I understand that Dr. B recommends dextrose tabs for first-wave treatment of hypos, but what do you have after that?

I am trying to follow a fairly strict interpretation of a "clean" low carb diet (kind of Paleo/Bernstein) to get my BG's under control and to lose weight. I've gotten almost all of the sugary, starchy, carby stuff out of my house (there wasn't much left, but still).

I realize that I have plenty of emergency gels and dextrose tablets on-hand for hypos, but what am I going to eat for the second wave of treatment, after I get the initial boost from the dextrose? I don't want to go flying off my diet by keeping a bunch of tempting junk in the house, but I also don't want to sit there yo-yo-ing up and down on dextrose tabs all night in the event of a miscalculation or unforeseen drop in my insulin resistance, either (this happens sometimes a day or two after strenuous exercise.) I do have a bunch of emergency Ensure (in case of the flu or an earthquake) but...yuck.

In the past I would have made a sandwich, grabbed a stack of crackers with cheese or microwaved starchy leftovers. I guess I could keep some plain canned yams on hand or something like that, but that seems kind of brutal at 1:30 in the morning.

Any ideas on moderate carb snacks that are Bernstein approved for treating hypos, preferably with a Paleo spin, i.e. no bread, pasta, peanut butter or yogurt?

All I can think of are starchy vegetables like pumpkin, but how do you make pumpkin snack-worthy in a hurry?!? Just heat it up with a pinch of salt? I guess I could do that.


Tags: Bernstein, Paleo, hypoglycemia

Views: 125

Replies to This Discussion

I'm not sure what you mean by second wave. i use jelly beans (not a choice for you) until my BG's at target. Don't understand why anything else is needed. Once BG is where it should be, there's no need to eat anything. If you continue to drop, more glucose not anything starchy.

After BG is back up, I eat a small amount of protein, either cheese or nuts, to keep it stable. I usually go with cheese since it's hard for me not to pig out on nuts.
Hey JeanV:
What type of insulin dosage do you use? Needles or pump? When I was on needles, I would have the second low blood sugars (sometimes). If that be the case ... it was a watch game. But always followed with protein, & a little fat.

Now that I use a pump ... the jelly beans (Gerri's suggestion) & protein is a good trick.

I remember the 911 calls & the perimedics would refer to the "dual wave" as a "low blood sugar rebound."
Yes, I'm on shots -- once the Lantus is in, it's in. There's no getting away from it until it wears off or the insulin resistance kicks back in to its "normal" level.

I've seen this happen every time I try to eat better and walk more, at some point I can't keep ahead of the insulin resistance remission and the Lantus is too much -- boom, hypo -- but usually not while I'm exercising. It hits later, perhaps 24 to 48 hours after a "big" walk. I can't really predict it because it doesn't happen at a predictable time after a predictable amount of exercise. I think there's a certain amount of hormonal voodoo in the mix, as I also have PCOS and I'm in the late stages of perimenopause.

I think it's important to work to improve my insulin resistance, but now that I'm injecting insulin, it's challenging to keep up with the weird, unpredictable fluctuations in insulin resistance in relation to long-acting insulin. When I went down to 36 and couldn't move, I was on Lantus only, a dose that had been keeping me a bit too high for weeks up until that hypo. Then I improved my diet and started walking a bit more and one morning I'm sitting at my desk, checking my e-mail, still in my bed-clothes, an hour after injecting my usual Lantus (half my daily split dose) and...BLAMO...36 mg/dl and unable to move.
Lantus--ugh. I had staggering Lantus lows.
That's what I meant, the cheese/nuts stabilization phase of your hypo treatment.

I've been told by several docs (and the EMS guys who treated my hypo where I couldn't use my arms or legs) that after the glucose phase (raise it immediately) one needs a second phase of something to eat that will keep it from dropping again -- I'm T2, remember, so I could get a second drop from whatever caused the first drop, e.g. an unplanned for, temporary remission of my insulin resistance while I still have, temporarily, "way too much" Lantus on-board. Or I might have injected too much Novolog (this would be true of any diabetic, insulin resistant or not). I want to go back to sleep, not sit up all night testing and eating dextrose tabs every 30 minutes.

The more I read these boards, Gerri, the more I realize that treating T2 with insulin is very different from treating T1. My body doesn't just respond to insulin/food the way a T1 body responds to insulin/food unless that T1 has some pretty severe insulin resistance, too (a T3...?)

If I have a hypo, it's often because of something I did 24 to 48 hours earlier, and it lasts for a while (several hours). It's not a quick-fix thing; it's a ride that wave to shore thing. What I've done up till now (if the hypo is at night) is just eat way too much higher-carb food so I could get off the roller and get some sleep. I don't know what else to do.
I can only answer as T1, but I believe that glucose followed by protein would also work for you. I've had lows that continued to drop, but just continue to take more glucose until stable. Too easy to overtreat eating something too carby & ending up high. We've all been there.

How low is low? .

One of many things I learned the hard way is to ignore the 15-15 guideline because 15 glucose grams can be too much & it can take longer than 15 minutes to know the full effect. Another thing is that healthcare people would always rather see us high.
OK, so next time I wake up shaking, sweating and 52 or 53, I'll take a few glucose tabs (4 grams of carb each) and test again in 5 minutes (I can't stand waiting). If it's going up, I'll test again in 15 minutes and in the meantime, resist the urge to eat the world. If it's above 70 and rising, I'll eat some protein/fat (e.g. turkey roll-ups and some almonds, or some scrambled eggs with onion) and give it 15 to 30 minutes and test a few more times. If it's above 90 and sticking/rising I'll go back to sleep.

Does that sound like a plan?

However, if I'm really dropping and can't control it with this modest approach, all bets are off and I'm diving into the Ensure. :0\ Sometimes, the adrenaline just gets the best of me.
Do you know how much 1 glucose tab raises you?

Testing in five minutes won't show much & you'll be tempted to take more glucose tabs. Do your best to wait to get accurate results. This will give you an idea what to expect in the future. It can take up to an hour to see the full effect.

Yep, resisting the urge to empty the fridge is a plan, as is knowing exactly how much glucose to take:)

Tell yourself that it's just a low & you can handle it. Know it feels like an eternity waiting. Deep breaths, calming your thoughts & trying to remember the name of your second grade teacher helps.
LOL on the second grade teacher: Mrs. Duncan and she ruined my love of math for the next thirty years or so. She was scary, but in perfect hind-sight, I think she and all the other staff at my Catholic grade school were grieving pretty hard that year for President Kennedy. I took their grim faces and irritability way too personally, I'm sure.

I don't have a consistent, reliable response to x gm of carbs or to y amount of insulin. It really does vary -- wildly -- depending on my insulin resistance at any given moment. How much x gm of carbs will raise me is a roll of the dice. I just have to keep testing to see what happens.

The waiting is the hard part -- I usually am pretty strung out on adrenaline. I think I'm getting better at talking myself through one. I did much better last time than I have in the past, but it was only 63 when I caught it, so perhaps I didn't dump as much adrenaline. In fact, I'm pretty sure I didn't because I didn't sweat during this last one like I'd taken a shower in my clothes. When I was 36, 52 and 53 (previous hypos) I soaked my clothes and my hair was soaked, too.

My body thought I was being chased by a polar bear or something.

You're right that testing at 5 minutes is probably counter-productive. But if I've gone up even 1 md/dl (and not down 10!!!) then somehow I feel better. But you're right, I'm tempted to treat again right away and that is counterproductive. Oh for that perfectly accurate CGMS, eh? I'd give my whole kingdom for one of those. :0(
The problem with testing at 5 minutes and finding you've gone up 1 mg/dl is that that is well within the margin of error for the meter, and therefore doesn't mean anything. I know how hard it is to wait the 15 minutes (feels like a couple of hours, at least!), but that's about the soonest you can get a reliable result.

When I have a bad low (which is rare, now, with my CGM and LC diet), I just stretch out on the couch, and pet my cats and try to think about anything but the low. And then I get up and pace, and somehow, I make it through.

Keep on trying! :-)
Thanks, Natalie. I wish I had a cat to pet during a hypo. Or a doggie. That would probably help me calm down.

You're right about the testing. Five minutes seems like an eternity. I know I'm wasting the test strip, but waiting fifteen minutes seems impossible. Maybe I'll make it a game and give myself a prize if I can make it to fifteen. A new DVD or something.
Now THAT's an idea!! Just don't have too many lows, or your house will fill to overflowing with DVD's!!! Chuckles! Natalie ._c-




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