I find that, as Dr. Bernstein suggests, one glucose tab raises my bg by 20 mg/dl. I’ve tried precision treatment, such as taking half a glucose tab to raise it from a 70 to an 80. I’ve also done fine with one and a half glucose tabs to raise it up from a 50. (My target is 83 at the moment.)
But once or twice, I’ve gone ahead with two tabs (I think also from a 50) - without any other treatment - and I shot up to 150. That’s a 100-point jump, way more than the estimated increase of 40.
Has anyone else noticed this? Or, if you have any idea what may be impacting this, I’d love to hear it and solve this math mystery.
When blood sugar drops to around 60-70 mg/dl, it starts to elicit an emergency response from counter-regulatory hormones like adrenaline and cortisol. The actual threshold when this happens varies from person to person and probably a bit from day to day in the same person. For me, this threshold is usually at 65 mg/dl.
This response also engages the liver to release glucose. These actions are a part of a survival mechanism. These counter-regulatory hormones serve to disable the active insulin and neutralize it. Unfortunately, depending on the depth and duration of the hypoglycemia, this hyperglycemic rebound effect can go on for hours.
So, to answer your question. Providing you don’t engage any of the hypoglycemia counter-regulatory actions, you probably can mostly depend on the ratio of one 4 gram glucose tab raising your BG by 20 points. If you hit hypoglycemia, all ratios are thrown out the window! This is why avoiding lows is a big deal to overall control.
It’s difficult to compare one 50 mg/dl incident to another since our meters can be off by a fair amount. Duration is also a large factor here. One 50 mg/dl incident that last 10 minutes will behave differently in the aftermath than another 50 mg/dl incident that lasts 20 minutes or more.
That’s a really interesting response @Terry4 . I was not aware of this mechanism within the body. Does that theoretically mean that even as a Type 1 Diabetic, in some instances my body could naturally correct a hypoglycaemic incident?
I think a person’s size also affects how much a gram of carbohydrate will raise blood sugar. I’m very sensitive to both carbs and insulin. I find my BG usually goes up about 7 points per gram of carb, so 28 points per glucose tab and sometimes even more.
Thanks, @Terry4. That makes a lot of sense. So if I’m in a position where I need two glucose tabs, my body is probably responding on its own at the same time, resulting in a double-correction of sorts of the low. I’ll monitor this and try to keep to (needing but also just taking) one glucose tab at a time to help avoid the un-intended over correction. Mystery potential solved.
It’s my understanding that we as T1Ds still have significant natural defenses against severe hypoglycemia. In my 32 years with T1D I have personally survived several multi-hour lows sustained in sub-40 mg/dl (2.2 mmol/L) range. While severe lows can and do kill, most times we survive due to counter-regulatory hormones and the liver. While our glucose metabolisms are compromised, the important low-BG survival mechanisms are still mostly intact.
You’re right. Keep in mind, however, that the body’s counter-regulatory solution to lows will often spoil efforts to correct the subsequent high blood sugar levels or rebound highs for up to several hours. It’s much better to pre-empt the natural low BG defense from being triggered at all, if possible. I’ve also observed in myself that if I can keep the excursion below 65 mg/dl to under 15 minutes or so that I will prevent the full deployment of that natural solution along with its built-in sustained hyperglycemia rebound.
If the same action (eg eating 1 glucose tablet) yielded the same exact result (eg increase of 20 points) every time-- then anyone with even basic math skills could keep their blood sugar level precisely pegged at whatever level they chose 24 hours a day with minimal effort— it’s not quite that simple in reality…
I agree with you, @Sam19, but I have found it to work most of the time with me. At least, to help me know how much of a glucose tab I should take to treat a low. Do you have a CGM? I find that if my low is flat (and not trending down) then using the math works fairly well (again, assuming my bg is not too low to trigger this natural remedy). It has helped calm my nerves about not over-correcting because I still feel low. Otherwise, IOB can mess with the impact of the treatment for the low. Anyways, as always, YMMV.
