Hypo? (Newbie type 1)

KesLouise said:

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?

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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.

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.

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.

KesLouise said:

I get a bit confused when it comes to mentioning fast acting insulin etc because mines mixed - I think? It’s humalog mix 25

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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.

KesLouise said:

I get a bit confused when it comes to mentioning fast acting insulin etc because mines mixed - I think? It’s humalog mix 25

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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..

helensaramay said:

OK so this be contraversial

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Lol, H, leaving out the "might" has turned you from a middle class software engineer into a gangsta rappa!

KesLouise said:

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

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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.