Correcting Lows Without Spikes!

One of the many interesting details contained within Dr. Bernstein’s Diabetes Solution book is Chapter 20, discussing of the treatment of hypoglycemia.

DO NOT CORRECT A LOW BY EATING OR DRINKING CARB/SUGAR-LADEN FOOD!!

This is not an excuse to eat non-plan sweets. DO NOT raid the kitchen cabinets. As hard as it might be, it’s recommended to use the following chart to determine how much edible glucose your body will need to raise your blood sugar to the target of 83 mg/dl. It is all determined by body weight and how much you need to raise your blood glucose levels:

Based on this knowledge, how much glucose is contained within your glucose tablets? Usually it’s 4 grams of glucose per tablet. If you are 140 lbs/64 kilos and you need to raise your blood sugar 40 points, you eat 2 tablets, or 8 grams of glucose. Then wait 15 minutes and re-test your blood.

Question: How much did your blood glucose level go up? Do you need another tablet? Some people may find that they need 2 tabs, others might need 1/2. A child might need less.

Always correct your blood glucose level to 83 mg/dl. That is your benchmark. You don’t want to over-correct and spend hours yo-yoing through hypo and hyperglycemia.

Dr. B always recommends treating a low with pure glucose tablets because it’s the most fast-acting form of sugar that can pass directly through the lining of the gut without being processed in the liver like other sugars. There are some exceptions.

If glucose tablets are not available where you live, consider an alternative treatment source. Small candies such as Smarties candies (0.5 g carb each) are an option since they contain nearly 100% glucose, and you can dose precisely without overshooting.

Below is the link where I got this information… have a good read! and a good diabetes day :slight_smile:

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I always used Skittles, which are 1g CHO each. And started with 4 Skittles. I also ate something with protein and fat in it to sustain the rise. Otherwise, I would find myself in a low again in an hour or so.

However, now I have a Tandem x2 pump with Basal IQ which keeps me from going low unless I have taken a overly large bolus of insulin, which I try not to do. My pump keeps me in the safe range, especially during the night. A great relief!

I limit my low treatments to glucose tablets mostly but will sometime use pomegranate juice in small < 1 ounce swigs. When I check my CGM trace due to a low and find it is a slowly sinking trend, I will usually just eat 1/2 of a glucose tab, 2 grams of carbohydrate.

That old rule of thumb that calls out for 15 grams of carbs, wait 15 minutes, and then check and re-treat if needed overdoes it for me and will just start me off on the gluco-coaster. That’s appropriate advice for someone whose blood glucose variability is high, like a CGM standard deviation of >= 60 mg/dL, but for someone who enjoys a SD of <= 30 mg/dL, that standard hypo advice just creates ongoing problems.

Bernstein was/is right. I always aim for 83!

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I carry Skittles (Wild Berry) with me wherever I go but at home I eat/drink other things for lows. My wife is always telling me to “have some Skittles” when at home but I prefer a small amount of choco milk, honey, fruit, etc.

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I find this hard to practice in real life because it doesn’t really account for frighteningly rapid drop of acting insulin.

I’m pretty good with estimating carb counts for the food I prepare myself, but there’s still a whole lot of guesstimating. Or sometimes when I’m home alone, I actually forget to eat after pre-bolusing. Since Basal-IQ can accommodate for any small hypos, most of my treatable lows are caused from such over-bolusing, and cgm will show something like 45 double down. And they come on QUICK! In those instances, I’m not going to be counting carbs and waiting 15 minutes or more to see just how low I can get before I digest and absorb dextrose. (By the way glucose tablets are NOT the fastest way to raise bg, sublingual absorption is… But the gels are disgusting.). I’m going to go ahead and just over-treat to get out of the danger zone, and start correcting as I see bg raising again. It’s not difficult to avoid spikes that way, either.

I like the 6oz juice boxes. There’s 24g of carb in mine, which is equal to about 2 units worth of over-bolusing, which is enough to correct any serious low for me without the excess shooting me too high. They’re small enough to be portable, and the sugar is pre-disolved. I can swish the juice around my mouth for faster absorption, too.

I tried the Skittles after seeing so many people rave about them. I don’t know how you all do it. I find them too hard to chew/swallow when I’m hypo. It’s like they make a glob of gum in my mouth.

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I sympathize with your anxiety. For many years, I was poorly controlled and would freak out big-time when I’d drop. For the last 20-some years I’m just blase about it all. Yesterday I was in the garage grooming my dog, which took over 90 minutes and I just wanted to get it down without interruption. I KNEW I was low from almost the start, but kept working. Quite a change from the bad ole days on Regular and Ultralente. When I do drop fast, I just treat and go about my business. I don’t know if my lack of concern is because I’ve never passed out (even in my bad ole days) or because I’ve got so many years under my belt with diabetes.

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Must have over bolused last night. My pump woke me up with a low alarm last night which I silenced for 45 munites until it woke me up again. This time I read my pump and saw it was reading 47. When I got up and verified the low reading with a test strip, I decided to take advantage of the situation and consumed a mint Oreo. 15 minutes later my pump read 42 so I consumed a second Oreo and went back to sleep. When I woke up at 8:30, My pump showed 174 so I took a Bolus correction which brought me back into range.

I don’t often get an opportunity to consume two Oreo cookies.

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:frowning: Me either! Whenever I mention Oreos I get a disapproving comment from my fellow T1 wife.

As Robyn_H said, this chart doesn’t account for the rate at which BG is falling. If your CGM says you are dropping at 0.5mmol/L (9mg/dL) per 5 minutes then at 64kg/ 140lb you would need to add an additional 6g glucose to counteract the drop over the 15 minutes until you re-test (75% more than suggested).

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When I am in the process of going low or am low I am pretty fuzzy brained and figuring out a chart and then how many grams of carb in my emergency snack then divide this into that etc. is way beyond my capabilities half asleep at 3AM. Over the decades I have found the best way is to test a sample food and stick with it. My go-to is Swedish Fish candies and all I know is when I go low, eat 1 Swedish fish for each 10 points I wish to raise my BG and it always works out. Pop the candy(ies) into mouth and go back to sleep worry free.

Every so often, on an overseas trip I may run out of Swedish fish and then just go to any store and buy a bag of small candies. When my blood sugar is stable test BG (base test), eat 3 candies and then exactly 15 minutes later and then 45 minutes after that take an additional BG reading. I take the difference between my base test reading and the first 15 minute reading and divide by 3 (since I ate 3 candies). This gives me a pretty reliable count of how high my BG will rise both after 15 minutes and 1 hour from low for each candy.

I like Swedish Fish because they are easy to eat, taste great, do not get too hard when cold or too soft when warm. I can keep a pack in my pocket even during exercise as they will not melt and make a mess. The package is very small and always wraps tightly around the remaining candies. They are everywhere, in my home, office, car console, etc.

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Fruit snacks were my go to for ages, for exactly those reasons. Easily portable and always easy to eat. Now that I have very few lows, but the few I do have are real doozies, I’ve found the juice to be quicker. Unfortunately, I’ve still got a Sam’s club size of Skittles to exhaust.

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Yeah, I do agree with all of you.
Everyone should test it out and see how your body reacts to glucose… this was just a base line on how you can treat your lows. Just like your correction formula… trial and errors.

I’m glad Y’all know what works for you… I’m still in the testing phase though.
Just learnt this yesterday when I shared this information in the forum.

My treatment is Smarties. About 7g per roll of dextrose. Depending on my level and trajectory, I take 1-3 rolls. If it’s a shallow drop and not very low, I indulge in a treat, Oreos being one, if there around. The hard part is that I get ravenous when I’m low, and the symptoms don’t stop until well after the bg get back into the normal range. So I usually try to distract myself for a while. Reading is not possible when I’m low. Youtube or a Hanayama puzzle work well.

This is what makes treating lows hard. It’s a body and mind game. But it can respond well to forethought, a plan, and persistence until a habit can settle in and make things easier. Looks like you’ve solved this puzzle!

I’m sorry, I didn’t mean to sound discouraging. It’s a lot of information to figure out.

If it’s any help, I actually did use that chart to figure out if my insulin to carb ratios and correction factor were in the ballpark, and they were. Just divided my correction factor by my corresponding b value in the chart (I actually guesstimated a middle value closer to my weight), and the result was exactly what I use for my I:C. If it wasn’t, I may have starting tweaking my values.

How many are you putting into your mouth at once? I usually do up to about a dozen or maybe 15, max. No problems chewing them but it takes a bit to get them all down.

Lol. I am very petite. I could never put that many in my mouth. I usually put just one or two in, part of it dissolves and I’m left with an insoluble glob, to which I add another. After I’ve gathered 5 or 6 Skittles worth of glob, I have to sip water to help choke it down.

They’re very chewy like Taffy, which is known for being a difficult sweet to eat. I accept I’m unique in my dislike for them, as they’re so very popular. At least for this usage, I don’t dislike Skittles when I’m more coherent. I just don’t understand why people like working so hard to treat their lows.

I don’t work hard to eat them. You and I have differing experiences with chewing Skittles, for sure!

My wife is also petite (she takes FOREVER to eat) but eats skittles for lows. Go figure.

Oh, the good old days, when you use to crawl to the refrigerator and eat everything inside it!!
But that was before meters and CGMs and pumps and faster acting insulin’s.
I have also realized this is a very specific situation. What works for me, won’t work for the next person. And what works for me today won’t work as well for me tomorrow.
Unless I am really, really low (which thankfully doesn’t happen much anymore) I just do one maybe two tablets. Sometimes just one tablet is all I need. I also use juice boxes that I get from Costco. They are called Honest Juice and they have 8 or 9 carbs depending on the flavor. I find them much easier overnight and again, not a huge carb load, just enough to bring me back up.

I do live in the mountains. Maybe it’s a high altitude/low dew point thing.

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