When Do You Need To Treat A Hypoglycaemic Episode?

bookworm01 · Aug 31, 2018

At what level do people tend to treat their hypoglycaemia with extra glucose? Say if I had a hypo about an hour before a meal, how low do you recommend letting it get before I eat some quick-releasing carbs, as I don't want a constant cycle of meal, hypo, eat for the hypo, not hungry for much of the meal, increased likelihood of another hypo, etc. I'd rather wait it out until my next meal if I can tolerate the hypo symptoms, but at what glucose level would this be dangerous to do? Thanks.

Kittycat_7_ · Aug 31, 2018

Hi,
I'd eat something if it was about 4.5 as blood glucose can drop rapidly.
You can't really wait the symptoms out, you will keep dropping usually.
Be careful at night, if it is low at bedtime eat some quick acting carbs.
Take care

Grant_Vicat · Aug 31, 2018

bookworm01 said:
At what level do people tend to treat their hypoglycaemia with extra glucose? Say if I had a hypo about an hour before a meal, how low do you recommend letting it get before I eat some quick-releasing carbs, as I don't want a constant cycle of meal, hypo, eat for the hypo, not hungry for much of the meal, increased likelihood of another hypo, etc. I'd rather wait it out until my next meal if I can tolerate the hypo symptoms, but at what glucose level would this be dangerous to do? Thanks.

Hi @bookworm01 I wouldn't ever recommend sitting it out till the next official meal! I think that could make for even more vicious circles. There are several variables here. First is your glucose tolerane level. The higher your HbA1c, the higher the tolerance level usually. This means that you could be hypo at somewhere around 5.0. When my HbA1c was 5.6, I could go down as low as 1.3 before shaking, dribbling, being utterly confused, experiencing auras etc. Obviously that is dangerous. Research is continuing on the effects of persistent hpos and impaired cognitive function (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2528851/ for example). I think you need to discuss your levels with your GP, Hospital doctor and or nurse, depending on which one you find the most helpful. In the meantime I would try to bring yourself up to a non-hypo level (suggested range is 5.0 - 7.0) before worrying about the meal ahead. It's great that you ask the Forum as there are thousands of us who know where you're coming from. I hope you get sorted quickly. Good luck!

KK123 · Aug 31, 2018

Hi there, how low are you on about firstly? A hypo down in the low 3's for example would surely need treating immediately, not an hour later. I personally would not take any chances with a true hypo, as others have said it can drop rapidly. My Mum was in and out of hospital regularly with hypo's and they always told us how dangerous they could be as the brain is being starved of oxygen. They can actually kill you. Are you on insulin? If you are having hypo's on a regular basis then it needs adjusting.

Antje77 · Aug 31, 2018

bookworm01 said:
Say if I had a hypo about an hour before a meal

I'd treat with something between a half to 2 glucose tabs or sweets when somewhere between 3.2 and 4, that would bring me up nicely to between 4 and 5 and won't spoil my appetite. If above 3.6 and having fresh fruit on hand I would treat with a couple of bites of that instead of glucose tabs. Below 3.2 I'd treat and expect to eat ridiculous things when hypo, ruining dinner. It all depends on if I'm dropping like a brick (doesn't happen often anymore on the Libre) or very slowly moving into hypo territory too. But the amounts you need could be wholly different.

bookworm01 · Aug 31, 2018

Thank you all for your advice. I'll make sure to have something then if it drops into the mid 3's or below. I don't take insulin but I'm currently being investigated for hypoglycaemic episodes, and I've only just started testing so I'm not sure how low it gets when I'm very symptomatic. I haven't had a bad episode in the last couple of days, but I've been mildly symptomatic at 3.5 mmol/L a few times, so I thought I'd better check what I should do next time it happens.

Antje77 · Aug 31, 2018

Antje77 said:
something between a half to 2 glucose tabs or sweets

My friends by now know to beware of all the bitten in half pieces of liqorice in my bag when I offer them some

Antje77 · Aug 31, 2018

bookworm01 said:
Thank you all for your advice. I'll make sure to have something then if it drops into the mid 3's or below. I don't take insulin but I'm currently being investigated for hypoglycaemic episodes, and I've only just started testing so I'm not sure how low it gets when I'm very symptomatic. I haven't had a bad episode in the last couple of days, but I've been mildly symptomatic at 3.5 mmol/L a few times, so I thought I'd better check what I should do next time it happens.

Ah, when not on insulin or gliclazide the answers might be very different. Do you have diabetes as well as being suspect of hypoglycaemic episodes? The urgent need to treat hypo's in diabetics on insulin or gliclazide has to do with the risk of falling lower and going unconscious. That's different from most people with other forms of hypoglycaemia.
I'm tagging @Lamont D for you, as I think he knows more about these kind of things.
Good luck!

Brunneria · Aug 31, 2018

bookworm01 said:
Thank you all for your advice. I'll make sure to have something then if it drops into the mid 3's or below. I don't take insulin but I'm currently being investigated for hypoglycaemic episodes, and I've only just started testing so I'm not sure how low it gets when I'm very symptomatic. I haven't had a bad episode in the last couple of days, but I've been mildly symptomatic at 3.5 mmol/L a few times, so I thought I'd better check what I should do next time it happens.

Hi @bookworm01

You posted this in the reactive hypogycaemia section in the forum. So i am just checking whether your suspected hypos are alongside diabetes? And if so, type 1 or type 2 or another? Or are they suspected reactive hypoglycaemia?

The reason I ask is that different conditions tend to require somewhat different hypo handling.
Type 1s on insulin treat their hypos differently from myself (with reactive hypoglycaemia).

You can see which condition each poster has underneath their avatar picture, which should help you understand why they have given the responses they have.

As a reactive hypoglycaemic, I control my hypos by a strict low carb way of eating which prevents hypos from happening in the first place. If i miscalculate and go hypo (hey, I’m human! ) then I don’t treat it with glucose, I have something like a nut bar, because I am trying to avoid rapid rises in blood glucose almost as much as I avoid the lows.

Hope that helps!

Antje77 · Aug 31, 2018

And I only now see you've posted this in the Reactive hypoglycaemia-part of the forum. I think none of us who have reacted had noticed, as we just read 'New posts'.

Bigbloke48 · Aug 31, 2018

bookworm01 said:
At what level do people tend to treat their hypoglycaemia with extra glucose? Say if I had a hypo about an hour before a meal, how low do you recommend letting it get before I eat some quick-releasing carbs, as I don't want a constant cycle of meal, hypo, eat for the hypo, not hungry for much of the meal, increased likelihood of another hypo, etc. I'd rather wait it out until my next meal if I can tolerate the hypo symptoms, but at what glucose level would this be dangerous to do? Thanks.

Type 1 or 2?

Lamont D · Aug 31, 2018

My experience with hypos is different than with T1, T2, and those on meds that drop you into hypo levels.
For instance, if your breakfast has too many carbs, the hypo episode, will occur before lunch (dinner up north!) , you have lunch it brings you out of hypo levels. But because your BG is fluctuating, you will get the rebound effect, which means it becomes very difficult to control BG. You will spike, then go hypo all day, depending on what you have ate, and how much you have exercised, how much and how often you have eaten. This is why the standard medical advice is to eat small meals every three hours, this stops the hypos, but does not stop the high spikes and triggers the overshoot after every meal, you may not go hypo, but your BG and insulin levels do go high.
The trick is not to trigger the spike by eating very low carb, keeping your BG levels in normal range as much as possible. No hyper, no hypo.
However, if you do go hypo, the treatment is not to overuse quick acting carbs or sugars to alleviate the symptoms, I have found that having a few carbs just to nudge you back into normal levels, then test after fifteen minutes, if it is back in normal levels, then eat a small low carb meal, test again after half an hour and you should have stabilised levels. If it still too low, then up your carbs to address the hypo and monitor, eating low carb meals until you get your control. And try and keep your BG steady. When I use to hypo, when first diagnosed, I would try something like a couple of plain biscuits, rich tea, that would nudge me up and I would have a small bowl of salad with a piece of fresh meat as my protein. This worked for me.
But you might try something else.

Hope this helps.

Best wishes

bookworm01 · Aug 31, 2018

Thank you, all that info was very helpful!

DCUKMod · Aug 31, 2018

bookworm01 said:
Thank you, all that info was very helpful!

Bookworm - It would be extremely helpful if you would update your profile, in account settings from your browser, to reflect your type of diabetes. That will help people offer appropriate advice.

Atlantico · Sep 10, 2018

Lamont D said:
My experience with hypos is different than with T1, T2, and those on meds that drop you into hypo levels.
For instance, if your breakfast has too many carbs, the hypo episode, will occur before lunch (dinner up north!) , you have lunch it brings you out of hypo levels. But because your BG is fluctuating, you will get the rebound effect, which means it becomes very difficult to control BG. You will spike, then go hypo all day, depending on what you have ate, and how much you have exercised, how much and how often you have eaten. This is why the standard medical advice is to eat small meals every three hours, this stops the hypos, but does not stop the high spikes and triggers the overshoot after every meal, you may not go hypo, but your BG and insulin levels do go high.
The trick is not to trigger the spike by eating very low carb, keeping your BG levels in normal range as much as possible. No hyper, no hypo.
However, if you do go hypo, the treatment is not to overuse quick acting carbs or sugars to alleviate the symptoms, I have found that having a few carbs just to nudge you back into normal levels, then test after fifteen minutes, if it is back in normal levels, then eat a small low carb meal, test again after half an hour and you should have stabilised levels. If it still too low, then up your carbs to address the hypo and monitor, eating low carb meals until you get your control. And try and keep your BG steady. When I use to hypo, when first diagnosed, I would try something like a couple of plain biscuits, rich tea, that would nudge me up and I would have a small bowl of salad with a piece of fresh meat as my protein. This worked for me.
But you might try something else.

Hope this helps.

Best wishes

Hello D Lamont,
I too am post prandial reactive hypoglycaemic and am really struggling. Can you have a hypo without dropping below a BG of 4 ? Today I got so shaky, no energy, couldn't think clearly. I was playing golf and reached our 12th hole (top of a big hill) and had to come off as I was so exhausted. I couldn't even work out what I should eat/drink to help myself.
I had been eating cooked sausages and pieces of cheese. Also, assorted nuts, raisins. When we got back to our car I tested my BG and it was 5.
Any advice would be much appreciated.
Thank you.

Brunneria · Sep 10, 2018

@Atlantico

There are real proper below 4mmol/l hypos
And there are things that feel the same but the bg doesn’t drop below 4. These are usually called ‘false hypos’. Sometimes they happen when our bg has been high for a period, until lower numbers feel unfamiliar and wobbly. Other times they happen when our bg drops sharply - triggering those hypo feelings even if the bg doesn’t drop below 4.

For me, there are a few different workarounds, depending on circumstances.
- making sure i eat a good, large, low carb meal before doing the activity that could trigger the feeling.
- always carrying a low carb snack, and eating it before the hypo feeling arrives.
These two head the thing off at the pass, and stop it from happening.
Or
- if blindsided by the feeling, i try and settle quietly, eat the lc snack, stay resting til I feel a bit better, then go and find a good, filling, low carb meal.

If I treat a hypo or ‘false hypo’ with rapid carbs (like a type 1 diabetic would)then I will bounce right up into a hyper and then plunge into another reactive hypo. Far better (for me) to keep to low carb, and bring my blood glucose up gently.

Lamont D · Sep 11, 2018

Atlantico said:
Hello D Lamont,
I too am post prandial reactive hypoglycaemic and am really struggling. Can you have a hypo without dropping below a BG of 4 ? Today I got so shaky, no energy, couldn't think clearly. I was playing golf and reached our 12th hole (top of a big hill) and had to come off as I was so exhausted. I couldn't even work out what I should eat/drink to help myself.
I had been eating cooked sausages and pieces of cheese. Also, assorted nuts, raisins. When we got back to our car I tested my BG and it was 5.
Any advice would be much appreciated.
Thank you.

Hi again, @Atlantico.

Until you gain full control by eating very low carb all the time, you are liable and likely to have these symptoms, I would put it down to your pre golf meal, or your carb total prior to playing is too high, the residual effect is the shaking and even though you have gone low carb, your body has not adjusted to its new diet, it is still fluctuating and it is these sudden drops in glucose, that your brain is telling you to have more carbs by the symptoms you describe. You could be on your way down to a hypo and the early onset of symptoms is telling you to do something about it. It is telling you to put more glucose into your brain by eating carbs, you have not totally got your blood glucose levels stabilised.
Until you go through a period of using ketones for energy rather than carbs, then you will still get the symptoms.
You are still getting the tiredness and lethargy, the hunger pangs, probably craving carbs?
I notice you have raisins, fruit can be a problem with RH ers, the high concentration of fructose can be just as bad as sugar or carbs, you may have a fructose intolerance. The sausage may have too much Rusk, not enough protein. You won't know until you test.
I had to go through lots of test strips to find out what I could do eat, exercise and how to get the balance right for how I work, rest and play!
It will take time.
What I found out about going hypo, is to have enough low carb to nudge you up to relieve the symptoms, then test again after fifteen minutes, then if ok, eat a low carb small meal to offset any further symptoms or the rebound effect if you try and boost your BG levels too much. You would still be go hypo later. If you are still too low, repeat, then keep checking every fifteen minutes. Until you have your control again.

It would be worthwhile, to track your BG levels every tee off and hole you play, just to see if what you are having before is doing this to you.
Trial and error and experimentation is the only way you will find out.

Intermittent fasting has helped me, with work.

Best wishes

Atlantico · Sep 16, 2018

Lamont D said:
Hi again, @Atlantico.

Until you gain full control by eating very low carb all the time, you are liable and likely to have these symptoms, I would put it down to your pre golf meal, or your carb total prior to playing is too high, the residual effect is the shaking and even though you have gone low carb, your body has not adjusted to its new diet, it is still fluctuating and it is these sudden drops in glucose, that your brain is telling you to have more carbs by the symptoms you describe. You could be on your way down to a hypo and the early onset of symptoms is telling you to do something about it. It is telling you to put more glucose into your brain by eating carbs, you have not totally got your blood glucose levels stabilised.
Until you go through a period of using ketones for energy rather than carbs, then you will still get the symptoms.
You are still getting the tiredness and lethargy, the hunger pangs, probably craving carbs?
I notice you have raisins, fruit can be a problem with RH ers, the high concentration of fructose can be just as bad as sugar or carbs, you may have a fructose intolerance. The sausage may have too much Rusk, not enough protein. You won't know until you test.
I had to go through lots of test strips to find out what I could do eat, exercise and how to get the balance right for how I work, rest and play!
It will take time.
What I found out about going hypo, is to have enough low carb to nudge you up to relieve the symptoms, then test again after fifteen minutes, then if ok, eat a low carb small meal to offset any further symptoms or the rebound effect if you try and boost your BG levels too much. You would still be go hypo later. If you are still too low, repeat, then keep checking every fifteen minutes. Until you have your control again.

It would be worthwhile, to track your BG levels every tee off and hole you play, just to see if what you are having before is doing this to you.
Trial and error and experimentation is the only way you will find out.

Intermittent fasting has helped me, with work.

Best wishes

+

Atlantico · Sep 16, 2018

Thank you D Lamont for your very full reply and explanation for some of my problems. I am now taking your advice. I am playing golf tomorrow and hopefully will see some improvement. Regards, Atlantico

Lamont D · Sep 16, 2018

Atlantico said:
Thank you D Lamont for your very full reply and explanation for some of my problems. I am now taking your advice. I am playing golf tomorrow and hopefully will see some improvement. Regards, Atlantico

Hope you feel above par and your score below par.
Or is it the other way round?

When Do You Need To Treat A Hypoglycaemic Episode?

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