Treating Hypos: Never Learned This

Type 1 & LADA
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Few non T1Ds truly understand the adrenaline thumping of a plummeting low, the alerts clanging, while waiting for a glass of juice to kick in.

I was, as the Brits say, gobsmacked to read Dan Hellers piece, having never heard of “delayed gastric emptying”

But indeed I have been having better low treatment following his suggestion to “avoid the gut” and absorb glucose tablets through holding in my mouth. It sure seems to work better over last few rounds.

I know everyone has their recommended treatment, but it’s the waiting that grinds me. And having to stop whatever I’m doing.

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My husband (retired physician) agrees that the sub-lingual route is likely faster. As another example, he mentioned sub-lingual absorption of nitroglycerine tablets. I am going to give this a try.

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This was fascinating! I’ll have to start training myself to do this with my glucose tabs. Someone also recently shared that they make 8 g. glucose gels now – those seem perfect for this.

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Transcends sells the larger 1.1 oz, 15g gel packs and “Minis” which are .6 oz, 8g gel packs. The only issue we have is that while we can use HSA funds for the larger of the gel packs, it’s not an option on Amazon for the Minis. I reached out to the company and they indicated they will be investigating, but that was months ago.

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When I went to diabetic summer camp more than fifty years ago, if a camper was seriously crashing, the counsellors would give them a glug of corn syrup and shout “Don’t swallow! Keep it in your mouth!”

Everything old is new again!

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Corn syrup (not HFCS) is close to 100% dextrose, d glucose. 1 oz = 15g of glucose.

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Great article Thank You!

Corn syrup is what I kept around for my dog as a quick fix!!!
That’s not to disparage it, it was one of the fastest ways recommended to solve it!

I read years ago about a study for kids absorbing sugar faster on the tongue than swallowing it. That turns out to be the study he cited. I know it feels like if I suck on my vegan gummy bears they work faster than just chewing them. I discovered that by accident when I had a dentist appointment and I didn’t want to chew sticky candy before it!!! Now I’ll have to try to let the mix stay in my mouth …

So then in further reading it mentions it needs to be Glucose and I’m going uh oh and then hmmm, why do the gummy bears I have seem to work better when sucked on? It turns out it uses tapioca syrup… no help there, but it also contains pear juice which has glucose and organic sugar which also has glucose. I guess enough that it seems to help faster!

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Saliva contains the enzyme, Amylase, which breaks down polysaccharides like starches but also disaccharides such as sucrose into glucose and fructose. That may be why sucking on the gummy bears works faster, gets converted to glucose in the mouth and passes through the mucosa into the bloodstream.

Who knows, I may be rightt.

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I must of went to the wrong camp! At Camp Glyndon in 1970s I remember going to the infirmary feeling a low, and had to wait in a chair 20 minutes waiting for that tiny half cup of OJ to work.

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Heller mentions that a key factor is that. The dextrose molecule size is small making it easier to be directly absorbed into the blood.

There is a lot of vasculature in the oral mucosa, and since dextrose is a very small sugar molecule, it can be absorbed directly into the bloodstream, bypassing the gastrointestinal tract entirely

His point is a quicker trip into the system means less chance of over treating that starts your roller coaster ride.

On a recent Doctor visit I mentioned this and my doc just nodded and affirmed that’s what she knew. Not sure why no other doc in 55 years T1D ever said anything about this!

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I don’t think we had an infirmary at ours. The nurse just appeared at urine test and injection time, but where she came from or where she went, nobody knew. If you went low, all over the camp there were yellow jugs of corn syrup and bags of peanut butter sandwiches hanging from trees, and counsellors dished them out freely. The sandwiches were also great fun to steal, since we always seemed to be hungry. Years later, when I worked in the kitchen of a diab camp, we had to make up dozens of those pb sandwiches every morning, and we’d grumble, “Why do the little effers steal them all the time?”

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In the middle of this article this guy states he no longer needs basal insulin overnight because of his exercise regimen. He then referenced another article he wrote to explain the process. In that article he says he runs 3 miles/walks 20-30 minutes after each meal and talks quite a bit about his VO2 max. He shows a graph showing he takes 38units a day.

Has anyone read both and can explain it to me? I understand the phrase significantly reducing basal of course but do not understand not using any overnight basal at all as he is suggesting. Unless he is in some sort of honeymoon but it seems that he’s a long time-50 years T1D.

Here is a copy of the portion of the article I’m referring to:

“As a general rule, yes, we need background (basal) insulin, but that doesn’t mean it’s ok to have too much of it. Tired of so many night time hypos, I refined my use of basal insulin by pulling back on it—significantly . Over the course of a couple weeks of experimentation of just watching my CGM more often and bolusing Humalog “as needed”, I eventually just stopped taking basal insulin altogether. It was surprisingly easier and less stressful than expected. In fact, knowing I don’t have all that insulin in me was a huge relief.

You might wonder how I mange overnight insulin needs without basal insulin. The short answer is exercise. For more, see my article, The Paradox of Low-Carb Diets: A1c vs. Metabolic Health, where I how exercise taps into its glycogen stores during activity, but then those stores are replenished at night, while you sleep , by pulling glucose out of the bloodstream, without insulin mediation. I show charts about how this works. Any basal insulin would trigger hypoglycemia.

Without basal, I no longer have any fear of hypos, and any insulin absorption variability that may happen with Humalog is much easier to manage. It doesn’t mean hypos don’t happen. They are rare and quickly managed, and I don’t get on the roller coaster.

Taking less basal also helps by avoiding the overconsumption of carbs, and makes it much easier to exercise and eat more “flexibly.”

My experience is not unique to me, though it’s not common either. Learning this technique, while not that hard, is also not encouraged. It takes diligence to develop it.”

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Wow, Camp Glyndon had like 4 full time medical staff on site, MDs, nurses, maybe dietitians. They lived in the more modern bunkhouses. The camps founder, Abraham Silver had founded the camp and the Maryland Diabetes Association. I can say how bad web search has gotten because my query on Abraham Silver MD Maryland diabetes came up nil except my own blog post.

I also remember the camp participated in a research study (1970s) on diabetic retinopathy with the John’s Hopkins Wilmer Eye clinic. Each year they came out for a day and dilated the eyes of all the kids to take photos. This is where I now bore the assistants at my Opthamologist when the can my eyes and I talk about remembering when they took photos on 35mm slide film.

Diabetic summer camp was such a huge gain for me as a diabetic kid.

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I don’t think it’s entirely accurate for him to say he’s not taking basal insulin anymore… He’s just doing it like pump users, with only short acting insulin!

I think he means he’s not taking a longer-acting insulin anymore. And/or no set pump basals?.. But what is a basal rate except us trying to anticipate a correction for our body’s daily cycles? It sounds like he just corrects it on the other end, in response instead of in anticipation. Which sounds kinda like a recipe for burnout personally. :sweat_smile:

I agree that bad basal rates can mean too many lows. I went from ~6% time low to ~2% when my endo helped me pull back my basal. No way do I want to give up my basal rate altogether though!

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Yeah Heller is an ultra extremist in his management and operates at a level of detail I can mildly appreciate but never would really want to manage like that.

What he describes there sound like night mode on my tandem.

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I read Phil Southerland’s account on how bicycling as a child made insulin injections while riding unnecessary. I know that this worked for Phil and not for everyone. But it shows how aerobic/cardio exercise really increases insulin sensitivity.

"But after taking up cycling and embarking on what had previously seemed an unlikely professional career, Southerland discovered a reliable means of controlling his diabetes.

“When I was on the bike, I didn’t have to check blood sugar, I didn’t have to get insulin,” he says.

“All I had to do was eat so I didn’t bonk and that was what every other cyclist was doing. So I was absolutely normal and that felt really, really cool.”

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I read that linked post and it gave me fierce anxiety. No shade if it works for him, but what he does would drive me completely out of my mind. I already keep way tighter control than most of my care team asks me to (96% TIR, and they would much prefer if I loosened up a bit).

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I really cannot adopt anyone elses routine, and yeah, I would not last 1/24 of a day trying that.

I almost pretty much got away with that from my tweens to early 30s, I never tested, never really followed a diet, just took my daily injections (not recommended). Our bodies are all so different.

And Yikes, 96% TIR, that’s amazing. I’m “improving” just to get to 70% :wink:

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