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Treating the high after the low

Discussion in 'Ask A Question' started by Isobel94, May 22, 2013.

  1. Isobel94

    Isobel94 · Well-Known Member

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    Dear all,

    I was told by my Diabetes Nurse that you don't treat the high after the low-- her words, "never, ever, treat the high after the low". I'm not really sure what to think of this, especially when I've had a slight low before bedtime. I don't think it's a good idea to leave a high untreated for my usual eight hours sleep, so I like to take a bit of Novorapid and then I go to bed, and usually wake up fine.

    I'd like to know what others do when they treat a low, and when they get a high as a result? Do you just let it happen, or take an extra couple of units at your next meal (which I sometimes do)?

    By the by I am Type One,

    Thank you,

    Izzy.
     
  2. picklebean

    picklebean Type 1 · Well-Known Member

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    What do you mean by 'high' in this instance... how high? And do you mean, 2hours after treating the hypo when you test your sugars, like after a meal?


    Really, I don't think you should be getting so high that it needs treating after a hypo. It suggests you are 'over-treating' your hypo with too much carbohydrate. Unless you have a very bad hypo, you generally don't need as much as you might think to bring your levels back up. My consultant says many of us over-treat hypos and then have to deal with the high afterwards - it's a natural reaction to want to stuff sugar in your mouth to get your levels up quickly but it's about taking the small amount you need and waiting for it to work.


    I may be wrong - see what other people think.
     
  3. weeezer

    weeezer · Well-Known Member

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    Agree with picklebean...sounds like you may be 'over treating' your hypo's. I did this for years, and ended up with the rebound effect like you sometimes. It's hard, especially when you have the kind of hypo that makes you want to eat the world! But do a little experiment and next time you are low, try and have a little less hypo treatment than usual.

    It's easier for me now, I am on the accu chek combo pump, and depending on how low I am, it advises me how many grams of quick acting carbs to have, it seemed really 'wrong' at first to only have 3 gluco tabs (like dextrose tablets but in a tube, 4g each) when it advises 12g, but it is remarkable how my hypo treatment has changed, I no longer over feed the hypo and as a consequence avoid the high after. Although its different on a pump because it only deals in fast acting insulin, so only quick acting carbs are required, it's still an eye opener to how much I used to over treat a hypo.

    I will admit to correcting a post hypo high with insulin, but it was explained to me in great detail why this is a bad idea (typical, I can't remember any of it now!) it may be something to do with the liver regenerating its glucose store after a hypo, and if you inject insulin it acts more aggressively?? So you could end up with a more severe hypo. But I may be way off!!!!! Hopefully a science type can explain it better!?

    Good luck, it's not an easy science to master (I am by no means a master, but I am defo better at it now!) worth a try tho?



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  4. czj

    czj Type 1 · Well-Known Member

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    I'm not the science type weeezer was hoping for, so I can't give you a reason for things, but I do treat a high after a low quite differently to a unrelated high.

    It just always seemed to me they were quite different, and had a different effect on me. For example, let's say I woke up in the morning with a reading of 15. If it was because I had messed up and got my insulin wrong, then I'd be thirsty and desperate for the loo. But if it was the rebound from a hypo, then I'd feel a bit under par, but not thirsty etc. For the first one, I'd give maybe 4 extra units of fast acting, for the 2nd, I'd give 1 extra unit just to show willing. I think I must have come up with that approach in the pre-blood testing days.

    I agree with picklebean that over-treating a hypo is very easy to do, and best avoided. But over-treating a high is possible too.
     
  5. Isobel94

    Isobel94 · Well-Known Member

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    Hi all,

    I'm sorry I didn't clarify, when I'm around 3 I would have two dextrose tablets and two Rich Tea biscuits, and and extra tablet depending on how low I am below that, so three tablets for a 2 reading and so on. If it's not the Rich Teas I may have a slice of toast or a piece of fruit, like an apple, banana, or orange. Sometimes I'm out and about around an hour before my next meal and I deal with the low then, then come back and take maybe an extra 1-2 units at my next mealtime. In essence, I don't overeat (even though the temptation is very much there :wink: ). There are certain times of the day where I'm more insulin resistant-- like the morning. So if I have a low before bed I will most definitely wake up around 15-17 mmol/l, hence why I think I should take an extra couple of units if novorapid if it's been two hours after that low.

    During the day I might go up to around 10-13 mmol/l after treating the low. Such a vicious circle!
     
  6. LittleWolf

    LittleWolf · Well-Known Member

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    Sorry to thread jack...

    I am not diagnosed diabetic but last night I had a reading of 'Lo' and ate some jelly babies and Doritos to make myself feel better. Then I went to bed and woke up early feeling like **** with a raging headache. I thought something wasn't right so tested and it was 19mmol at 6:48am
    It went down to 7-9 for the rest of the day (9 now) in about 8 hours. I just drank water and slept for those hours because I felt sick.

    If I call a doctor now showing that reading would they say I did the right thing in avoiding another Low-to-high pattern and would I be able to get some advice/treatment with no questions asked...

    I'm assuming you guys arent supposed to treat an after-hypo high in case it repeats the cycle?
     
  7. weeezer

    weeezer · Well-Known Member

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    Littlewolf...threadjackin, lol! 19, that ain't right!!!! Have you been back to your docs? Your readings are so not non diabetic ones??? You are a conundrum...coz your body corrected that, but you shouldn't be going to 19 in the first place! Hope you get an appt after bank hol, don't be fobbed off x


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  8. Finzi

    Finzi · Well-Known Member

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    Definitely doesn't sound right Littlewolf - I'd be straight back to the doctors too. 19!!! Several hours after eating some jelly babies!!!

    (Just to quickly check though - you did wash your hands before testing? Jelly babies have a dusting of icing sugar on, could give a reading like that if there was a trace on your fingers. But you mentioned having hyperglycemic symptoms too, so probably not)



    Type 2 on Metformin, diagnosed Jan 2013, ultra low carber, Hba1C at diagnosis 8% (11mmol), now between 4.5 and 5.5 mmol. 20kg lost so far :)
     
  9. LittleWolf

    LittleWolf · Well-Known Member

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    Hey guys. Yes my hands were clean and I did 3 readings to be sure because I was so in shock. My previous record high was 15. Something more immediately after food. If I get an erroneous high reading it is always 25.6 for some reason (maximum level?) So if I see that I know for sure my hands aren't clean. I usually use antibacterial gel or alcohol wipes.


    When I last went to an appointment and described all the falling asleep after meals, hot flushes (when hyperglycemic) mood swings, the nasty symptoms I get when having a random or reactive hypo(and the dozens of times taken off in an ambulance on my way home from uni), unexplained nerve pain, numerous digestive problems, numbness/tingling in extremities, repeated episodes of thrush/lichen planus/tinea, slow healing, many skin problems, joint and muscle pain, eyesight blurring and intensely itchy/burning + being a high risk ethnic group, strong family history and having PCOS the doctor would barely look at means said I was just depressed. I tried to press her to just to a fasting test if not a GTT or whatever but she was having none of it.

    I'm thinking of bringing it up when I go for my repeat prescription of BC for the PCOS. I thought the mood swings were all to do with the pill until I got used to it and after breaks from it and of course, actually testing. The swings correspond to swings in my BS.

    I don't normally shoot so high...Do you think My liver dumped glucose overnight in addition to the jelly babies and Doritos whilst I was asleep? I'm currently ill was possibly dehydrated too but yeah... 19 scared me and was uncomfortable...Thanks for wishing me well. Calling the doctors office again Tuesday...


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  10. LittleWolf

    LittleWolf · Well-Known Member

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    Isobel appears similar (I'm a conundrum... Hehe..) waking up in the teens after a low. This is new for me though. I /used/ to have the opposite problem bad hypoglycaemia/reactive hypos, not hyperglycemia or high BS in reaction to a low .


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  11. Finzi

    Finzi · Well-Known Member

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    You see, while I'm not for a minute excusing your GP (why, seriously, would they not do an Hba1c, what harm could it do?), your list of symptoms would not be nearly as "red flag" to a GP as a fasting blood glucose of 19. A lot of the symptoms are either non-specific, or not classic diabetes symptoms, or could be caused by other things such as depression. I don't think a list of those symptoms would necessarily make "diabetes" spring to mind ( although it was a concern of yours, and therefore should have been investigated for that reason alone. No good reason not to).

    But a fasting glucose of nineteen IS diabetes. End of. If they refuse to take you seriously, it is change GP and complain to the PCT time. This is your health that is at stake. And from what you say, it sounds like you've had it for a while.


    Type 2 on Metformin, diagnosed Jan 2013, ultra low carber, Hba1C at diagnosis 8% (11mmol), now between 4.5 and 5.5 mmol. 20kg lost so far :)
     
  12. Isobel94

    Isobel94 · Well-Known Member

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    Hi there Little Wolf, it's refreshing to meet somebody who's in the same pickle as me! :D

    As for not being diagnosed as diabetic, I think you should get that checked out... if you were non-diabetic you would not be going so high afterward. Perhaps, though, the Doritos were a bad idea, being a fatty food, but I suppose it was the first food you saw and I know the way it is sometimes.

    I remember one time I had a low of 3.8 mmol/l. I had a small chocolate bar and a Rich Tea biscuit. Did a blood test a couple of hours later to find I was 22 mmol/l!! :O Of course this was when I was approaching my period so there were probably many things against me, but still! That was just uncalled for! And it took ages for me to go down as well.

    I suppose there are certain foods that suit certain people better than others. Little Wolf, I'd see the doctor first about the low and especially the high, because that's not normal. Then I'd see about experimenting with treating lows with different food-- maybe try something a little plainer? I know someone who is also type one like myself who carries around a Snickers bar with him in case he goes low, but that would probably send my sugars through the roof. I suppose try and find a method that suits you, and half expect a little high.

    I guess the best way is to avoid them in the first place.

    Best wishes,
    Izzy
     
  13. LittleWolf

    LittleWolf · Well-Known Member

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    As nasty as it is, yes it IS good to know you are not the only one. It happens- we are not going crazy!

    Aw, I thought a low carb high fat thing was good for diabetics?that the fat helps slow down glucose absorption or something? I don't know.

    My highs usually stop in the 15s. That 19 was a one off. I was ill, tired, dehydrated AND for some reason, bleeding again a week after my period @_@ So Izzy we have something else in common and I will keep in mind that cycles and BS swings go hand in hand as we are reminded by that menstruation thread

    The doctor should know I have lows already but they don't really care about that. I told them about passing out on public transport etc. Not interested. I've got to think of something plain that doesn't involve wheat because i had an issues nibbling on crackers last week.

    Maybe Snickers bars are not the best idea XP

    I was reading up on Somogyi effect the other day.. My guess is it doesn't necessarily have to happen during the night though it apparently did for me but for you during the day. You heard of this much? I know it differs from Dawn Phenomenon which I DONT have a problem with (do you?) FBG is 6.6-7.5 and one random 9.4 much lower than those after meal spikes.

    Seeing as we're so smilar, let me know if you successfully correct another hypo (of course I'm not wishing one on you :shock: ) and I will post if I do it, though i don't seem to have as many lately. Maybe between us we can figure something out.

    Many cuddles

    xx
     
  14. mrman

    mrman Type 1 · Well-Known Member

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    Littlewolf seriously request a different doc, those high readings your getting just aint right. Bank hol tomorrow, if your that high in the morning go to a and e, they will take it from there and skip the gp, they will most certainly not say you are depressed. Bring your meter and reading with u to show the. I was fobbed off by that for two years by gp, eventually ended up with having a 3 day stay in hospital on a drip and type 1 when i came out. PLEASE GO

    Sent from my GT-S5360 using DCUK Forum mobile app
     
  15. Isobel94

    Isobel94 · Well-Known Member

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    Hi again Little Wolf,

    For the past week I have had these dips in blood sugar at night, around 9 p.m. And they're the most annoying lows. I would deal with one and then have to deal with another one hour later. Now I have managed to curb it by keeping a close eye on things in the evening, that is, doing a blood test at the slightest sense of oddness. They wouldn't be bad lows, around 3.4- 3.8 mmol/l, but still they'd make you feel hungry enough to want to eat a horse sometimes.

    And it's so strange because once I deal with one I have another... I have reduced my insulin, eaten more carbs, and still feel like I'm heading down around 9 in the evening.

    This evening I could feel myself going down and did a blood test and was 7.2. I had some Snack a Jacks, and just two hours later my BS was 6.7. So good thing I had those!

    The best way you can avoid lows is to try and notice the symptoms and be as vigilant as you can. I know that when I get low I feel a pressure behind my eyes and could eat a biscuit whole :p. Occasionally I can also see bright lights that get in the way of my vision, but that's only when it's really bad. Passing out on public transport is a serious issue though. If the doctors aren't going to help you, at least try and figure out the warning signs, for your own sake, and carry dextrose with you and maybe a couple of biscuits.

    Best wishes,

    Izzy.
     
  16. LittleWolf

    LittleWolf · Well-Known Member

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    Hey Izzy

    I'm not sure if I can be much help because I don't use insulin... Do you know if your body still produces any insulin?

    Do you think it's reactive hypoglycemia? Is that even possible in T1 people? Like you pancreas decides it wants to wake up and help after your dinner? Or your liver goes to sleep? Again, I haven't a DN or anything and know very little about this stuff.

    My theory is that the body has some sort of 'memory' at least. The day after I've eaten alot of carbs I will be lower than normal. lIke my body said 'yesterday I needed x a mount of insulin so I will dish that out today'

    Funny you felt low at 7.2 and ate. I feel low at 6 and below but if I'm 7 and up already, then eat, I shoot into the teens so try not to do that... But then how to avoid a hypo @_@ You were lower two hours after the snack a jacks.. reactive? Ugh someone else with more knowledge help out please >_<

    As for carrying dextrose and biscuits I have taken to carrying around lucozade but have to be careful not to overcorrect... Heh..

    Many hugs

    Wolfie
     
  17. Isobel94

    Isobel94 · Well-Known Member

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    Hi Little Wolf,

    I have no idea what's happening in the evenings with me with these lows as I am a type one diabetic i.e I don't produce any insulin, whatsoever. Or at least I'm not supposed to. It really does feel like there's some kind of insulin surge in the evenings with me and I'm not sure where I'm getting this insulin from, exactly... :shock:

    Perhaps it could be a build-up of insulin throughout the day? I don't know...

    Anyway, keep us posted with your low issues! Can't be fun! By the by, my aunt had the same problem as you, as in, she's not diagnosed as diabetic but had hypoglycaemia on a couple of occasions. She went to the doctor and was told to treat it by taking a couple of dextrose tablets and then having something substantial after it like maybe a slice of toast. Of course my aunt had to be told to do this because the first thing she did was reach for a chocolate bar :p

    She was told that if she didn't deal with the lows properly (i.e eating loads of sugary things) that she would eventually become a type two diabetic.

    I did look up on the Net about this, and discovered this thing called "autosomal dominant diabetes". It's when a non-diabetic has lows and develops diabetes as the pancreas has over-produced insulin and becomes exhausted as a result. So if you have too much sugary stuff in response to a low, you're making your pancreas over-work after it has been overworked already. So really be careful about what you eat and how much you eat after a low.

    You don't sound like a diabetic, but those highs don't sound too good. You shouldn't really be having highs if you're not diabetic, but then you went down afterward, so I'm not sure... I would definitely watch out. I'd recommend doing a blood test an hour after treating the low (if you have one again), just to see where you're at, and then an hour after that again.

    Best of luck, and I hope you don't have another low!
    Izzy.
     
  18. LittleWolf

    LittleWolf · Well-Known Member

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    Well that sounds exactly like it Izzy!

    I have hardly any lows compared to when I was anorexic where Im sure I was hypoing (and my psychologist is convince this was the root of my mood swings etc) on a daily basis and yes, I would starve and starve and eat sugary things to keep myself going.

    That ON TOP of a vitamin D deficiency and family history may be why I am where I'm at now along with the Polycystic Ovary Syndrome...

    Having done a google search I've found 3 other ex anorexics now at normal weight or slightly under with T2 @_@

    I went down to 9mmol from 19mmol in 8hours btw. Not nice because I felt like **** and hang eaten since the previous night obviously... Ack food!!!

    Such a shame about your aunt :( I'm hoping she turns out alright...

    I'm being careful... And missing grape juice! *sulk*


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  19. Isobel94

    Isobel94 · Well-Known Member

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    I'm sorry to hear that you had anorexia, Little Wolf, that must have been awful, with hypos on top of that. Though I've never been anorexic myself, I'm glad to hear you talk of it in the past tense. I got type one at the age of six due to congenital hypothyroidism (born with most of my thyroid gland missing). Apparently diabetes and hypothyroidism are related, I suppose it has something to do with metabolism, and then metabolism has a lot to do with weight, so there are a lot of things interconnected, unfortunately, with different causes in different people leading to diabetes.

    Yeah, at 19 mmol/l you wouldn't feel right... are you on medication yet? I know that one time I was having a particularly rough day (time of month and dealt with a low with chocolate-- NEVER AGAIN) and I was in Tesco with my mother and I felt absolutely rotten. I had an awful taste in my mouth and my sides were beginning to hurt. That's the only time I've felt that way with a high. It's really not worth the trouble. I think I was up around 17 mmol/l? Thought I was going to explode.

    I miss chocolate cake :(

    Izzy.
     
  20. LittleWolf

    LittleWolf · Well-Known Member

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    Ouch sounds like you did have a rough time hun :/ even moreso as you were out and about. I had the option to drink water and go sleep it off

    Nope no medication. Still not diagnosed... Only last week coerced the GP into doing a fasting test though they still think I'm fussing over nothing

    I don't like pill popping but it kind of sucks to go from not eating to eating to fearing food all over again. I can't deal with diet-only. Anything puts me into double figures in the first hour at least XP then I get sleepy... :/ If I can get it I want to try Metformin. Apparently it stops hypos too?


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