# Hypo treatments....new ideas pls?



## maria22e

hi all

My son who is 3 has stayed low for 2 days now only seeming to raise in the night. he's not eating so not injecting, but when this first occured his usual hypo treatment of apple juice and 2 biscuits didnt touch the sides...have now been told that apple juice has a low GI so releases slower...aghhhh just found this out. so, been advised orange ( dont think he likes that) or ribena juice. any other ideas..? does anyone use normal jelly beans??
thank you all xx


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## Northerner

Hi, does he like coke or lemonade? Any sugary drink should work as well and quickly, just work out how much contains 15g of carbs (usually 150ml or thereabouts). I use jelly babies myself, but I'm 49 years older than your son so it might not work as quickly for him!


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## Northerner

p.s. what insulin regime is he on? If he's on MDI (basal bolus, long and fast acting) then it could be that his basal is a little high if he's still going hypo when not eating/injecting fast acting. Also, his long acting might not be lasting 24 hours which means he goes higher at night - depending on when you are injecting of course!


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## maria22e

Thank you northener, he has only been diabetic 1 year and i dont fully understand everything you are asking (ok i am blond too!) but i carb count, he has novorapid fast acting and levemir slow acting ( which i reduced last night by one unit) 
i have found lemonade works a treat, but am looking for the most flexible option (for school too) apple juice worked fine until Tuesday.
in ur opinion if he had a tummy bug would this cause this constant low??


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## bev

maria22e said:


> Thank you northener, he has only been diabetic 1 year and i dont fully understand everything you are asking (ok i am blond too!) but i carb count, he has novorapid fast acting and levemir slow acting ( which i reduced last night by one unit)
> i have found lemonade works a treat, but am looking for the most flexible option (for school too) apple juice worked fine until Tuesday.
> in ur opinion if he had a tummy bug would this cause this constant low??



Hi Maria22e,

Welcome to the forum.

A mini can of coke (or lemonade) is the perfect size for a hypo as it contains fifteen carbs which is what is needed for a hypo.

Apple juice is too slow and might mean that the hypo is prolonged. It could be a stomach bug that is causing the low's due to the food not being absorbed. Have you had your son checked for coealiac, this should be done every year. Your son could also be in 'honeymoon' where is he still producing some of his own insulin which could be why he is going low. MDI is 'multiple daily injections' - which is what your son is on and its great that you carb count to match the insulin. Also, hypo's breed hypo's so you can get into a cycle of them - so you are doing the right thing by reducing insulin for a few days.Bev


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## maria22e

thanks you for your reply Bev, it seems to have puzzled my nurses as its gone on for two days now, am starting to suspect tummy bug now. ive dealt witht the high temps and additional injections, but never this and i was so upset last night. wish i could take it away from him! funny thing is he appears absolutley normal within himself and says he doesnt feel low. im knackered tho from hourly night checks. x


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## everydayupsanddowns

Well there's just one more 'your diabetes may vary' to add to the list! I've only ever heard of illness raising BGs rather than lowering them. You learn something new about this silly condition every day!

I'd go along with Northerner... if your son is not eating (and you are therefore not injecting mealtime novorapid doses) the only active insulin should be the Levemir which ought to be just enough to keep his BG levels within 1-2mmol/L of whereever they are balancing the trickle of glucose fed out by his liver. If they are constantly falling by more than 1.7mmol/L it suggests the basal dose is too high.

Hope he feels better (and gets rid of those annoying hypos!) soon.

M


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## Pigeon

I had my first tummy bug with diabetes just before Christmas and I had a lot of trouble with lows. I read that the stomach empties slower when you had a bug, so I suppose that made sense - the food or lucozade just doesn't get through quick enough. Hope he feels better soon.


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## Pumper_Sue

maria22e said:


> hi all
> 
> My son who is 3 has stayed low for 2 days now only seeming to raise in the night. he's not eating so not injecting, but when this first occured his usual hypo treatment of apple juice and 2 biscuits didnt touch the sides...have now been told that apple juice has a low GI so releases slower...aghhhh just found this out. so, been advised orange ( dont think he likes that) or ribena juice. any other ideas..? does anyone use normal jelly beans??
> thank you all xx



Hi Maria,
I would be very warey about giving jelly beans, just in case your little man choked on them.
Would little lad drink the sport lucozade? It's a still drink but full of carbs fruit flavours as well. You could measure a bit out into a cup for him.
As a 3 yr old does he need as many as 15 carbs to treat a hypo? I know as a small child I had 5 carbs and as I got older it went up to 10 carbs then 15 carbs when about 12 or 13 years old.


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## Fandange

Hi Marie,

I have found with my son that electrolite drinks, like lucozade sport help to bring him up more quickly than anything. Also helps rehydrate if he isn't well. It is a stressful time for you, but it won't be forever and there is help available if you need it. 

Take care of yourself x


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## shiv

Sports drinks are lower in carbs though, so more would need to be drunk to have those 15g. 

Sue yes, everyone is advised 15g carbs for a hypo.


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## maria22e

Thank you all , so brilliant to know your not alone and how there are different things to try. thanks again to you all
m
x


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## Pumper_Sue

Another thought for you, would little one like a couple of spoonfulls of Jam?


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## Jennywren

Got some nice Lucozade flavours now that my niece whos diabetic likes too cherry and apple are favs at mo


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## Adrienne

Hi  

The best treatment for a hypo is lucozade (the normal one, never lucozade sport unless swigging it whilst playing lots of sports and you know how to use it for that specifically).     Lucozade though is a distinct taste that lots of children do not like.    The next best thing is full sugar coke.  You can buy the small party cans in the mixers aisles in all supermarkets.  It is quicker than lemonade due to the caffiene but lemonade or Sprite is ok, so long as it is all full sugar.

If your son does not like fizzy drinks then I would suggest very strongly that you start letting him have diet coke to drink so that he gets used to the taste, sometimes its the only way to do it.   

You could try full sugar cartons of ribenna.  

Of the lucozade you only need 100 mls as that is 15 carbs.  You can only buy the bottles, smallest of which is about 330 ml, three hypo treatments and you will have to carry a small cup with measurements on it around with you.   Or one party sized can of full sugar coke or full sugar Sprite are both 150 ml and are both 15 carbs approx and one can is one hypo treatment.

Do not give biscuits or any other long acting carb when you treat a hypo.  Always just the fast acting drink first.   Drinks are better than solids as well, get in the system quicker.    Test again after 15 minutes.  If levels are increased then you can give the long acting then if that is what you do.   The guidance now is that on MDI you do not need the long acting carb and lots of people do find that so you will have to just trial and error that bit.   If you give the coke or whatever and then the biscuits at the same time it will slow down the coke working.

Well done for carb counting, great stuff.

Yes lots of lows can be a tummy bug.   Vomitting and/or diarrhoea generally will be lows and could possibly be showing lows 2 or 3 days beforehand (as you are seeing) even though he seems ok.    Most other illnesses are highs not lows.

I hope that it isn't a tummy bug and maybe just a need for less insulin.

I hope that has helped and good luck with the fizzy drinks.


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## maria22e

thank you adrienne, ribena and lemonade are what we are going to trial now i think, ribena seems to be going down well thou. 
im suspecting tummy bug as stools are still loose, but no vomiting now (i think that was the sugar overload) its been a week now, and im really not thinking he's back on track...back to food diarys and carb counting is none exsiting at the moment, even 0.5 unit seemed too much at lunch and have just sent him to school on 4.1. (with a ribena before hand too!) aggghhhhh. feel dumbstruck by this and feel so bad for him that i dont know whats wrong.
M
x


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## Adrienne

Well if it helps to know, my daughter has been having funny levels and not quite feeling right and I couldn't put my finger on it.  Then the temperatures started and now finally she has a cough and cold and looks awful.  She is now off school, levels are not too bad but we all get this from time to time I'm afraid.   On a pump its a bit easier to control than on injections.   Good luck and I hope he is ok soon.


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## angela spiby

are you checking for ketones if your not giving insulin hun xxwe use mini cans coke ,caprisun ,any full sugar squash x


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## morgansmum

My little boy won't drink anything sweet so when he's staying low it's glucogel, milk or fruit. He had the winter vomiting bug last Easter and couldn't keep anything down for four days so pump was switched off and saline drip with extra glucose attached. Eventually he will start to eat and drink but it can mean hours of him sitting on my lap with a 5ml syringe and me trying to drip water into him. Hope your little one feels better soon.


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## Adrienne

Hi Morgansmum

Sorry to be a bit negative here but need to mention this for anyone new who might be reading.    

Milk or fruit are not good for treating hypos, they are not quick acting carbs at all I'm afraid so will prolong the hypo infact.

How old is Morgan?   Is he still a young one?  Have your tried perservering with sweet stuff.   I introduced my daughter to diet coke aged 2 bit by bit.  She hated it at first and it was only a mouthful at a time but soon got used to it.  

Sorry to disagree but thems the facts unfortunately


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## LouiseB

Find that strange about apple juice being low GI - you sure about that?  I could understand maybe the cloudy juice being a bit slower releasing but we find the little calypos juice shots (10g carbs) the perfect amount, they come in apple or orange and i've never noticed the apple being any slower than the orange......


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## Adrienne

Hiya

Here is a GI chart I found.  It clearly shows apple juice being low GI and orange juice being middle GI so neither a great idea to treat hypos.

*Low-Glycemic Index Foods: 
Less Than 50*Artichoke <15
Asparagus <15
Avocado < 15
Broccoli <15
Cauliflower <15
Celery <15
Cucumber <15
Eggplant <15
Green beans <15
Lettuce, all varieties <15
Low-fat yogurt, artificially sweetened <15
Peanuts <15
Peppers, all varieties <15
Snow peas <15
Spinach <15
Young summer squash <15
Zucchini <15
Tomatoes 15
Cherries 22
Peas, dried 22
Plum 24
Grapefruit 25
Pearled barley 25
Peach 28
Canned peaches, natural juice 30
Dried apricots 31
Soy milk 30
Baby lima beans, frozen 32
Fat-free milk 32
Fettuccine 32
* M&M's Chocolate Candies, Peanut 32
Low-fat yogurt, sugar sweetened 33
Apple 36
Pear 36
Whole wheat spaghetti 37
Tomato soup 38
Carrots, cooked 39
* Mars Snickers Bar 40
Apple juice 41
Spaghetti 41
All-Bran 42
Canned chickpeas 42
Custard 43
Grapes 43
Orange 43
Canned lentil soup 44
Canned pinto beans 45
Macaroni 45
Pineapple juice 46
Banana bread 47
Long-grain rice 47
Parboiled rice 47
Bulgur 48
Canned baked beans 48
Grapefruit juice 48
Green peas 48
Oat bran bread 48
* Chocolate bar, 1.5 oz 49
Old-fashioned oatmeal 49
Cheese tortellini 50
* Low-fat ice cream 50



*Intermediate-Glycemic Index
Foods: 50 to 70*
Canned kidney beans 52
Kiwifruit 52
Orange juice, not from concentrate 52
Banana 53
* Potato chips 54
* Pound cake 54
Special K 54
Sweet potato 54
Brown Rice 55
Canned fruit cocktail 55
Linguine 55
Oatmeal cookies 55
Popcorn 55
Sweet corn 55
Muesli 56
White rice 56
Orange juice from frozen concentrate 57
Pita bread 57
Canned peaches, heavy syrup 58
Mini shredded wheats 58
Bran Chex 58
Blueberry muffin 59
Bran muffin 60
Cheese pizza 60
Hamburger bun 61
* Ice cream 61
Kudos Whole Grain Bars (chocolate chip) 61
Beets 64
Canned apricots, light syrup 64
Canned black bean soup 64
Macaroni and cheese 64
Raisins 64
Couscous 65
Quick-cooking oatmeal 65
Rye crispbread 65
* Table sugar (sucrose) 65
Canned green pea soup 66
Instant oatmeal 66
Pineapple 66
Angel food cake 67
Grape-Nuts 67
Stoned Wheat Thins 67
American rye bread 68
Taco shells 68
Whole wheat bread 69
Life Savers 70
Melba toast 70
White bread 70


*High-Glycemic Index Foods:
More Than 70* 

Golden Grahams 71
Bagel 72
Corn chips 72
Watermelon 72
Honey 73
Kaiser roll 73
Mashed potatoes 73
Bread stuffing mix 74
Cheerios 74
Cream of Wheat, instant 74
Graham crackers 74
Puffed wheat 74
Doughnuts 75
French fries 76
Frozen waffles 76
Total cereal 76
Vanilla wafers 77
Grape-Nuts Flakes 80
Jelly beans 80
Pretzels 81
Rice cakes 82
Rice Krispies 82
Corn Chex 83
Mashed potatoes, instant 83
Cornflakes 84
Baked potato 85
Rice Chex 89
Rice, instant 91
French bread 95
Parsnips 97
Dates 103
Tofu frozen dessert 115







Low-Glycemic Index Foods: 
Less Than 50
 Intermediate-Glycemic Index
Foods: 50 to 70
 High-Glycemic Index Foods:
More Than 70

Artichoke <15
Asparagus <15
Avocado < 15
Broccoli <15
Cauliflower <15
Celery <15
Cucumber <15
Eggplant <15
Green beans <15
Lettuce, all varieties <15
Low-fat yogurt, artificially sweetened <15
Peanuts <15
Peppers, all varieties <15
Snow peas <15
Spinach <15
Young summer squash <15
Zucchini <15
Tomatoes 15
Cherries 22
Peas, dried 22
Plum 24
Grapefruit 25
Pearled barley 25
Peach 28
Canned peaches, natural juice 30
Dried apricots 31
Soy milk 30
Baby lima beans, frozen 32
Fat-free milk 32
Fettuccine 32
* M&M's Chocolate Candies, Peanut 32
Low-fat yogurt, sugar sweetened 33
Apple 36
Pear 36
Whole wheat spaghetti 37
Tomato soup 38
Carrots, cooked 39
* Mars Snickers Bar 40
Apple juice 41
Spaghetti 41
All-Bran 42
Canned chickpeas 42
Custard 43
Grapes 43
Orange 43
Canned lentil soup 44
Canned pinto beans 45
Macaroni 45
Pineapple juice 46
Banana bread 47
Long-grain rice 47
Parboiled rice 47
Bulgur 48
Canned baked beans 48
Grapefruit juice 48
Green peas 48
Oat bran bread 48
* Chocolate bar, 1.5 oz 49
Old-fashioned oatmeal 49
Cheese tortellini 50
* Low-fat ice cream 50

 Canned kidney beans 52
Kiwifruit 52
Orange juice, not from concentrate 52
Banana 53
* Potato chips 54
* Pound cake 54
Special K 54
Sweet potato 54
Brown Rice 55
Canned fruit cocktail 55
Linguine 55
Oatmeal cookies 55
Popcorn 55
Sweet corn 55
Muesli 56
White rice 56
Orange juice from frozen concentrate 57
Pita bread 57
Canned peaches, heavy syrup 58
Mini shredded wheats 58
Bran Chex 58
Blueberry muffin 59
Bran muffin 60
Cheese pizza 60
Hamburger bun 61
* Ice cream 61
Kudos Whole Grain Bars (chocolate chip) 61
Beets 64
Canned apricots, light syrup 64
Canned black bean soup 64
Macaroni and cheese 64
Raisins 64
Couscous 65
Quick-cooking oatmeal 65
Rye crispbread 65
* Table sugar (sucrose) 65
Canned green pea soup 66
Instant oatmeal 66
Pineapple 66
Angel food cake 67
Grape-Nuts 67
Stoned Wheat Thins 67
American rye bread 68
Taco shells 68
Whole wheat bread 69
Life Savers 70
Melba toast 70
White bread 70

 Golden Grahams 71
Bagel 72
Corn chips 72
Watermelon 72
Honey 73
Kaiser roll 73
Mashed potatoes 73
Bread stuffing mix 74
Cheerios 74
Cream of Wheat, instant 74
Graham crackers 74
Puffed wheat 74
Doughnuts 75
French fries 76
Frozen waffles 76
Total cereal 76
Vanilla wafers 77
Grape-Nuts Flakes 80
Jelly beans 80
Pretzels 81
Rice cakes 82
Rice Krispies 82
Corn Chex 83
Mashed potatoes, instant 83
Cornflakes 84
Baked potato 85
Rice Chex 89
Rice, instant 91
French bread 95
Parsnips 97
Dates 103
Tofu frozen dessert 115


Hope that helps.


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## everydayupsanddowns

Good list Adrienne, though I'm constantly confounded by supposedly 'low GI' foods being anything but for me.

As far as I've read GI is an averaged figure from the BG response of a relatively small sample (100 or so). It is also confusing to compare GI lists from different countries as recipes of some foods differ in different regions (not that this would affect fruit juices of course)

I don't use fruit juice as a hypo remedy myself but I can understand that parents might prefer it as an option to sweets. I *think* I saw a post from Bev following a conference (FFL?) that it was now being advised against by some.

All I know from my own experience is what 200ml of Orange Juice does to my BGs and that suggests that if I was low it would be a pretty good way of getting my levels up pronto!

M


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## Adrienne

everydayupsanddowns said:


> Good list Adrienne, though I'm constantly confounded by supposedly 'low GI' foods being anything but for me.
> 
> As far as I've read GI is an averaged figure from the BG response of a relatively small sample (100 or so). It is also confusing to compare GI lists from different countries as recipes of some foods differ in different regions (not that this would affect fruit juices of course)
> 
> I don't use fruit juice as a hypo remedy myself but I can understand that parents might prefer it as an option to sweets. I *think* I saw a post from Bev following a conference (FFL?) that it was now being advised against by some.
> 
> All I know from my own experience is what 200ml of Orange Juice does to my BGs and that suggests that if I was low it would be a pretty good way of getting my levels up pronto!
> 
> M



Hi Mike

Personally I don't follow GI at all.    I think on MDI it is hard to follow GI quite frankly but each to their own.

Yep you are right FFL conference, I was there too and yep juice is not recommended for hypos but that is nothing new.   It has never been recommended by those switched on teams.  It is just not quick enough and better to start the youngsters on something that will save their life at some point rather than something that tastes ok.

Jessica has orange juice or apple juice as a treat for a drink and we just bolus for it and its fine.  

However I do know that some people do use it for hypos and again its each to their own at the end of the day.


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## shiv

I'll use OJ if I'm in the high 3s and I don't feel too bad (fingers crossed my hypo symptoms still serve me well). Anything less than 3.5 and it's straight for the lucozade for me.


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## LouiseB

This has got me very confused now - according to that list, you'd be better off treating a hypo with a parsnip!! Cant be right surely?  Oh well juice seems to work quickly for use - usually about 5 minutes. I'd rather use that than sweets and my child doesnt like anything fizzy.  Juice was also the treatment recommended at dx by our dsn & consultant.


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## everydayupsanddowns

LouiseB said:


> This has got me very confused now - according to that list, you'd be better off treating a hypo with a parsnip!! Cant be right surely?



Thanks for that Louise. Made genuinely me LOL!

GI seems to be better understood alongside GL (glycaemic load) which accounts for things which are quick absorbed, but which you'd rarely eat much of in CHO terms (watermelon for example).

And of course as with all 'averaged' figures it can only be a guide. Some people will be at the fast, and others at the slow end of the results.

Can't really see that you'd have much joy forcing a parship down a littlun in a medical emergency!

M


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## Adrienne

LouiseB said:


> This has got me very confused now - according to that list, you'd be better off treating a hypo with a parsnip!! Cant be right surely?  Oh well juice seems to work quickly for use - usually about 5 minutes. I'd rather use that than sweets and my child doesnt like anything fizzy.  Juice was also the treatment recommended at dx by our dsn & consultant.



Hahaha don't worry.  Like I said everyone is different.  If juice works for you then that is fine.   All I say is be aware that things can change and one day juice may not work as well.   

I am not directing this at you personally by the way.  We cannot use glucotabs or hypofit as they don't work at all when hypo but they used to.  Some people can use those things and for others they stop working.   So just be aware that things change with time.

I just pulled that list of the internet, I don't use it at all.


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## LouiseB

Hey thanks for posting that list, always good to be aware of these things.  Like you we dont use glucose tablets cos he doesnt chew them up and they dont dissolve in the mouth very quickly - he mostly ends up spitting them out!  He does love a jelly baby but dont want to use on a regular basis, but they are my back-up plan if the juice dosent work for some reason.


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## Northerner

I love the idea of using a parsnip as a hypo remedy. I think GI is very misleading in this respect because it doesn't account for quantity consumed. The GI of a parsnip is high but you'd have to eat more than your bodyweight I think to get the requisite number of carbs in your system (OK, maybe not quite!). Hypos need to be treated by the smallest amounts of fast-acting carbs available, so when comparing similar quantities containing similar carbs, then you can use GI as a comparison


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## HelenM

> I love the idea of using a parsnip as a hypo remedy.


the trouble is you'd need to eat 80g to get 8g of carbohydrate and you'd to  wait whilst you boiled it. ( though I bet roasting would be higher GI, never seems to have been tested)

Just out of interest I looked up the highest ranking foods that have been teste for the GI index.(glucose is 100)
Number 3 was a frozen tofu dessert with high fructose corn syrup at 115
Number 2 was a variety of potato (Sava) boiled for 20min at 118
and your fastest sugar

Cornflakes (kellogs *US*) at 132.

and whilst it wasn't quite as high the UK version was 93.(compared with lucozade at 95)
(without milk though, that would lower it down to the 60s)
Supermarket type French baguette also has a GI of around 95.
interesting, I might experiment on myself, I wouldn't with a child.


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## LouiseB

So is this right? - the GI of a given food is how quickly it gets digested and into the blood stream (what size portion??) and GI load is how quickly a standard portion gets into the bloodstream?   Is there another index which shows how quickly a set amount say 10grams of CHO (an amount recommended to treat a mild hypo in a child) gets into the bloodstream as this is what is really important I suppose.


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## HelenM

For hypos with a child when acting quickly is possibly crucial, I'd go for tried and tested remedies. Things that work fast and are always easily available and easy to 'get down'

For reference about the GI.


> To determine a food's GI rating, measured portions of the food containing 10 - 50 grams of carbohydrate are fed to 10 healthy people after an overnight fast. Finger-prick blood samples are taken at 15-30 minute intervals over the next two hours. These blood samples are used to construct a blood sugar response curve for the two hour period. The area under the curve (AUC) is calculated to reflect the total rise in blood glucose levels after eating the test food. The GI rating (%) is calculated by dividing the AUC for the test food by the AUC for the reference food (same amount of glucose) and multiplying by 100 (see Figure 1). The use of a standard food is essential for reducing the confounding influence of differences in the physical characteristics of the subjects. The average of the GI ratings from all ten subjects is published as the GI of that food


http://www.glycemicindex.com/

The amount of carbs used depends upon the amount in a food that a volunteer could comfortably eat so for example they are never going to calculate the GI of something like celery. The GI site has a data base, including foods that have been tested by reputale sources. It isn't actually true that all the subjects are 'normal''. There have been many tests including people with both T1 and T2, these are in the data base and also in a separate list (the second table)http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2584181/bin/dc08-1239_index.html

  GL = (GI x the amount of carbohydrate) divided by 100
so takes into account the portion size.


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## LouiseB

thanks for the v. comprehensive reply, was just wondering hypothetically what the fastest food / drink was, will stick to what we've been doing, but interesting nonetheless.


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## Adrienne

LouiseB said:


> thanks for the v. comprehensive reply, was just wondering hypothetically what the fastest food / drink was, will stick to what we've been doing, but interesting nonetheless.



Its lucozade unless anyone can come up with anything scientifically of course 

Lucozade is even faster than full sugar coke and you don't need as much.


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## Pumper_Sue

Glucose powder in water or squash is the quickest thing to use. slightly warm is even better.


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## Adrienne

Pumper_Sue said:


> Glucose powder in water or squash is the quickest thing to use. slightly warm is even better.



We used to use Maxijul 500 soluable when Jessica was little, but we didn't know any better and mixed it in her warmed up bottle of milk so quick and slow altogether !!


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## Rosie.H.

try a teaspoon full of honey, use to work when my son was 3, now he's older (5) we stick to lucozade.


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