# Handling a hypo - anything that could be done differently?



## LynnAllan (Sep 30, 2012)

Hi,

It's a few hours after the fact, but when you are in the situation, it feels like you can't do anything else but deal with it.

Anyway, my daughter went out with her father yesterday and, as part of their day together, he gets to spend money on her.  He bought her diabetic sweets.  She scoffed a whole lot of them.  She already felt a bit dicey and the result of taking the sweets was in sore tummies, and a lot of running to the toilet .

She started getting stroppy and my husband got her blood checked.  It was 3.8.  She felt really rough and our response - over the next half hour or so she had 
1 tube of glucogel  :yeuch:
2 biscuits
1 bottle Dr Pepper (full sugar)
1 cupcake
(we didn't have any glucotabs at the time  )

Anyway, the result was that after another half an hour or so her body started feeling better.  It took a bit longer for her head to feel that way.

She said that she still felt a bit rubbish and was still going to the loo .

We phoned the kids unit who said that we should monitor her constantly through the night, as her blood levels could drop.

She requested supper on top of that lot, which was 2 pieces of toast and a glass of milk.  We gave her the usual 12 levemir to cover the supper.

The upshot was raised blood sugars through the night, with my champion husband heroically doing the checking.  At 3am it was 19 and we agreed that she would be unlikely to have a hypo an went to sleep.

At 8am her blood sugar was 16.4.  It's at least 6.4mml too high so I'm wondering what we could have done differently?


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## Pumper_Sue (Sep 30, 2012)

Hiya,
     sounds as if it was a fun day out 
Hypos need to be treated with caution over treatment as you now know causes the back lash of the highs.

So 15 carbs and a recheck after 15 mins if still low then treat again. Only use quick carbs though.

As you now know Diabetic!! or sugar free sweets tend to give you (daughter) the runs for your money  You also need to count at least half the carb value on the pkt as carbs to be counted for insulin dosage.



> She requested supper on top of that lot, which was 2 pieces of toast and a glass of milk. We gave her the usual 12 levemir to cover the supper.


Levemir is a basal only and is not meant to be used to cover that amount of carbs. Her bolus insulin should be used for this.
If she is dropping low on her levemir without supper then she is on far to much insulin.


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## LynnAllan (Sep 30, 2012)

still getting our head around it.  I'm speaking to dietician on Monday about the levemir as it's not covering her supper.  What a learning curve.  We thought it did but obviously not.

Anyway, my daughter has learned her lesson on the diabetic sweets but I think we overdid the correctives .  We need to get more glucotabs but also need to make sure she doesn't just eat them cause she likes the taste. Argh


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## Pumper_Sue (Sep 30, 2012)

LynnAllan said:


> still getting our head around it.  I'm speaking to dietician on Monday about the levemir as it's not covering her supper.  What a learning curve.  We thought it did but obviously not.
> 
> Anyway, my daughter has learned her lesson on the diabetic sweets but I think we overdid the correctives .  We need to get more glucotabs but also need to make sure she doesn't just eat them cause she likes the taste. Argh



Hi Lynn,
          I'm confused (it doesn't take a lot). Levemir is not meant to cover supper. It's a background insulin only. Her bolus which she has at meal times covers food/carb intake. So if your daughter want's to eat supper with all those carbs and it's a lot of carbs then she has to inject for it. If she doesn't want the extra injection then she either skips supper or has carb free.

Using the Levemir at a higher dose to cover food is a dangerous game to play..... The simple reason being if she became sick and couldn't hold food down she would be swiming in insulin and a bad hypo could happen, the same if she forgot to eat or just didn't want to eat.


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## LynnAllan (Sep 30, 2012)

I keep being told that levemir doesn't cover supper.  I'm beginning to get it.  However, that's what we've been told by the professionals.  That's why I need to speak to the dietician on Monday to get 'permission' to move to a new method.  I'm still in my first year so it's all learning learning learning


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## Pumper_Sue (Sep 30, 2012)

Lynn,
        there's a couple of books which may help you out.
Think like a pancreas and also using insulin. Both to be found on Amazon 

Sounds as if your so called professionals are letting you down big time.

Look at things on the logical side of things
If levemir was meant to cover food why is your daughter having to inject before meals and not at supper time?

Do an internet search and also read the patient leaflet.
The idea of a basal insulin is to keep the blood sugars stable whilst no food is eaten.
Bolus is to cover food/carbs.


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## LynnAllan (Sep 30, 2012)

Thanks Sue.  However, we do inject the levemir before supper and after testing her blood.  That's one reason why I thought the levemir would have 'handled' it.

I'm seeing dietician tomorrow so hopefully that will get some things started.


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## Tina63 (Sep 30, 2012)

Hi

Re the hypo, what exactly have you been taught?  Did you re-test after she had the carbs?  The rule of 15 is what we were taught.  15g fast acting carbs - mini 150ml can of Coke - small carton of orange juice - 150ml of lucozade or 3 glucotabs or dextrose tablets.  The glucogel we have been told is utterly disgusting so my son has never tried it.  You are then meant to wait 15 minutes, then test again.  Do not give any more carbs in this 15 minute period.  

If after 15 minutes she is still below 4, then you repeat the 15g of fast acting carbs again and wait another 15 minutes and test again.

The next bit there seems to be conflicting views on.  We were then told if he was then over 4, to either give him 15g slower acting carbs (a cereal bar or a slice of toast were examples given) or if a meal was due just eat the meal as normal, though possibly wait and inject for the meal halfway through.  In theory that should avoid all these massive rebound highs.  There is no need to launch into a carb-fest! 

We did put it into practice in the early days and it did seem to work, though he was inclined to want to over-treat as the feeling was quite scary to him.  It's just having confidence to wait those 15 minutes and to make sure you keep checking the blood glucose levels.

And as you have been told, the sugar free sweets are a nightmare.  My son too wanted some sweets for a long journey as he doesn't travel well in the back of car and I found M&S do quite a range of sugar free sweets in all sorts of flavours. I bought two mini boxes - and he paid the consequences later in the day having had a good go at both boxes.  Never again!  If she wanted a limited amount of sweets/chocolate that is fine, but keep them as pudding, and bolus for them accordingly.  Technically she can eat anything, as long as you calculate the bolus insulin to cover it.


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## delb t (Sep 30, 2012)

Hi 
 we have been told pretty much the same as you Tina-15 mins rule- only in addition- if about to eat fine -if not going to eat within an hour - have a couple of rich tea biscuits or equivalent.


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## Tina63 (Sep 30, 2012)

I know some of the more experienced people on here say there is no need to follow up with slower acting carbs - it seems to be one of those things that the advice changes from hospital to hospital.  As my son was diagnosed less than 2 years ago I thought our information must be the most up to date.  Could it also be that the advice given to children is slightly different from that given to adults?


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## Twitchy (Sep 30, 2012)

I think the slow acting carbs advice split might be down to a multiple injections vs pump thing? When i did Dafne I was on multiple daily injections (mdi) & was told if it was x hours or more until the next meal (2 i think??) to followup with slow acting carb, as the background insulin could still be dragging your levels down. On the pump, there's only quick acting insulin involved, so there's no need to follow up on the quick acting carbs. I suspect this is one of the reasons weight comtrol is easier on pumps, but that's another issue...

Don't beat yourself up over this - hypos are horrible & I can vouch that it takes extremen self discipline not to go into 'hypo hamster munchie' mode! The 15 min rule is a good one to start with, re the follow up carbs i guess that depends on how active your daughter's been recently & if you can figure it out, the reason for the hypo (ie duplicated insulin jab = licence to munch, just dipping low because of slight carb count mistake potentially less need for top up after correcting the initial hypo...). You'll get more of a feel as time goes by.

Take care, 

Twitchy xx


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## bev (Sep 30, 2012)

LynnAllan said:


> I keep being told that levemir doesn't cover supper.  I'm beginning to get it.  However, that's what we've been told by the professionals.  That's why I need to speak to the dietician on Monday to get 'permission' to move to a new method.  I'm still in my first year so it's all learning learning learning



Hi LynnAllan,

Hypo's - have a small can of coke - it works very fast - check again in 15 minutes - if not bringing levels up have another and so on. Fast acting glucose is much better than eating foods that have fats in them as it takes too long to enter the system - so always stick to fast acting drinks - they are quicker than glucotabs.

As far as not understanding the difference between levemir and novorapid - I am a bit surprised that your team havent explained things. This is really basic information and that you are still confused is a worry (not being critical of you at all - just of your team).

Levemir is background insulin and does NOT cover food at all. Novorapid covers all food as long as you have the ratio correct. When your daughter is high like she was - do you give correction dose's of insulin to bring the levels down? Bev


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## LynnAllan (Sep 30, 2012)

I'm doing the team down, and that's not right.  It's a good team.  It's me that's probably not got things straight.  I can make excuses - I have CFS, and a few other things.  I need to get my head around things.

I guess that's why I started these forums.  So I could get things right, and stop overreacting


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## Pumper_Sue (Sep 30, 2012)

LynnAllan said:


> I'm doing the team down, and that's not right.  It's a good team.  It's me that's probably not got things straight.  I can make excuses - I have CFS, and a few other things.  I need to get my head around things.
> 
> I guess that's why I started these forums.  So I could get things right, and stop overreacting



Hi Lynn,
          just a tip for you. When dealing with the team etc, tell them up front you have CFS/ME and your brain is a tad foggy. This way you will get help as well.
Ask if you can record things so it helps you with your memory problems. Also take notes so you don't forget things five mins later.
Have yourself a folder with coloured sleeves so you can store info in there.
Things like what a basal insulin does. Carb ratios etc.
If pos make sure you have a rest before the apts so you are not to tired to think straight.


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## trophywench (Sep 30, 2012)

You have also to take into account that some of us are pumpers Tina, where we probably only need the quick acting carb and not any longer acting ones, owing to the fact there isn't much insulin kicking round at all, whereas on MDI there always is.

(The insulin doesn't know it's Lantus and it isn't sposed to deal with carbs LOL)


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## LynnAllan (Oct 1, 2012)

Pumper_Sue said:


> Hi Lynn,
> just a tip for you. When dealing with the team etc, tell them up front you have CFS/ME and your brain is a tad foggy. This way you will get help as well.
> Ask if you can record things so it helps you with your memory problems. Also take notes so you don't forget things five mins later.
> Have yourself a folder with coloured sleeves so you can store info in there.
> ...



I feel like I do say this to them.  And it should be obvious as I turn up looking like I haven't slept.  That and working part time .  Honestly this is some stuffed up year.  It's probably no wonder I can't get my head around stuff.


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## novorapidboi26 (Oct 1, 2012)

Your doing the best you can and things can only get better........

We are all here to help....


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## Robster65 (Oct 1, 2012)

Hi Lynn.

Not sure if I'm stating things you already know, but as a rough guide...

Lantus or Levemir are basal insulins, given once or twice every 24 hours to provide a low level, slow release which covers the minor fluctuations in blood glucose. They would be needed even if your daughter didn't eat meals.

Novorapid or Humalog (plus some other types) are short acting bolus insulins to cover meals or snacks and to correct high blood sugars. They are given before or just after meals and can be given at any other time to correct high BGs.

Once the levemir has been given, it will last for about 12-24 hours and won't have any effect for about an hour or so. But will work for the next umpteen hours and will overlap with the previous or next dose.

I hope this helps to clarify and doesn't confuse further. 

Rob


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