What do you do?
For example, today, right before I tucked into my Arby’s chicken salad wrap, I noticed I felt low, tested and got a 61. Got me wondering, is it better to go ahead and take the glucose tabs or eat the meal and hope that the carbs kick in quickly? (Today, I just ate the meal because I didn’t want to ruin my favorite sandwich with glucose tabs). What do you do?
I was always told to get some rapid acting glucose first. Especially knowing my own system, the food isnt going to take care of the low. Especially if it has fats in it.
Ice cream doesnt work either…has to be something that dissolves and hits quickly or juice. Hubby has a habit of suggesting ice cream…
Hi Julie -
I will usually curse and then pop a glucose tab or two. If I start on the low side (even in the 70s) I will probably go low at 2 hours even if I back correct. Last night before dinner, I was at 52. I took 2 glucose tabs and then ate my main course, retested (109) and then bolused for the entire meal without a correction. An hour and a half later I was back down to 81 and then rose to 130 over the next 2 hours and 30 minutes.
Maurie
I don’t get low that often, but when I do I have small piece of fruit or a small sandwich. Luckily It has not happened on a long ride, because I usually don’t carry glucose tabs.
I do it differently, I don’t like taking extra corrections.If I’m at 61 I will go ahead and eat and then monitor my blood sugar, when it starts to rise, I go ahead and bolus. I never go lower and begin to rise just fine when I do that.If I’m lower, like in the low 50s or even 40s, then I will do two glucose tabs and eat after.
Oh, and I don’t bolus less if I’m low. I used to do that because it made sense, but then I’d end up high so now I bolus the regular amount, I just do it either right before I eat or after I start eating, rather than the 20 minutes ahead I normally bolus.
Julie,
What I do, is to treat first - glucose tab(s), or an ouce or two of my emergency real Pepsi. Then eat the meal, and do 2/3 of what my insulin dose would have been. That endork (before we parted company) a few years ago, told me to treat that way. I will give him credit for that. It works for me.
If I’m not mistaken, nursing moms will have more chances of going hypo, so be careful there.
Trisha
If I’m not symptomatic, I just eat and bolus slightly less or eat slightly more. I think you will probably have slightly more consistent/better results by doing it the long way, but this is one of those things where I don’t think it’s going to make a huge difference over the long run and I’m personally OK taking a shortcut.
We took shortcut today too, but don’t do it often. Son was 69 when I was on my way home for picking up food. He was all ready to pre-bolus because he had the carb count already. When he called me, we decided he would take one tab and recheck in only 5 minutes, believing he would be up at least up by one to be able to enter carbs into his pump. We have been trying not to over correct and like Zoe, don’t give less insulin because low (or at least give a little more insulin than the pump suggests), before it had always came back with high. Today he had a steady arrow (with very gradual descend trend) on his CGM, yesterday he can faster drop, that took 2 corrections of 3 tabs each to fix the low. Each situation can be different, for the later, the 15/15 rule still applies.
Have the glucose first and then eat a meal with slow acting carbs. Once your blood sugars start to drop that low, they will continue to drop however much carbs you get from the sandwich or other meal! I have often had a dessert before the main meal! I remember getting a severely bad low while out in my home country and got some weird looks from the waitress at a restaurant when I ordered something sweet BEFORE having a main course of potatoes and mushrooms and salad! She understood when I explained!
"Once your blood sugars start to drop that low, they will continue to drop however much carbs you get from the sandwich or other meal!"
What basis do you have to make this assertion without knowing the amount of insulin the OP has on board or when her last bolus was? Seems unbelievably bizarre to assert that glucose tabs would raise the BG but a sandwich would not. My experience has been that, unless you have an unusual amount of insulin on board or totally miscalculated, many mild hypos involve hitting 60-65 and then staying around there unless and until you eat something. The fact that the risk most posters here cite is of going too high, rather than going to low, indicates that the last thing the OP really has to worry about is an immediate crashing low (although a low 2 hours+ out might be plausible).
My pump trainer told me to treat the low. But I say that it depends what kind of hypo it is. If it’s just a “it’s time for dinner and maybe my basal is a smidge high (or I did yardwork today)” low, just eat the sandwich, pump trainer be damned. If it’s a “I got lots of insulin on board and will keep plummeting” low, eat the tabs.
I have a pretty effective carb counting system going on for me currently, so in that sort of situation, unless the meal is high in fat, I usually just start eating, delay my shot a little bit, and bolus for slightly less in order to prevent the low from reoccuring after the meal.
Had you already bolused? When I am low before a meal I go ahead and eat and bolus right after.
I don’t think there is a one-size-fits-all answer to this. It depends on your own diabetes mileage.
For me, 61 is not a hypo but a slightly low blood sugar. I also know that I do not have unexplained lows. So If I know I have no insulin on board, I don’t do anything about a 61. I can even wake up in the 50s and know I don’t have to correct because my morning cup of tea (splash of milk, no sugar) will take me up to the 70s. I don’t even carry glucose tabs because my off-book hypo treatments work fine for me. (At the moment these off-book treatments include cherries, strawberries, blueberries and peanut M&Ms.)
@ 61, I’d probalbly eat. A bit of the food and then bolus, if it’s a pretty stable 61 it will probably tun out ok? If there’s some sort of pre-bolus cb floating around, I’d have some candy.
For me it would almost never turn out ok because I eat so much fat and fiber that the first rush of insulin would outrun the carbs. I think each of ours answers to this question has more to do with our ususal post meal blood sugar profile rather than how stable the original 61 is.
I write this at 58 - 1:40 post bolus on a meal that I started at 73, took a glucose tab and then waited until I ate half my carbs and half my meal before taking my bolus. GRRR
Maurie
I tend to correct via a sugary ‘treat’ first and at least start to eat my brekkie/lunch/dinner prior to giving myself a shot. Retest to ensure the ‘treat’ is doing its thing and raising my blood sugar and then take my insulin minus a few units. My test two or so hours after eating will tell me if my adjusted insulin dose was correct.
I know the textbooks will tell you to treat the hypo wait 15 then bolus and eat, but sometimes this is impracticle. Like when Arbys arrives in front of you. I do not have the self control to wait the rest of the 15 minutes for correction while all my friends/family is happily eating and my food is getting cold.
This system works reasonably well for me. At 61 I would treat the hypo with 10 grams of carbs. I expect each carb to raise my BG 3 to 3.5 mg/dl, thus I expect to rise to 91-96 after correction is done. I would then bolus (Carb ratio and correction factor) and I would aim my correction factor a little lower, maybe 85-90 (I will manually decrease/increase bolus as needed on my pump).
Of course this system will work better with the longer amount of time you have between hypo treatment and eating meal. The other issue is when to bolus: pre-meal or during meal.
…I punch 61 into my pump and let the pump calculate a dose for the meal based on 61. I probably won’t wait the 20 minutes before eating though.
Generally, I’d say correct a hypo before dosing for a meal, but, personally, I’ve never had a problem with dropping too low by dosing for a meal while in the 60s.
Sometimes I am low right before breakfast. If it is super low, I will have a couple of glucose tabs. But if its in the 60 I will take my shot and eat and go along like a regular day.