Timing for correcting lows

Hi, I’ve only been a T1 for a little over a year, was a T2 four years earlier and my endo said I’m in the LADA category now. I’m not confident in knowing when to actually start correcting for a low. I use a CGM, Dexcom6, and when it gets to 80 I start to feel a bit nervous and sometimes I over correct at that point. Thinking that I maybe should wait until it gets to 70 before I start correcting? Thanks for your help.

Hello @DFBB welcome to Type One Nation. The thing about using G6 as with all CGM, it your blood sugar is dropping the CGM is typically saying a higher number than your actual blood sugar. And on the way back up it’s saying a lower number than your actual blood sugar.

If I don’t have a lot of insulin on board(calculated from the last time I took insulin) then I correct below 70, if I had a lot of insulin on board (like I just had lunch) I might correct at 120, or I might add sugar at 120 if I was getting on a bicycle. so it all matters.

Work with your doctors for a good strategy. The other thing if I was 80 and dropping, I miiiight not eat 7 bags of jellybeans. Over correction is a problem too. 15 grams of carbs raises my blood sugar over 30 mg/dl points so I use that to figure out how many fast carbs I need to correct with.

You can get a book called Think Like a Pancreas it is very informative. Cheers and good luck :four_leaf_clover:

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There’s no definitive number for correcting for lows. I might be a little above 100 but if I’m going to be driving soon I’ll have a snack. If you’re feeling low and your numbers are on the lower end of the scale that’s probably a good time to consider having one. Also check your CGM to see if you’re dropping even if your numbers are normal - I’ve found that to be the case when I’m normal, high normal or even high. I may or may not level out so I keep checking and snack if necessary.
It’s tempting to over-correct so some use the 15-15 guide: take 15g of carbs, wait 15 minutes and see if you’re leveling off or rising. I was told liquids work faster than solid foods but juices cause a relatively quick rise that doesn’t stick with you so have something to help stay level - cheese/peanut butter crackers are convenient.
Think Like a Pancreas is an excellent resource.

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Hi Diane @DFBB! I have been a type 1 diabetic for about a year and a half. I correct when my cgm says 80 with a diagonal arrow down. If the arrow is straight down, I correct at 100-115. That said, I am really sensitive to carbs so I only take 5g of sugar at a time ( unless the arrow is straight down). 15 g of sugar sends me over 150 and the jump gives me a headache. I would also like to second what Joe and Dorie said. If I am staying home, or my husband is driving, I am fine with my numbers being in the 70’s and STEADY. If I am going shopping or taking the kids to the park, I need my blood sugar over 100. And Dorie is so right about the peanut butter and crackers. It keeps your blood sugar up and sticks with you. My NP recommended it to me and it really works.

@DFBB Hi Diane, and welcome to the JDRF TypeOneNation Forum! I’m not a medical provider so I won’t tell you what you should do, but I will suggest an approach based on my trial & error history.

The three members above all offered good information, especially Courtney @homeschoolingmomof5 with her advice to look at the Dexcom arrow. I’ll expand her most important tip and suggest that you look at where you have been. Do not use only the current reading AND ARROW on your G6 receiver, but also look back at the several previous “dots”; also consider how long it has been since your last meal, what you have been doing and anything else that may have influenced you body glucose level.

As an example, I just came home from 90 minutes of relaxed-moderate activities including driving. My G6 read 102 with a horizontal arrow; I ate 9 gm. carb, did not take insulin and by BGL dropped to 75 before returning to 106 within a half hour. Every on of us is different in how our body responds to insulin and a little bit of food at different time of the day - you will need to figure how your body responds. Unless you have been exercising or done something that causes a BG drop, limit the amount of carbs you use to treat.

Another thing, Keep in mind that the Dexcom G6 is a “predictive” device - it tells you where you MAY be at 20 or 30 minutes later based on data it has been gathering. Accept its prediction but weight the prediction by what you know about yourself. In the example I gave above about needing a little food at 102 was based on the fact that I had been driving for 25 minutes which often causes a BG drop; under other conditions, I will see a CGM reading of 75 and not bother eating and let my body correct itself. Yes, I’ve had decades living with diabetes and time to learn how my body “usually” reacts. In time, diabetes will become second nature to you, as natural as knowing when to breath.

@DFBB

Diane, you said you are on a CGM. Are you also on a pump? The reason is a pump, especially if you are on one that watches the CGM reports and throttles back insulin can make chasing lows a real yo-you situation ending with deeper and deeper lows.

If you are on the G6, look into alarm laddering. I will put a little collection of ideas about it at the bottom of this post. Individualize the numbers based on your report of how you feel at 80mg/dL.

The idea behind alarm laddering is, using the CGM reporting, remain situationally aware. From your cruising level, know (with first tier alert) your BG (glucose level) is starting to slide. A little later as your BG continues to slide start paying attention to the activity you are in and consider corrective activity changes. And finally, at the lowest level you select, STOP activity and treat your hypo state.

Keep in mind with a CGM the time from mouth to CGM reporting is about 20-30 minutes instead of the frequently preached 15-15 (15 grams of CHO wait 15 minutes) because in addition to traveling from the mouth to the stomach, to the liver, and out in the blood, the interstitial fluid bathing the CGM sensor wire takes another 10-15 minutes to react.

Here is what I have collected about Alarm Laddering for pumping with a software driven pump. Some will not apply. The total collection should illuminate the situation.

Alarm Laddering:

The concept of CGM (Continuous Glucose Monitor) alarm laddering can be used to keep the person with the insulin pump (PUMPER) informed of excursions from the desired range of CGM readings. This is done by using two or more pieces of software on a smartphone and the pump’s own alarm structure. For example, the Tandem X2 with CIQ software alarms at LOW of 80 mg/dL and HIGH of 200 mg/dL. Many pumpers want tighter control.

Next, there are the alarms of the Dexcom G6 CGM which are set at 70 & 200mg/dL. You can change these to help you.

Third, it is possible to add a third reporting app like SugarMate to the technology suite or software on your phone.

Now, using the customizing features of the various apps, you can set the alarms and their tones to suit your glucose management style. Watch what is happening & how CIQ is helping in the t:Connect app. Don’t fight CIQ. It is best to leave the CIQ alarms alone and note them in your ladder and consider these suggestions (these are only suggestions and should be made to suit you and the rules/laws where you live):

165mg/dL – 9.1mmol - CIQ High

150mg/dL – 8.3mmol -CGM High

135mg/dL – 7.4mmol - SugarMate High

85mg/dL – 4.8mmol - CGM Low (be aware of fall)

75mg/dL – 4.2mmol - CIQ Low (stop activity, prep to treat)

65mg/dL – 3.7mmol - SugarMate Low (treatment point watch action in t:Connect)

55mg/dL – 3.0mmol - FDA (USA) mandated PANIC Low

By having these settings, you can take appropriate action and be well informed of your CGM reporting so you can either:
[1] let CIQ deal with the drift into undesired areas, or
[2] take carefully calculated and proportional action to supplement the CIQ’s own actions dependent on the specific pump settings.

Hope this makes sense and supports your journey thru the battle with glucose.

Hi @987jaj . I often learn something new reading your posts so thank you for the material you provided on alert options/suggestions. Not to find fault by any means - you did say to use the alerts that suit you. I just wanted to say that I’ve found they can be too much of a good thing and it might be good for a “newbie” to use them both sparingly and wisely, initially with guidance from doctor as they learn what works best.
A person who is afraid of going low might choose multiple alerts, only to be frustrated if they sound at 10- or 15-point increments. My personal example: i used to use the ones notifying my that I was dropping (and rising). Our house is on a terrace, and I may be going up and down steps inside as well, which causes me to drop. Every time I walked up the terrace steps to go to my car - drop alert; coming up from the basement with laundry - drop alert… And sometimes there are going to be small changes when when you’re not doing much of anything - drop alert😬, so I turned them off, use set ones for lows and highs, and periodically peek at my pump (which is my CGM receiver) instead. Of course that’s just me - others may want or need and be able to handle the ones you listed. I would just suggest @DFBB work with her doctor to see if all are necessary or to narrow them down if necessary so she gets the advantages withoit being inundated with overwhelming interruptions.

@wadawabbit

Dorie, The concern of lows originates from a galaxy far, far, far away in the Facebook Universe. (GRIN). There a unique species strive for control using all available technology of pumps with integrated CGMs and laddered alarms to hold their BG in the window 120 or lower with situational awareness of their CGM data stream. GRIN, again.

Alarm laddering is a necessary feature and some of the species even report using the laddered alarms to annoy jurists on their lofty benches to escape what call the dreaded societal drudgery of jury duty.

Hope this fine tunes the telescope observing the alarm overload of alarm laddering.

GRIN…

Ha ha! Funny you should mention it - I’m summoned for jury duty next week. I’ve served on a jury twice before, and been called to the courthouse for consideration (only to be rejected) as well. That was before CGMs and alerts so this time I did respond that I’m “wired for sound” and might be distracting to my esteemed fellows. I guess we shall see what happens next week​:clock10::clock10::clock10:.

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Hi Jaj @987jaj this is a lot of really interesting information for programming devices, but I think you and Dorie @wadawabbit would be better off posting this under a new Topic rather than hijacking this Topic.

I believe the originator of the Topic was asking for suggestions as to when it is best to begin eating to avoid going too low.

@Dennis

The question I heard in the original post was a series of questions fumbled into one. The question I understood was, "Given I feel nervous & have concerns about when should I start correcting, either at 80 or 70?

Our gracious Diane @DFBB gave us only a sliver of information. She is a relative new comer to the world of crazy sugars in her body.
Known:
[1] She has a Dexcom G6.
Unknown:
[1] What apps does she use to support her G6 and journey?
[2] Does she manage her glycemic journey with MDI?
[3] Does she manage her glycemic journey with simple pump?
[4] Does she manage her glycemic journey with closed loop pump, like the Tandem CIQ?

Absent the information, I believe Dorie @wadawabbit and I took the proverbial bull by the horns, explained conundrum, including the consideration of the old 15/15 rescue rule not working with CGM reporting.

Enhancing the situation blossoming from the unknown facets of the question, painting all of the roads entering the intersection was the only feasible option to:
[1] support Diane’s @DFBB problem, yet
[2] at the same time assure all of the hidden considerations are addressed at a basic level, and
[3] assure Diane her plight was heard and a polyfactoral plan presented to support her decision on the optimum extraction, supporting her actions.

If I have missed the boat, please, let me know. My background tells me to think outside the box, and better yet remove all of the boxes so all options are visible when a dynamic solution is put in play and should an unexpected hurdle rear its head, it is swiftly and effortlessly incorporated into the action plan.

Thanks for your guidance. You are correct. I like to stack the deck.

jaj

All of the above is good advice. For us abandoning the 15-15 rule was a good thing. I think that’s a general, early guide just to keep you from going low. It’s great to know how much 1g of carb will raise your BG. That way, you can pretty accurately estimate how much to use to get you to your target BG. You’ll probably need a bit of a better snack, like a cracker or something to that effect to maintain after that.

For us, we look at the Dex trend and go back 15 minutes to see how fast BG is falling. That sort of tells us how fast and how aggressively to act.

With time, we’ve learned to know where things are headed based on a variety of variables, so reaction is quick with no roller coaster rides afterwards.

It’s all about cautious experimentation.

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Glad to see you making a post. Thanks for the info.

How is your child?

We’re chugging along, still learning everyday.

Still MDI, by choice, for now. Continually trying to steer my son towards a better, healthier diet. He’s a very picky eater so its not easy, but we’re making progress. We’re not necessarily aiming to live a low-carb lifestyle, just lower carbs with less processed stuff. We definitely see better numbers/lines with well balanced meals.

His A1C is in the normal range for non-diabetics, but I’ve been focusing more on improving Standard Deviation.

That’s it in a nutshell.

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I am only a few months in, when I started I was crashing all the time, then peaking.
We cut my novorapid and toujeo down, now I crash less. So all things being equal, I am comfortable at or above 70 without thinking of correcting. As the others say, it eventually depends on the bigger picture too …