Recommended hypo treatment?

Hi, I live with T1 Diabetes and have for the last 44 years. I’m using a Tandem Control IQ and Dexcom G6 sensor. My challenge is severe night time hypos. I thought I was winning as I havent had any for a month, unfortunately not.
I had a hypo in the night, 1.7 in bg readings, usually OJ sorts out hypos at that time, not today. 1 pkt of jelly babies, 2 OJ cartons & 2 glucojuice and still I continued to drop. Would glucogen have been a better option?

Any advice would be gratefully received before I get another one, thanks.

Hi @Scrumpyjack65. I’ve had Type1 for nearly 60 years and have found that some of my old “tried and true” methods don’t work as well as they used to. The key word may be “old.” I’m not a medical professional and didn’t do well in science but I have a pet theory that the body - well my body - is changing with age and I have to adapt, and either my age or the method itself just doesn’t do as well - not just for diabetes but life in general. I’ll give the non-medically-proven analogy of antibiotics: you take them if got need them but at the same time taking the same one too much can cause your body to develop a resistance.
So try something you haven’t used, or used much. In the forum I’ve read some people find milk is fast and effective. I like Clif Bloks gels - they’re made for athletes so you can find them at a sporting goods store, or if course on Amazon. I’ve always hated the texture of glucose tabs but I really like these - personal preference. There are similar gels at the grocery store but I haven’t tried them.
If you’re having continuing issues you may need to look at adjusting your basal rate for that time period - those need to be tweaked now and then anyway.
I consider glucagon the treatment of last resort as it is a shock to the system and is meant for use when someone is unconscious or so combative you can’t get them to eat or drink anything.
My nutritionist recommended yogurt as a good option to keep numbers stable overnight and I’m sure yours can give other suggestions for prevention - which of course is preferable.
There were some conversations about treating lows where got may find other successful snacks. All the best to you.

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Hi @Scrumpyjack65 I’m a little behind you and Dorie here with only 42 years treating T1 but I just call those a “stubborn low” when they happen to me. Most unexplained stubborn lows, for me, means I’ve somehow depleted my liver of glycogen (sugar stored in the liver). When that happens, I need huge amounts of glucose because I’m fighting the low bs as well as what I call “recharging my liver”. This can be attributed to many things like adrenaline, which causes your liver to dump a little glycogen, or sometimes a long slow decline in blood sugar where my liver is supplementing blood sugar but slowly running out. Long distance runners call this empty liver thing “ Hitting the Wall” during a long run or marathon. When their glycogen stores run out their blood sugar plummets and they become unable to continue.

Glucagon works by causing your liver to dump all of its sugar. If your liver is already out of glycogen, glucagon will not be particularly helpful.

Glucose works fast. Mixed fats (chocolate covered nuts) mixed fiber(oranges) and mixed fat and protein (cliff bars) are more of a slow release long acting sugar. If I’m very low I always go for glucose.

I can’t use my CGM for figuring out when my sugar is coming up because it’s too slow. I always switch to finger sticks to verify the low and to verify when I am coming back up.

You did good. You are still alive. Happy New Year. Cheers and good luck :four_leaf_clover:

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Sally @Scrumpyjack65 , it looks as if only long-termers are looking in today; I’m just halfway [as of today] through my 65th year using insulin.

@Joe gave a much more concise summary than I might have written of the science of what you have experienced and Dori @wadawabbit correctly points out that as our bodies age we find what had worked in the past might not now work as well. My usual “fix”, especially during late evening for this situation, which occurs when I’ve had extraordinary strenuous activity earlier that depleted the liver store of glycogen, is to do a quick mental calculation of carbs I need to eat and immediately ingest about half that value in fastest available, and then follow with slower acting carbs with long-lasting glycemic effect - plus a small margin so I won’t be awakened through the night.

That said, and I’m NOT a licensed medical advisor, may I suggest that you revalidate your basal rates and food/carb ratios AND your insulin sensitivity/correction factor as those “little bits” appear to me to change more rapidly as I age; I have used Control IQ since the month it was released to the public. Your ISF may be the lead culprit as it is the prime factor used to auto-correct CIQ basal rates and correction bolus. It is important to note that ISF changes during the course of 24 hours, and is rather simple to determine and validate; with CIQ I have four different correction factors each day, ranging from 1:75 to 1:100. Yes, my body has become much more sensitive to insulin during the last 15 - 20 years/

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Robert Osthues T1D 66+ yrs. All these comments are true for those making them. This is an individual disease. When I hear a low at night, I just get a small glass of juice COCKTAIL, that word says they “enhanced” it with sugar, works great, but not too much. The above comments on aging, for me it was the vaccine, tripled my insulin requirements. To whomever mentioned vitamins B1 and B7, thanks, now, insulin requirements are only about 2.5 times pre-vaccine levels, every bit helps. I also have the random insulin antibody condition, makes all this a bit more challenging.

Hi! Less experienced diabetic here with only 17 years under my belt but I find that different things work better for me at different levels and this is usually how it goes:

Hard candy works best for me if I’m borderline hypo or barely hypo for me that’s 65-75. I need this more when I don’t really have insulin on board.

I have to do liquid if I’m 55 or below otherwise it takes a little too long for me. I always do gatorade or apple juice. I don’t know why but my body responds weird to OJ. Apple juice hits me asap and oj sometimes does but sometimes doesn’t and then I need more and will shoot up super high.

If I’m not officially low yet but in the high 70s low 80s, and am trending in that direction and I have a decent amount of insulin on board I do skim milk like Dorie said. Usually it hits me quick enough to prevent the low and then has enough protein to keep me up as my bolus continues to do it’s thing.

Sometimes this all works great and then there’s other days where my diabetes likes to test me and then other things work better like randomly a banana, cuties, grapes, gluc tabs, skittles or fruit snack work better. I just try to roll with it and on days I have a ton of lows, I adjust both my IC and basal for that day until the sensitivity dies down.

A little over 30 years here.

Juice or soda is usually the best option if you haven’t eaten recently and need to get back on track quickly. The point is that it’s sugar that’s already dissolved in liquid. So you take that, don’t eat anything else, and wait for it to kick in. Then you can follow up with more solid options to keep you from going low again.

Some people use glucose tablets. They’ll dissolve quickly enough when you chew them and let your saliva do its job. I never quite got the point of that, though, when you could have candy instead.

Personally, I always keep a Snickers bar handy. It’s my favorite candy, and it’s rare in that it has a mix of simple sugar, complex carbs, fat, and protein. It’s pretty much guaranteed to get your sugar up and keep it there for a couple of hours.

As others have said, see what works for you. The body does change, and some people digest certain things better than others. A common example being lactose intolerance. Some people develop it early or are born with it, but most people lose the ability to digest lactose as they get older. So milk will work great for most kids, but is likely to be less helpful for an old-timer.

The question, though, is why are you getting these lows, and what can you do to prevent them? That’s something to discuss with your endo. You may need a bedtime snack. Or to change your nighttime delivery profile. A less aggressive correction factor may be necessary. Or a higher target BG. Are you putting your pump in sleep mode when you go to bed? That gives it more room to adjust the basal rate while keeping it from giving correction boluses.

Hi @Tee25 . You may have “only” 17 Type1 years under your belt but you’ve made some excellent observations. When I was growing up with diabetes my parents were told to give me orange juice to treat lows, so juices (or sodas) have been my typical go-tos for a quick “pick-me-up” - although they no longer work as well. Aside from eating a meal a little early or having a substantial snack of a low was just starting to come on, it never occurred to me to change my treatment based on how low I got.
I’m impressed by your finding different treatments work at different ranges: was that “calculated” find or did you discover it by accident?

Kind of a little trial and error and some observations!

With my dex over the last year and then paying extra close attention to my low treatments last year since I was going through weight loss I was able to document it a lot and just kind of noticed patterns throughout that!

I was shocked to find that 15 grams of carbs for most of my lows was complete overkill and explained the years of rebound highs I had after lows. so once I realized that I just tried experimenting with things I knew had a set amount of carbs and just tried different things at different levels!

Very well done - I’m impressed!

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Snickers worked for m last night. It’s my go-to for sure.