How Many Hypo's Is Too Many?

Janetoby

Member
Messages
21
Type of diabetes
Type 1
Hi Circuspony, I find that my BSL can drop really really quickly when I am doing something I really enjoy, even if it is with little physical exercise. This might apply to your feeding your horses - it is an enjoyable time for you despite the manure! I'm not sure if I just become more relaxed and this triggers the BSL drop? Any one else have ideas on this? I have not read about it anywhere else.
 

Keith_Simpson

Active Member
Messages
31
Type of diabetes
Type 2
What do you guys think? Hypo's are just an unfortunate inevitability of being a diabetic but how many is too many before you should think about switching up your insulin and/or speaking to your doctor or DSN?

In the last 3 months I've become more insulin sensitive, I think due to starting to exercise again, and have been adjusting my insulins, both basal and bolus. I was on 18 units for basal a night, then moved to 16, then 14 and now 12 and my bolus to carbs ratio has moved up especially for my lunch and dinner in the last few weeks where I seem to need less insulin than I would for my breakfast even if the carbs are the same.

Anyway, how many hypo's a week is too many do you think? I'm probably having like 6/7/8 a week the last 3 weeks maybe and this is very different for me. The most I've been having since diagnosis probably. I used to have like a couple a month, although that was when my diabetes wasn't as well controlled. Not poorly controlled just my hba1c was probably like 55ish whereas now it is closer to 40 I would guess.
The more closely you monitor the less likly to have a hypo but that won't be encouraged by the GP because of the cost & so it probably means buying extra test strips. The difference between morning & other times of day is because the liver starts to dump glucose when you haven't eaten for around 8 hours & so typically breakfast requires more units.
 

tim2000s

Expert
Retired Moderator
Messages
8,934
Type of diabetes
Type 1
Treatment type
Other
Novorapid seems to have a very long profile with me. I am very insulin sensitive and often hypo around 5:30pm when I start giving my horses their evening feed (think of it like 30 mins of gardening - there are wheelbarrows and manure involved!!). I will have injected around 1 for lunch & likely have been running high all afternoon and can fall from 13 to hypo in 30 mins.
It has a long profile in everyone. People are just mistaken in thinking that it only lasts for 3 hours. Nearly all the fast acting insulin has a half life of around 55 minutes, which means it gets down to practically less than 1% being active in about 7 hours. Very few people are really aware how long the tail is and as a result, most people's insulin dosing doesn't account for rapid and long acting insulins correctly.

We can see that in a healthy individual during a 10 day fast. Glucose can drop below 3 mmol (~60 mg/dl) but there is sufficient ketones to keep the brain from shutting down. That is why those on ketogenic diet are able to function with much lower glucose levels.
Agreed, however, short term studies don't clearly tell you what the impact on hypo symptoms are in the long term, which is the real concern about running low levels for long periods, whether cognitively functioning or not.

So... if they discourage a moderate degree of ketosis in TIDs are dietitians, DSN and doctors making TIDs more susceptible to hypoglycaemic brain damage??
No. There have been studies in monkeys showing that levels need to get REALLY REALLY low before brain damage occurs. Brain cells and synapses aren't damaged until glucose levels drop down below 1.1 mmols for long periods (5-6 hours).
 

evilclive

Well-Known Member
Messages
464
Type of diabetes
Type 1
Treatment type
Insulin
No. There have been studies in monkeys showing that levels need to get REALLY REALLY low before brain damage occurs. Brain cells and synapses aren't damaged until glucose levels drop down below 1.1 mmols for long periods (5-6 hours).

Got any references to hand for that? Looks good news.
 

Circuspony

Well-Known Member
Messages
959
Type of diabetes
Type 1
Treatment type
Insulin
It has a long profile in everyone. People are just mistaken in thinking that it only lasts for 3 hours. Nearly all the fast acting insulin has a half life of around 55 minutes, which means it gets down to practically less than 1% being active in about 7 hours. Very few people are really aware how long the tail is.

That would explain my afternoon problems - effectively a build up in my system from breakfast / 2nd breakfast and lunch.
 

cassie091

Active Member
Messages
39
Type of diabetes
Type 1
Treatment type
Insulin
I have suffered severe night time hypos coming round on the floor and wondering where the hell I am. It takes a while for me to realise I am hypo. I am usually able to find the glucose tablets that I keep in various places in my bedroom. I consume about 3 and drag myself into bed to recover. I am usually soaking wet but unable to do anything about that for probably half an hour. Since I have been using the Libre I do not have as many but I find it difficult to predict what will happen during the night. The same number of carbs, the same insulin dosage, the same BG reading before I go to bed can result in a hypo, or an elevated BG or a stable BG in the morning. Don't understand why this should vary. Diabetes consultant has prescribed a different long-acting insulin. I am waiting for it to be prescribed by my GP and will be interested to see whether it stabilizes my night-time BGs.
 

lollyann1

Well-Known Member
Messages
141
Type of diabetes
Type 1
Treatment type
Insulin
What do you guys think? Hypo's are just an unfortunate inevitability of being a diabetic but how many is too many before you should think about switching up your insulin and/or speaking to your doctor or DSN?

In the last 3 months I've become more insulin sensitive, I think due to starting to exercise again, and have been adjusting my insulins, both basal and bolus. I was on 18 units for basal a night, then moved to 16, then 14 and now 12 and my bolus to carbs ratio has moved up especially for my lunch and dinner in the last few weeks where I seem to need less insulin than I would for my breakfast even if the carbs are the same.

Anyway, how many hypo's a week is too many do you think? I'm probably having like 6/7/8 a week the last 3 weeks maybe and this is very different for me. The most I've been having since diagnosis probably. I used to have like a couple a month, although that was when my diabetes wasn't as well controlled. Not poorly controlled just my hba1c was probably like 55ish whereas now it is closer to 40 I would guess.


Hi

I am T1 on Novorapid and have about 1 Hypo a month.
 

evilclive

Well-Known Member
Messages
464
Type of diabetes
Type 1
Treatment type
Insulin
I have suffered severe night time hypos coming round on the floor and wondering where the hell I am. It takes a while for me to realise I am hypo. I am usually able to find the glucose tablets that I keep in various places in my bedroom. I consume about 3 and drag myself into bed to recover. I am usually soaking wet but unable to do anything about that for probably half an hour. Since I have been using the Libre I do not have as many but I find it difficult to predict what will happen during the night. The same number of carbs, the same insulin dosage, the same BG reading before I go to bed can result in a hypo, or an elevated BG or a stable BG in the morning. Don't understand why this should vary. Diabetes consultant has prescribed a different long-acting insulin. I am waiting for it to be prescribed by my GP and will be interested to see whether it stabilizes my night-time BGs.

Miaomiao (or blucon) on your libre + mobile phone = alarms to catch this. It's solved my night time hypo problem.
 

Sideburnt

Well-Known Member
Messages
106
Type of diabetes
Type 1
Treatment type
Insulin
That is because they consider only the glucose component and not the ketones.

Our brain function with glucose AND ketones. So if ketones avoidance is the main strategy, then there will be no ketones available when glucose drops too low. That is when diabetic coma typcially happens.

We can see that in a healthy individual during a 10 day fast. Glucose can drop below 3 mmol (~60 mg/dl) but there is sufficient ketones to keep the brain from shutting down. That is why those on ketogenic diet are able to function with much lower glucose levels.

This is a really good point, there's also a big difference between being under 3mmol/l feeling low but otherwise still able to help oneself and being incoherent and unable to do anything to help yourself. Perhaps this is another benefit of Low Carb. Not banging on that drum again, but I've been incredibly low felt physically terrible and still able to think coherently if not lightheaded.