Type 1 Understanding results and a hypo

Hi,

Regarding your wife's pregnancy, I'll tag in @azure @catapillar knows her onions too..
Personally? It looked like your wife went low on the bolus for her evening meal? Then over treated the hypo..
The correction dose at 5am dropped her blood by 7. There does tend to be a peak in the profile after two hours with me on novorapid.
I'm going to stick my neck out and suggest the 6u of novo was a slight over reaction to the 15mmol?
I would have administered 3..
But that's just how I deal with it as a fella...

I hope your wife's OK now..?

@C96 What a nasty rollercoaster - I hope your wife is ok now.

Important question: How many weeks pregnant is she?

Pregnancy can cause sudden and fierce hypos. That could have contributed to your wife's problems (depending on what stage of pregnancy she is).

I agree with @Jaylee that the 6 units correction sounds like too much. Correction ratios can change during pregnancy too.

The continuing drop after her evening meal does sound like a bolus issue. Has she checked her ratios now she's pregnant? They can change too.

The trick to pregnancy control is lots of tests and lots of little,adjustments - tiny corrections, if needed, small food top ups if needed.

You mention 5.4 - is that the fasting target your wife was given?

Would you like me to move this to the Pregnancy section for you?

Hi @C96 . Hope your wife is feeling better now.
It appears that you found yourselves yo yo ing. You go low and over correct, you go high and over correct, a bit like being on a see saw.
My one concern would be your choice of hypo treatment. Glucotabs 1st . Great, but personally would follow this with something more along the complex carb foods, maybe some cereal, a sandwich but not crisps.
Before bed 3 Jaffa cakes? Probably not the ideal food to go bed on, especially with sugars at 4. Again something a bit more complex carb maybe. 3 digestive biscuits would have been far better.
6 units of novorapid at 5 a.m. Does your wife carb count and have a correction dose ratio? Basically you injected bolus insulin 6 hrs after last consuming food, that's a very risky option.
At 7 a.m. Obviously the 6 novorapid was doing its job. Juice and Glucotabs best thing to do but it needs following up with a good carb breakfast, toast ,cereal etc and . The important thing to remember is the 6 novorapid at 5a.m. This is insulin on board for another 3 hrs possibly taking you up to 10 a.m. Taking this into account maybe half your normal dose of insulin at breakfast would have kept things stable, but regular checking of sugars is essential to keep your wife safe.
Hopefully some of our wonderful T1 mothers will be along soon who may cast more light on what's happened, I'm sure pregnancy can wreak havoc with sugar levels. Not my field of expertise thankfully.
Good luck.

You mentioned scanning so I assume she has a libre. If so, there's a book I found quite useful, Sugar Surfing by Dr Stepen Ponder. It's on kindle and paperback. He's an endo who is also T1. Lots of tips on getting the most out of cgm.

Has she done a DAFNE course? Good for fine-tuning even for old hands. There can be a long waiting list, though, depending on area. Mine's was over a year!

As a very general rule 1u lowers by 2 to 3, and 10g raises by 2 to 3.

So, my take on it is that the meal bolus combined with albeit modest exercise (you should be doing the hoovering from now on, dude!) was too high, hence the drop, liver probably started producing glucose in response, and then by 11pm, the meal bolus is practically worn out (novo tends to last 3 to 5 hours) so there'll be very little or no bolus left to deal with the crisps, say 25g, and the jaffas, say, 30g, so there's 55g of unbolused carbs kicking around, sure some of that'll be used to recover from the hypo but, even so, let's say there's 40g in free play, so 4 times 2 to 3 means an easy 8 to 12 rise, giving you the 16.

Likewise, 6u correction might be expected to drop by 6 times 2 to 3, so 12 to 18 drop, so lo result isn't a surprise even though it's accepted that the 2 to 3 generallity often doesn't apply that well at high levels. There's a chance the liver might also have been pulling back some glucose to restock after the earlier hypo. I'd have been more cautious with a 3u correction.

Both DAFNE and the book are pretty good at pointing out how little is needed to correct a hypo. It was a mistake I used to make a lot in my early years - all too easy in the panic of a hypo to overfeed. I'll tend to use no more than 10 to 15g now for common or garden hypos, although will obviously increase that if it's clear that there's a harsh and continuing drop with lots of peak insulin still kicking in.

When I see a slow slide now on libre, it still amazes me what a mere 5g will do to tail it off and nudge up by 1 to 2 whereas before I might have been inclined to hoover down a whole twix and then wonder why I ended up too high - duh!

C96 said:

and 1 unit of novorapid to reduce every 1 unit of her levels

Click to expand...

Yes, these things are always messy! We're supposed to get a nice tight balance all the time, but they don't tell you the scales are set up on a shoogly trolley cartwheeling down a rusty track!

We can't advise on dosing but 1u will generally drop a lot more than 1 on the meter, normally it'll take it down by 2 to 3. But there might be some stuff going on which makes 1 to 1 true for her, I simply don't know. The fact that 1 to 1 led to an unreadable lo suggests the advice you've been given is wrong.

One thing which is quite useful to do if on libre is to wait until relatively stable kicking around the 6 to 8 area when there's no active insulin or food on board, then take 1u then just sit back and watch what happens over the next few hours.It should dip down and then level out again and you should be able to see that on the graph. It'll give you a clearer real world idea about what 1u does in practice than any advice you'll ever get from a dsn.

Personally, that sort of test doesn't work that well for me with 1u, I'll normally run it on 2 and then do the arithmetic after that.

Likewise for raising. Wait till stable, try 10g unbolused, wait for an hour or two, see how much it raises by.

Hi @C96

I hope you are both okay now.

I'm no expert and not pregnant but just a thought on food type when treating hypos. I tend to have 100ml juice (works quicker than tabs for me) and something to maintain levels like half an Alpen light bar or some kind of cereal bar - just be careful as the carbs vary drastically!

Something similar happened to me which I couldn't explain at the time. It was also highly embarrassing as it was my hen do, right in the middle of a meal!

Pre-meal my BS was normal and I did an estimated carb count and pretty much soon after my meal I was dropping uncontrollably to the point of almost fitting. When I fed this back to my DSN she explained my insulin had hit my system way before the food (it was some kind of pasta dish). Pregnancy will complicate readings as mentioned in this thread but just a bit of advice re: food type - be careful with pasta.

I also try to avoid crisps and chocolate at night because it seems to have a strange effect on my BS. I tend to go for a cereal bar, nuts or Greek yoghurt. Maybe try cereal or toast too?

Hope this helps a little

Ahh I see! I'm not familiar with the Daphne course to be honest, just experience.

It will depend what phone you have but have you thought about downloading any of the diabetic apps? I download one yesterday for free called One Drop. You input your BS levels, exercise, insulin and food and it shows the tends. I like you can search from the food library too and it shows you the carbs.

Sounds like the best plan!