Treating rebound highs

So as I sit here and ponder how high I am going to end up after (over?)correcting a low, I wonder, how long do others wait after a low before correcting a rebound high to avoid setting off the roller coaster for the rest of the day? I just had a low that left me feeling out of it while waiting for it to come back up, and at 20 minutes, hadn't moved any (second reading was about 4 points below the first). I treated again and began to come up, but I'm sure I over shot my correction.

I just recently (well a few months ago, really) got a CGM. One thing that I am learning about low blood sugar, now that I have the cgm, is that I have been eating way too many carbs to treat my lows. If I get to be lower than 70 mg/dL, I need to only eat 5 to 10 grams of carbs TOPS. It can take a while to kick in, but if I just wait it out instead of eating more carbs, the resulting spike is much less severe. Sometimes, if I do need to treat my low a second time, I will take enough insulin to cover the second dose of carbs so that by the time the carbs take effect, the insulin has kicked in, too, and will prevent that post low spike. Another trick you can try is ingesting some type of good fat (I like nuts or nut butter) with your carbs that you use to treat your low. It takes longer to bring you back up to within range, but a slow and steady rise in blood sugar helps to prevent the spike and crash.

Best of luck!

As Alex said, over-treating a low is one reason for the rebound high. Another reason is if a low goes on longer than about 20 minutes then liver and counter-regulatory hormones can create a high resistant to adding insulin.

I know it's tough to resist over-treating a low, especially if you're very low and your system feels a basic threat to its survival. That sensation may cause us to "empty the refrigerator" in a cognitive impaired eating frenzy.

I often treat with one, sometimes two glucose tablets. I'll even bite a glucose tab in half for some shallow trending (on CGM) lows.

If I find that I eat 20 grams of carbs and soon realize that I ate say, 12 too many, then I'll immediately dose for the 12 grams of carbs, An intra-muscular injection would work well in this situation because you want the insulin to work faster than usual.

It's tricky business and your main goal is to eliminate boarding the glucose roller-coaster.

I am a horrible over-treater, especially if i wake up with a terrifying low at night. I don't even try to stay moderate, because I know I just can't.
I usually just try to know how much i eat, and then, when my BG is in range again, i estimate how much I would have needed and bolus for all of the extra stuff. I bolus right away and then go to bed again. and thank diabetes for the awesome sleep he has granted me again… yay

One thing that I learned from tudiabetes, is to learn exactly how much 1 gram of carb raises your bg, and use that to calculate how much carb you need to correct your bg back to your target level.

You can do this experimentally, by eating , for example, a 4g glucose tablet when your BG is stable and at target. See how high that raises you.

A starting point can be arrived at by using your I/C and ISF ratios. For example,
if 1 unit of insulin lowers your BG 50mg/dl, and 1 unit of insulin covers 10g of carbs,
divide 50 by 10, and you will get an estimate that 1 gram of carb should raise your BG by 5mg/dl.

It is just a starting point, you will have to test it.

Then, let's say you are at 60 and want to raise it to 90 mg/dl. You can start with
a correction of 30/5 = 6 grams of carb (or 1.5 glucose tabs) This will prevent you from overshooting too much.

Of course if you have a lot of insulin on board , this wont be enough to cover that.
You will have to adjust as needed.... But the key is not to take 50 grams of carb to correct a minor low.

At night it may be too much thinking to work this out.... :-)

I get panicky so that is part of my problem, but I also feel like I could eat anything that isn't nailed down when I am low. I'll have to try correcting for the extra when I'm on the way up. As simple as it sounds, I've never thought of it.

I'm still working on nailing down exactly what a gram of carb will raise me, as well as recalculating my I:C. Its been a long time since I really had all of that down to a pseudoscience.

It depends on the low, whether it was a resistant, bad low and so on. For mild lows when I'm not too active I can often treat with 1-2 glucose tabs or the equivalent, juice/glucose drinks for worse lows and often eat some protein/fat after I start coming up. I sometimes add a bolus when I see a rise, other times I wait till I'm out of my range to make sure it isn't one of those sneaky lows that comes back to bite me later on after I think I'm totally out of the woods. With the pump I can do smaller corrections and temp rates to do more mild corrections for rebound highs to try to stop them before they take hold. I don't care that much about rebound highs if I'm dropping fast/bad low, I don't like them but I know I can always correct them with more insulin/exercise eventually.

What I'm stuck on with correcting them is that I tend to spike to 200 or so, and hang there for a while, but without treating it, it usually sings on its own. I just don't like sitting so long with it high.

I'm with you, swiss!

Although I don't regularly over-treat, I sometimes do get the lows that won't respond to my initial attempts to treat. I also get those lows where I am just ravenous, too. For those times, I cautiously bolus for the extra, initially using a SWAG I:C. I have also had some success with using a square wave bolus over an hour.

Do you mean it comes down on it's own? Mine often don't so if I'm that high I will definitely do something. I guess it depends on the situation, how much insulin is on board etc. but I don't want to create another low if that started out as a low, it is hard to decide what to do, but I agree, definitely don't like sitting there for long and I usually feel awful at those levels depending on how quickly I went up. My bg doesn't usually respond the same way, so measuring things out etc. is pretty much useless for me except as a general idea for a plan, then I have to observe and do the wait and see.