Lows and how to treat them

I was wondering how everyone deals with a low. Do you eat a certain amount of carbs and wait for it to come up. I'm having really bad lows that don't come up for what seems like forever and I eat and nothing happens so I eat something else then I end up way high and that won't come down so I treat that and the cycle starts all over. In the last 2 hours I've been 41 & now I'm 306 and my cgm shows it's going up even with a temp basal and boluses.

I meant to add I was doing great until this week.

I drink juice. Have been at this D thing awhile, so I just glug some. My CGM is set to re-alert me after 20 minutes, but it always takes 30 to come up to 70. I kept it at 20 minutes, as I often get low at night--when I am alone I set it for 10--want to keep alert to it.

There is the general 15/15 rule. But for some of us, that does not work for really low lows. Everyone is different, but this is a good starting point.

The conventional wisdom is to take 15 grams of fast acting Carbs when your BG is below 70. Wait 15 minutes and test again. If still below 70 take another 15 grams of fast acting Carbs, and so on.

Here is a quick summary: http://www.mayoclinic.org/diseases-conditions/diabetes/expert-blog/...

P.S. Don't rely on the CGM to treat lows (or highs for that matter) - especially fast changing ones. Remember the readings are delayed about 15 minutes and they are not always perfectly accurate.

P.P.S. I've had my more than my fair share of lows and had a few that required upwards of 100 grams of Carbs to get back up into range.

I used to follow the 15 g of carbs (usually dextrosol for me) and wait 15 minutes.. after reading on here though I have fiddled a bit and found that often 10 g will work if I wait 20 to 30 minutes and then I don't end up with a rebound high (which I used to do).

As others suggest though, it is probably a matter of experimenting and seeing what works. Of course, only experiment when not alone - you don't want to dip too low and run into an emergency situation.

I have tried many different forms of carbs, by the way, and for me the dextrose tablets work best, though again, everyone is different.

I should also add that every now and then I will have a wickedly stubborn low that really takes A LOT of treating to get me up and staying up again. Those ones unfortunately seem to hit at night which always seems rather cruel :)

Ideally, you have some idea of how fast and hard the low is hitting. I have a Dexcom and I use that information (the rate of the drop) coupled with the amount of insulin I've taken to make an educated guess. If I've taken a lot of insulin and I'm crashing hard, I'm taking a lot of sugar and accepting that I'll go high. If I've taken a little insulin and it's a slow drop, I might just take like 6 grams.

I'm the same as Scott, I have had enough bad lows that I just drink juice, or glucose drinks if it's really bad and or glucose tabs, sometimes without testing first and I accept that I'm probably going to spike, but then cautiously get myself back down. Sometimes I haven't spiked though, so those were pretty bad obviously. I can usually tell from how I feel. For mild or not so bad lows I usually take anywhere from 2 to 12g and I usually wait 15 minutes to test to see if I'm coming up.

It all depends on my activity and how much insulin may be kicking in like basal etc. I have a Dex- sometimes it is accurate but at other times it has told me I'm dropping and I'm not. I can often feel if I'm going to drop even at 120 or so and I will treat with a little carbs and some nuts.

The rate of the drop is really important in figuring out how much to take also. Sometimes if I can see I'm coming back up even 5 points I know not to take any more glucose. While at other times you can just feel you're dropping fast.

Usually 15 minutes to half an hour is the point where I will come back up to normal or out of hypo territory for mild lows.

Overall I think it is usually better to take something that has pure glucose in it or candy/juice. I like smarties because you can only take one or two if you don't think you need more than that. I did once treat a low with a snickers bar after taking juice and or glucose tabs and it worked with only a moderate spike I think. But fat can slow down your rise.

I use time since my last meal and the amount of active insulin yet to work (insulin on board). I also use the slope of the low as indicated on my CGM. If the slope is fairly steep and I have a more than 1 or 2 units IOB, then I treat with 3-4 glucose tabs.

If the approach to the low is shallow and I have little to no IOB then I might only use 1 glucose tab.

And then there are those once-in-a-while tenacious lows that don't respond until you overdo it with the glucose and food. I'll often bolus after these lows when I think I've over-treated the low. But I try to be conservative. The real goal here is to stop the roller-coaster before it gets started. Or at least minimize the follow-on high and then land back in the normal range.

It's maddening. We all hate to over-treat a low but we also know that lows can cause serious harm, even death. When in doubt it's probably best to over-treat and live to fight another day! As a person who lives alone, I have to take that into account as well. I have no back up.

Thank you all so much! My lows have subsided & oddly I'm back up on my basal rates to higher than before because I started having a lot of highs. I've been using a cgm for less than three months and Tuesday I had a doctor visit my A1C is down from 8.8 to 7. I'm not sure what happened for that odd week but things are good now.

I can never successfully treat lows with food. It always ends in the roller-coaster ride you describe. Rather, I use fast-acting glucose tablets and liquid. 4g raise me 16 points. 1ml raises me 1 pont - a bottle is 60ml, so I know if I drink the whole thing I'll be up 60 points in about 10-15min.



Christopher my problem with the glucose tabs is they don't keep my blood sugar up. I'll grab some of the liquid I haven't tried it. Such a difficult balance to get the blood sugar up but not too far. Thanks again everyone for the replies and help.

I treat my lows similarly, Terry.

My standard treatment is 3 glucose tabs, or 12g. But, I take into account what else is going on - am I exercising or engaged in some other activity, am I sick, etc, etc.

If my CGM is telling me that I am dropping at a single or even double down arrow, I may take more than 3 tablets. Recently, I had an experience where the CGM had double down arrows, 45 minutes after a meal and a reading of 135mg/dl. I tested and received a 99 mg/dl, so I did a 0% tempy basal for 1 hour, ate 4 glucose tabs and softly landed at 72 when the tempy basal rate ended. My CGM during this time dropped as low as 41 even when my meter was reading 30 points higher. It just takes the interstitial fluid a longer time to recover from a low.

PS - I have had some serious lows that take way more to recover from, too!

Hi Alisha - This might suggest that you are over-bolusing and/or your basal dose is too high. If you have no residual bolus and your basal is set correctly, supplementary glucose should raise you and keep you relatively steady, provided, of course you are not engaged in physical activity. I find that if I inject a bolus of 5 units or above, the tail can be quite long and it will require several glucose corrections if the dose was more than I needed to cover my meal.

Lows are a real pain for a bunch of reasons. We can all relate that it is about the creepiest feeling ever, and it seems like it takes forever to come out of it. Then there's the whole rollercoaster effect afterwards, and it can take a while to stabilize. If you're only around 60, try eating only about 10g of carbs. Make sure it's not chocolate or anything fatty, which will just prolong the absorption of sugar into your system. Skittles (10 of them), 3 hard candies, or 1 cup of juice are all good choices. That should in theory raise your BG up about 35 points into the 90's, but everyone is different. If you're lower than that like in the 40's, take a full 15g. Set a timer for 15 minutes, because it will seem like an hour. It's tempting to "overtreat", but this will just feed the rollercoaster effect. Then test again after the 15 minutes, and eat another 10g if you are still low. For mild lows I find 15g to be too much, especially if I take another 15g a few minutes later. But for lower lows it works well. I just had this the other night and the rollercoaster is frustrating, but sometimes that is an effect of your liver naturally kicking in some stored glucose, so that's why it can spike up afterwards.

Thanks all for the tips and tricks. I just a small low and I had some pez I just bought because I collect the dispensers. I ate one roll of them and it worked good. The package says 1 roll of the candies is 9 grams of carbs. Of course it's hard to stop at one roll when they usually have 3 in the whole package. You can buy just a pack of the candies alone usually anywhere near the dispensers. I've been eating fruit gummy snacks but I find they are too much unless I only eat half the package.

I bet that the sugar in 1 fruit snack = the sugar in 2 packs of Pez. But, Pez are MUCH more delicious. mmmm...pez.

I know they're so good but I have to share with my french bulldog because he loves them too. Not too many for me or him I go high & he pukes pink all over the place.

I make a mix of Smarties (dextrose, yummy) and Starburst jelly beans, with the green ones taken out (w00t, Van Halenbetes!). It's a "chore" to make so I'm not tempted to munch on them but they are pretty delicious and sort of radiate catharsis when I'm like "woah, I'd better eat something". I get little bags at the craft store and schlep them around. Usually, I can nudge many lows with < 15 carbs and take my chances. If I'm home, I'll set the kitchen timer for 20 minutes and find something to do until it goes off and see how I reacted.

I usually take a glucose tablet (usually 1 or 2 but sometimes 3 ) and wait 15 minutes, and I'll repeat as necessary. If I'm really low though I might go for the liquid glucose shot I have instead. Once I'm up to where I want to be, I either eat my meal as planned (I tend to go low before meals...) with insulin or have a small snack like an atkin's bar. .

I should add that Halloween is the time of year to find "fun size" Skittles packets. Perfect 14g of carb and I keep them all over. They never melt, and all the chewing gives you a sublingual head start!