Taking insulin is tricky. First you don’t have enough, and then suddenly… ohgodgivemeallthefoodintheworldnow!
Hypos, in spite of their binge-y nature, are not very much fun at all. You’re weak, shaky, and your brain is telling you that eating quickly is the only thing you’ve been put on the earth to do. The problem is this often leads to over-treating them.
Supposedly, you only need 15g – 20g of carbohydrate to treat one. But in reality this means you need 15g – 20g of carbohydrate, 15 minutes for your blood sugar get back up to normal, and the will power of an Olympic athlete to stop yourself from eating any more.
15g – 20g of carbohydrate is only 60 – 80 calories. If you over-treat it by a few hundred calories (easily done depending on the food you eat), and have a couple of minor hypos in a week you can easily see how you might take in and extra 1000 calories a week. That doesn’t sound like a lot perhaps, but if you estimate that one pound of body fat is anywhere around 3500 calories, then a couple of over-treated hypos a week could lead to you gaining about a pound a month.
Putting on weight isn’t great for you physically and psychologically as a diabetic it can send you to a dark place – where you have feelings of being out of control.
So my advice is – think ahead! Have a Strategy and some Tactics.
Your Strategy should be to avoid hypos. Easier said than done, I know, but regular measuring and puzzling out glucose changes should help you get a rough understanding that you can gradually make more accurate.
Your Tactics might be different - experiment! - but mine include:
Being prepared. I have something sweet on me all the time. That way, I’m never in a tricky situation, desperate, and so willing to eat anything to raise your glucose.
Choose my weapon. I pick only fast acting, (preferably low fat) foods and drinks to treat a hypo. Things that I find are good and practical (they don’t go off quickly and you can find out how many carbs are in them) include: Jelly Babies, Marshmallows, Crunchy bars, glucose gels (Lucozade, GSF, SIS or other sports gels), and Cadbury’s Creme Eggs (only for home use – they can crack and leave you with sticky pockets…)I try to avoid things like biscuits and milk chocolate: they tend to work slowly so can lead you to over-treat.
Timing. If I’m going a little hypo before a meal I try treat it first with quick-acting carbohydrate rather than account for it in the dosage for my main meal. It tends to work out better this way for my sugar levels (though this isn’t always practical).
In-correction. If I go a bit high after a hypo (i.e. around 13 mmol/L), I accept it as normal. The liver realises (a bit late…) that something was wrong and releases a lot of glucose into the blood stream.
The weird thing is that this glucose seems to have a ‘use it or lose it’ tag attached to it. If I take enough to correct for the full amount, I find I’ll probably end up going hypo again a couple of hours later.
I don’t correct if it’s ‘only’ 13, but just take my normal dosage at the next meal. I find my glucose goes back to normal after that.
If it does go higher than 13, I try only correcting a bit (perhaps take only one unit of insulin) so that I feel comfortable, and then take the normal dosage at the next meal.
If you're looking for more advice like this, why not check out Joe's Rough Guide to Diabetes?
How do you treat your hypos?
Have you got a favourite food for it?
Are there any tips you’ve got to make sure you don’t over-treat?