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Low A1c means lots of hypo's?
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<blockquote data-quote="Katharine" data-source="post: 31004" data-attributes="member: 7958"><p>Low aics and hypos can indeed go together like a horse and carriage but the link can be broken.</p><p>some tips:</p><p></p><p>1. low carb diet = less blood sugar = less insulin injected = less error (Bernstein's law of small numbers)</p><p></p><p>2. 7 unit rule. No more than 7 units in one shot (you can have multiple shots though) results in the insulin working over the time it is meant to eg regular is finished by 5-8 hours, rapid acting by 3.5-5 hours, so less carry over of effect.</p><p></p><p>3. What is happening overnight? If you adjust your basal insulin for your morning bs levels and not your 2-4am levels and you have an appreciable dawn phenomenon you WILL get night hypos.</p><p></p><p>4. Match the insulin to the meal and be particularly wary of the "pizza" effect. Say you eat three slices of an Italian base pizza at 30g a slice and cover it with a rapid acting insulin. The pizza takes 6-8 hours to digest but the insulin peaks at one hour. Result a hypo soon after eating and a corrected hypo and then another surge in blood sugar as the pizza comes onstream. You may need to use regular insulin for pizza and split the bolus. What Steven is doing for pizza is: taking 3 boluses of regular insulin for the total carb + carb weighting calculation + protein estimation sum. Splitting this into about three. First jag 15 mins before eating, second jag when pizza eaten, third jag one hour after the second jag.</p><p></p><p>I hope you can find out what has caused the hypo. Then you have an opportunity to prevent the same thing happening. </p><p></p><p>I think it is worth aiming for normal blood sugars but agree that unpredictable hypos can be a limiting step. I have done a lot of work in trying to get tight meal to insulin matching and I just wish diabetics were taught more about this so they could decide for themselves if the effort is worth it or not.</p></blockquote><p></p>
[QUOTE="Katharine, post: 31004, member: 7958"] Low aics and hypos can indeed go together like a horse and carriage but the link can be broken. some tips: 1. low carb diet = less blood sugar = less insulin injected = less error (Bernstein's law of small numbers) 2. 7 unit rule. No more than 7 units in one shot (you can have multiple shots though) results in the insulin working over the time it is meant to eg regular is finished by 5-8 hours, rapid acting by 3.5-5 hours, so less carry over of effect. 3. What is happening overnight? If you adjust your basal insulin for your morning bs levels and not your 2-4am levels and you have an appreciable dawn phenomenon you WILL get night hypos. 4. Match the insulin to the meal and be particularly wary of the "pizza" effect. Say you eat three slices of an Italian base pizza at 30g a slice and cover it with a rapid acting insulin. The pizza takes 6-8 hours to digest but the insulin peaks at one hour. Result a hypo soon after eating and a corrected hypo and then another surge in blood sugar as the pizza comes onstream. You may need to use regular insulin for pizza and split the bolus. What Steven is doing for pizza is: taking 3 boluses of regular insulin for the total carb + carb weighting calculation + protein estimation sum. Splitting this into about three. First jag 15 mins before eating, second jag when pizza eaten, third jag one hour after the second jag. I hope you can find out what has caused the hypo. Then you have an opportunity to prevent the same thing happening. I think it is worth aiming for normal blood sugars but agree that unpredictable hypos can be a limiting step. I have done a lot of work in trying to get tight meal to insulin matching and I just wish diabetics were taught more about this so they could decide for themselves if the effort is worth it or not. [/QUOTE]
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