Lost hypo warning signs

[cjw]

Hi all,

I have, over the last couple of months, lost my hypo warning signs. Had 2 where I blacked out at home and another when I collapsed in someones house. Plus done a few tests where it has been below 4 but no symptoms. Been Type 1 since 1975.

I do try to keep my levels low and check my BS about 4 times each day. Spoke to my DSN and she advised to reduce my insulin doses by 2 units for 3-6 months, then my warning signs will hopefully come back. I am on Humalog and Lantus.

Has anyone else had this problem and if so how did yours get fixed?

Grateful for any replies as this is quite a worry for me. Thanks.

 

[Tracey167]

Hi

Yes i have also lost my hypo awareness apparently i was told that when you have had diabetes for years this can happen. I was also told to run on high sugars but only for a couple of weeks which i did, but i still have no awareness, i have done my sugar test feeling perfectly ok and its come up at 1.8 its very worrying. Luckly for me my husband can tell by looking in my eyes if my sugars are low so usually he gives me lucuzade before anything happens. I don't about you but if my sugars do go high like over 16 for any reason i feel really terrible infact sometimes i feel worse being high than i do being low. The diabetic nurse said this is probably because my sugars are running low alot that when they do run high my body can't cope with all the sugar, i suppose it would feel the same for someone who run high sugars alot then went low. I do hope your awareness comes back good luck

Tracey167

 

[cugila]

Have a read of this link for a couple of methods for Reversing Hypoglycaemia Unawareness.

http://www.diabetes1.org/news/Reversing ... nawareness

Ken

 

[Hobs]

AM a type 2 and while I was taking metformin alone, I did not suffer any hypo. It was only when 8mgs of rosiglitazone was added ( now changed to 30mg pioglitazone) I had a few hypos and they were usually after a brisk walk when I was able. The shakes would set in with the inability to grip anything firmly and a finger test would reveal a BG of around 3 to 3.5mmol.
I lost that sensation after the beta blocker Sotalol (changed from Atenolol) was prescribed for an arrhythmia (AF) and the first I knew about was when I first injected Victoza. On day 2 I started to feel thirsty with a dry mouth, but when I went to get up from my chair, my legs struggled to take my weight. I suffer with arthritis, but I knew this was lack of muscle strength and called my wife. Only as a matter of routine when I have a 'strange' event she tested my blood and saw a 2.8 on the meter. . . .I was in the hypo state and I did not realise it.
I checked with my GP and sure enough my Sotalol can (in some people) mask a hypo. It had blocked an adrenaline surge that would have given me the shakes, but now that I know this, I check my blood at the first hint of a dry mouth and that symptom arrives around the 3.5 to 4 mark.

If your hypo warning does not return, maybe you can be aware by other symptoms such as a dry mouth or some other clue.

 

[CarbsRok]

y

 

[cjw]

Thanks for all the replies.

I didn't know that about Lantus. I asked my DSN about switching insulin but she said that wasn't the cause of it. I will look into that.
I do carb count but not sure what "basal testing" is - will look that up as well.

I am planning to test at all those times!

 

[janabelle]

Hi,
I agree with carbsrok about Lantus-no surprises there Your DSN needs educating.
You've been type-1 for a long time so you're probably aware that when synthetic human insulins were introduced in the 80s, many people lost hypo awareness. This link shows how some people were affected. http://www.mindfully.org/GE/Diabetics-Not-Told.htm
Jus

 

[roo.be]

I have been Diabetic since '73, type 1 from the start, and went on to Humalog and Glargene in the late 80's. Some years after (mid 90's) I began to loose hypo symptoms and had a couple of blackouts with no warnings similar as you describe. This freaked me out at the time as I thought something really serious was going wrong. Through extensive research I concluded that the duration of time as an insulin dependant diabetic was more likely to be a contributory factor than the insulin I was using. There are many other factors which can help to evolve this state also, Certain other medical conditions can take away hypo symptoms, also, being pregnant is a classic for negating symptoms.

What I have found though is that as time passes still further I have developed new symptoms, namely palpitations and visual weirdness! Testing before meals and 2 hours after is a good way to indicate what's going on with the insulin you're taking and of course carb counting. It's really important to know your carb to insulin ratio too. It may be that this is what needs altering. You say you've been advised to lower your dosage but not to which of your insulins. It may be your ratio is wrong and that it's only wrong at a certain time of day. Were the hypos at a similar time of day?

You're not alone in your no symptoms situation and I hope either you find a new way of recognising the onset of a hypo or a reason for the current loss of symptoms to better help you return to a safer state of being!

roo.be

 

[cjw]

That's interesting roo.be - I am not pregnant!!!

I have had 2 phantom "hypos" - was overjoyed that I thought my symptoms had come back only to check my BS and it was 9 or 10. Must admit I am finding it hard to get a stable BS now as so scared of it going low. I am now testing every 2 hours as a few have advised and have carb counted for some time - though I do make mistakes.

I was told to reduce all insulin doses by 2 units - I hadn't thought about ratios. The 3 bad ones were all lunchtime ish, 1 just before lunch where I collapsed and the other 2 early afternoon where I blacked out.

Spoken to my (very understanding and helpful) GP who has referred me back to see the diabetes professor to discuss options. Been investigating CGM which sounds good to me - anyone tried it?

I am hoping to come off Lantus as I have heard of a few side affects. (Thanks Jus!)

 

[wendyaldred]

Hi, i am on Humalog and Lantus and have been diabetic for 42 years. i told my gp about this and he told me it is because of nerve damage due to poor control. as it is your nerves that alert you to your hypos. i now find my family will tell me when i am low before i know it because i am slightly "vacant"
so if i think my sugar might be low i set myself a question (even a simple sum) and if i can do it straight away i them test my blood. If I find i am slow answering a question someone has asked me thats a sign for me as well. I hope this helps x

 

[cjw]

I guess that is possible but since HBA1Cs have been around mine have all been spot on according to the doctors. Though possibly nerve damage is possible just due to the duration of it.

 

[lisaloo]

Hello - ive also lost my signs I am waiting to see a consultant about going onto the pump as ive had it 31yrs I also do my bg many times aday and am on dafne at the moment doing 5 injections a day or more if my bloods are high then more injections they said I would get better control with the pump so I will wait and see I must say I am nervous and aprehensive about it !!!!!

Lisaloo

Hi all,

I have, over the last couple of months, lost my hypo warning signs. Had 2 where I blacked out at home and another when I collapsed in someones house. Plus done a few tests where it has been below 4 but no symptoms. Been Type 1 since 1975.

I do try to keep my levels low and check my BS about 4 times each day. Spoke to my DSN and she advised to reduce my insulin doses by 2 units for 3-6 months, then my warning signs will hopefully come back. I am on Humalog and Lantus.

Has anyone else had this problem and if so how did yours get fixed?

Grateful for any replies as this is quite a worry for me. Thanks.

 

[cjw]

Best of luck with the pump. I'll be discussing that with my consultant as well.

 

[iHs]

I guess that is possible but since HBA1Cs have been around mine have all been spot on according to the doctors. Though possibly nerve damage is possible just due to the duration of it.

Hello cjw

Believe it or not but your hba1c is more or less comparible with a non diabetic person. A non diabetic persons a1c is anything from 4.6 to 6.4%. I was quite shocked to be told this by a leading D consultant as my a1c was 6.8% and was told that it was 'too tight'. I have been told to loosen up as about 35 bg levels of 4.? were counted in my record diary over 1 month. So I have now upped my target values to 7 before I eat a main meal and then bolus enough insulin so that I am on 9 or 10 mid morning or mid afternoon. It's been lovely especially for my OH as he feels a lot more relaxed and doesn't feel that he's got to keep a look out for me.

 

[noblehead]

That's interesting roo.be - I am not pregnant!!!

I have had 2 phantom "hypos" - was overjoyed that I thought my symptoms had come back only to check my BS and it was 9 or 10. Must admit I am finding it hard to get a stable BS now as so scared of it going low. I am now testing every 2 hours as a few have advised and have carb counted for some time - though I do make mistakes.

I was told to reduce all insulin doses by 2 units - I hadn't thought about ratios. The 3 bad ones were all lunchtime ish, 1 just before lunch where I collapsed and the other 2 early afternoon where I blacked out.

cjw, Testing your bg every 2 hours is a good idea to determine stable control, but your pre/post lunch hypo's are cause for concern. I would say that although you say you carb count, you may not have got the correct ratio of insulin to suit your carb intake, remember as little as 1 unit of insulin is sufficient in lowering bg by 2-3 mmol, so it is important to have the correct ratio in place. I did the carb counting course last year (DAFNE) but prior to this I had the same problem, mainly mid-afternoon hypo's, but it was apparent that my lunch ratio was totally wrong.

I assumed prior to the course that my ratio of insulin to food would be the same for breakfast, lunch and evening meal, when in fact nothing could be further from the truth. Our bodies may need less or more insulin to match each 10g of carbs as we progress throughout the day, sometimes the difference is very small, but enough to cause such problems that you have been experiencing. Therefore, if you haven't done the DAFNE course, do ask your DSN to put your name forward for the next available place.

Since completing the DAFNE course, my hypo's have become less frequent and I can honestly say that I have reduced these episodes by around 50 per cent, but as we use insulin it is nearly impossible to avoid them altogether as so many other factors come into play. Although I have always had good hypo warnings, I have noticed that now I don't have as many hypo's as say 12 months ago, my warning signs are much stronger as a result, so hopefully in time your hypo warnings will return, but do take on board the good advice been given so far. Good luck!

Nigel

 

[Beav]

I had a time where my readings went very low and my nurse said to me I may have to run my sugar level alittle higher for a while (im not sure how long for). This way when it goes low you will have the hypo signs again

 

[cjw]

Thanks Nigel that is very interesting.

I didn't know that it varied throughout the day.

I haven't been on a training course just learnt from my BS levels etc over the years. I will see if I can get on a DAFNE course. I guess that I am over confident as dealt with it myself for so long without any problems. I've always been worried about the complications of high blood sugars so been determined to keep mine low.

This forum is excellent for advice thanks to you all.

 

[uncleboab]

Hi all
I have been type1 diabetic for over 20 yrs , approximatley 5 yrs ago I developed control problems causing frequent hypos which resulted in me being sacked from my job.

I was then put onto "Lantus" and my daytime insulin (Humulin S) remained the same. As far as I was concerned "Lantus" was the miracle cure I had been looking for and I returned to work shortly after the change.

For the next 3 years I had no problems with my diabetic control and more often than not worked 7 days a week , 10 hour days with no problems at all.

Last April I was involved in a serious motorcycle accident that resulted in a broken back , leg , arm and dislocated wrist and have been off work since.

As far as I knew my control was ok until 4 months ago when I had my regular diabetic check-up. When I showed my DSN my blood sugars diary she asked how I had been dealing with my hypo`s , I asked what hypo`s ?. She pointed to my diary and highlighted 11 bloodsugar counts of less than 3.5 (the lowest being 1.6) in the previous 14 days.

It was explained to me that I was no longer hypo aware and I was put onto the apparently usual routine of running my blood sugars high for 3-4 weeks. After this period I tried to get my sugars back to normal , but it soon became apparent that I still had no hypo symptoms. My "Humulin S" was then changed to "Humalog" , but there is still no improvement in my hypo awareness.

I am now being told that my problems are down to the stress caused by my accident and the resulting insurance claim etc. I have now almost fully recovered from my injuries , and I am desperate to get back to work , but the problem is now this hypo awareness problem and as I am a mechanic the possible problems with my driving licence.

Having read some of the answers in the forum , I am now going to ask to be changed off of "Lantus" but would be gratefull if any one could enlighten me on "basal testing" and/or "CGM".

I am desperate to resolve this problem and get back to work , so any suggestions etc most welcome

 

[uncleboab]

ok
I`ve just checked the tinternet about the "basal testing" and "CGMS" stuff and realised I am barking up the wrong tree :roll: .
I am after an easy answer to getting my hypo awareness back , but I am begining to think there are no easy answers :evil: .

Boab.

 

[CarbsRok]

y