Treating Hypos when on basal-bolus

If you end up high after a hypo your basically overtreating the hypo. It is a tricky one because when I am hypo I want to eat the entire contents of the kitchen lol. There are a few factors to consider though. The main one is how much bolus (qa) insulin you have left when hypo. for me if I'm hypo within 2 hours of my last bolus i treat the hypo with a few sips of Lucozade,but, I know I have another 2 hours left of my bolus injection and therefore not enough food in me to sustain myself till next meal so would also have a 20 carb snack. If hypo after the 2 hour point of my last bolus there is less active insulin in me so the Lucozade would usually be enough.
However, if hypo and the hypo is treated and you want to eat a larger snack, that bit is trial and error, although a small snack is a sufficient follow on treatment after a hypo a larger snack requires usually requires a bolus, but, after replenishing a hypo my body wants to re-store the sugar its had to loose which makes any injection more potent, so in this case I bolus 1\2 my usual dose for the amount of carbs. That works for me but then I will think about why I was hypo at that time such as did I estimate my carbs, had I been more active than usual etc

No it wouldn't be advisable to take insulin, as Brett says your over-treating the hypo, it's a mistake many of us have done over the years.

marktype1 said:

I dont feel I am over treating the hypo, the guidelines tell us to intake glucose followed 5 minutes later by a small amount of carbs to keep the blood sugar level from dropping again. Unless this is different when on basal-bolus?

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Glucose ( depending on the amount you take) plus a sandwich would push anyone's bg up high, have a chat with your DSN about how you treat your hypo's and the post-hypo bg results you get.

I was and always have been told by the DSN not to take any bolus after a hypo, even to drop the bloods
sometimes I do though as I have always had a tendancy to go over the amount of carbs needed to get my bloods back in order, very rare though these days tbh

I would never take more insulin after a hypo unless part of the next meal a few hours later. I would hope to get the estimated glucose and carbs right to treat the hypo and if the blood sugar overshoots who cares?

Mark do you watch how many carbs you eat? A lot of us limit our carbs in order to prevent large rises followed by lows and the need for a lot of insulin all of which leaves a high margin for error. I am reading Bernstein's book at the mo, it is quite drastic though but you might want to google Bernstein's rule of small numbers for a better explanation than I have given lol.

Ali

Hi Mark, yes for me it keeps me within quite a tight range between 4 - 8, mostly 5s and 6s, and I have reduced my bolus quite a bit. Have you done a basal test to see if your basal is set at the right amount?

http://www.salforddiabetescare.co.uk/index2.php?nav_id=1007

Might help you see any trends. Generally, if you are going hypo after a meal and taking bolus, you are bolusing too much I believe.

Hope you can sort it, not nice swinging around all day.

Ali

marktype1 said:

Just a random question thats been bothering me.

When you are injecting basal-bolus insulin (as in long acting and short acting insulin separately) and have a hypo, are you supposed to take some short acting insulin after eating carbohydrates (following eating something sugary). I always seem to have high blood sugar after hypos. I take the right amount of glucose but then will have some kind of sandwich or something and this seems to raise my blood sugar. Would it be advisable to take a few units of insulin when eating this carbohydrate? Anyone else have similar occurrences?

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Hi, I am exactly the same as you, as it sends my BS soaring. I have a much smaller amount than recommended, but like others I could eat the entire contents of my kitchen. No sandwiches ( well I can't eat certain foods), If I was say, 3.4, had one jelly baby, out and about, it would send me higher than someone else. I have my own foods that work well for me, but not for another type 1. It can be so difficult at times trying to get the right balance, but we must act upon a hypo quickly. With even lower readings, it just wants to climb back up so quickly and then I get the constant yoyo-ing throughout the day. I feel like

I am with @brett and others on this one, I dose about half for the carbs I use to treat the hypo and for the meal I usually have right after the hypo. This tends to even out. Frankly I usually over treat. The conditioned fear of coma is too great.

During the hypo you will often lose a lot of liver glycogen and immediately after the hypo your body will restock this vital glycogen, directly taking glucose from the blood stream to do so.

On the minority of occasions when I manage to successfully avoid over treating the hypo that usually also means I have not triggered the liver glycogen dump adrenaline response. In those situations I don't take insulin for the treatment carbs and don't reduce the next meal insulin as much.

I find the guidelines on treating hypos completely ridiculous and guaranteed to send my BG into orbit.

One jelly baby (about 6g carb) will raise my BG 2.5 to 3 mmol - if I had 10g quick-acting glucose followed by 15g long acting carb I dread to think how high my BG would go - it would certainly need insulin to bring it back down. I treat BG between 3 and 3.5mmol with 1 jelly baby and test 15 minutes later; BG below 3mmol with a few sips of Coke and test 15 minutes later. The only time I take any long-acting carb is if I am about to go to sleep - I'll then have 1 rich tea biscuit, a few almonds or a handful of peanuts following the jelly baby or Coke to make sure I don't drop again overnight.

Smidge

Hi Im on basal/bolus & what I do when having a hypo is take around 15g of fast acting sugar, I don't like the glucose tablets so I carry around the tiny packs of Haribo sweets, 1 pack of those contains around 15-16g of carbs. After 15 minutes, I test my sugar level again to see if it is going back up, & it usually does. I find if I eat these plus a slow acting carb my levels get way too high. I don't like to drink a high sugar drink such as lucazade as I find it harder to monitor how much to drink with my sugar levels but that's down to each individual to decide, may be totally different for you. Hope you get them sorted

We're all different though smidge. One jelly baby does very little for me for some reason, whereas two maom pinball jump me 3.6 mmol! Different sugary things seem to have differing effects. I need 9-12g of dextrosol to raise 1.5 to 2 mmol. All slightly different.