1. This site uses cookies. By continuing to use this site, you are agreeing to our use of cookies. Learn More.
  2. Get the Diabetes Forum App for your phone - available on iOS and Android.
    Dismiss Notice
  3. Guest, we'd love to know what you think about the forum! Take the Diabetes Forum Survey 2019 »
    Dismiss Notice
  4. Diabetes Forum should not be used in an emergency and does not replace your healthcare professional relationship. Posts can be seen by the public.
    Dismiss Notice
Dismiss Notice
Find support, ask questions and share your experiences. Join the community »

Hypo? (Newbie type 1)

Discussion in 'Blood Glucose Monitoring' started by KesLouise, Aug 25, 2019.

  1. KesLouise

    KesLouise · Member

    Messages:
    24
    Likes Received:
    17
    Trophy Points:
    3
    Sorry if this is a silly question!

    At what level should you treat low blood sugar? I’ve not been feeling right today and my blood sugars have been dropping with the last reading being 4.5, do I treat this?
     
  2. Scott-C

    Scott-C Type 1 · Well-Known Member

    Messages:
    2,485
    Likes Received:
    2,718
    Trophy Points:
    158
    Hi, KesLouise, that's a perfectly sensible question!

    Although 4.5 is not technically hypo, with strip testing alone, you don't know if it's a stable 4.5 or still heading down.

    If you were to do another bg test, and it shows lower, or if you had tested a while before the 4.5 and it was higher, those would be good clues that it's not a stable 4.5 and is heading down to hypo land, so there would definitely be a case for some glucose to tail off the drop.

    How much glucose to take depends on a few things. If your last bolus, fast acting shot was more then, say, 4 to 5 hrs ago, there's unlikely to be any fast acting still pulling you down, so a couple of dextrotabs, about 6g, may be enough to pin the drop without sending you too high.

    Whereas if you've injected fast acting within the last couple of hours, that'll still be dragging you down, so a fair bit more might be needed, say 10 to 15g.

    It's difficult to be definite about amounts - it's one of the skills a T1 needs to learn, how to pin a drop without sending it sky high.

    If you end up getting libre or cgm, it's much easier to make judgment calls on this sort of thing. You can see how slowly/rapidly the trace is dropping which tells you how much is needed to pin it.
     
    • Agree Agree x 3
    • Like Like x 2
    • Winner Winner x 1
  3. ert

    ert Type 1 · Well-Known Member

    Messages:
    795
    Likes Received:
    829
    Trophy Points:
    133
    Dafne recognises hypos as below 3.5 mmol/L. If your blood sugars are this low then you should have 2 CPs of rapid-acting carbohydrate (equivalent to 100-120 ml Lucozade, 150-200ml cola or fruit juice, 5 glucose tablets). This is the best way to normalise your blood glucose as it will raise it by 4 - 6 mmol/l at the most.
    If your blood sugars are between 3.5 and 5 mmol/L you can have a snack of 10 grams of carbs, like a small apple to raise your blood sugars 2 to 3 mmol/L.
     
    • Like Like x 2
  4. MeiChanski

    MeiChanski Type 1 · Well-Known Member

    Messages:
    1,994
    Likes Received:
    1,088
    Trophy Points:
    158
    For me, it depends if you still have insulin on board - fast acting insulin lasts about 4 hours and if you're 4.5 half way through it, you might need to treat it. If you're 4.5 after that 4 hour window and it's not long until your next meal, I'd say leave it.
    Personally I would treat a 4.5 because of my past history of hypos and I don't really want to hang around between 4-4.5mmol/l.
     
    • Like Like x 1
    • Agree Agree x 1
  5. KesLouise

    KesLouise · Member

    Messages:
    24
    Likes Received:
    17
    Trophy Points:
    3
    I get a bit confused when it comes to mentioning fast acting insulin etc because mines mixed - I think? It’s humalog mix 25
     
  6. MeiChanski

    MeiChanski Type 1 · Well-Known Member

    Messages:
    1,994
    Likes Received:
    1,088
    Trophy Points:
    158
    Oh sorry, we assumed you're on a basal/bolus regime. In that case it might be a difficult one because thats 25% fast acting and 75% long acting. I'm assuming the 25% lasts 4 hours, but I think it might be best to ask your team. If you keep testing and do go low, please treat it.
     
    • Like Like x 1
  7. KesLouise

    KesLouise · Member

    Messages:
    24
    Likes Received:
    17
    Trophy Points:
    3
    I’m due to speak with the team next week about changing insulin now the diagnosis has been confirmed but I’ll treat it if it gets low like you say
     
  8. Scott-C

    Scott-C Type 1 · Well-Known Member

    Messages:
    2,485
    Likes Received:
    2,718
    Trophy Points:
    158
    Ah, now that's trickier! I was on mix for a while after dx 30 yrs ago, it's unusual for newly dx'd to be put on it these days, but I suppose there's an argument for it reducing variables.

    If you google the name of it, you'll find time graphs of it's action pattern which makes it easier to guesstimate when the fast acting part of it will be kicking in, and that may help deciding whether a nudge up with a biscuit or some dextrotabs is needed.

    Eating patterns need to be quite fixed with mix - I'd ask your team about moving to basal/bolus, it gives much more flexibility.

    Advice on sorting potential hypos out remains the same though. If you identify a downtrend which looks like it will end up sub-4, treat with a biscuit or dextrotabs before it gets there, but don't overtreat.

    Easy to say that, but it's more difficult to do in practice. Even old hands will neck way to much apple juice in the panic of a hard fast drop.

    Practice on slow gentle drops. It's extraordinary how effective 1 or 2 dextrotabs, 3 to 6g can be in those situations.

    The average body only has about 5g glucose in the entire bloodstream, so, provided you've not got stacks of peaking insulin on board, very small amounts can be enough to nudge back into a safe range.

    I recall from one of your earlier posts that it was the loss of control which was phasing you. T1 can be controlled, but it has messy variables, many of which we can't see or measure, so our concept of control is more of a greyish, "near enough" thing. I tend to think of it as co-operating with an occasionally naughty child than absolute control.

    Fortunately, after 30 yrs in, the naughty child has never gone full Damien on me...yet..
     
    • Like Like x 3
    • Agree Agree x 1
  9. KesLouise

    KesLouise · Member

    Messages:
    24
    Likes Received:
    17
    Trophy Points:
    3
    Thanks for be advice! I’m speaking about changing over next week so that’s good.

    I think it’s just getting used to managing things, but I’m seeing it can be done.

    You guys are amazing!
     
    • Like Like x 1
    • Friendly Friendly x 1
  10. helensaramay

    helensaramay Type 1 · Expert

    Messages:
    6,385
    Likes Received:
    6,267
    Trophy Points:
    178
    OK so this be contraversial and I don't want to worry @KesLouise but as our bg is affected by so many things, I always say diabetes can be managed but not controlled.
    I think of it like managing a group of guys at work. I can usually get them to do what is needed but things like illness or family bereavement or a night on the town or a stupid company edict and my staff may not do what I expect. I can sit them down, chat about their recent performance and suggest what we can do to make things easier but I still don't control those guys.
    Diabetes is the same : it usually does what I need it to do but then I get sick, stressed, celebrate,... and i have to sit down, review what has happened and propose new ways of dealing with it.

    The important thing is diabetes can be managed.

    Incidentally, this is the "official" terminology as, if you fail to "control" your diabetes, you may feel a failure.
     
    • Like Like x 3
    • Winner Winner x 2
    • Informative Informative x 1
  11. KesLouise

    KesLouise · Member

    Messages:
    24
    Likes Received:
    17
    Trophy Points:
    3
    That makes sense thank you
     
    • Like Like x 1
  12. Scott-C

    Scott-C Type 1 · Well-Known Member

    Messages:
    2,485
    Likes Received:
    2,718
    Trophy Points:
    158
    Lol, H, leaving out the "might" has turned you from a middle class software engineer into a gangsta rappa!
     
    • Funny Funny x 2
    • Like Like x 1
  13. Scott-C

    Scott-C Type 1 · Well-Known Member

    Messages:
    2,485
    Likes Received:
    2,718
    Trophy Points:
    158
    When I was learning to drive a car in my 20s, it was slow and steady, learned on slow, quiet back streets how to accelerate, brake, 3 point turns, all that basic stuff, before moving on to faster stuff on the bypass, and it wasn't till a lot later that I loved chucking my Rover 416 SI round bends at speed.

    Your team will be taking you through the initial stages of this slowly because you are not yet ready to do the fast bends at speed.

    This may involve what seems like a very limited diet to start with, but bear with it. They are trying to reduce the variables until they have a basic idea of how you respond to insulin.

    There'll be a point at some stage in the next 6 months or so when they loosen the reins and you will have to make the decisions.

    T1 has been described as the, "ultimate patient treated condition".

    You'll have to make the calls on how fast you drive that Rover 416 SI round the bends.

    It can be exciting and terrifying, and you will inevitably make mistakes when you are learning this stuff.

    There's a lot of techniques which you're not aware of yet: pre-bolusing timing; stacking; absorption rates differing dependent on macro components; gi; and so on. You'll learn about those over time.

    I'd encourage you to avoid the "all carbs are bad, don't eat them" meme which is very popular with T2s on this site. That is not true for T1s. Carbs can be managed very well in a T1 context, provided some basic rules are learned.
     
    • Agree Agree x 2
    • Like Like x 1
  • Meet the Community

    Find support, connect with others, ask questions and share your experiences with people with diabetes, their carers and family.

    Did you know: 7 out of 10 people improve their understanding of diabetes within 6 months of being a Diabetes Forum member. Get the Diabetes Forum App and stay connected on iOS and Android

    Grab the app!
  • Tweet with us

  • Like us on Facebook