BG is very high, not sure what to do... [Archive]

gary.keith

11-03-2009, 09:27 AM

I tested my BG this morning upon awakening and it was, as usual, slightly high at 147. So I bolused 3 units of Novolog.

Yes, I know I said I'd wait before doing this on my own, but it's my body and my life and if the endo doesn't like it that's her problem!

An hour later I tested again and my BG was up to 169. At that point I was ready for breakfast so I bolused my prescribed 25 units of Novolog and proceeded to make breakfast. Half a cup of hot rolled oats with a tablespoon of Agave nectar. Two scrambled egg beaters. In all a 67 carb breakfast. Note to self: we really need a lower carb breakfast.

An hour later I checked my BG again and it was 245! That's never happened before.

And so here I sit wondering what I should do. I'm thinking about an 11 unit bolus of Novolog, which is what my logging software is recommending.

I know you folks can't tell me what to do. So how about I ask what would you do in a situation like this?

Subby

11-03-2009, 09:31 AM

In the absence of experience, and if I was type 2 with some internal insulin function that meant that things (eventually) come down or stabilise to some degree, I would not take a correction, or take only a small correction. Personally 11 units would feel like too much of a risk, within the context of the doses you have been talking. It might be unpleasant to be high, but you don't want to bring on a potentially brutal low.

245 might feel and be high for you, but it is hardly danger zone as far as a real short term danger, if you take it easy, monitor, drink plenty of fluids. If I was still high or getting higher in a few hours, I might consider some medical help.

And while speaking strictly for self, I'd be aiming for about a 20 - 30g carb breakfast, only carbs I know do not badly spike me (I would know through observation, trial and error) and would expect a definite improvement in post meal blood sugar :)

fgummett

11-03-2009, 09:34 AM

Your profile shows you as a Type 2 so assuming you do still have some of your own insulin I'd suggest holding off on any additional insulin and to keep testing to see what direction your BG is heading.

There is a possibility that you actually went low and this is a rebound high... adding more insulin on top of what you already have "on board" could just send you on another roller-coaster ride.

Another possibility is that the insulin was ineffective... in which case your BG may have just been going higher since you woke up... in all probability it will start to come down.

By testing (every 15 - 30 minutes is not a bad idea) you can gain a better idea of where you are and what to do next. Are you stable, going up or going down?

---

ETA my post crossed with Subby's but I think we are both conveying the same message.

gary.keith

11-03-2009, 09:42 AM

Thanks for the quick replies and good advice. The 245 was at 11:11 AM Eastern Time. I just tested again at 11:39 AM and it's 219. I'll keep testing.

fgummett

11-03-2009, 09:47 AM

jenb

11-03-2009, 09:47 AM

If you started breakfast at 169, the rise to 245 is really not that unexpected. In the future you might want to postpone eating and do a little cardio to bring your BG down to a lower starting point. Also try bolusing at least 20 minutes before you begin eating so that your insulin has a chance to kick in at about the same time the glucose from your meal is entering your system.

Jen

fgummett

11-03-2009, 10:04 AM

gary.keith

11-03-2009, 10:10 AM

That's going in the right direction :)

I'm wondering if your logging software (iPhone app?) makes allowance for Insulin On Board? Most Insulin Pumps will suggest a lower correction bolus within about 2 hours of a previous bolus; as at least some of the previous insulin is still active in your system. By simply giving the preset amount per carbs, or per BG correction, regardless of time since last bolus, you can end up with a cumulative effect of too much insulin.

I'll ask the developer about that. It makes a lot of sense so my guess is it does. But I learned long ago never to make assumptions about other people's logic.jenb;518225]If you started breakfast at 169, the rise to 245 is really not that unexpected. In the future you might want to postpone eating and do a little cardio to bring your BG down to a lower starting point. Also try bolusing at least 20 minutes before you begin eating so that your insulin has a chance to kick in at about the same time the glucose from your meal is entering your system.

Jen[/QUOTE]

For me the rise was quite dramatic. I tend to eat the same breakfast each day, at least in terms of carbs, and have never seen this high a spike before.

BG is continuing to go down. Latest number is 197.

It Ain't Over

11-03-2009, 10:23 AM

gary.keith

11-03-2009, 10:38 AM

Anytime you find and unexpected occurance of insulin resistance always be on the watch for an infection, cold, or flu starting up. This is the time of year and any of the above will cause insulin resistance.

I do have a bladder infection. I've been taking 500 mg of Cipro twice a day since last Friday. The sensations I'm experiencing haven't gotten any better so my PCP said I should see my urologist. I'm going tomorrow at noon. Still, I've never had any abnormal spikes like this after breakfast unless I eat something that I know makes me spikey like real syrup instead of Agave nectar.

195 @ 12:32 PM. Seems like it's stabilized for now, albeit still higher than I'd like it to be. But now it's almost lunchtime and another 25 units of Novolog so I'll wait instead of bolusing now.

Subby

11-03-2009, 10:49 AM

In order for any software to be ballpark on the correction, it needs ISF (insulin sensitivity or correction factor or how much one unit brings you down X mg/dl) and an awareness of all recent bolusing, such as the breakfast (IOB, and an algorythm for the particular insulin to predict the remaining effect at a given moment in time. Hopefully finetuned to your body, based on a different set of observations).

Usually one would not correct 2 hours after a meal, as even if the BG is high, that may be a variation in the way the insulin and food is still nuking it out, insulin action will still be in progress, and food action may or may not be about to run out. I don't think my pump (which of course takes ISF, IOB into account) would suggest much at all within 2 hours if I put 250 mg/dl or so into it, given a high carb meal (meaning a lot of insulin used). It conservatively and safely recognises that the remaining insulin may in fact be enough to return me to normal or close to normal in the future.

By "safely" I don't mean it's right: I mean that as far as a prediction from a machine with limited information, it's the safest suggestion. The previous bolus might bring me down a little later: a full correction without insulin on board considered could effectively double or triple the required insulin in me and land me in very hot water.

The exception is when you really know what is going on, what went wrong, and you can really predict strongly what a dose is likely to be doing. As in, after a lot of observation of the particular foods and corrections, and knowing why a meal might have stuffed up.

I actually also wonder if another possibility is you had slow absorption on the shot, letting the carbs get a jump start. Unfortunately injections can just vary sometimes, depending what exact type of of flesh you hit.

howdysf

11-03-2009, 11:33 AM

25 units of novolog seems like an awful lot!

gary.keith

11-03-2009, 11:54 AM

25 units of novolog seems like an awful lot!

As I understand it, my body is still fighting the urge to have normal BG, so it still takes a lot of insulin to get the desired results. I'm just under four weeks into this journey when I was DXed with a BG of 1,240.

I had an almost no-carb lunch. Salad with red onions, grape tomatoes, broccoli florets, this really good (Walden Farms) no fat, no carb, no sugar, no cholesterol dressing I found in the produce section of the supermarket, and a quarter chicken chunked and tossed in.

Before lunch I bolused 5 units Novolog instead of the prescribed 25 units. One hour PP BG is 122. I'm happy again!

I'm glad I took everyone's advice here and waited on the bolus when BG was 245.

jenb

11-03-2009, 12:06 PM

That is true Jen but for some if the morning raise is DP, it can tend to keep raising until we eat... D seems to get us coming and going ;) As ever the answer seems to be testing for yourself and establishing repeatable patterns that work for you.

Oooh, that DP is really a nasty beast. I'm subject to it too, and try to hit it at 6:15 a.m. with a little half unit bolus before it can get going. The food intake thing is more a T2 difficulty?

The more I know about diabetes, the more I know I don't know!!!

Jen

gary.keith

11-03-2009, 01:23 PM

Two hour PP was 80.

Lunch was just six grams of carbs so perhaps 5 units of Novolog was a bit.

I'm still testing every 30 minutes.

Jen, yep so far DP has been my only ongoing battle that I can't seem to win. Right now I'm stuck between two options that I can see. First is keeping something slightly carby on my nightstand and have that as soon as I wake up. Second is bolusing a small amount to cover it until breakfast.

rededmcm

11-03-2009, 01:44 PM

"Using Insulin" by Walsh(available from Amazon) was very helpful to me when I started using insulin.It shows how to determine
correct bolus and basal insulin doses.You have to count carbs
and let that determine the bolus units for each meal.Keeping
carbs low will require less bolus insulin.
Good luck
Eddie

gary.keith

11-03-2009, 02:14 PM

jenb

11-03-2009, 02:38 PM

Two hour PP was 80.

Jen, yep so far DP has been my only ongoing battle that I can't seem to win. Right now I'm stuck between two options that I can see. First is keeping something slightly carby on my nightstand and have that as soon as I wake up. Second is bolusing a small amount to cover it until breakfast.

If you can identifiy when your DP starts, a small bolus really does the trick. I did a lot of testing starting at about 3:00 a.m. and continuing hourly until the mystery was solved. It turns out that somewhere between 6:30 and 7:00 a.m. is my "witching hour". I do a 1/2 unit bolus at 6:15 a.m. no matter what my BG is at that time (unless it's high already - then I also correct). This keeps me in the 75 to 90 range before breakfast most of the time.

By the way.."Using Insulin" is a great book. I've referred to it many times, and use it to this day.

Jen

chucklejeff

11-03-2009, 02:38 PM

Hi, Gary -
I am new to this group, but not to diabetes. There is something called insulin resistance which means your body just kinda gives up when sugars have been high for awhile. It just means that your body isn't utilizing the insulin very well at all. My encounters with insulin resistance produce exactly the symptoms you are describing. The ONLY thing I have found to "reset" my ability to utilize insulin, other than an extended period of normal sugars, is VIGOROUS excercise. I'll play basketball or ultimate and that has ALWAYS snapped me back. Moderate exercise, however, has not---at least for me.

One note of caution: the tendency is to keep pouring more insulin into the problem. When I have done so, it has sort of been like this: isn't working...isn't working...isn't working...oops, the floodgates just opened and I'm way low. So if you do pour insulin on the problem, please be sure to test frequently. But try some vigorous exercise. It works for me 100% of the time and it's not a bad thing, in general.

If you do try that, let us know how it goes.

Warm regards,
-jeff

I tested my BG this morning upon awakening and it was, as usual, slightly high at 147. So I bolused 3 units of Novolog.

Yes, I know I said I'd wait before doing this on my own, but it's my body and my life and if the endo doesn't like it that's her problem!

An hour later I tested again and my BG was up to 169. At that point I was ready for breakfast so I bolused my prescribed 25 units of Novolog and proceeded to make breakfast. Half a cup of hot rolled oats with a tablespoon of Agave nectar. Two scrambled egg beaters. In all a 67 carb breakfast. Note to self: we really need a lower carb breakfast.

An hour later I checked my BG again and it was 245! That's never happened before.

And so here I sit wondering what I should do. I'm thinking about an 11 unit bolus of Novolog, which is what my logging software is recommending.

I know you folks can't tell me what to do. So how about I ask what would you do in a situation like this?

jer.lawrence

11-03-2009, 02:53 PM

This is probably a stupid question, but is Novolog fast acting? I thought the Novorapid (or something) was the fast acting insulin.

Sorry if I'm butting in unnecessarily. :)

Edit: I just googled it, so, double-ignore me. :)

dbaratta

11-03-2009, 03:24 PM

And so here I sit wondering what I should do. I'm thinking about an 11 unit bolus of Novolog, which is what my logging software is recommending.

I know you folks can't tell me what to do. So how about I ask what would you do in a situation like this?

Next time try a big glass of water with your meal. Sounds silly but sometimes with me instead of taking more insulin I drink water and it helps bring the numbers down. I learned that from my dietition.

dbaratta

11-03-2009, 03:25 PM

Subby

11-04-2009, 03:53 AM

Novolog and Novorapid = exactly the same, just different marketing terms. These are one rapid acting, the current alternatives are Humalog and Apidra.

Gary, glad you got through it all ok. Enjoy the John Walsh book, it will really inform.

gary.keith

11-04-2009, 08:47 AM

If you can identifiy when your DP starts, a small bolus really does the trick.

I was going to follow your suggestion last night, but it was a full moon so nothing went right! ;) I went to bed high at about 11:30pm, bolused a few units to try and cover it, fell asleep so I couldn't check if the bolus worked, woke up at about 3:30am with BG at 145, woke up again at 9:15am with BG at 172. Clearly I missed the onset of DP so I'll try again tonight.

The ONLY thing I have found to "reset" my ability to utilize insulin, other than an extended period of normal sugars, is VIGOROUS excercise.

I miss being able to exercise. I'm out of the game for now awaiting a new right hip because I seriously injured it many years ago in a rock climbing accident and now it's to the point that even walking more than a hundred yards or so is painful.

Next time try a big glass of water with your meal. Sounds silly but sometimes with me instead of taking more insulin I drink water and it helps bring the numbers down. I learned that from my dietition.

I drink a bit over two liters of water a day. Should I increase it? Or perhaps just drink more when I see that my numbers are high?

gary.keith

11-04-2009, 09:27 AM

Sometimes I wonder why I bother trying to do all the right things.

Pre-breakfast BG was 172. Bolused the prescribed 25 units of Novolog. Had the same 67 carb breakfast as yesterday. Two hour PP is 230!

New day, same old same old. :(

jenb

11-04-2009, 09:28 AM

I was going to follow your suggestion last night, but it was a full moon so nothing went right! ;) I went to bed high at about 11:30pm, bolused a few units to try and cover it, fell asleep so I couldn't check if the bolus worked, woke up at about 3:30am with BG at 145, woke up again at 9:15am with BG at 172. Clearly I missed the onset of DP so I'll try again tonight.

The past few days I've been waking up very high (115-120) and have been totally frustrated. It was tempting to blame it on the full moon, but I finally realized today that the change from daylight savings has me sleeping an hour later (duh!) and I've missed my comfortable little pre-DP window. So many details, so little brain power:D .

Jen

foxl

11-04-2009, 09:31 AM

Pre-breakfast BG was 172. Bolused the prescribed 25 units of Novolog. Had the same 67 carb breakfast as yesterday. Two hour PP is 230!

New day, same old same old. :(

That is a lot of carbs, especially if you are already high. Can you try lowering it to see what happens?

fgummett

11-04-2009, 09:35 AM

Especially a lot of carbs for breakfast... many seem to report find a different tolerance to carbs throughout the day, with early morning being the worst.

I suggest you do a web search on "Dr Bernstein's Law of Small Numbers" (you can even read it online for free, gratis and for nuthin'!)... unless you want more roller coaster rides like yesterday ;)

GretchO

11-04-2009, 09:41 AM

This is coming from a T1 so a slightly different ballgame, but I find when i go high like that I also start becoming insulin resistent...if i'm that high i wait to eat, or don't eat carby. On top of that, breakfast is the hardest time of the day for me to cover carbs. Even small amounts take a larger bolus. If I were 172 in the morning I'd have to do a correction and wait it out sans food. It can be such a frustratingly difficult game to play, I feel for you!

gary.keith

11-04-2009, 09:42 AM

The past few days I've been waking up very high (115-120) and have been totally frustrated. It was tempting to blame it on the full moon, but I finally realized today that the change from daylight savings has me sleeping an hour later (duh!) and I've missed my comfortable little pre-DP window. So many details, so little brain power:D. Jen

This seemed to start when we made the switch, so maybe that's the problem for me, too. I'm sleeping until 9am now instead of only until 8am. Which means I'm taking my morning bolus an hour later too. Hopefully I can get back to a normal sleep schedule soon.

That is a lot of carbs, especially if you are already high. Can you try lowering it to see what happens?
Especially a lot of carbs for breakfast...

I agree, but it's endo-approved. Still, tomorrow I'll try some extra Egg Beaters and skip the carby stuff like rolled oats or waffles.

foxl

11-04-2009, 09:45 AM

I totally understand as a T1, and heck even for the "rest" of us (I am a 1.5 rilly), "endo-approved." Mine told me 40 per meal though and I am like nuh-uh, no WAY. It might be the only way she would prescribe insulin for me ... ;) so maybe someday?

Subby

11-04-2009, 09:45 AM

If you started breakfast at 169, the rise to 245 is really not that unexpected.
Jen

This point got a little lost somehow but it's central. This 2 hour spike you are reporting isn't all that unusual for a high carb meal.

Yes, you may not like that spike of about 50 (I don't like to see that spike much either). But what takes your BG so high overall, is that you are jumping off from a high pre meal place already. So while you can (and I think should) look into modifying your meal and bolus somewhat, to notch that pp spike down - the biggest or most obvious problem is that you are 170 before breakfast. That needs to be addressed.

For the spike - two suggestions I have is lower carbs (and probably lower dosage - what is very hard to say - full I:C dosaging is I think mandatory if you do want to nail your BGs better), and to prebolus.

For the pre meal high - well, tackling DP can be tricky. Baring a pump, sounds like the trick of taking some rapid acting before the spike runs away, might be a tactic to try. There is a lot of discussion to be had about trying things to combat DP.

fgummett

11-04-2009, 09:45 AM

I agree, but it's endo-approved. Still, tomorrow I'll try some extra Egg Beaters and skip the carby stuff like rolled oats or waffles.You may also need less insulin if eating fewer carbs... again check out the "small numbers" idea... you may find that smaller inputs lead to more predictable outcomes.

Granny Shanny

11-04-2009, 09:53 AM

Penny made a suggestion the other day that makes sense to me . . . she keeps one clock that is never switched to/from DST, and that is "her" clock to go by for meds/injections.

And Gary's endo's approval would carry a lot more weight if he/she were diabetic him/herself! Sometimes the book learnin' doesn't help us much . . . :( :( :(

jenb

11-04-2009, 09:59 AM

I agree, but it's endo-approved. Still, tomorrow I'll try some extra Egg Beaters and skip the carby stuff like rolled oats or waffles.

As you gain experience with this you'll find that sometimes advice from your doctor doesn't jibe with your real world experience. The Endo is a member of your team, but you're the captain!

To lower the carb content of your breakfast try replacing the starchy carbs with a serving of something like blackberries and strawberries. You can eat a pretty generous serving of these and still come in with under 10 net carbs, and a limited BG spike.

Jen

gary.keith

11-04-2009, 03:44 PM

Thanks again, everyone. The main problem, is, I think, my horrible DP spikes. I'm going to make a concerted effort to keep my BG under control the rest of the day so I have a good starting point at bedtime from which to see when the DP starts.

Unforunately I went a bit hypo (69) this afternoon after a pre-bolus and then running out of time to eat enough carbs. I had to swallow some glucose gel in the dentist's chair. Two hours later I'm stable at 91.

Anyway, point taken about either more insulin or less carbs at breakfast. I have my Using Insulin book now so I'm sure it'll be lots easier. I've been looking for strawberries and blueberries but haven't been able to find any the last few weeks.

Shanny, I'll give the dual clock thing a try, but honestly, my mind doesn't work that way. I can't easily fool myself into thinking the time is different. I guess I've spent too many years as a programmer. ;)

gary.keith

11-04-2009, 09:09 PM

After this morning's DP fiasco, and this afternoon's lunch plunge into hypo territory, I seem to have rebounded quite nicely.

I dropped to a BG of 69 after lunch. Swallowed half a tube of glucose gel and about two hours later I was back in normal range with a BG of 91. Two hours later it was 101. Before dinner I bolused 19 units of Novolog then ate a dinner with 58 grams of carbs. One hour PP BG was just 130. Two hour PP was back down to 113. Three hour PP was still 113.

So tonite I'm going to try getting up regularly so I can see when the DP spike starts and stop it in its tracks!

I'm two chapters into Using Insulin and it's great! Thanks to everyone who recommended it to me. I'll be a know it all before you know it! :laugh:

gary.keith

11-05-2009, 07:36 AM

I didn't manage to wake up throughut the night to check my BG. Sleeping thru the night without awakening was quite unusual for me. Perhaps it's because my BG at bedtime was in my normal range at 88 instead of being slightly high. I woke up at 6am, checked my BG and it was 101. I took a chance that this was the start of my DP spike and bolused 4 units of NovoLog. Then I fell back to sleep until 9:00am. BG at 9:00am was 96. Normally it's well into the high range by now. It's currently 9:30am so I'll check it again in half an hour.

It seems like my body woke me up at just the right time to catch the spike. I'll keep testing this over the next few nights to confirm what I suspect.

Granny Shanny

11-05-2009, 07:44 AM

Great start on your day, Gary!

Dunno about you, but I love it when I waken & realize I've slept straight through! That's really sleepin'! :D :D :D

Subby

11-05-2009, 07:52 AM

Unforunately I went a bit hypo (69) this afternoon after a pre-bolus and then running out of time to eat enough carbs. I had to swallow some glucose gel in the dentist's chair. Two hours later I'm stable at 91.

The dentist is something special for an insulin dependent diabetic, I think. If I haven't checked my BG recently, about 20 min in, what with the strange stress and weird feelings, I invariably want to stop everything and take a BG test. Of course, that's often not so easy. I always check just as I sit down.

Anyway, the prebolus thing, you obviously have to make sure you follow it up. I would suggest never prebulosing if you are rushed or otherwise have a chance just to miss your food. This could be life and death stuff, if for example you prebolus a decent amount, forget and go driving.

I think it's one of those things that will slowly get shuffled in your head as automatically top priority. Prebolus - must eat in x minutes, like an iron clad chain, no thing in this world can interrupt that. It will come to you, but be careful.

gary.keith

11-05-2009, 08:10 AM

Great start on your day, Gary!

Dunno about you, but I love it when I waken & realize I've slept straight through! That's really sleepin'! :D :D :D

Same here, Shanny. I feel lots more rested than usual.

Now for the bad news... It seems I didn't catch the DP spike after all! I took a shower, just checked my BG again, and it's up to 136! I haven't eaten anything, haven't even swallowed all my morning meds. I dunno, maybe I need an early and later bolus to cover DP.

Now I don't know if I should wait until the pre-breakfast bolus or try something now. I think I'll just wait because I've done enough experimenting for one morning.

The dentist is something special for an insulin dependent diabetic, I think. If I haven't checked my BG recently, about 20 min in, what with the strange stress and weird feelings, I invariably want to stop everything and take a BG test. Of course, that's often not so easy. I always check just as I sit down.

Anyway, the prebolus thing, you obviously have to make sure you follow it up. I would suggest never prebulosing if you are rushed or otherwise have a chance just to miss your food. This could be life and death stuff, if for example you prebolus a decent amount, forget and go driving.

I think it's one of those things that will slowly get shuffled in your head as automatically top priority. Prebolus - must eat in x minutes, like an iron clad chain, no thing in this world can interrupt that. It will come to you, but be careful.

Thanks, Subby. I'm also sure it'll all get sorted out in my mind given some more time. I sometimes forget I'm a bit more than a month into this adventure and barely three weeks out of hospital.

You raise an interesting point about the dentist. Every time I've been there since being diagnosed, that's three times so far, I've gone hypo within 20-40 minutes. I have no fear of the dentist and all his whirring, hissing gadgets. So I doubt stress is the reason. Still, it is an interesting coincidence.

Subby

11-05-2009, 08:16 AM

fgummett

11-05-2009, 08:21 AM

I've experienced similar where a stressful situation has lowered my BG... I figured it has something to do with extra brain cycles using up BG (it can be a real energy hog) together with tension in muscles. Perhaps similar to moderate activity/exercise?

gary.keith

11-05-2009, 08:23 AM

Gary, it's interesting to consider that for some people, some stress appears to lower their BG, contrary to the usual scenario of stress releasing hormones, glucagon and shutting down insulin receptors in the cells (thus causing IR and highs).

I do hear you that you don't feel stressed at the dentist (and am jealous). I guess whatever is going on, you are getting a profile to act on next time at the dentist. It may be co-incidence, but you can always experiement if you wish. You could try a small medium term carb snack vefore the dentist, without bolus (something that should have some effect, but won't shoot you up dangerously) and see if that gets you through the visit intact BG wise.

Next time you go to dentist bring your mp3 player along and crank up the volume. Music is my pacifier. Always has been. I can block out anything external when I've got music blasting in my ears! I've worked out some hand signals my dentist can use to let me know what he wants me to do. Tap on the right shoulder and I turn my head right. Opposite with the left shoulder. He runs his finger down my chest to open my mouth. Up it to close my mouth. When I bite his finger it means I want him to stop! :D

What would you consider a medium term carb snack?

I've experienced similar where a stressful situation has lowered my BG... I figured it has something to do with extra brain cycles using up BG (it can be a real energy hog) together with tension in muscles. Perhaps similar to moderate activity/exercise?

Good point on both your parts about stress sometimes causing BG to go down. I doubt that was the case at the dentist, but it could easily explain it in other scenarios.

Subby

11-05-2009, 08:50 AM

Next time you go to dentist bring your mp3 player along and crank up the volume. Music is my pacifier. Always has been. I can block out anything external when I've got music blasting in my ears! I've worked out some hand signals my dentist can use to let me know what he wants me to do. Tap on the right shoulder and I turn my head right. Opposite with the left shoulder. He runs his finger down my chest to open my mouth. Up it to close my mouth. When I bite his finger it means I want him to stop! :D

What would you consider a medium term carb snack?

Well done on getting yourself a trained dentist there ;) Luckily, the dentist doesn't actually stress me that much or ruin my BG, it's just a not so common mix of loss bodily of freedom, with certain physical stresses and sensations I often associate with going low, that precipitates me wanting to check my BG "just in case".

I recently did need to keep going back, and it was starting to get on my nerves. I will keep the mp3 player idea in mind if I am blessed with too many dentist visits...

A medium term moderate carb snack... hard to say specifics as we are all different. I guess in this scenario of wanting some upward action over the next 30 min - 1 hour, half a piece of moderate spiking fruit might be suitable, or a relatively low GI couple of biscuits. If you find out what raises you say 30 or 40 mg/dl over the course of an hour, without continuing into trouble land, that would seem to be a good basis to try. I'd suspect about 20g carbs, but we are again all different. Such snacks may also be helpful in the case of certain exercises, when the presence of insulin that normally keeps you even (your basal and remaining boluses), is in some circumstances going to cause persistant lows as you exercise... and the way to deal with that may be to snack the right amount of mid-range carbs to keep your BG up over a period of time.

gary.keith

11-05-2009, 09:18 AM

A medium term moderate carb snack... hard to say specifics as we are all different. I guess in this scenario of wanting some upward action over the next 30 min - 1 hour, half a piece of moderate spiking fruit might be suitable, or a relatively low GI couple of biscuits. If you find out what raises you say 30 or 40 mg/dl over the course of an hour, without continuing into trouble land, that would seem to be a good basis to try. I'd suspect about 20g carbs, but we are again all different. Such snacks may also be helpful in the case of certain exercises, when the presence of insulin that normally keeps you even (your basal and remaining boluses), is in some circumstances going to cause persistant lows as you exercise... and the way to deal with that may be to snack the right amount of mid-range carbs to keep your BG up over a period of time.

A half dozen grapes will send my BG up 30-40 points in about an hour and it usually stops there. Not sure why I don't carry grapes in the go-pack I take with me whenever I leave the house. Am I correct in assuming grapes are a better option than a tube (15g carbs) of glucose gel?

Subby

11-05-2009, 09:21 AM

I think it's safe to say it depends on what you are using them for. For a hypo fix, you want the fastest carbs for your body, and glucose tabs/gel/whatever are a sure and safe bet. For the purpose of a strategic snack to prevent a future downward movement of BG, or to combat continuing downward movement on the BG... that's when the "medium term" carbs would be preferable, providing energy at a more suitable and sustained rate as the body may need it.

gary.keith

11-05-2009, 09:41 AM

Got it, I think. If I'm already hypo use the gel. Eat some grapes to stall a downward trend and prevent me from going hypo. That seems so sensible when I look at it, and yet it wasn't immediately obvious to me until you said it. Thanks again!

fgummett

11-05-2009, 09:46 AM

Seems to me that stability is preferable to managing highs and lows... did you look into that law of small numbers yet ;)

Subby

11-05-2009, 09:51 AM

Seems to me that stability is preferable to managing highs and lows...

I assume your comment is meant to be relevant here as far as using energy intake to avoid lows from enhanced basal action at times of stress or exercise. Please elaborate on how this is an undesirable or discardable "managing highs and lows" as opposed to the concept of "stability".

fgummett

11-05-2009, 09:54 AM

I assume your comment is meant to be relevant here as far as avoiding lows from enhanced basal action at times of stress or exercise. Please elaborate on how this is an unpreferable "managing highs and lows" as opposed to the concept of "stability".I was responding to what I read as Gary's realisation, just above, that it was perhaps better to take the medium carbs and avoid a low, than carry glucose gel to treat one... while of course, still being prepared for either eventuality.