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Thrown by comments at clinic

Engineer88

Engineer88

Well-Known Member
Messages
2,130
Location
Wales
Type of diabetes
Type 1
Treatment type
Pump
Morning all, hope you are well.

Been to clinic this morning and discussed a extreme hypo I had Saturday morning. I was floating around 2.2 for 20-30 mins struggling to get it back up.

Consultant has said I should have had long acting carbs as well as short acting. I have always gone on i want to see a rise before taking anything which will slow absorption.

Who is right?

She also told me I should have used glycogen?! I have always seen that as a final resort before dialing 999.... What are your thoughts please?
 
being down a slow as 2.2 I would be taking on quick acting sugar, sugary fluids preferably.........

I don't usually take on slow acting carbs unless there is a while to my next meal, but it wont do any great harm to have a biscuit or something....

I also wouldn't use glycogen, basically as its not meant for us to use, its there for someone else to use on us, when we are unconscious......or unable to help ourselves........
 
As I did (3 rounds of juice and glucogel)

Cant believe my consultant is telling me to do glycogen o_O
 
My GP/DSN actually prescribed my pack of 3 glucogen for my
"husband" to use .
Should I 'ever' be in an unconscious state .

We ourselves cant possibly draw it all up and self
inject this in an unconscious or seriously confused hypo state .

Cant understand why you're consultant suggested this .
 
I too was told that the glucogen kit was only for if I ever became unconscious and therefore unable to treat myself. I was told that if all else fails and I'm struggling to get my numbers back up or are really low then I should use the glucogel and always have slow acting carbs 20-30 mins after any hypo (I rarely do unless I suspect I might dip low again)
 
Engineer88 said:
Morning all, hope you are well.

Been to clinic this morning and discussed a extreme hypo I had Saturday morning. I was floating around 2.2 for 20-30 mins struggling to get it back up.

Consultant has said I should have had long acting carbs as well as short acting. I have always gone on i want to see a rise before taking anything which will slow absorption.

Who is right?

She also told me I should have used glycogen?! I have always seen that as a final resort before dialing 999.... What are your thoughts please?
Click to expand...
It's a known fact you do not follow up with slow carbs whilst using a pump.
Rule of 15 is treat wait 15 mins then if no rise or dropping then treat again with quick acting carbs. Using slow carbs will only slow the absorption of the quick acting.
Before I developed Addison's disease I had to use glucagon on myself as knew I very close to passing out so can use it yes as a last resort only.
The warmer the liquid glucose is the quicker it acts.
Glad you are ok now.
 
So would anyone trust the consultant who told you this?

More background info, I've been hypoing with a TBR of -20 all week near enough. Its been a seriously high stress week. I have been treating hypos and bouncing (up straight back down) rather than staying up or alternatively rocketing on 10g of carbs. Basically just playing by ear until I could calm down.
 
Engineer88 said:
So would anyone trust the consultant who told you this?

More background info, I've been hypoing with a TBR of -20 all week near enough. Its been a seriously high stress week. I have been treating hypos and bouncing (up straight back down) rather than staying up or alternatively rocketing on 10g of carbs. Basically just playing by ear until I could calm down.
Click to expand...
I would perhaps educate her as no one is perfect. Trusting her wouldn't come into it I would just attend, listen to what she said agree or disagree then go and do own research.
It does sound though as if you need to break with your tradition of not basal testing. ;)
If you do get into the situation again (hope not) of a very long drawn out hypo and you are alone then consider disconnecting your pump until you see a rise in blood sugar. This would probably save your bacon if you do pass out. I've not been in that situation whilst on a pump and certainly would not recommend this action for normal! hypos.
 
I have been told the same thing that you consultant told you, not about the glucogon though. That is reserved for that last minute, "lets try this before we dial emergency' events.

I was told that if ever get into a low the best thing would be to take some fast acting sugar carbs, and then follow that with some long acting carbs. I was told the reasoning behind it is that if you have a persistent low like that it is usually caused by something like to much insulin, a drop after a work out, or whatever else. Because its persistent it will likely stay low, or keep dropping. The fast carbs will get it up fast, and the long acting will essentially counteract the following drop if the 'cause' is still there (ie - you may be having a basal dump, or to much bolus that still needs to finish acting).

If you keep taking fast acting carbs in a situation like this, you will spike, and then drop right back down, and then spike and drop etc. Where as the fast+long carbs will give you a spike and (hopefully) prevent the following drop. IMO its more of a 'stable' treatment, but would take more precision to execute (ie - at 2.2, I would probably take 10g of fast carbs, and then 20g of slow carbs, and then sit on my hands for 20 minutes before checking again. and if it has gone up to at least 3.5 i would be happy and keep waiting)
 
Diamattic said:
I was told that if ever get into a low the best thing would be to take some fast acting sugar carbs, and then follow that with some long acting carbs. I was told the reasoning behind it is that if you have a persistent low like that it is usually caused by something like to much insulin, a drop after a work out, or whatever else. Because its persistent it will likely stay low, or keep dropping. The fast carbs will get it up fast, and the long acting will essentially counteract the following drop if the 'cause' is still there (ie - you may be having a basal dump, or to much bolus that still needs to finish acting).
Click to expand...
Engineer is on a pump and rules are different on a pump for treating hypos.
There never used to be any slow carbs whilst using pens or syringes, then someone brought the idea in, now it's all change again and it was discounted as useless advice a few years back. :rolleyes:
 
CarbsRok said:
Engineer is on a pump and rules are different on a pump for treating hypos.
There never used to be any slow carbs whilst using pens or syringes, then someone brought the idea in, now it's all change again and it was discounted as useless advice a few years back. :rolleyes:
Click to expand...

The pump would surely change things, I am not on one lol

Also, I am not in the U.K, so maybe the approach here is different then the approach there, but i did want to say i have been told the same thing..
 
CarbsRok said:
I would perhaps educate her as no one is perfect. Trusting her wouldn't come into it I would just attend, listen to what she said agree or disagree then go and do own research.
It does sound though as if you need to break with your tradition of not basal testing. ;)
If you do get into the situation again (hope not) of a very long drawn out hypo and you are alone then consider disconnecting your pump until you see a rise in blood sugar. This would probably save your bacon if you do pass out. I've not been in that situation whilst on a pump and certainly would not recommend this action for normal! hypos.
Click to expand...


I had disconnected. the problem is was at 8:45 am which is prime DP for me - this was in fact the polar opposite of DP where I had woken at 19 (checked twice on meter dex confirmed) so gave 3.5 u of correction i drop 1:3 so expected to come down to about 10 then let basal take care of the little more (tried and tested method) what actually happened was i went crashing through the floor with LOW displaying on dex with a single downward arrow.

Sorry the essay is just to prove it wasnt basal! this is actually one of the areas of the day basal testing is regularly carried out as I dont eat breakfast early.
 
Just to say basically, I'm thinking about changing hospitals. I have thought about it a few times but think it could become reality now
 
Engineer88 said:
Just to say basically, I'm thinking about changing hospitals. I have thought about it a few times but think it could become reality now
Click to expand...
You need to do what's best for you and your health. Def move if not happy with care as that just add extra stress.
 
Engineer88 said:
I had disconnected. the problem is was at 8:45 am which is prime DP for me - this was in fact the polar opposite of DP where I had woken at 19 (checked twice on meter dex confirmed) so gave 3.5 u of correction i drop 1:3 so expected to come down to about 10 then let basal take care of the little more (tried and tested method) what actually happened was i went crashing through the floor with LOW displaying on dex with a single downward arrow.
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There's no chance your cannula hasn't nicked a small vein somewhere and caused that major drop?
I'm just glad you are in one piece :)
 
The only time I treat a really low bg with just sugar or jellybabies is when the acting time of my bolus has no more than 1.5hrs left to finish. If Ive gone low mid acting time, then its sugar or jellybabies plus a biscuit to deal with the remaining acting time. So Engineer88 consultant gave the correct advice. In a perfect world, everyone's basal rates will always be precisely correct, but the world is not perfect and basal rates change and mistakes happen.

Glucogel is not Glucagon. Glucogel is swallowed or can be massaged carefully into the lips or buccal lining of the mouth, whereas Glucagon is a hormone that has to be injected and prompts the liver to release stored glucose. Glucagon is very expensive to prescribe so is only ever to be used as last resort when someone has passed out or suffers from very low bg due to aAddisons disease. The pancreas has beta cells to generate insulin and alpha cells to generate glucagon to prompt the liver to release stored glucose. As time goes on, beta cells diminish and unfortunately, alpha cells do as well.
 
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iHs said:
Glucagon is very expensive to prescribe so is only ever to be used as last resort when someone has passed out or suffers from very low bg due to aAddisons disease.
Click to expand...
Glucagon can not be prescribed to anyone with Addison's disease.
Carbs/ glucose don't help either if you have a crisis it's steroids and a blue light to hospital.
 
CarbsRok said:
Glucagon can not be prescribed to anyone with Addison's disease.
Carbs/ glucose don't help either if you have a crisis it's steroids and a blue light to hospital.
Click to expand...
Can you explain 'more' on Addisons disease @CarbsRok
Why cant glucagon be used for example ?
Why steroids can be used ?
 
Thank goodness I dont suffer with Addisons. Diabetes and Coeliac disease is enough to contend with
 
anna29 said:
Can you explain 'more' on Addisons disease @CarbsRok
Why cant glucagon be used for example ?
Why steroids can be used ?
Click to expand...
Addison's disease is due to your adrenal glands packing up they produce cortisol. So if you have Addison's you take a replacement steroid every day of your life. cortisol regulates BP, blood sugar and goodness knows what else. I don't know the ins and out of why no glucagon, but vaguely remember it was something to do with not storing glucose in my liver. (Patient leaflet has the info I think) Steroids are used to treat an Addison's crisis because that's what's missing to cause the low BP and blood sugar. Before knowing I had Addison's I lived in hypo land and one day I had to eat over 500 carbs just to stay conscious. Once I had a diagnoses and on right treatment problem solved.
About 7 years ago I had a massive crisis due to food poisoning. Ended up in hospital after paramedics had pumped me full of steroids and the hospital put in more so had about 700mg in 24 hours. :eek:
 
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