What are causing these hypos

[olivk02]

My husband has had type 1 since 2008. He has had poor control, despite many attempts to lower his bg. After suffering high bg and developing neuropathy he has finally started to get his blood sugars under control. His range is set between 8 and 15 so that it's not too sudden and everything was going great, average 10 for about 6 weeks until this week. He is now having several hypos a day. He has none of the symptoms that he used to get, shaking and sweating. We have tried raising his insulin/carb ratio from 1-7 to 1-10 but he is still getting The hypos. I'm sure his carb counting is ok, we are checking and double checking everything. Could anybody help? Why are his hypos not displaying symptoms? Is it a good idea to lower his basal dose (40 units per morning) or change his insulin/ carb ratio further?

Thanks

 

[catapillar]

Hypos are caused by too much insulin. To analyse whether the hypos are related to too much basal insulin or too much bolus insulin you need to look at when the hypo are happening. If the happen within 5 hours of a bolus dose it's likely related to the bolus, if not then it might be the basal.

The speed of the drop can cause different symptoms. A more gentle decline can cause more subtle symptoms.

 

[ickihun]

@catapillar do type1s get phantom hypos like type2s? Where if after longterm highs a good meter reading still gives hypo symptoms until highs are brought down more and settled.
Hope you don't mind me asking.

 

[catapillar]

@catapillar do type1s get phantom hypos like type2s? Where if after longterm highs a good meter reading still gives hypo symptoms until highs are brought down more and settled.
Hope you don't mind me asking.

You mean "false hypos". Yes, anyone who has been high for an extended period can, and probably will, experience hypo symptoms when they aren't actually hypo. That obviously isn't what is happening to the OP though as he is getting hypo results and apparently not getting such extreme classic symptoms.

 

[ickihun]

You mean "false hypos". Yes, anyone who has been high for an extended period can, and probably will, experience hypo symptoms when they aren't actually hypo. That obviously isn't what is happening to the OP though as he is getting hypo results and apparently not getting such extreme classic symptoms.

Thanks @catapillar for clarification.

 

[olivk02]

@catapillar thank you for taking the time to reply. There's really not much pattern to the hypos some are within the 5 hours and some are not. It's made more complicated as he has insomnia because of the pain he suffers from the neuropath so I can't regularly see his bgs after a nights sleep. I'm thinking they are caused by too much long lasting insulin as his dose hasn't been changed since he started to get his readings under control. I'm worried to change this though as I know that if he starts getting high readings again then he'll get disheartened but equally I know that these hypos are damaging him. It's so complicated!

 

[catapillar]

You could do some basal testing to check to see if his basal dosage is correct for him.

Here's a guide on how to basal test - https://mysugr.com/basal-rate-testing/

 

[SimonCrox]

Hypo unawareness is probably quite common; it was thought that it related to long duration diabetes and/or autonomic neuropathy which often occurs with the regular neuropathy.
But there is good evidence that hypos make one less aware of hypos and increase risk of further hypos.
And good evidence that ageing (age over 65 years) is associated with loss of awareness.
I am sure that the advice above to check on basal dose is really important, and if awake, it would be worth checking a few 3.00 am-ish levels to see not hypo in night - often half the hypos happen at night but are not noticed.
Neuropathic pain is horrible - I guess he has gone down the vitamin D, antidepressent eg duloxetine, anti-eplieptic eg gabapentin, pregabalin, and opiate eg oxycodone, tapentadol route? There are also lidocaine plasters and capsaicin cream as topical treatments; but the treatments are not great - might make pain bearable, but often when abolished pain, unbearable drug side effects.
best wishes