Hypo - where did I go wrong?

I'm no professional - at least, no letters after my name to make me so, just a very long time of type 1 - but here's my advice.

The only mistake you made was to think that 7.6 was something you had to correct and you had a little extra insulin when you were going to be active after your meal. If you are not normally physically active in the evening, then you need look no further for why you went hypo. It happens, you can't juggle eggs and never have one hit the deck because you blinked.

Your other worry about going 'high', is again nothing to worry about. The general rule is never to correct a post hypo high. Again, these happen and are quite normal, and your morning BS proved that there was no problem. Your BS will not stay stable all the time in the same way that a non-diabetic's will because however clever our insulin replacement regime is it cannot be as instantly responsive as a normally functioning pancreas. The closest you can get is with a pump, but I cannot comment on those as I have never used one. What you have described is a completely normal and expected response to a slight over-estimate of how much insulin your needed for your tea. No worries.

Oh, and ps: 12 is not particularly high and certainly not dangerous. (Ducks behind parapet before people start throwing rotten eggs...)

Hi smidge,

It sounds like you over corrected your hypo. I have done this loads of time. When you drank your juice and it went to 5.1 maybe you could have left another 1/2 hour to check again to see if you had gone up again. Then if you felt a bit low then maybe have something to eat.

I remember the once a dr told me the best thing to eat when having hypo is a sandwich and have lucozade. I laughed and said "making a sandwich when hypo" to which he said "get someone else to make it" so I said "Im only allowed to have hypo when im in company!" :lol: :lol: :lol:

Josie

The cream that you had with your fruit, was it full fat, and did you have a lot of it?

Just wondering if "the pizza effect" might have come into play?

If the carbohydrate that you had eaten wasn't yet available because your body was still processing the fat when you started the box crushing, but was metabolised later, it might explain the hypo and rebound afterwards?

I'm 100% with Margi, I don't think you did anything 'wrong'.
If you try and chase every bg spike, you end up swinging back and forth and making yourself feel ill.

Yup, I agree with Margi too.

(Also for 12 not being so bad as a post hypo spike...is there room behind that parapet for 2 Margi?)

I had similar problems with my daughter when we had takeaway curry a couple of weeks ago, i posted about it on here and somebody said that the type of meal might have slowed the absorption of the carbs so next time i am going to try giving her insulin after eating instead of before.

smidge

Apridia profile is pretty short lived peaking very quickly then burning out the system very quick.. This with the food you ate probably caused the problem..

Rice and the cream would have slowed the aborbtion of your meal down quite a bit, rice has the tendancy to start impacting much later and longer so kicks in about 30 mins after eating, and still impacting on the BG's 3 or 4 hours later.. This is also slowed by the cream, fats have the same action slowing the absorbtion rate down..

This is difficult enough to inject using normal quick acting insulin's such as humalog, novorapid that take 10-15 minutes to start working, peak at then have a smaller impact on bg over the next 2-3 hours..

You may need to either inject after you've eaten or spilt your dose a small amount before eating, then he rest after eating, the amounts on the spilt and timing of the injections etc are all trial and error I'm afraid to find what works best with you

Margi said:

Oh, and ps: 12 is not particularly high and certainly not dangerous. (Ducks behind parapet before people start throwing rotten eggs...)

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Margi, I agree about the dangers of correcting post meal high's can lead to a roller-coaster ride and isn't advisable, but to suggest that ''12mmol is not particularly high and certainly not dangerous'' I would have beg to differ on this one.

Smidge, As Joper says the fat in your food would have delayed the absorption of the carbs and as Apidia is a fast acting insulin the food didn't stand a chance against the action of your insulin. When eating curries or chips I inject two thirds of the dose immediately before eating then the remainder of the dose 1 hour to 1 1/2 hors after the food which works can't well for me, however before considering split doses it is advisable to discuss this with your dsn as safe option for you and they will advise on how best to approach this in future, alternatively injecting the full dose after you have finished eating may work just the same, it really is a game of trial and error!

Of course split doses means another injection, but if you eat curries as a rare treat then one extra injection to prevent a post-meal high or hypo isn't to much of a inconvenience in my opinion.

Nigel

noblehead said:

Margi said:

Oh, and ps: 12 is not particularly high and certainly not dangerous. (Ducks behind parapet before people start throwing rotten eggs...)

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Margi, I agree about the dangers of correcting post meal high's can lead to a roller-coaster ride and isn't advisable, but to suggest that ''12mmol is not particularly high and certainly not dangerous'' I would have beg to differ on this one.

Nigel

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I didn't make my meaning quite clear there. What I meant was that 12 for a post hypo spike is not particularly high, and if there for a short time, as that one was, is not dangerous. If your BGs spend a lot of time over 10 or so then, of course, it's a bad thing, but now and then if it goes up and comes back to normal I wouldn't sweat over it too much.

DAFNE advises not to do too many between meal tests because this happens a great deal and is no problem so long as the BS comes back down before the next meal. They say if you test at the point when it has peaked, then all you will do is fret for no reason.

I think I have remembered that right, but if anyone knows different I'm happy to be corrected.

BTW It is still true that the real test of long term control is in your HbA1c, and if that is good then so is life. You will get more ill by worrying about the odd spike than you will by it being there. If the spikes were regularly going over 14 then yes, I would worry. Bearing in mind, of course, that we are all different and 'high' is relative to what we are used to. I am very pleased with myself if my BS stays in single figures for a whole day's tests. And after 36 years I still have no complications so I guess I must be doing something right.

Hope that doesn't sound like a rant. It certainly isn't meant to be.

Margi said:

BTW It is still true that the real test of long term control is in your HbA1c, and if that is good then so is life.

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The Hba1c is only a guide in my opinion, it doesn't show the high's or low's (hypo's) which can hinder the life of living with type 1 diabetes. The consultant at my own clinic is more inclined to look at your diary and see if you are swinging between high's and low's and is specially interested in how many hypo's you are having each week, therefore daily bg numbers are by far a better indicator of how well diabetes is controlled.

Nigel

smidge said:

I guess I still have a lot to learn!

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Join the club! We never stop learning and no one has all the answers.

Nigel

I illustrated my own point to myself today.

My BS was about 14 something when I got up this morning (results from memory because I can't be bothered to fiddle through my meter to get exact ones) because I was not too careful the night before, so I had a little more insulin than usual before breakfast and work. About three hours later I felt a little off so I tested in case I was hypo - sometimes it's not that obvious to me - but the test said 13 something. Since I have been working, my BS mid morning has usually been lower than that, and 13 is above my comfortable 'I can ignore it' level, and as it was my not so physically active working day I, stupidly thought I should correct it. For me 1 unit will bring the BS down about 2 Mmols/l, so I had three units. Stupid! I still had a couple of hours cleaning work to do; the BS had been taken only three hours after breakfast and it had been 1 mmol lower than before breakfast (duh!! I should have realised it was coming down!), so the result was, about an hour later, a 2.1 test. :shock:

I had an orange juice and kept on ironing because that doesn't use much energy, ate a savoury sandwich from my lunch box when I finished about forty minutes later and went off to find a pretty place to have my picnic lunch between jobs. I didn't inject for that sandwich, I only counted the carbs in the rest of my lunch to calculate the dose and mid afternoon my BS was around 8, which for me on an active day is safe. It was 4 something later on at tea time.

So you can see from that convoluted sequence that I was an idiot to correct a 13 test mid-morning. It would have sorted itself out courtesy of my basal insulin combined with the residual humalog and my activity level. It's a mistake I don't remember making since I did the DAFNE course that taught me not to do it. I could have so easily started a real roller coaster, but DAFNE taught me how to not do that and the uncounted sandwich did the job.

The official book of words, I think it is some invention of the NICE people, says our BS should not go over 9, two hours after meals. Well, if they lived in the real world where people whirl around like spinning tops between meals, they would know that 9, three hours before the next meal, is only going to be safe if you are sitting on your ***** in an office. There is a thread somewhere about increasing your BS on purpose before exercise and my answer is: absolutely. A slightly higher BS for a short time will do no harm; a serious hypo can knock you out and leave you hungover and feeling like death, not to mention allow you to make irrational decisions and possibly do something dangerous, like for instance, dropping the carving knife on your toes because your fingers wouldn't hold it.

I should know better after all these years.

Margi, you put things beautifully, and you are 100% right. I wish I'd had you to talk to when I was first diagnosed.

Margi said:

...I had an orange juice and kept on ironing because that doesn't use much energy...

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Blimey Margi, you're braver than I am. I woudn't go anywhere near a hot iron if I were hypo. It'd be a recipe for disaster for me :?

frenchkittie said:

Margi said:

...I had an orange juice and kept on ironing because that doesn't use much energy...

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Blimey Margi, you're braver than I am. I woudn't go anywhere near a hot iron if I were hypo. It'd be a recipe for disaster for me :?

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Yeah, well... I just re-read my post and realised that perhaps continuing ironing is a pretty good illustration of my last paragraph about doing dangerous things when hypo! :wink:

Smidge, the recovery time from a hypo is as long as it takes to raise the BG to normal. If you were not hypo for any length of time, there should be no after effects at all. You just need to be careful for a while after to make sure you have built up a bit of reserves of glycogen to call on when needed, because hypos deplete the stores.