It’s easy to panic when having a low glucose. Your heart is racing, your body is pumping out adrenaline, and your stomach says “Feed me! FEED ME!!!” Your brain isn’t working logically, and if you live alone you may be afraid if you don’t eat that chocolate cake, you might pass out and not wake up.
But binging to correct lows only causes rebound highs. Your body will also be raising your blood glucose by releasing stored glucose from the liver. Dual responses from you and your liver keep the roller coaster going. So eat quickly, but restrain yourself from piling on more carbs in a ‘binge til you stop shaking’ routine. If you are on an AID, remember that your basal delivery has been reduced for some time beforehand, reducing the number of carbs that you need for treatment.
Here are some tips:
- Use glucose tabs instead of something yummier. Not only do they work fastest, but they’re not as tempting to overeat, and it’s easy to track the carbs by the number of tablets you eat. Smarties or Sweet Tarts, made of glucose or actually dextrose that is two glucose molecules hooked together, are optimal and less expensive options.
- Fix every low immediately at the first CGM alert before it turns really bad. Speedy treatment reduces the release of stress hormones and minimizes rebound highs.
Treatment Plan for Lows
- First, eat one gram of quick carb for every 10 pounds of body weight, such as 15 grams for someone who weighs 150 lbs. (A small child should eat at least 6 grams.) See Textbox 1 for Quick Carbs.
- If any IOB exists, eat 10 more grams for every unit of IOB to cover this residual insulin activity, OR add grams = IOB (units) x CarbF (grams/unit).
- If any extra activity has occurred, a few more carbs may be needed.
- Wait 15 minutes and recheck with a glucose meter, or look at your CGM screen after 20 minutes because its reading lags a bit behind.
- If you overeat in a weak moment, calculate the grams of excess carbs you consumed once your brain is working again. Then bolus for them to avoid going high. It might feel wrong to bolus when low, but any excess carbs you eat will send your glucose up before a bolus begins to work.
*** Remember that IOB calculations CANNOT be accurate unless your Active Insulin Time (AIT) or Duration of Insulin Action (DIA) time is set to at least 4.5 hours or LONGER!
More grams of carbs than these will likely be needed:
- If you forget and take 2 boluses/injections for a meal, or
- If you took a meal bolus but never ate the meal (IOB x CarbF should cover this).
Quick treatment reduces stress hormone release and the chances of your glucose rising sharply afterward. Plus you’ll quickly feel better and your brain, muscles, and cells will thank you for resupplying the fuel that shortens their misery.
Box 1. Quick Carbs with 15 Grams
3 BD Glucose Tablets
3 Smartie® Rolls (in cellophane)
4 CanAm Dex4® Glucose Tablets
5 Dextrosol Glucose Tablets
5 Wacky Wafers®
6 SweetTarts® (3 tabs/packet)
7 Pixy Stix
8 SweetTarts® (3/4″ Lifesaver size)
14 Smarties® (3/4″ diameter roll)
The “sugar” in the blood is glucose. Dextrose, a double glucose molecule found in Dex4, Glucolift, BD Glucose tablets, and in candies like Sweet Tarts and Smarties rapidly resupplies glucose. Glucose and dextrose reach the blood as 100 percent glucose, making them ideal choices for hypoglycemia.
Table sugar is made of one glucose molecule and one fructose molecule and has only half as much glucose as glucose tabs. Fruit juices, like orange juice, contain a bit less glucose, take longer to raise the glucose, and are often over-consumed. For serious hypoglycemia, choose the fastest high glycemic food available for a quick rise in glucose and to get back on your feet quickly. Box 1 shows examples that have 15 grams.
Don’t Go Too Far
Lows do not mean unlimited treat time. A panic overdose of orange juice with sugar, a box of chocolates, and the entire contents of your refrigerator makes your goal of stable blood sugars hard to achieve. These panic attacks arise from the release of stress hormones during lows.
If your glucose frequently goes high after lows, overtreatment is quite likely. Wear a CGM and act on the first alert with an immediate intake of quick carbs to eliminate unwanted spiking.
Be Prepared for Panic:
- Memorize how many grams you need for rapid treatment.
- Keep glucose tabs or other quick carbs handy at your bedside, in your pocket or purse, at your desk, in the glove compartment, and where you exercise.
- Use them automatically and allow time for your glucose to correct before eating more.
- Intense hunger will lessen as you recover and you’ll be glad later that you did not indulge.
Check your CGM or test your glucose 20 minutes after treating a low to ensure it has risen. After a moderate to severe low glucose, wait for 30 to 45 minutes before driving or operating machinery. Coordination and thinking take longer to return to normal than the return to normal glucose in the blood.
When Low Before a Meal
When a low glucose occurs before a meal, should you reduce the meal dose? Once quick carbs are taken to treat the low, a slight reduction in the rapid insulin by bolus or injection can be considered to reduce the risk of having another low.
Remember though, never skip and try not to delay a bolus. This only makes the glucose spike and a delayed bolus may cause insulin-stacking at the next meal.