Pushing a Hypo

[baz1191]

Hello everyone, I'm new on here and pretty much newly diagnosed with Type 1 DM (Feb 2014). At first i was put on novamix but was all over the place, now i am on Novarapid and Glargine.

Just looking for a bit of advice on a few things, first, the honeymoon period... I have heard of it but I have no idea what it is, how long it lasts and how would I know if I'm in or out of it???

Also, I am trying to work out my carbs to insulin units, and also my correction unit levels but I have had a few hypo's (lowest about 1.9 mmol)

I'm just wondering if I can push a Hypo to see if my liver kicks in (like it should) and releases glucose to get me out of it... I know as a T1 diabetic my pancreas is nackered, but its the Liver that's supposed to respond to a low blood sugar...will it work? And how low do you go before coma?

 

[noblehead]

Honeymoon period can last weeks, months or years in some incidences. As for carb counting and working out ratio's, take a look at the following:

http://www.bdec-e-learning.com/

As for pushing a hypo, if you do be prepared and keep fast-acting glucose to hand, personally I wouldn't bother and would prefer to stay safe, seems silly and pointless to push things to a point where you might lose all control.

 

[Emmotha]

I wouldn't push it, as a 1.9 is well into a hypo! You need fat acting sugar to brig u back up, ur liver won't be able to respond fast enough!

Have u been on the DAFNE course yet?

 

[baz1191]

I wouldn't push it, as a 1.9 is well into a hypo! You need fat acting sugar to brig u back up, ur liver won't be able to respond fast enough!

Have u been on the DAFNE course yet?

No, they have advised it, have you been on it? I sort of know how to work out carbs to units and am doing carb counting anyway... is there much more you learn on the course?

 

[Emmotha]

Well I've just done it and like u I was having hypos. I realised my carbs ratio was wrong and rather than 1:10 I'm actually 1:22!
Might be worth doing

 

[Ambersilva]

Definitely do not delay in treating a hypo in the hope that your liver will rescue the hypo. It will not. As soon as you know you are heading for a hypo deal with it with fast acting glucose. The last thing you want is to risk going into a coma which in itself can cause damage to your body.

The honeymoon period is when your pancreas decides to kick in which results in messing with your blood sugars and the need to reduce insulin doses..

 

[baz1191]

Thanks Noblehead, I will have a look at that... probably won't push it, because it does get to the point where I don't know what I am doing and cant help myself.
Just wondered what other peoples experiences of it are.....
I would never inject way more than I need to purposely put myself in a hypo, but if I did get in one by accident i'd like to know if my body could pull out of it, I think it depends on how much you injected like Emmotha says, your liver don't get chance to respond if you inject too much.

 

[noblehead]

No, they have advised it, have you been on it? I sort of know how to work out carbs to units and am doing carb counting anyway... is there much more you learn on the course?

Loads, get your name down for the course.

 

[noblehead]

Thanks Noblehead, I will have a look at that... probably won't push it, because it does get to the point where I don't know what I am doing and cant help myself.
Just wondered what other peoples experiences of it are.....
I would never inject way more than I need to purposely put myself in a hypo, but if I did get in one by accident i'd like to know if my body could pull out of it, I think it depends on how much you injected like Emmotha says, your liver don't get chance to respond if you inject too much.

I'm assuming your newly diagnosed Baz. Believe me you'll get your fair share of hypo's over time so there's no need to try this experiment and put yourself in danger (to drop levels where you may lose unconsciousness). When I was first diagnosed they wouldn't let you out of hospital until you had your first hypo, if you didn't have one they would induce it, but all was done under medical supervision.

 

[baz1191]

Definitely do not delay in treating a hypo in the hope that your liver will rescue the hypo. It will not. As soon as you know you are heading for a hypo deal with it with fast acting glucose. The last thing you want is to risk going into a coma which in itself can cause damage to your body.

The honeymoon period is when your pancreas decides to kick in which results in messing with your blood sugars and the need to reduce insulin doses..

Preview
I am new to all this so I really appreciate the fact you taken time to answer my question. I do treat a hypo ASAP, but I usually have them at work. My boss doesn't understand it and is asking me to do things but I am shaking and cant concentrate and its like a panic attack, I have to run off because I lose all concentration. It makes me embarrassed, coz if I say I am having a low blood sugar, he looks at me like ...'what?'
Don't think he knows what it is, its hard to explain when it happening. lol

 

[Miss90]

Don't push a hypo... I had a nasty one in my sleep last year - I was fitting and eventually fell unconscious - I have no recollection but my poor mother was absolutely terrified!!!!
1.9 is well into a hypo so always treat on the onset!!!!

 

[moz1]

Do the DAFNE course it is brilliant and they will help set the correct ratios etc for you and help with carb counting. Your brain cannot function on a bg of less than 1 so you are risking damage to this vital organ. Also having those around you witness you fitting then going into a coma is not nice so would not advise pushing a hypo. Sorry to be blunt but hypos can be life threatening!

 

[Emmotha]

Definitely speak to your boss when you are feeling ok. Let him know the risks and that you have to have sugar on you all the time and that you need regular breaks to check ur blood sugar.
Does your work have an HR or Occupational Health department?

 

[SamJB]

Hi Baz,
Take a look at this thread, which explains why you shouldn't push a hypo: http://www.diabetes.co.uk/forum/threads/diabetic-coma-hypo.65649/

Regarding carb to insulin dose calculation, this requires experimentation. Do it for low quantities of carbs because there's up to 20% error on nutritional labels and a 30% variance in the amount of insulin that enters your bloodstream. Also, do it when your levels are in single figures as there's a 15% error in the reading on you BG meter, so you will get less accurate numbers the higher your levels. Finally, don't be an insulin hero, be conservative when you start experimenting, you don't want a hypo! Test before and two hours after.

So try it for a nice round figure of carbs, 20g would be good and a BG level of 6/7/8 is good.

 

[jack412]

till you get on your course this may help, the basal test and workbook 2 especially

This set of workbooks are worth reading and practising working examples of carbs and doses and corrections
Don't change dose without nurse approval
Workbook 1
http://www.diabetesinscotland.org.uk/Publications/9225 Carbohydrate Counting.pdf
Workbook 2
http://www.diabetesinscotland.org.uk/Publications/9226 Carbohydrate Counting the Next Steps.pdf

Carb list
http://www.diabetesinscotland.org.uk/Publications/9227 Carbohydrate Tables A6.pdf

Diary
http://www.diabetesinscotland.org.uk/Publications/9228 Free Diary Portrait A4.pdf

Basal testing
http://www.diabetes-support.org.uk/info/?page_id=120

Sick day rules
http://www.diabetes-support.org.uk/info/?page_id=141
http://www.diabetes-healthnet.ac.uk...flet_-_Sick_Day_Rules_for_Type_1_-_Nov_13.pdf

Sick day rules flowchart
http://www.leicestershirediabetes.org.uk/uploads//documents/Type1 Sick_day_rules_InsulinV3.pdf

A workbook with USA numbers and math rules, but it has a good trouble shoot at the end
http://www.bd.com/us/diabetes/download/insulin_adjustment_workbook_complete.pdf

 

[Ambersilva]

Preview
I am new to all this so I really appreciate the fact you taken time to answer my question. I do treat a hypo ASAP, but I usually have them at work. My boss doesn't understand it and is asking me to do things but I am shaking and cant concentrate and its like a panic attack, I have to run off because I lose all concentration. It makes me embarrassed, coz if I say I am having a low blood sugar, he looks at me like ...'what?'
Don't think he knows what it is, its hard to explain when it happening. lol

Good morning @bz1191,

On work days it may be a good idea to inject less insulin by one or two units to cover your breakfast and other meals during the day. Keep reducing the bolus until you manage to achieve a blood glucose level that prevents a hypo. Non work days provide an opportunity to test your basal insulin by missing breakfast and testing blood sugar to see whether your basal is correct. Our friend @jack412 has provided a link for basal testing.

Always carry your quick acting hypo rescue stuff in your pocket so that you can treat a hypo at the very first sign of the hypo. I wonder whether @jack412 knows of any links that you could show your boss to explain how diabetes affects staff with diabetes and how the boss can support your needs.

 

[alaska]

In theory, the body should respond to low sugar levels by releasing glucagon which stimulates the liver to release glucose into the blood.

However, those of us on insulin need to consider another factor which is that we take insulin and insulin can inhibits glucagon, preventing glucagon from doing its job of raising blood sugar levels.

I don't know how much insulin is needed to have inhibitory effects on glucagon but I assume that the more insulin we have circulating, the more of an inhibitory effect it'll have.

Please note baz that running your sugars too low for extended periods of time could cause you to lose your hypo signs putting you at much greater risk of severe hypos (these are not pleasant!). Also, if you're driver, definitely do not leave hypos untreated as losing hypo awareness means losing your licence and could also lead to killing someone on the road if a hypo whilst driving happens.

Few bosses understand the problems we type 1s have. Make sure your boss knows that testing and treating the hypo is on their interests as much as yours. It only takes a couple of minutes and the Equality Act should ensure that you're not discriminated against for properly managing your diabetes.

All the best
Ed

 

[novorapidboi26]

I haven't intentionally pushed a hypo, but it has happened on quite a few occasions now over the last few years...........

your liver should kick in, however I only recently discovered that the alpha cells ability to alert the liver may become less efficient over time due to the lack of communication with the beta cells, so in fact, after many years of diagnosis, your liver may not be as alert as you may have hoped....

15 years down the line, mine seems responsive, but it much better to be safe and treat your lows as normal.........