I think it's the hypo aspect I'm more worried about
Hi, Emma, yes, hypos are a major concern for insulin users, but there's ways of dealing with them.
I'm T1, so this is all from that point of view. I don't know much about MODY, but I imagine there's some broad similarities when it comes to insulin use.
You say you're running at about 14. Longer term, you'll be looking to get down to around 5. That's a big drop. Your body will have gotten used to the higher level, so, as
@_petal_ says, you might experience false hypos when you start getting lower than the 14 you've become used to. When T1s are newly dx'd, docs don't bring them down to 5 straight away. They do it in stages, like a diver coming up slowly from depth so they get used to the changes in pressure gradually. So, be patient with it and try to nudge it lower over a few weeks.
Once you start getting into the 4 to 7 zone, that's where you're thinking more about true sub-4 hypos. The difficulty is that the dividing line between a "good" 5 and a "bad" hypo sub-4 is quite a narrow one. Ironically, the occasional hypo is a sign of good control.
One important thing to bear in mind is that because that dividing line is so narrow, modest hypos are pretty easy to fix. We've only got about 5g of glucose in our entire bloodstreams, so if you start feeling a bit squiffy, it's not necessary to hoover up a litre of lucozade and three Mars bars. Generally speaking, a few dextrotabs, about 10g will do to nudge you back up. It will be different, though, if it's a deeper hypo and/or you still have lots of active insulin on board - that can require a lot more. You'll get a feel for how much you need as time goes by.
I'd encourage you to spend some time thinking about the time pattern or "shape" of insulin. If you get a typical fast-acting like Novorapid, you inject before a meal, it takes about 20 mins to start working (which is why many of us inject 20 mins before the meal, to give it time to get to work before the food hits it), peaks at about 1.5 to 2 hours and wears off after 3 to 5. It varies a lot between people. The takeaway point, though, is that because it peaks at about 1.5 to 2 hours, that's the time when you're likely to start getting clues about whether the dose amount was right or wrong - if it was too high, you might be starting to look at a sharp drop into hypo territory, and if you catch it in time, think about tailing off the drop with a dextrotab or biscuit. Once that's sorted, you can then think about the amounts and whether you need to make any changes for a similar meal in the future - it's trial and error, and there's nothing wrong with making mistakes.
And remember how it lasts for 3 to 5 hrs. That means that the amount you take for lunch might differ depending on whether you're going to be sitting at a desk for the rest of the afternoon, or walking around a lot. Exercise generally means less insulin.
If your finances allow it (about £100 per month), or you live in an area which prescribes it (it's a postcode lottery), I'd definitely consider getting Freestyle Libre. It's a glucose monitoring system which gives you a 24 hour picture of glucose levels in real time, instead of the tiny little snapshots which strips give. It significantly reduces hypos, purely because if you can see on the live graph when levels are trending to sub-4, it's simple to just take a dextrotab to nudge it up a bit before it gets there. Strips just don't do that. There's also small transmitters, blucon and miaomiao, which send the results to a phone app which you can set hypo alarms on so you get woken up if you're getting too low.
If you end up with a serious deep hypo, well, yes, those are scary, confusing situations. Your brain won't be working properly because of the low glucose. Try to keep a bit of space at the back of your head which say, "ok, I'm Emma, I'm having a bad hypo, and it will be fine once I get some glucose in me." Those sort of situations normally occur at night, you've missed the initial symptoms because you're sleeping. Don't keep the glucose in the kitchen. You won't be able to get to the kitchen in that state. Keep a couple of bottles of Glucojuice and a few packets of glucotabs beside the bed. We've all got our own preferences on deep hypo treatments, but Glucojuice is a winner for me - fast, fast, fast.
Anyway, good luck with it all, Emma! Insulin can be a scary gig to start with, but you get used to the ins and outs after a while.
