Twenty minutes or more until eating glucose is showing effect?

Type 1 and LADA
#1

Hey all,

today I went through the unpleasant experience of a significant low – and it took a long time to get back to a safe BS, which really scared me:

I had lunch and bolused accordingly, but spontaneously decided on a walk in the forest two hours after injecting. I measured before i got out of the car, was on 115 mg/dl, so with having my leftover insulin in mind, I had a chocolate bar (12g of carbs) before starting to walk. Ten minutes into the walk, I measured, just to be sure, not because I felt hypo. (Which concerns me in itself – why didnt I feel the drop at all?? Could I be hypo unaware although I am very well controlled and always have been??)
Anyway, I measured and read 62 mg/dl. I panicked a bit, since I was in the middle of the forest, Took action straight away, with 2 tabs of glucose and a another chocolate bar. Sat down, waited for 10 minutes, measured and was still 61mg/dl.
Got more nervous, ate two more glucose tabs, waited another ten minutes, measured again, was still 68mg/dl. Nervously waited again for 5 minutes, measured and STILL in the 60s. So I ate ANOTHER glucose tab. It took nearly half an hour to get to 78mg/dl, when I finally felt safe enough to walk the ten minutes back to the car. Needless to say, when back at home 30 mins later, I measured a freakishly high number: 289 mg/dl...

Three years into this annoying illness, I still cant treat my lows accordingly.

Because I was out in nature and still had bolus on board, I wanted to be extra cautious, so I knew I was overtreating.
But my question is, could I have safely treated with quite a smaller amount of glucose, or would I have put myself in danger that way? And if my glucose takes 20-30 mins to show effect, would it have been dangerous to keep walking back to the car after taking my glucose, instead of sitting down and waiting until I saw a rise. (It was very cold and I was scared, but didn't dare to walk even a metre while still being on 62mg/dl. I seem to be super sensitive to my insulin as soon as I am physically active – even just a ten minute walk can drop me 150 - 200 points easy.

I would appreciate any tips and advice to avoiding these scary rollercoasters as well as these delayed effects on treating.

Wishing everybody a nice week and more successful sunday walks than mine.

#2

Hi Julez,

It can take up to 30 minutes for glucose tabs to begin to do their magic for me. I don't even test at 15 minutes most of the time. Chocolate takes a much longer time to bring up blood sugar and I tend not to use it with a serious low because I figure the fat will actually slow down the absorption of the glucose tabs.

The 12g of carbs from the first chocolate bar probably weren't reflected in the 78 so you had 5 glucose tabs and 2 chocolate bars (44g of carb)working on that original low. Doing the math, it's not hard to see that you were going to end up high after everything hit. That's easy to say in hindsight - but when I fight a very stubborn low, I just surrender to the fact that I may end up high.

Being in the middle of the forest rather than sitting in a cafe would change my tactics. I would try to get my blood sugar up quickly and efficiently and probably would have taken 4 glucose tabs (and no additional chocolate) right away. If I was feeling OK, I might have also started walking back once my blood sugar changed direction rather than waited until I was around 80.

You probably would have ended up high anyway although you might have topped out at "only" 200. I don't think we can totally avoid these roller coasters. Life gets in the way of diabetes management sometimes.

I'm glad you're OK.

Maurie

#3

I will typically see rise within 15 min. of 12g, but this is just prob normal for you. Or, you were on the way down from the start.

You sound a little exercise sensitive. I will get 100 points drops,from x-country skiing, that start from 10 to 20 min in, sometimes, but not from walking. I could walk for 12 hours straight and not see a decrease in BG. I try not to go out skiing, deep in the woods, by myself, for that reason. I go somewhere with a bunch of other people around, early in the season, if I'm by myself.

#4

hi julez. i think we were diagnosed at more or less the same time. i would tend to agree with maurie about just eating straight sugar with no fat in it.

i dont usually have lows that are hard to bring up but i do have that same problem with being very sensitive to exercise when there is IOB. to avoid the rollercoaster of low then high, i just try not to use bolus insulin and eat very low carb if i know im doing exercise. for example, i go to a running techniques class that lasts an hour and a half two mornings a week. i only have carbs in the form of milk in my coffee (about 9ch) before i go. solid food is an omelette of2 eggs and spinach/broccoli/cheese/whatever other veg i have in the fridge. before cycling 7km to work, i have a salad, so just loads of veg, with boiled egg or chicken or tuna or smoked salmon and some avocado. that way i dont have to bolus, just have the basal in me. halfway thru the hour and a half class is when we finish strength training and go into the park to run, so i test just before running and then when i get home again. i test as soon as i get to work, about 7 km away.
this is for some not the best, freest way to do things but it works for me because its much harder to anticipate what will happen with bolus. my insulin needs keep changing and i would rather be safe than sorry on the road on a bike with these crazy drivers in my city or embarrassing myself in a running class.

#5

Hi Julez,

I agree- I would eat glucose tabs/drinks/gels(very light weight) till you come back up, the fat will slow it down if you mix them, although I once ate a snickers bar to treat a bad low and it worked, lol. Then once you're stable, if you want to continue on your walk maybe have a snack too if you think you need it. I hate those lows that don't respond, good thing you were able to get back up and get back to your car ok. I would always carry a working/charged cell phone too in case you need help. Hope this helps!

#6

It is just over six years since I was diagnosed as Type 1 and under certain conditions I am very susceptible to Hypos when I have insulin on board. It took me some time to work out that after I had been working physically hard for several days and had run down my Glycogen reserves, that with any bolus insulin on board, I would Hypo when I was at the gym. I would have to test every 10 minutes to make sure BGL were not falling fast. At times I could not eat enough carbs to prevent BGL from falling and ended up with BGL in excess of 300 about one hour after I had left the gym. I had the most trouble when my bolus insulin was peeking, eg; 2 to 3 hours after injecting.
After a few days of book work and very little physical exercise, then a visit to the gym, I would see my BGL rise above 300 while I was exercising. After a lot of data collection, I worked out a strategy that kept BGL between 80 and 145 and prevented the spike in BGL after I left the gym.
I have had only one Hypo that I would classify as stubborn and frightening. I had made a bolus correction for additional carbs that were in a meal and was involved in physical activity as the boluses were peeking. The first reading of 35, I thought I would treat with yoghourt and fruit salad (80g carbs) because BGL had been very stable at about 100 for the last 3 hours. The next reading, 10 minutes later, showed a reading slightly south of 30 and then I panicked. I had a further 50g of carbs in the form of Glucojels and Dextrose. I took readings every 5 minutes and it was 20 minutes later that BGL started to rise slowly and I stopped the carbs. For over 40 minutes I was below 50. The next morning, 5 hours later, my reading was slightly above 370. It was not until I checked the times of my boluses that I realized what went wrong. My Hypo awareness is above 50 but under certain circumstances my judgment can be compromised and I can (very rarely) see reading as low as 35.
I now treat all Hypos that fall to 50 with Dextrose or Glucojels. For me it takes 5 to 6 grams (one teaspoon) of Dextrose to see BGL start to rise after 5 to 7 minutes. If I do not see a rise after 10 minutes another 5g is taken. It is very hard not to over compensate and I also take into consideration the time of my last bolus and when my next meal is going to be.
I agree with Maurie but every one is different. It is good practice to treat all “self treatable” BAD Hypos with Glucose and make sure that it is Glucose and not some other sugar.
It takes time and data collection to work things out but it gets easier with experience. It is good to share your stories and realize you are not the only one having difficulties with Diabetes.