12 Hypoglycemia: Targets/Goals Unable to recognize & verbalize lows: >80Able to recognize & verbalize lows: >70Pregnancy: >60<10% of readings below target at each time of dayNo severe lows
13 Hypoglycemia Prevention Strategies 1. Insulin Program Setup (background/basal)
14 Hypoglycemia Prevention Strategies 1. Insulin Program Setup (background/basal)
15 Hypoglycemia Prevention Strategies 1. Insulin Program Setup (background/basal)
16 Hypoglycemia Prevention Strategies 1. Insulin Program Setup (background/basal)
17 Hypoglycemia Prevention Strategies 1. Insulin Program Setup (background/basal)
18 Hypoglycemia Prevention Strategies 1b. Insulin Program Setup (Meal/Bolus)
19 Hypoglycemia Prevention Strategies 2. Meal/Snack TimingMajor issue w/a.m. NPH/LenteMinor issue w/Lantus or UltralenteNot usually an issue with pump use
20 Hypoglycemia Prevention Strategies 3. Proper Correction Doses1500-Rule (aggressive)1800-Rule (conservative)(Total Daily Ins.)/1500 or 1800May vary day vs. night(nighttime often 50% more than day)
21 Hypoglycemia Prevention Strategies 4. Proper Meal/Bolus DosesI:C Ratio that matches pre-meal BG 3-4 hours (not 2!) after eatingI:C Ratio often varies from meal to meal(bkfst dose > lunch & dinner)
22 Hypoglycemia Prevention Strategies 5. Account For “Unused” Insulin*Time sincemeal insulin 1 Hr2 Hrs3 Hrs4 HrsConservative Approach70% left40% left10% left0% leftAggressive Approach67% left33% left* Newer pumps figure this automaticallybased on the insulin duration you set.
23 Hypoglycemia Prevention Strategies 5. Account For “Unused” InsulinExample:Gave 6.0 units at 7pm, BG 200 at 9pm.Conservative approach: 40% remaining (6 x .4) = 2.4 units leftAggressive approach: 33% remaining (6 x .33) = 2 units leftSubtract the unused insulin from your usual correction dose!
24 Hypoglycemia Prevention Strategies 6. Carb Counting AccuracyProper Portion MeasurementLook Up Unknown / Restaurant FoodsUse Carb FactorsSubtract 100% of FiberSubtract 50% of Sugar Alcohols
25 Hypoglycemia Prevention Strategies 7. Extend Meal Insulin When NecessaryUse When:Portions are very largeMeal is prolongedFood is low-glycemic index (pasta, legumes, dairy…)Apply Via:Square/Dual/Extended/Combo bolus on pumpDelayed or Split bolus on injections
26 Hypoglycemia Prevention Strategies 8. Adjustment for Physical ActivityExercise, recreation, chores: all count!Reduce meal insulin (25%, 33%, 50%) for after-meal activitySnack prior to after/between meal activityLower long-acting/basal insulin prior to and during prolonged activity
27 Hypoglycemia Prevention Strategies 8. Watch Out for D’OH!(Delayed Onset Hypoglycemia)Following High-Intensity ExerciseFollowing Extended Duration ActivityMay Occur Up to 24 Hours AfterAdjustments to food and insulin may be necessary
28 Hypoglycemia Prevention Strategies 9. Adjustment for AlcoholAlcohol reduces the liver’s output of glucose and masks hypoglycemic symptomsDelayed BG drops can occurDecrease basal insulin (or overnight long-acting insulin) after drinking
32 Hypoglycemia Prevention Strategies 11. Recording & AnalysisReview every 7-10 daysLook for patterns> 10% below target given timeLows during/post-activityLows on School/Work vs. off-dayLows Post-Menstrual
33 Hypoglycemia Prevention Strategies 12. CaffeineHelps reduce risk of nighttime hypoglycemia, but not daytimeBenefit seen with 4 cups of coffee per day (250 mg caffeine twice daily)WILL YOU SLEEP???
35 Hypoglycemia Treatment Use of Glycemic IndexLower GI foods digest & convert to glucose more slowlyHigh-fiber slower than lowHi-fat slower than lowSolids slower than liquidsCold foods slower than hotType of sugar/starch affects GI
36 Hypoglycemia Treatment Use of Glycemic Index (contd)