course with the specialist. It works for me. Fruit is always the best way to treat low sugar (above hypo level) to avoid spikes. Below that it should be hypo treatment with fast-acting sugar like dextro or orange juice. But the question was about the 3.8 mmol/l blood sugar not the hypo.

ert said:

The 2-3 blood sugar rise in mmol/l for a small apple (10 grams of carbohydrate) is in the DAFNE course handbook and recommended to everyone on my course by the DN who lead the course with the specialist. It works for me. Fruit is always the best way to treat low sugar (above hypo level) to avoid spikes. Below that it should be hypo treatment with fast-acting sugar like dextro or orange juice. But the question was about the 3.8 mmol/l blood sugar not the hypo.

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Hi,

Let's try not to cloud the pot with what it is & what it's not.
It was alledged at one point in time the BG rapidly dropped to 2.9
In my experience a libre can read 0.6 higher than the meter.?
A DAFNE course is a T1 thing. Be wary of the cross posting..

It is unusual for a T2D on orals and not an insulin user to experience a hypo that is a blue light emergency. This is because the source of the insulin is the person's own pancreas, and most T2D on orals retain some semblance of control of insulin output, so there should be a tendency for the body to limit the action of the med, and allow the liver to provide adjustment dump to compensate. Keto diet in the early days before fat burning has become the norm is one possible worry to consider since there is a time lag between reaching hypo levels, and the recovery during which assistance may be necessary, and this is the danger point that DVLA considers to be a reportable Hypo. Personally, I had hypo's myself but was always in control and able to prepare a suitable treatment on my own even on 320 mg Gliclazide.

Insulin users tend to have deeper hypo's.

The libre 1 reports low for me. A finger prick will show in the mid 4s but the sensor reports in the high 2s. Both align around mid 5s and higher. So you may wish to verify with a finger prick

Oldvatr said:

It is unusual for a T2D on orals and not an insulin user to experience a hypo that is a blue light emergency. This is because the source of the insulin is the person's own pancreas, and most T2D on orals retain some semblance of control of insulin output, so there should be a tendency for the body to limit the action of the med, and allow the liver to provide adjustment dump to compensate. Keto diet in the early days before fat burning has become the norm is one possible worry to consider since there is a time lag between reaching hypo levels, and the recovery during which assistance may be necessary, and this is the danger point that DVLA considers to be a reportable Hypo. Personally, I had hypo's myself but was always in control and able to prepare a suitable treatment on my own even on 320 mg Gliclazide.

Insulin users tend to have deeper hypo's.

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Great post. My point is fruit is a good way to avoid rollercoaster highs. What did you treat your lows on gliclazide with?

EllieM said:

The OP's wife is T2 so am guessing may be more insulin resistant than the T1s on a DAFNE course? We have to be very careful about cross posting T1 advice here.

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T1s can be really insulin resistant. This was half the people of my course. It was just a starting point to understand how blood sugar comes up with treatment. You find what works for you.

ert said:

Great post. My point is fruit is a good way to avoid rollercoaster highs. What did you treat your lows on gliclazide with?

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Nothing really. Slice of toast or a wafer biscuit. I did carry glucose tablets because that was what my T1D mum used but never really used them in anger. Funnily enough, on the very day I completed this site's Hypo Awareness course, I went to Boots to purchase some glucose tabs and had my very first hypo as I walked out of the shop. The one and only time I have treated a hypo with sugar.

But my hypos were quite benign, and apart from some visual disturbances, I was able to take readings and function. My T1D buddy can have severe hypos suddenly. One minute chatting away, then suddenly he switches off and his mind goes into neutral. If you try to get him to eat, he takes a swing at you and refuses. I usually end up calling the paramedics when he has a hypo since there is very little communication. Several times we have been onstage and halfway through a song when It hits him, and he just freezes mid verse. I have the luxury of being hypo aware, as I get warning signs that are quite unique to the condition.

Since fine tuning my gliclazide to match my diet, as well as becoming fat-adapted, my readings rarely drop below 4 mmol/l, even when fasting, so I am content. I still have my driving licence, and have never needed any assistance.

However, I would be careful when drinking alcohol. A glass of whisky can drop me a couple of points quite suddenly, and that could send me onto hypoland. I am not abstemious, but careful,

byeazucar said:

I guess it is time to review medication as with her current diet, looks like her sugar levels are really under control and Glycazide might be too aggressive for her.

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It certainly looks that way. Few with levels at 7 or less consistently would be prescribed glic.

Does her dr know about this amazing progress? They should reduce or stop her medication if her current diet and levels don’t require the medication she used to need. Beware - a few might tell her to increase carbs to avoid hypos rather than decrease medication. Absolutely insane. Medicate to the needs not compensate with glucose to allow the medication prescribed to reduce glucose. This might be useful https://bjgp.org/content/69/684/360