Greetings all.
Does anyone find themselves to be super resistant to insulin, just after a hypo? For example, i woke up this morning, drifting lower…and by the time i’d showered and dried my lock-down mass of hair and was downstairs in the kitchen, i was registering <3.0. I made myself my usual breakfast, added a 100ml orange juice (c. 10g quick acting carb) and injected 3u (the usual dose for this amount of carb), knowing i will spike quickly…and spike i did. I went straight up to c. 13mmol (almost vertical line up) and am now drifting back down. I often spike up to 20mmol, depending on how long i’ve been low. Does anyone else see this period of massive insulin resistance, immediately after a hypo? it makes treating hypos difficult, not least because you generally don’t have your wits about you… i end up having to inject while i’m low in a (usually vain) attempt to prevent a spike, and then subsequent yoyo-ing. Do others find this typical? How do you deal with it?
My BG rarely hits 20 mmol/l. Does your breakfast contain any other quick-acting carbs?
I wish mine didn’t but when i’m battling to fix a hypo, it sometimes does. Breakfast for me was 50g of ‘porridge-like’ creation (oats, bran, crushed nuts, chopped dates and milk, in the fridge overnight) with some greek yoghurt, a couple of chopped figs and a spoonful of honey. all measured out and a very typical breakfast… i seem to have very little insulin resistance in the morning (2u would typically cover this c. 50g carb portion, so 1u/25g), and a lot more resistance in the afternoon and evening, where it moves to a more typical 1u/10g. But regardless of the time of day, a hypo will give me massive insulin resistance. there is seemingly nothing i can do to stop a spike. just a 100ml glass of orange juice (10g carb) to fix a hypo, and i’ll soon shoot through the roof.
With these carb ratios it’s quite odd indeed that you shoot through the roof like that. Does this happen too when you drink a smaller glass of orange juice? Have you tried that?
It’s difficult to go much lower when battle the raging ‘need’ for sugar when dealing with a hypo, but whenever i try a smaller amount, my BG seems not to budge…and then i quickly run out of patience, take more, and then i spike.
So i guess it seems like a ‘digital’ outcome - no move, or a zoom upward. never a sensible, slow, managed recovery. Perhaps i just need to wait longer, but crikey it’s hard to do.
I’ve never thought of it as insulin resistance, but I am extremely sensitive to carbs when I’m low - it usually just takes 2-4g to bring me up; any more than that and I have to bolus for it (so I usually end up bolusing for more because trying to just stick to one glucose tab or a couple of jelly beans when I’m low is tough 
). If I drank juice and ate a 50g carb meal, I would certainly need more than my usual dosage for all of it, and I would rise much faster than normal.
Thank you. How long does the ‘hyper-sensitivity’ last, typically? 2-4g…interesting. how long does it take for those 2-4g to act, and bring you back up?
I wonder if those of you with increased sensitivity to carbs or insulin resistance when hypo are actually experiencing functional alpha cells at work, so your body is responding to the low with glycogen release from the liver at the same time you are treating it, so the need for extra insulin is to cover both the intake of carbs and the extra glycogen release. Are both of you LADA? I would expect that to be more likely in people with both slow and relatively recent onset of T1 that maybe has also not fully progressed. Most longtime T1s do not have functional alpha cells either, but I believe that is not as immediate as destruction of the beta (insulin-producing) cells.
i’m not particularly familiar with LADA, but my T1D onset was fairly sudden, at the age of 23, which is 17yrs ago now. It more or less just ‘hit me’, soon after i started work in a relatively stressful career.
This is very interesting regarding alpha cells… i have very much thought mine to be active, particualrly given my tendency to experience the Dawn Phenomenon, which i put down to a spewing of the liver of glycogen stores ‘ready for the day’, which must surely need alpha cells? however, there always seemed to be a paradox in this, in that if this were truly the case, surely i’d never have hypos, as my liver would just release it’s store of glycogen when i go low? i put it down to the effect of an overdose of bolus having a greater effect than the alpha cells could cope with, and hence the hypo ‘won over’ the glucogenesis. perhaps this explains why my major hypos have (so far) haven’t finished me off… i’ve always come around, sometimes hours later, via a liver dump of glucose, just enough to get me to the fridge for some orange juice. Perhaps without the alpha cells, i wouldn’t even be able to do that? that’s a little scary.
i didn’t realise most T1Ds suffer from alpha cell destruction also. that’s interesting.
I’ve experienced this, too, where I am sometimes on the floor when I come to, what could be hours later, and am able to crawl to a source of carbs! I’ll have no recollection what had transpired the previous hours for me to get where I was!
I’m not sure I am insulin resistant after a hypo, but like @Pianoplayer7008, I usually only need to take 4-8g to correct. If I take more (being impatient!) I will definitely need to take insulin, which of course, requires a prebolus! So if I eat too much for a hypo, yes, it will typically spike me because the insulin hasn’t had enough time to peak.
I haven’t really paid enough attention to it to know how long it lasts; my lows are usually not bad, so I just treat and move on most of the time (and check back in an hour or so later to make sure I didn’t go too high). It only takes a low treat about 10-15 mins to start working.
@cardamom, yes, I do have LADA and had attributed my carb sensitivity to that, though I wasn’t familiar with the details of the alpha cells response…very interesting.
I would advocate a slightly different approach. The foundation is to use the fastest practical carb source, which seems to be glucose (dextrose) tablets. Some people advocate a particular kind of Smarties sweets which largely consists of dextrose. The goal is not a sensible, slow, managed recovery. It is a spike that zooms upwards, but it is such a small spike (from such a small amount of carb) that it’s all finished just as you reach your normal BG range.
I agree. Taking too much of a slower kind of carb, or a carb that contains fat and/or protein will solve the problem promptly but cause a spike. Taking a barely sufficient quantity of a slow carb takes a truly intolerable amount of time to solve the problem, so we can’t do that. 
Very small amounts of very fast carbs, that’s the way out of this dilemma.
I experience this as well. Each glucose tablet has 4gms of fast carbs. each tablet will bring me up about 20 points. But I MUST be patient, otherwise I will spike. I have read on FUD so many who respond to the tablets within 15 minutes. I don’t even budge until 1/2 hour. And, I won’t see the full effects until around 45 minutes. Now I know that this is an uncomfortably long time to wait out a hypo, but if you can hang in there, I have found, IMHO, that it works well and there is no spiking.
Now I cant by any means call myself some patient saint of sorts! This morning I went down to a 30 BG, and of course, I couldn’t see an inch in front of me; I was all google-eyed, seeing stars, sweating and shaking, and I made it into the kitchen and very thoughtfully poured myself 1/2 Cup of apple juice. But then the hunger rage came over me, and I reached in for a small container of refrigerated barley/mushroom/onion salad and devoured it without a thought in my head. Well, within 1/2 hour, my BG was a steady 115, however, when I looked at my CGM reading with an arrow heading straight up, I tested with a finger stick, only to find that my BG had risen to 188!!! OMG, from 30 to 188 within an hour.
Fortunately, I caught it in time; I took an over-zealous IM shot into my thigh muscle and within half an hour my BG had come down to 90, then 73, then 60. Phew. I Took 1 tablet and let it all go. I won’t be reaching for the barley again any time soon for correcting a hypo! 
Interesting, thank you. I must say, I never understood why the ‘fastest practical source’ was of such importance. Obviously it’s an unpleasant situation to be in, but …
i) fast carbs (e.g. dextrose, smarties) have shown to be unhealthy for the gut, brain and other organs, often processed/full of toxins and of zero nutritional value… isn’t orange juice a better bet? might the slightly slower action be a better trade off…why this need for such speed? is being low-for-longer deemed to be inherantly bad/unhealthy?
ii) i thought fast glycemic responses (up or down) were sub-optimal, and movements should be slow and gradual. Perhaps treating a hypo exempts us this general rule? Or did i miss the memo that said fast glycemic excursions are actually okay?
This is helpful. I think ‘holding in there’ is better than the spike. I will practice this.
Here is where our worlds diverge. I would honestly be reasonably happy with 188, if that were the max. To hear that you consider that a disaster and deserving of an ‘OMG’ reaction is … depressing. I often jump to 300+ after treating a hypo with 10g of carb, particularly if i’ve been low for hours. And then i’m yoyoing for the rest of the day. It suggests i need just 2-4g, and some real patience. Now having the miaomiao reader/CGM should help prevent the occasions of being low for hours when asleep, so here’s hoping.
IMHO, I would say that the fastest carbs for treating a dangerous hypo definitely exempts the rule here; it is very damaging to the brain and to other organs to be that low for any lengthy period of time.
In my experience, something like apple juice or OJ is your best fast carb source. If I am in my 30s, chewing on a bunch of glucose tablets just doesn’t do the trick fast enough (despite what “they” say about any form of pure glucose being just as good as any other; I have NEVER found that to be true.) And, I definitely want to avoid the Yo-Yoing from a spike later on, which I will ALWAYS get when taking in something like Wheat Thins or other starchy form of carbs. If I know that 4gms of carbs will raise my BG by 20 points, then a 1/2 cup of apple juice will bring me up to about a BG of 90-100 within 15-30 minutes and then I will stay in that range without a later-on-spike. Fast glucose is in and out of my system once its done its job.at least for me.
Make sense?
PS: Keep in mind that all carbs are not created equal, even if their grams are the same.
Glucagon isn’t the only counterregulatory hormone. When glucagon isn’t released to solve the problem, eventually the body resorts to primitive full panic. Adrenalin causes shaking, sweating, liver glucose dump, elevated heart rate and respiration, any of which may be needed in a last-ditch attempt to survive.
For me, that’s the answer right there. With fast carbs I can correct a low with the right amount and it will have comforting effect before I am driven to empty the pantry into my mouth. I want to quiesce the excursion, not overdrive it into an excursion in the opposite direction.
That depends on quantity, doesn’t it? Glucose is a principal energy source for the cells of our body. In the non-diabetic body the liver is signaled to release pure glucose into the bloodstream to counteract hypoglycemia. We’re just doing it manually (oral rather than IV). Taking 8g of glucose sweets to counteract a hypo is entirely different to eating the whole bag for amusement.
It’s certainly not the condition the body would choose for itself if it were still able to regulate the BG. The normal body keeps remarkably tight control on the BG level. I suppose there’s a reason evolution selected for that ability. My endo did advise me that a severe low can cause loss of consciousness, can trigger possibly fatal cardiac arrythmia, and perhaps may cause some amount of brain damage although this point is not as well understood. Hypoglycemia does cause physical impairment of hypoglycemic awareness and the autonomic processes that would correct the hypo. To me these are all inherently bad and unhealthy.
I think in large part that advice for self-treatment comes from the time before CGM, where a fast move was likely to overshoot and produce an extreme in the opposite direction, whereas a slow move was more likely to edge towards the desired value. There is an important exception: when correcting a severe high accompanied by diabetic ketoacidosis in hospital, a gradual treatment is important so that the entire blood chemistry can be managed safely. I don’t remember what goes wrong with too fast an IV correction, perhaps it was potassium? Anyway it can be fatal.
With CGM, some of us are coming to prefer numerous small corrections rather than large excursions followed by large slow corrections. Certainly the healthy body’s approach is for tiny corrections lightning fast (IV insulin or glucose) to any detectable excursion. And the automated closed loop systems are trying to approach that, but with limited success as yet because we’re using relatively slow corrections via subcutaneous insulin and oral carbs.
daisymae is far less accepting of BG excursions than I am, but the OMG reaction is because the BG was not merely elevated, it was rocketing upwards so was heading much higher. For myself, I’m not shocked by 180 or even 200 and would be reasonably satisfied provided I bring the BG right back down to range. I do believe that we begin to accumulate damage over 150 and the amount of damage is proportional to the area under the curve, so both the amplitude and duration matter.
Very nice and informative reply @bkh
Agreed, lots to think about and ponder. Thank you @bkh.
Are we sure of that? i haven’t read anything scientific to suggest that. Sure, it doesn’t feel good (it feels horrific) but i haven’t read anything that definitively suggests brain/organ damage is a result. I might be wrong here, of course.
Yes, i find the same. Glucose tablets, aside from tasting awful, don’t seem to be all that quick. Which is pretty odd when they have a GI of 100. Don’t understand that.
Thank you for your thoughts and comments.