Sarah Howard
Sarah Howard has worked in the diabetes research field ever since she was diagnosed with T1D while in college in May 2013. Since then, she has worked for various diabetes organizations, focusing on research, advocacy, and community-building efforts for people with T1D and their loved ones. Sarah is currently the Senior Marketing Manager at T1D Exchange.
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When treating a low (i.e, less than 70 mg/dl) how often do you over treat, resulting in high blood glucose levels? Cancel reply
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I’ve been T1D for over 30 years, and it used to happen entirely too often. I have it down to a science now, unless I wake up with a bad-feeling low.
Many times but not always. I may cancel insulin delivery for awhile or switch to a lesser basal rate. Take a little juice and monitor my glucose levels.
Often but the pump makes corrections if I over correct.
Sometimes, but rarely unless I don’t catch it in time. Used to be more frequent before I was on CGM with alert alarms and self-adjusting pump.
In the old days when still on MDI of Regular and UltraLente or Lantus my endocrinologist instructed me to take 2 to 5 units of Reg insulin after a BG < 70 to counteract a high rebound from happening. Amount of rebound insulin depended on how much below 70 the BG level got.
Why I have to check my insulin on board which is wrong I make my own adjustments. Can’t do it solely on CGM except for emergency quick fix. Then must use the blood glucose monitor several times and react to what’s going on.
i watch the freestyle libre numbers, but they are delayed. I treat and wait to see what the numbers are in 10-15 minutes. Sometimes I have untreated, sometimes I have overtreated. Being a T1D with fluctuations 24/7/365 is still quite a mystery. If I am going to be driving somewhere, I make sure the arrow is horizontal or going upwards.
Sometimes when I treat it’s like y digestion is at a standstill or something. There’s no increase in BG, so I’ll treat again. (Sometimes multiple times). And then it’s like my body is “oh, ya…I should do something about this sugar that has been ingested” and I’ll go up (sometimes to a “good” number and sometimes way higher than I’d like)
That’s exactly what happens to me!
Often because of gastro paresis.
Formulas, heuristics, CIQ? They’re all thrown out the window. Without at least SOME degree of digestive certainty, (and speed), you just hope like the dickens that the orange juice, apply juice, pineapple juice work some kind of a miracle and get absorbed immediately.
This waiting for the digestive nerve to decide to act is for the birds. ¯\_( ͡🔥 益 ͡🔥)_/¯
If it doesn’t recover in 15 minutes and I have obligations.
I said rarely because I have made a continuing effort to treat with 15-20 gram of sugar as juice and wait for a response. I am not perfect, but that helps- a fast and generally predictable response. I try not to eat to correct- then I over do it. Having CGM then a control IQ system has helped, because it warns me and try to avert lows, so that when they occur, they tend to be less severe and easier to treat. None of this is perfect, but it is much better than I was doing 15-20 years ago. I started Dexcom CGM in Aug 2006. I can divide my life into 3 periods- pre diabetes (8 years), T1D pre cgm (38 years), and T1D post CGM (15 and counting)…
I did better before the closed loop system. With it, I see a lot of extended lows, Ie 15 carbs wait 15 minutes, but when it is 1 am and your spouse is punching you to make it stop, you tend to wake up with a bg of 200+.
If I am near the kitchen and eat, it will go high. I try to just do the glucose tablets and I know how to bring it up. I also set the Dexcom CGM at a fake calibration of 85 BGs. Then it won’t alarm me again. In 15 minutes it will be 85 so that is fine.
I tend to over eat/treat when my bg is <60, or it doesn’t rise (by finger stick, not my Dex). I have hypo unawareness but will sometimes get symptoms-that’s when it’s hard to not overreact too.
Much depends on when and where I experience or am warned of a low. Glucose tabs are much slower than a swig of regular Coke. If I’m concerned about others reaction to the CGM alarm I’ll go for the quick fix, and then pay the price of dealing with the resultant high. If I’m home I try to stick to the approved 15 g carbs/wait 15 minutes.
Rarely these days. Aven when it was more common I’d kick myself because I’d end up feeling sick for hours. Once the symptoms have kicked in do have to fight that sensation of panic that is part of the physiological response- even though my brain knows better.
Gastroparesis slows the digestive reaction. If my CGM IS SENDIBG alarms and I’m out and/ or going to be driving, I will overshoot it for safety reasons. But now — pay later safely at home.
Depends more on activity level or stress. Treating a low while at work is different than treating a low at home.
My desired range is between 75 and 120. I consider high and will treat above 120 unless it is flat. So quite often a treatment of a low will result in what I consider to be a high. I always shoot for 100.
Many times it will go straight up after waiting quite a while for my food correction to act at all.
when it happens I always overtreat because I hate the shaking, sweating and all the other debilitating symptoms of hypoglycemia so much that I panic treat.
I do too. I hate the impending doom feeling.
Yes exactly me too
Waiting is SO hard!! =8/
I said often. Often suspend basal, eat or v overeat snack/s, an gunshy to bolus until I see CGM climbing, forget and then end up high. Had 68 overnight last night and did pretty good with a temp basal of 0% for 1hr + small pouch of fruit snacks at my hubby’s insistence. Woken again by triple arrow rise alarm at 158 and bolused for half the carbs and came down to a steady 96 for c the rest of the night.
I should mention that I’m on the Medtronic 670G. I exit automode the week before my period because my BGs run higher then tend run low the few days after. My diabetes nurse advised I do so since the Medtronic algorithm adjusts based on a running average of the last 6 days, so explained these unusual days would throw off my calculations more than help. However, when I exit automode, the 670G seems to require that I manually turn the auto suspend feature back on. If I’d remembered to do that, I probably could have avoided the low mentioned above.
I wish the 670G would default to my pre-programmed auto suspend settings when I exit or get kicked out of automode.
If I am not being active, I many times just take one glucose tab (4 grams of carbs) as 15 carbs will shoot my sugar way too high if am not currently exercising. I wait at least 30 minutes instead of the 15 minutes if not exercising because sometimes it takes a little longer for the sugar to rise but if I take another glucose tab after the first 15 minutes then the sugar will be too high as the first glucose tab kicks in and because the basal rate was suspended for awhile which causes the sugar to rise.
I have learned that it takes very little to correct a low because I’m very sensitive to carbs. I treat with a glass of milk, or only 6-8 skittles if I’m away from home. Sometimes I don’t treat at all and just let me pump suspension treat it before I go low and so t have to worry about lows as much.
I don’t treat until it’s <60. I don't really feel symptoms until <50. Part of that is my 45+ years as Type 1 and part of it is my low A1c, <6, and part of it is my lack of concern for hypo until I sometimes have symptoms. Then when I do, I sometimes overtreat – mainly because I have some gastroparesis, which means that digestion of even simple carbs is slower than it used to be.
Sometimes I feel that I just can't "get it right".
It’s incredibly disconcerting when the BG continues on a downward trajectory… so, when it’s below 70, I will often take more glucose than the regularly suggested 15 mg. Once the BG levels out, and I know the BG is finally turning around and heading upwards, I will take sufficient insulin to cover the excess glucose taken. Rarely does my BG go high afterward. (The benefits of using a pump and a CGM)
Years ago I hit upon a handy tip for dealing with an attack of the Hyposaurus Rex. It was one of those 3am ones. I hate glucose tabs, so a shakily made my way into the kitchen to see if I could find something more palatable. I mean, might as well take the opportunity, right? There was some honey in the pantry, right next to a jar of peanut butter. A lightbulb went off in my hypo-befuddled head. Cuz the problem is the terrible impulse to keep eating SOMETHING even though you know you’ve had enough. And here’s the thing: PB is pretty low carb, goes great with a dollop of honey (high carb obvsly) on top, and it’s bulky and pasty and resists being eaten very quickly. So it slows you down and satisfies the urge to keep shoving food in your mouth long enough for the honey to work.
Brilliant! Thanks for the idea!
I consider iob, how low bg is and the direction it’s been and where it’s heading (via pump➡️)but some times I miscalculate.😥
I chose often, because control iq often corrects my treatments now. My BG may be low, going low or crashing and I will have some soda or tablets and then ten-twenty minutes later my pump is delivering insulin for a sugar high above 180 that is going to disappear on its own quickly.
I tend to overeat a lot when I get low, I’m hungry and I just keep eating until the low symptoms go away
In recent years I have been following the recommended 15 – 15. However, 15 grams is often too many carbs and I end up with a high blood glucose reading afterwards.
Like others, it depends how low I’m heading and how panicky I feel. I’ve had times when I couldn’t stop myself, knew I was over-treating & took extra insulin shortly after!
My days are consumed with caregiving an elderly relative, talking to doctors and hospitals (for my husband, myself and my relative). I often over-correct in trying to get my BG quickly back to normal so as to not make mistakes in care decisions. I just add a correction bolus to cover the ‘mistake’.