New carb counting and treating a Hypo

Here in this post are the recommended treatments for a Hypo, just scroll down to the treatment for a Hypo section............

viewtopic.php?f=20&t=18529#p168549

Basically fast acting carbs then a small carby snack in accordance with your gluten free choices. Is he having too much Lucozade initially and then going too high ?

If the lucozade and crisps works then I'd go with it. Living with diabetes is all about compromise and finding a balance. Crisps are 'bad' for you only because of the fat and salt, so one alternative would be to try low fat/baked crisps and low/no salt crisps; or just keep an eye on the overall fat and salt in the diet and try to reduce it elsewhere. Also don't forget that the fat in the crisps will actually slow the release of the carbs in the crisps... which in hypo treatment, once he's had his lucozade, is kind of what you are aiming for; something a bit slower releasing to avoid high/low blood sugar spikes.

Personally I use Fruesli bars for this part of hypo treatment - have just checked online and they are not gluten free, but while I was looking I came across this site granarywholefoods
there are some fruit bars on there which are gluten free and might be worth checking out? (gluten free things on the site have a little red circle with a G on it next to them)

stoney,

Jelly babies are gluton free and can be used to treat a hypo, stick with the lucozade if this is his preference as it is fast acting and used by many in the treatment of hypo's.

Nigel

200ml cartons of fruit juice (not drink) work very well and you are less likely to overdo it which can be the problem with lucozade. Maybe then a banana as a gluten free follow up snack. If the hypos are happening regularly at a specific times (eg every morning) you may need to look at adjusting insulin doses. Your GP/Diabetes Specialist nurse should be able to give you guidance and support on this.

Good luck :|

I think I have to agree with Snodger on this but with the exception that crisps are not used too much to correct hypos even though they are very acceptable to most kids and adults.

Jelly babies or jelly beans are good for hypos but are expensive so sugar coated fruit pastels can also be used if lucozade is not available. Also, many newsagents and some supermarkets are now selling a glucose spray called by various names - candy spray or spray candy (not sure if this contains gluten though?) It comes in various flavours and is fairly cheap, easy to carry in a pocket or bag Depending on how low bg level falls to, about 4 sprays will be enough to lift the hypo feeling but would need something like a gluten free biscuit afterwards to sustain the bg level. Gluten free bread could also be used with about 2tsp of jam. The jam provides the sugar fix and the bread provides the slightly longer acting carb.

The preferred medical way of treating a hypo would be to use glucose tabs or lucozade but although lucozade is ok for most people; glucose tabs are not. Many people hate them and I think it might be very hard forcing anyone to eat glucose tabs if they are adamant that they are not going to. So with this in mind, anything really that is acceptable to eat which contains some sugar with carb in it will do. It may take a tiny bit longer to lift the hypo but it will work so all is not lost.

As your son has only just started using bolus/basal there will be some hypos unfortunately and it will take a while to sort out the correct bolus doses. If you find that hypos are happening at the same time, then it's time to alter the bolus insulin so that bg levels are at a better level. Sometimes a small snack is necessary, sometimes it won't be so you find yr way with it all by doing bg tests and looking at the results and then looking at the amounts of carb eaten and the amount of insulin that has been injected.

The rule of thumb that I was taught on DAFNE about treating hypo's

The usual 15g rule firstly to treat the hypo itself, then dependant on when your next meal is due to whether to have a slow acting carb snack..

If you next meal is less than an hour, then there's no need for a slow acting carb snack..
If more than an hour then yes have a low carb acting snack, but it doesn't need to be more than 10-20g..

If snack has been given, then check about an hour later to see what BG is like.. Actions to be taken will again depend on when the next meal is due..

If BG is high..

If less than an hour to a meal, it can be left until the meal and an correction given at the meal time with meal dose..

If longer then a hour then correct..

What you have to keep in mind though if you correct before a meal, is when you get to the meal you may have to adjust insulin dose in taking activie insulin from the last injection into the factor..

Which is roughly at the 2 hour mark the insulin has peeked, it's used 80% of the dose to lower the blood glucoe, the remaining 20% will have a limited effect with lowering the glucose level over the next 2 to 3 hours...

Yvonne.
It's a necessary evil unfortunately so that the Nurse can see what the readings are and then probably adjust the Insulin doses. A bit of gentle persuasion with young son and assuring him that it isn't going to be for ever is what's needed at the moment.

It does get better.......honest !

Hi

are you positive the reading at 12.17 was 14+, and then dropped by 9mm down to 5+ 3/4 hour later........Just that I had an accidental overdose of insulin thinking that my hands were clean enough to do a blood test....my reading came out at 15.9, so I did an immediate correction...2 minutes later I wasw totally, very badly hypo.......the reason, I think that I must have had something on my hands that I thought were clean and weren't.
I admist that I am testing huge amounts during the day whilst I am at home and of course predriving.....and I didn't wash my hands each time before I test. But now I even have a gel cleaner for my hands kept in my car to wipe my hands before driving home from the shops or if I visit anywhere, as there is no way I will ever get an accidental hypo like that again....

To drop 9mm in 3/4 hour is a pretty big big drop for blood levels in such a very short amount of time expecially before a meal time....
There does seem to be a pattern lining up with your son's drop in levels in the afternoon 2 hours+ hours after your son has ate, so I would imagine that your DSN may look at slightly lowering your bolus insulin for the lunch, but she is best placed to advise on this. The DSN will be looking at patterns, so you will find that you will get better control for the hypo's quite quickly I am sure, and the same applies for the slightly elevated levels that you are getting pre lunch.

Don't panic, as it is early days of basal/bolus and unfortunatley the nurse does need these tests to see patterns in levels.

Can't really help with gluten free for hypo's but yes Jopar is absolutely spot on about advice to treat a hypo, because it is nice to bring levels back to normal, but not to raise them too high.....

stoney said:

Is he right Do we really need to do this 2 hour testing all the time. I did say that when we see his Nurse it won't be necessary all the time as she just wants to get the full picture as this regime is new to you.

Click to expand...

It can be horrendous when you are first diagnosed, having to cope with everything at once. You are totally right that the point of it is to get the full picture and understand how his body responds - that's for him to understand as well as for you and the nurse, of course. Shortly after I was diagnosed, my diabetes nurse gave me some tips which might help you. (she was one of the loveliest nurses ever and to be honest pretty much saved my life with her wisdom and practical outlook). Yes, you need to get the full picture, but if your days are fairly regular, give yourself a day off every three or four days - no blood testing at all all day (unless you need to check for hypos). She also made the rule, never test unless you know why you are testing. You are doing it to understand what is going on; so once you've seen the patterns and can roughly estimate what your blood sugar will be, you can ease back a bit, and use the tests to check you are still on track. It's easy to get hung up on testing for testing's sake, it's easy to get hung up on 'perfect' blood sugars when actually that's pretty much impossible to do 100% of the time, and it's very depressing when you are first diagnosed to think that you've got to test to such a tight regime. When my nurse pointed out to me that it's a tool for me to use to understand what's going on - and it's my choice to use it or not - it really helped me take control.
I know I've kind of repeated what others have said but I think my point is that it helps (as the one living with the disease) to feel like you have choices.

It sounds to me as if you have the right attitude towards it and I don't think the readings you quote are out of control at all. They look very much like the kinds of readings I'd expect while you are learning what works. The main thing is to make sure his blood isn't packed full of sugar all the time - and you've already achieved that - don't forget to congratulate both yourself and your son!

Have you done any fasting tests to see that his basal is set at the correct amount?

stoney said:

Hi SophiaW the DSN put James on 16 units of Lantus but did say that this could/would change in the near future. I will be seeing her in clinic on Thursday so will let you all know the outcome. Also I know the word fasting but don't know what this would entail. The DSN has not mentioned anything about that YET.

Click to expand...

Hi

Very few diabetics using bolus/basal will be advised to 'fast' by a dsn or consultant. It's thought not necessary and to just let people figure out the correct bolus insulin to carb ratio at different meal times. Unfortunately the likes of Lantus and Levemir don't always keep bg levels at a steady level all day long. Bg levels fluctuate according to the background action the insulin has. This is why loads of people adjust the bolus insulin and use different ratios.

When Jess was first put onto a basal/bolus from mixed insulin her basal was set too high. This resulted in a problem with hypos if her meal was delayed. This kind of defeated the object of being on a basal/bolus, we wanted the flexibility to delay meals if necessary, particularly around lunch time and evening meal. I read in a diabetes book how to do a fasting test (or it might have been on the forum, but I think the info was in the book). I did some fasting tests and realised that the basal was causing a problem and so adjusted it. Once that was corrected then her control during the day was a whole lot better. Likewise I would imagine if the basal is set too low it could also cause a problem in the reverse of having readings too high. I'm not saying his basal is incorrect, just something to consider if you find that it's proving difficult to get things to work.

We did a little bit of fasting with our kids too. We used to give them an early lunch ( say around 11.30am) and then do tests at 2, 3, 4, 5 and 6 hourly intervals. This also allowed us to get to know how long the novorapid was working. If they got very hungry before tea we would give them a small non carb snack. We found that increasing or decreasing levemir by half a unit would make a difference. It did take a few weeks and lots of testing, but we got there in the end.

Remember to only make small changes and don't keep changing the dose. Try and leave for a couple of days before each change to get a clearer picture of what is going on.