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Hypo or not?

phoenix

Expert
Messages
5,671
Type of diabetes
Type 1
Treatment type
Pump
This morning I popped into the hospital to arrange an appointment to borrow a CGMS.
Whilst I was there Evelyn, the nurse (probably the equivalent of a DSN in the UK) noticed I was sweating ... I'd just walked half a mile on a humid day. She asked if I was hypo. I tested and was 3.8mmol , translated this to Evelyn as 68mg/dl(was just about right!) and she offered me a compote (pureed apple), not glucose as she said it wasn't really hypo.
A hypo needing fast acting glucose was she said below 60mg/dl.(3.3mmol) At the level I was, I should have something with a low GI that wouldn't cause a fast rise and equally fast fall.
Since I was about to walk 12km, I took my dextrose rather than the offered compote, but 20 mins and a slog uphill I was struggling and was at 3.5mmol.
I know the 'official' rules ....15g wait 15 min and the take a slow acting carb if necessary, but have rarely needed to to take as much as 15g carb and almost never the follow up with slow acting. I often wondered if the 'rules' were based on the unpredictibility of some older insulins.
Now I'm back I wonder was she right? Would I have been better with the slower carb (a pot of compote has about 20g carb) in the first place..She insisted that there was no need to treat with fast acting sugar. She should be 'up to date' I know she has been doing an advanced course in T1 management at Toulouse.
 
Pheonix,

I can see where your coming from with this, but I would say it all depends upon the accuracy of our meters, and more importantly how far we trust them. Had I been sweating and had a bg reading of 3.8, I would treat it as a hypo, and eat 2 glucotabs and a slow-acting snack 10 mins after. I was always told by my dsn that, if in doubt always treat as a hypo, as it is better being safe than sorry, so have always stuck with this advice.

As I have always had good hypo awareness, there has been occasions where like you I have walked a long way and confused my sweating with a possible hypo, only to find later that my bg is high and I may not have been hypo after all (don't always carry testing equipment) but I don't worry to much about running levels above my normal range if it gives me the reassurance of getting home safe and sound.

I would normally only eat a slow -acting carb if my bg was in the low 4's, more-so if it were a couple of hours till my next meal, as I feel much more comfortable being 5 and above, so personaly 3.8 I would eat fast acting glucose. As your nurse has recently completed a course in type 1 management, I don't doubt that she is well informed of recent developments regarding hypoglycemia, but as I was told that 4 is the floor, and I wouldn't be happy with levels as low as 3.3, given that past experience has shown that levels can fall rapidly when on a insulin regime, I would tend to stick with what we all know from experience.

Pheonix, what are your thoughts on this then, has this nurse persuaded you to change your view?

Nigel
 
I totally agree with nigel,

anything below 4 and i treat with glucose.

If i'm below 5 i also have a small snack as i feel more comfortable between 5-7

I always carry my Testing kit with me, but on the occasion i was caught without i wouldn't risk feeling hypo and not treating it just incase as this can be corrected later if i'm out of range.

I don't see how she could ask you if you were hypo, then tell you not to treat it. that sounds a bit backwards!
 
As I've just stopped myself sliding into hypo unawareness it seems a bit silly not to treat at that level.
I'm sure the hypo was caused simply by walking in the heat when my breakfast bolus was still working, I had thought about it and reduced my basal but not soon enough. After the second hypo, the rest of my walk was fine and I ended up at 4.8mmol before lunch. I didn't actually need too many extra carbs of any sort, my porridge just took longer to digest than the speed of the insulin.

I did a bit of looking on French sites. There are a lot of handouts from medical school endocrinology lectures giving 0.6g/l( 60mg/dl, 3.3mmol) as the level below which it is considered to be a hypo. I think that this is the level when reduced cognitive function becomes more apparent.
There was also a lecture from a French Professeur to the IDF, so an international audience. She used 0.7 (3.9mmol) to classify a mild hypo (there were 3 levels).
Controversial bit now, at home, (with lots of testing and a husband around!) I think that I might experiment using a fruit for this sort of 'minor' hypo, it seems healthier and after all there are large numbers who use chocolate even though that is low gi (and we always tell them it is wrong!)
For the most part and certainly outside the house, glucose tabs are far more convenient and predictable. (and I certainly don't think it was a good idea not to treat with a fast acting sugar when I was about to walk 12km alone on remote footpaths!)
 

Hi again Pheonix,

The 3 levels of a hypo make perfect sense, we do loose cognitive function the lower we fall, I know when I fall into the 2's I struggle to make sense of what I am doing sometimes. I read somewhere that the upper figure for a hypo is 3.9, but as this figure may be easily forgotten, it was rounded up universally to the figure 4, with the saying that we all love or hate '4 is the floor'!

With regards to fruit, when in the low 4's I use this opportunity to top up my fruit intake and regularly have a banana or pear to boost my bg, I find this raises my levels up to the middle/late 5's, but usually below 6. Likewise, I also find eating fruit after my main meals has little impact on my bg, so always try to eat 3 portions of fruit a day.

Nigel
 
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