Rebound effect

when i go really low 30s - 50s, and i treat with either a glass of OJ or glucose tabs,and i wait about 15-20 minutes, my BS come up to a nice normal range. but when i test again in a few hours, OMG, my BS have sky rocketed.

is there a way to avoid this "bounce-back"?

How big of a glass and what kind of orange juice? Some kind of OJ run 20-30G of carbs/ "serving" I think. We saved a bunch of little "sippie cups" from IKEA from when our daughter was young. They're like 4 oz but OJ will crank it up, at least for me.

I generally avoid OJ.

Oj with lots of pulp from Trader Joes is my favorite (except the real stuff, fresh and just squeezed).i have an old (antique) CokaCola glass that i use. it is quite narrow at the bottom, so i know exactly the amount i need. other glasses, not so.

I often drink OJ when low. I keep an 8 oz cup near my refrigerator and meter. If I test low I can pour 6 oz OJ (which = 15 carbs) and is about a half inch from the top of the cup. Or if I am really low I can pour 8 oz (which = 20 carbs). OJ kicks my BG up really fast and does not effect my BG for a long time.

I would suggest that if want to continue to treat with OJ that you measure out 6 and/or 8 ounces in a small cup so that if have an idea of how many carbs you will take. You could even draw a line on the cup if necessary as it may help others if you need help pouring it.

To avoid those rebound numbers, the first place to start is avoiding lows of that severity. Once you do get that low, a glycogen dump is very likely.

MIKE< what is a glycogen dump?

When you get low your body gets stressed out or hasn't eaten for a while hormones, particularly glycogen, stored in your liver are released producing a "home grown" rise in BG. In my experiences, these are hard to "tap" reliably and I usually find post-low runups generally more attributable to too many carbs. Unless I have a ton of insulin "on board,", I will usually try 5-10G of carbs and see how it goes. This AM I was at 54 or something like that so I got the water for MrsAcidRock's coffee going, had 4 jellybeans, put the milk in her cup, drank the rest of the skim milk in the bottle (4-6 oz maybe?) and then puttered for 1/2 hour or so and then tested and seemed pretty decent at 104 or something like that. Probably not more than 10G of carbs and I like to try to wait longer too. It seems like at 15 minutes, the rocket is still going up and that waiting longer gets closer to a final number.

The glycogen dump is more a myth than a reality. Usually our lows are caused by too much insulin. Insulin is a signaling hormon for the liver that carbs have been digested - otherwise there would be no reason for high levels of insulin. Thus if insulin is present the liver will not dump glucose.

Some individuals might show counter regulations. But to me they belong to the subgroup of individuals with a release-happy liver. For them the liver will release with little stress or waking up etc. This makes them more the exception than the rule. For all others it can be said that counter regulation in insulin dependend diabetics is broken by design. The insulin level will need to be exceptionally low for the liver to counter regulate. Even the small amounts of basal we all use will render the mechanism useless to fight insulin induced lows.

I treat lows with glucose tabs only. The slower digested juice has lots of fructose that is digested over a longer period of time. After more than 20 years I know exactly how many tabs are needed to get up to my target. For reliability I use only one brand of tabs that I know very well. Thus I see a rebound very rarely.

That sounds very logical Holger. I rarely have a rebound EXCEPT when I consume too many carbs to correct for a low. Similar to you, I try to only treat my lows with glucose tabs, as they are the most reliable and fastest way to get glucose into the bloodstream.

thx Holger. after my 25 yrs of D1 i too know how many tabs i need to treat certain low BSs. and, like you, i only use one brand( my personal favorite is Duane Reed brand. i like the tropical flavors best, but i'll take what i can get. i buy the lg container and refill the small tube to carry around with me.

The trick is to know how many points you are low and calaculate how many grams of glucose you need and eat only that much.

If you are at 60, and you want to go to 80, that's a difference of 20 mg/dl. If you know that each gram of carb raises your BG 5 points, then eating exactly 1 4 gram tablet should get you there. If you are at 50 and want to go to 100, then 50/5 = 10 grams so eat 2 and 1/2 tablets (they have a line on them to split them, usually).

The exception is when you have LOTS of insulin on board because you massively overdosed insulin or underestimated what you ate. Then this sort of calculation won't work as you need to offset all the insulin that is still active.

A quick way to estimate how much 1 gram of carb wil raise your BG is to divide
your ISF by your I:C ratio.

Let's say your ISF is 50. 1u of insulin lowers your BG by 50 mg/dl.
Let's say your I:C ratio is 1:10 1U of insulin covers 10grams of carb.

50mg/dl / 10 g = 5 mg/dl per gram. Each gram of carb will raise your bg 5 points.

So a single 4 g tablet will raise you 20 points.

This estimate should be tested of course , by seeing what happens when you eat one tablet when your BG is at a known value and stable.

This is basically my suggestion too, and what I try to do when I got low. Using your carb ratio and your ISF you should be able to determine how many carbs you will need to eat to bring you into your target range. I like this rule better than the standard "15-15" rule that a lot of doctors tell you to do (eat 15 grams of carbs, wait 15 minutes and test and if you haven't come up, eat 15 more and repeat, etc.) I find that if I follow the 15-15 rule, I end up with highs. Once I treat a low, my blood sugars don't tend to raise for about 20-25 minutes, so I need to wait it out. That's just me, though, and you should do what works best for YOUR diabetes.