AS many of you know, i like to use Glucose tablets to treat my lows. even though they are considered “fast acting” i have never found this to be very true. sometimes i will notice that my Bgs may come up within a half hour, and sometimes it will take over an hour to see a realistic and healthy “safe” target range rise.
i notice that early in the morning, i am much more sensitive to 1 Gtab than i would be later on in the day. this has never surprised me, but thats not the point. the point is that 1 Gtab is about 4 gms of glucose. if i am in my 50s, i will take 2 tablets and wait it out. if i am in my low 70s, i might take 1 tablet. anything above 75 (so long as i am not trending down) i wont take any correction.
so, that being said, at what point do you decide to treat a low? how many carbs do you need to take for different BGs? and, what do you find to be the most effective carb correction method? also, how long do you have to wait to get the thorough effect of your correction?
really curious. would love as many responses as possible !!!
thanks, y’all, DM
I almost never use glucose; I save that for when I am quite low or when no food I like is within reach (I ALWAYS carry emergency glucose with me, so I always have that as a fallback). So then it depends on how low I am, and what I believe my BG trend to be. If I’m in the low 70’s and think I’m trending lower, then I’ll usually grab a piece of fruit, which has 10-15 grams of carb and will bump me up about 30-40 points in a somewhat sustained way. If I want to go up a smaller amount, say 20 points, when I think my BG is more stable, then I’ll eat about half that, maybe a dozen raisins. Sometimes I’ll eat chocolate or some cookie or whatever else is around but that will usually be most useful when I can see I need a bigger rise or I have more insulin on board.
My BG will go up quickly with fruit or other sugar; I don’t think I’ve ever seen an hour delay - I would attribute that to simply not taking enough in the first place.
Jag, do you use a CGM? or do you feel the low coming on and do a finger stick?
i dont use a cgm, so i rely on how i am feeling and on finger sticks. i can generally feel if i am trending down, though, 'cause i feel the BG drop, although, there are many times where i am completely unaware that i am low until i test post-meal bolus.
No CGM here, so going by fingersticks and how I feel. I’ve only used g tabs when I had nothing else with me - like @docslotnick always says, never waste a low. I’ve used gummy bears, chocolate chips, and jelly beans so far for most of my lows. I find 4g carbs will stop the drop, and then additional 2-4g will raise me ~20-30, which gets me back in range (have only gone down to 50s so far).
If I’m in the 70s but feel like I’m still dropping, Ill eat 4 carbs, wait 15 minutes, and if I’m holding steady/rising a bit, I follow up with a tablespoon of peanut butter (also 4 carbs) to raise me to safe range but also help hold me there til the next meal. If I’m lower than 70, I do 6-8g carbs, wait 15 mins, and if I’m going up, then I dose for and eat a snack with protein/fat to help hold my BG up.
do you actually notice a change in BG after only 15 minutes? most often i dont see the full effect of the change for an hour. if i am lucky, i will begin to see a change in 1/2 hour, but nothing ever sooner.
and, PS: my favorite go-to for lows is my Lindt Dark Chocolate with a Touch of Sea Salt. it rocks and does not spike me (milk chocolate spikes me right away)
DM, are you wanting a faster method? There is a trick I do to make it faster.
You remember the thing about over-bolusing for meals? Well there is a faster way to treat lows that is similar. It is taking a larger amount of carbs than you need.
For example, 30 grams would raise you faster than 10 grams. Of course 30 grams may be too much and cause you to spike higher than you want to go. So that’s where it gets a little crazy. You also take insulin (which is slower than a simple sugar).
So there are times when I want a quick rise out of a low, so I will over-treat the low. Taking much more than I need. And in order to prevent it from being too much, I will take insulin at the same time.
For example if I am 45 I might take a small bolus and eat much more than I need, like 30-40 grams. Much faster!
This isn’t anything an endo would tell you to do, or not anything you will see in a book. It takes extra care because you need to take the exact right amount of insulin to keep from spiking, and also to keep from dropping back down.
I am not advising you to try this, but just telling you what I do.
In general, if you want a faster rise, try liquids instead of solid foods.
for a severe low (30s) i will drink 1/3 C apple juice. works fast and is always reliable. i am more interested in treating lows that are not severe, but will interfere with doing a bolus before eating. like, for example, if you are testing before you are getting ready to eat, and your BG is 50, i’m not going to bolus for my meal. i need to be at least 70. so, i’l take 1 tab and then wait it out. but this could take forever. (quite often it does.)
i am looking for a more efficient method of correcting. i want to make clear that when i take a tab to bring my BG up, i will not see the full effect of the rise for about an hour; so, if i have a rise that brings me from 50 to 70 in half an hour, i know that if i bolus for a 70 BG, it will be a kind of “false” bolus. i would need to guess how much the full rise would be after the hour period is up (say that my full rise would bring me to 100; and if am bolusing with a BG of 100 for a certain amount of carbs, my insulin bolus is going to be different than if i am bolusing for carbs and i am only at 70 )
Yes. I’m pretty sensitive to carbs, especially when on the lower end. That’s why I also need much less than the recommended 15g to correct. When I’m not low, food starts raising my BG in 20-30 mins, depending on the fat content (I only know this because of doing experiments for Afrezza dosing - I have to dose it as my BG starts rising). It’s also why I pre-bolus 30-45 mins ahead with Novolog, because otherwise it’s starts hitting later than my food.
I always go for the dark chocolate, too! Mostly because I can’t do dairy right now, but even when I can, I prefer dark chocolate
I think there is an easier way. Just bolus for your dinner and eat right away. If you are used to waiting 30 minutes, don’t wait. Or bolus less for your meal. Or bolus a few minutes after you have started eating. All that depends on your circumstances and how much you need.
I don’t understand how a low BG would get in the way of a meal! Those are the meals that won’t spike you. That is the ideal time to eat dinner!
I’ve been in the 60s before eating a couple times (shaky, sweaty, weak, etc, too), and what I’ve done in that case is popped a couple jelly beans, bolused, and started eating within 15 mins instead of my usual 30-45mins. Similar to what @Eric is suggesting. The jelly beans are usually unnecessary, but it makes me feel more comfortable bolusing.
i have tried this method more than several times, and what ends up happening is that i go even lower mid-meal. i could start out at 60, bolus and eat right away, and then i will sink down to 30 before i even finish eating. maybe if i were eating a piece of fruit this would work for me, but not with veggies and proteins.
truly, i feel like i have tried every variation on this subject. i will end up going lower, spiking, etc. i know that if i used my old dexcom i would probably be better able to deal with this issue. i would have the assistance of the direction arrow. but as frequently as i do finger sticks, i do not do them every 15 minutes, etc.
I think you’ve mentioned before that insulin starts working for you sooner than most. Do you think it’s the bolus starting to work at that 15 min mark, ahead of your food hitting? If so, if you know that it takes 30 minutes-1 hr for food to raise your blood sugar, and insulin takes 15 mins to get working, you could start eating, wait 30-45 minutes, then bolus, so it’s starting to work at that 45 minute-1hr mark when your food is already causing your BG to rise. Does that make sense? And I say this with the caveat that I have nowhere near the experience as @Eric, so if he has a different suggestion, go with that.