Hypos happen, and you need to be prepared. When a hypo hits, have a strategy you can implement readily. Your Hypo Plan should be simple and easy to remember when your blood glucose drops and your brain gets foggy. Having a plan of attack will help you recover faster, feel better, and prevent rebound hyperglycaemia in the hours after. There are five important things to consider as you develop your Hypo Plan: Fast-acting hypo treatment Let me answer this one for you - glucose tablets! Glucose tablets have either 1 gram or 4 grams of carbohydrates, so you can take a controlled amount, which helps you to avoid overtreatment rebound highs. I recommend you use glucose tablets over lollies, soft drinks or other ‘treat’ foods. Lollies, such as jellybeans, can get stuck in teeth and cause dental caries, and treat foods can be easy to overeat. Stick to plain glucose if you can – it rinses away more easily than a lolly does, and nobody wants to eat any more of those sweet, chalky tablets than they have to! How much carbohydrate should I eat? The guidelines recommend 15 grams of rapid-acting carbohydrate to treat a blood glucose of less than 4mmol/L, but many people find the amount they actually need depends on the blood glucose level they catch their low at, and how fast they’re dropping. Determining the right amount of glucose to treat the level of hypoglycaemia takes practise and experience. Consider recording your lows and how high you spike after a 15 gram treatment - after you’ve recovered of course! This will help you find patterns and adjust the amount you take, with the goal of avoiding rebound highs. Everyone is different – some of my patients rarely need much more than 4-6 grams of glucose to treat lows, and others need significantly more. Hold on tight The tough part about hypos is that your brain is signalling ‘EMERGENCY - EAT ALL THE FOOD, NOW!’, and it’s easy to devour the contents of the whole pantry before you know what’s happened! This is why I recommend treating with glucose instead of food - it’ll help keep you away from the pantry or fridge. When a big hypo hits, treat it with an adequate amount of glucose, sit down away from the kitchen, and breathe. Let your family or partner know what’s happening and ask them to help you hang in and resist the urge to eat everything in sight. Wait ten minutes, and test. If you’re still low, treat again with glucose – if you’re not, then you just got through a hypo with far less risk of a rebound high that if you smashed the packet of biscuits that was open in the pantry. Well done. Follow-up snacks Remember being told to follow up hypo treatment with a glass of milk or half a sandwich? Although many people no longer follow this advice, the follow-up snack still has a place in certain situations. For mild hypoglycaemia that is treated with enough glucose, a follow-up snack can result in hyperglycaemia. But if a hypo happens before bed, during the night, or prior to/during exercise, then a follow-up snack may be advisable. Another situation may be stubborn hypoglycaemia, where blood glucose levels just won’t remain above 4mmol/L, despite repeated rapid-acting glucose treatments. What’s in my kit? Living with type 1 means always carrying hypo treatment. Don’t get caught out! Have hypo treatment in the car, at the office, in your pocket when you’re out for a run and in every backpack/handbag you use. Leave a pack on the hall table or on a hook near the front door as a reminder to take it with you on the way out. You can’t always predict a hypo, but having easily accessible treatment on hand will keep you safe. Better hypo treatment leads to better diabetes management. For help developing your Hypo Plan or for any other diabetes questions, contact Amy at the Family Centre.
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