Help! I can't stop over-treating lows

I agree with what everyone is saying. I am way too lazy to figure out how much carbs raise my BG specifically. The missing thing in many analyses of hypos is the FOB that’s there with the IOB, if you have something cooking away (waffle mac and cheese…) that might be slow deploying or whatever, there might be 2U IOB plus 10-20-30G of carbs too. In those situations, you might just need a nudge of something to get it turned around. I also find it very helpful to use our kitchen timer and I set it for 20 minutes most of the time and just do something, put dishes in the dishwasher, put dishes out of the dishwasher, throw magazines into the recycling bin. I’ve shared my go to solution before but the SmartieBeans are handy because mixing them up is a chore so I don’t eat them freely, only for hypos:

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Could the anxiety you describe be affecting your bg, thus raising it further than the carbs you eat and muddling your ability to ascertain the proper amount of carbs needed?

That’s a nice solution on both a physical and mental level.

The method I use is my basic method. Works pretty well most of the time when my thoughts can be a little woozy and wonky. However, now that I am no longer using NPH, I rarely get those lows where the ONLY thing I can focus on is the need for food, food, food … now, now,

NOW!

As a result, I regularly try and add some analysis to my treatment considering FOB and IOB. If the FOB has decided to delay its conversion to glucose and arrival in my bloodstream, then I may reduce or delay glucose tabs. Conversely, if my metabolism is running high and I have “used” the FOB early, leaving me with excess IOB, I will adjust the number of glucose tabs to try and get to the safe zone more smoothly. I sometimes will have some glucose tabs even if my BG is above 70 if I realize that I will have IOB without matching FOB.

??? Are you sure that is correct?? My understanding is that when calculating how much a gram of glucose with raise your BG, ISF and ICR are not relevent since this is actually not dependent on insulin signaling. The key parameter is body mass (and to a lesser extent body composition). If you leave out any movement in BG or ongoing insulin activity (and these are not going to have a significant effect over 15 minutes) how much effect the correction has can be crudely estimated as a function of Grams of Glucose divided by volume of liquid in your body. OK, that’s an oversimplification because you have to take into account absorption from you digestive tract and then equilibration between your plasma and the rest of the cells in your body, but even so, it is a bit like dissolving sugar in a jar of water. The increase in concentration in solution will depend only on the mass of sugar and the volume of the water.

The rule I have seen and used, is that for an average sized person (whoever that is) 4-5 g of glucose will raise BG by around 1 mmol/L. That’s in the same ballpark as the 1 g for 5 mg/dl (US numbers). According to the pack information on my glucose tabs, 4 tabs contain around 15g of glucose which should raise BG by around 3-4 mmol/L (approx 55-70 US). If my BG is around 3 and especially if it is falling, one tab is not going to cut the mustard (maybe you have different sized ginormous Texas style tabs in the US?)

I find the 15/15 rule works pretty well and that means 3-4 tabs.

Joel

this is somewhat helpful to the discussion, IMO. http://diatribe.org/issues/55/thinking-like-a-pancreas

there is no hard and fast rule for how much a gram of glucose will raise one’s bg’s. to think otherwise is to risk going either too high or not high enough. One must be flexible in figuring out how much one needs under any particular set of circumstances when low. When too low to think clearly, that can be nigh impossible. IMO, if you can’t think well enough to decide appropriately, err on the side of too many carbs, wait for your head to clear, figure out how many EXCESS carbs you just ate, and then bolus for only HALF of those excess carbs, to get yourself back on a somewhat even keel. that calcuation has served me well over the years. it takes practice to do that, but it does work a whole lot better than bolusing for ALL of the excess carbs you just consumed (by “excess”, mean the extra carbs you ate above and beyond what you SHOULD have eaten to get yourself up to a safe level)

Furthermore, there are so many variables to consider, I can’t list them all, but one obvious need to deviate from my “bolus for 1/2 of the excess carbs” method, would be when engaged in strenuous activity. For that, you may not want to bolus for ANY of the EXCESS carbs, or just a TINY portion thereof. There’s plenty to think of when trying to normalize one’s bg’s when it gets out of whack!

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I usually do it by pure will power alone, and my hypo-unawareness help. However, I woke up in the middle of the night a week or so ago and , well, too much. I had a 14carb juice box, then I had two peanut butter sandwiches, 3 pieces of white chocolate, and a light greek yogurt. Ooops. So, I just took insulin for everything that I ate that I didn’t need to raise my sugar. As long as I start eating right before or while I take my insulin, this system works pretty well. I might go a little high (less than 200), but I watch it closely and correct as needed.

I experiment with my lows. I do it while I’m at home and someone is with me. It seems dangerous, but lows aren’t something to be feared! It’s okay!

Several people have mentioned this so I’m just going to spell it out as blatantly as possible: calculating ratios, no matter how cleverly or elegantly done, is no substitute for empirical testing. You can read every book, analyze every piece of available advice here, and work out precise computations until the end of time; but the only way to KNOW how much a gram of carb will raise you is to TEST IT! And more than once, so that you know your data isn’t a one time blip.

Once ounce of empirical data is worth a thousand pounds of theory and calculation.

P.S. There’s a famous story along these lines from the American civil war. During the Peninsula campaign, General McClellan and his staff were reconnoitering and came to a small river that the army would need to cross to reach the objective. They were concerned about the depth of the river and whether the equipment would be able to make it across. They sat on the bank, discussing the matter at great length and trying to judge the river’s depth. After several minutes of this, one of the young lieutenants on the staff lost patience. He rode his horse out to the middle, stopped, turned around, and announced, “this is how deep it is, General.”

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Many great comments here! As many have already mentioned, there are no easy fixed rules for treating lows. It all depends on IOB, COB, bg value, and (most importantly) how fast bg is moving (use your CGM to your advantage!). Here is my annotated example from yesterday, which included exercises, treating lows, restaurant food, … hope it’s more or less self-explanatory. Timing is important: note how I attempted to treat all anticipated lows before they actually happened. Overall, this was a very enjoyable evening, including lots of ‘sugar surfing’ fun.

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This is a great chart! Thanks for sharing, @Dragan1. It sure helps to see how others handle lows, and graphically, too.

Lots of advice…
More or less agree with the said above.
i now, with the new 640G have a new challenge, to trust the auto suspend of my pump and not eat anything at all when i see i am approaching a low. that can be hard at times too, but i know that my pump often does the right thing without me adding carbs into the mix.
easier said than done… :confounded:
I like the idea of distracting yourself from the low once you have corrected. talking to someone close can help at that time, tell them: “i have corrected my low, please help me not to eat for the next 15 minutes” or something similar.
then, what i do if my cravings for food get really bad and i just cant sit still anymore

  1. i either eat slow carbs that satisfy my cravings and bolus simultaneously for the added carbs.
  2. or i eat a carrot or cucumbers or whatever i find, something without carbs (often veggies). i seem to be one of those who just needs food in her mouth when she is low, no matter if it is sweet or not, so that helps too.

but, after all, we are just human, and many of us overtreat from time to time and that is ok too… :blush:

:slight_smile: :slight_smile: Interesting way to start a conversation. :smirk_cat:

Do you think trying to ween yourself slowly off the eating might work. That is, eat something to correct but use less and less as time goes on? Depending on the situation, naturally. As others have pointed out, depending on how sensitive you are to insulin, how much bolus is still active, and how fast you may be dropping, you still may need to drop some carbs to avoid the hypo since your liver alone might not be able do it all.

Aside from lows while sleeping, the other contexts I have heard the 640G can be helpful in are situations where you are awake but occupied. Like giving a presentation or driving and such. Have you ever had your pump decide to suspend in a context similar to that?

I used to use the 15 carb rule–4 glucose tablets. Then I realized that in most cases–not all, of course, as that just doesn’t happen in diabetes–1 tablet raised my bg by around 55-60 points, so 4 tablets would be 240 points, overkill for sure. Now, unless there is IOB, I start with 1 and go from there, depending on ever-changing factors, like the ambient temperature, whether it’s an odd or even day, how annoyed I am at my dogs, and other important stuff

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Well, not to start a conversation, but if a close friend is there, they usually know already, so they can also help you not to overtreat

of course i have had that happen, like a million times!
Be it in the anatomy hall having the hands stuck in some work or driving to pick up my sister, this pump has saved me tons of hypos, or at least bought me more time to react!
:heart_eyes: so in love :heart_eyes:

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I use fun-sized candies (like the mini boxes of nerds or fun-sized Skittles) to treat lows. I will eat one pack and if I’m really feeling the urge to over-treat, I’ll eat a non-carby snack, like almonds, or drink something. I still over-treat on occasion, but this helps me a lot because when I’m low I really really want to eat. I just try to give in in ways that won’t spike my blood sugar back up.

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Hi ther. I’ve had type 1 for 47 years. What’s happening to you is very normal. Your body goes into survival mode and its almost impossible to stop eating. Have a apple or oranje juice box and try to wait. Follow with some protein. A rebound high almost always happens. It’s ok

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