BG Spikes After Hypoglycemia

Type 1 and LADA
#1

So I seem to consistently run high after low episodes again and again.

Example 1:
Last night I was low for a good two hours.
Saw I was low. 8g sugar and 8g peanut butter. Wait 20 minutes. Still low.
Had 15g crackers. Wait 20 minutes. Still low
Had 15g crackers. Wait 20 minutes. still low
Had 15g Crackers. Wait 20 minutes. still low
Had 15g crackers. wait 20 minutes. still low
Had 15g crackers. Wait 20 minutes. Starting to pickup. It's 1AM and I'm tired so I sleep.
Was around 150-200 all night overnight.

Example 2:
Saw I was getting low. Had 8g sugar. Wait 20 minutes. Still low
Had 20g crackers. Wait 15 minutes. Still low
Had 8g sugar. wait 15 minutes still low.
Had 15g crackers. Wait 20 minutes. Starting to pickup
Was around 150-200 within 1 hour.

I don't know how to properly respond to lows without having spikes afterwards! Does somebody have a good snack they use to avoid spikes afterwards? Or some better eat/wait routine? I am so tired of this happening.....

Followup: glucose tablets are working well when I am not dropping too fast and do not have insulin on board!

#2

Yep, I'd be even higher than that if I took that much glucose! I use glucose tablets as they raise blood sugar rapidly, don't taste good enough to want to eat too many and can be precisely measured. I generally wait 1/2 hour not just 20 minutes. You don't give numbers so I don't know just how low you were and if you were (slowly) going up, or perhaps most importantly, if you had insulin on board. If I am not drastically low and I see some improvement and don't have IOB, I will wait a bit longer, or maybe take one more glucose tablet. If I am very low and/or continue to drop or have significant insulin on board, I will perhaps take two more glucose tablets and again wait 1/2 hour. You might try some time when you are not low to take glucose tablets and figure out exactly how much a gram of glucose raises your blood sugar so you know your needed dose. For me I take 2 glucose tablets (8gram) if I'm in the 50s. If I'm lower I will take 3. Then if I need to repeat, I only take 2 at a time and wait 1/2 hour.

Finally, I'm not sure what the peanut butter was for. It won't do anything significantly to raise your blood sugar and being fat will delay the rise so that's not useful.

#3

Yeah, I am going to return to the tablets for a while and do as you recommend. Do you find they offer a sustainable BG increase over, say, an hour or so? Or will my BG be bouncing near lows over the next few hours?

#4

There is no way to say for sure as we are all different, but once you determine the correct amount for you to raise your blood sugar, assuming you have no insulin on board it should be fine. Some people say they need a protein snack (not high fat) to sustain it, but I've never found that to be true for myself. The other variable, of course is your basal. If your basal is too high, that too can be causing or exacerbating lows.

#5

This is one of those situations where a CGM really came in handy. I was really surprised to learn how slow most carbs were to raise my BG and how long the effect lingered. It helped with corrections, basal testing, and especially with figuring out my BG profile during various workout activities.

Overall, I learned to be a lot more pro-active when it came to preventing work-out induced hypos and a lot less aggressive when it came to simply treating them. I can tolerate hypos into the 60s and still get through a workout, but anything lower and I'm floored for the duration. If I'm not working out or obviously heading downward from the 70s or 60s, I'll ride them out as long as I can, especially if it's getting close to mealtime.

You might actually still be in your honeymoon, which makes things even tougher to predict. As much as it sucks to have your islet cells finally give up the ghost, it does make BG management a bit more predictable once you figure out your own peculiarities. =/

#6

I like Level Life glucose gel (15grams) if you need a fast acting product and it sounds like you do.

#7

Dear DFresh, try using Orange juice or better still 1 glucose tablet to control your lows rather than crackers. it takes longer for your body to break down the carbs in the crackers than 15g of orange juice or 1 glucose tablet. So right now, what you are doing is accumulating the carbs hence the high when u wake up.

#8

D, in my humble opinion the problem is your choice of treatment for hypo. You're using things that are slower to digest and get in to the bloodstream, especially the peanut butter. In fact, the PB, since it came first, likely got in the way of digesting the crackers faster.

Given what you describe above, I'm not surprised it took 2 hours to get your BG moving.

Stick to sugar, ideally dextrose, to treat lows, and nothing else. My treatment of choice is skittles, 'cause they're 1g carb per. Makes it easy to dose.

#9

DFresh, a bit more: The reason you rebounded back so high is you ate an enormous amount of carbs and didn't give yourself insulin to cover it. By my count, you ate 83g (ignoring the PB) -- that's a TON!!!

While far from precise, it is very helpful to determine your (what I call) "carb to bg delta" ratio. That is, how much does your BG rise for a given amount of carbs? Or the way I prefer it, how many carbs does it take to raise your BG 10 mg/dl?

This is very useful when correcting lows, and handling "overshoot" like you experienced. It helps you control how much you eat to counter a low -- and this can be tough sometimes because when you feel low, your brain has a very strong compulsion to eat -- carbs especially.

Your carb/deltaBG ratio is easy to determine. Take your insulin/carb ratio, and your correction factor (also a ratio, mg/dl per unit insulin) and divide. For me, I:C is 1:4 (0.25), and CF is 1:10. So, I rise 10 mg/dl for every 4g.

Given that, when I'm low I can figure how much carb to take, rather than blindly downing fixed amounts. I shoot to correct to 100 (although my target it 85), so I have some margin in case there is active insulin still driving my BG down. with a low of 60, I'd take (100-60)/10 * 4 = 16g. Then I'd wait at least 30 minutes for doing anything else.

If my BG has turned the corner and started to rise, I'll leave it be. If not, I'll take another +20 mg/dl carb dose (8g for me), and wait another 30.

I've never had to go beyond that.

Also, do not eat any fat or protein when you're correcting a low. It slows absorption of the sugar.

Finally, if you do dose yourself with a large amount of carbs, don't wait to bolus for the excess (minus the amount that would bring you back to target) after your BG gets back to normal. If you don't cover it, you'll wind up with high BG -- just as you did.

#10

I've found treating lows to sometimes be very tricky. You want to get your BG up as quickly as possible but not overshoot. If I have no IOB, I'll eat one or two Dex4 tabs (4 grams CHO each) and chase them with 4-8 ounces of water. The water will enable the dextrose to get to the small intestine and then absorbed quickly. Then I'll wait 20-30 minutes and repeat the process.

If I have some IOB, then I'll do the math to figure out how many carbs I need to eat. If I have 2 units IOB and my I:C is 1:6, then I'll eat a 12 grams of carb snack without a bolus.

When my BG drops below 60 for anything more than 10-20 minutes then I find that my liver and counter-regualtory hormones come into play and they create large insulin resistance for me. And this can go on for 3-5 hours. Very frustrating.

I will use peanut butter if I'm awoken early during my sleep, say before 1 a.m. and I've already taken one or two Dex4s with water. I only use peanut butter if I had some inkling that my BG may drop again while I'm sleeping. I base this judgment on recent history and trends. If I had more exercise than usual that day then that's a good reason to follow up with some peanut butter. I only use about 1 teaspoon.

I don't think you have a CGM but for those that do, I never treat low BGs based on a CGM number. I've already made that mistake -- more than once.

#11

I definitely admire your diligence to waiting 20 minutes each time. For me, I get wicked low (35-40)and will chug a small bottle of gatorade and eat a handful of dried cranberries. At times I will continue to eat the cranberries until the room stops spinnning, the spots clear from my eyes and my heart stops trying to beat out of my chest. If you're lower than 60 it's helpful to follow the 15-20 carbs, but any lower and you'll need more. The PB is good for sustaining your blood sugar, but it inhibits the rapid absorption that your cells need when you're having a hypoglycemic reaction.

#12

I agree crackers are not the best choice for hard lows. I mostly use a mix of Smarties (Dextrose) and Starburst Jelly Beans (yummy) as they are cheap, like a few bucks for like a 1/2 lb or lb of goodies. They are really tasty, so it's not like "aack" to eat them or anything but the hassle of mixing them up and taking the green jelly beans out (yuck) is enough of a chore that they become "precious" (cf. Gollum) so I don't just munch them. I put them in these little bags I get for like a buck/ 100 at Hobby Lobby. Quick, tasty and convenient. I usually have like 5-10 of them, depending on how fried I am.

#13

the average conception of "snack" is very much related to junk food, hence lots of sugar, I would advise you to totally drop everything that contains wheat, try to go with beans peas chikpeas lentis ect, plus veggies mostly raw (now potatos or coocked carrots).
Going back to the snack issue, I think it's much better having some fruit rather than 8g of sugar, plus remember that fats slow digestion, hence carbs absorpion, if you eat sugar and peanut butter (which normally has a lot of sugar per se) you're not gonna fix low BG any time soon, go for a banana insted , it has a good quantity of monosaccharides, and also deliver a lot of potassium which helps you to deal with spikes. Also not to be too pedant, but this trend of yours, in my opinion, is a sign of slow methabolism, try to do some exercise at least 3~4 times a week (crossfit makes miracles) you will feel the difference in less than fortnight.

#14

I was told to treat with 15g of fast acting carbs (juice, low fiber fruit, sugar tabs, hard candies, etc) and then a snack with carbs and protein within an hour. Don't treat with crackers or peanut butter unless you have to, the peanut butter slows carb absorption and the crackers take longer to digest anyway.

#15

When I am treating a low, the first thing I consider is 1) How low it is 2) How does it look to be trending 3) When is my next meal 4) What activities do I have to complete after I treat?

Not having a CGM, I err on the side of caution, but I am also careful not to over-treat. I usually down a juice bottle, pre-filled with Hawaiian Punch and perhaps a pack of M&Ms, durable in the summer, easy to carry, easy to chew and swallow, and they have a slightly longer-lasting effect if I need to carry over a longer duration before a meal.

I don't avoid sugar and try to eat healthy to treat a low. There are times for that. A hypo isn't one of them. Sometimes I mix snacks, sometimes I don't, but my main concern is always bringing my BG up above 70. I've experimented with glucose tablets, the official treatments, and non-official treatments.

In the end, it's what works best for you.

#16

Carlo, IMO your advice is great vis a vis general nutritional practices, but for correcting lows, which are neurologically dangerous, the best and most medically sound advice is to eat pure dextrose.

There's nothing inherently "bad" or unhealthy about sugar. It's not like alcohol, for example, which is a mild poison. Consuming pure sugar when medically indicated should be encouraged, not discouraged.

I love bananas. Eat them all the time. Compared to a dextrose tablet, though, sugar absorption takes much longer. Fruit generally is a poor treatment for serious lows, because the fiber and other nutritional ingredients low digestion and absorption.

#17

I think you are starting out with protein and carbs, and then stacking more and more carbs on top. But that initial protein (peanut butter) in your digestive system can powerfully delay the absorption of follow-on carbs. Eventually it all kicks in and by then it's too much.

I myself kinda resisted glucose tablets for a long time, but finally gave in recently and have to admit that they are overall the best way I have to treat a hypo. When I was a kid, before glucose tablets, I used foil-wrapped sugar cubes.

#18

I use Glucose Tablets, the older I get the faster my sugar can drop. Years ago I was in the Hospital and they tried the Cracker routine with me, it didn't have enough sugar for what I truly needed so I use Candy, Glucose or Juice it works quickly and breaks down fast so you wont have more sugar in the body than needed. The Diabetic Body is ever changing so we all have to change the process as the years go on.