When titrating insulin up, I get palpitations, clammy after few hours

[GuidingSenses]

Hi, I’m Type 1.5 and prescribed insulin for just one week. Been told to titrate up 2 notches every 2 days to get my high readings lowered. I’ve done this twice this week, today I started on notch 14 of insulin pen and after my very low carb dinner (realised I’d had too many carbs for breakfast and lunch) I had steak and salad, so just 6g of carbs. Three hours later I go clammy and palpitations. Had sweet tea and toast and peanut butter and now calmed. Does this happen when titrating up insulin?

 

[Antje77]

What was your blood sugar when you were feeling off? Sounds like a hypo to me but without testing there is no way to know for sure.
Blood glucose changes hour by hour, or even minute to minute, depending on food, activity and some other factors.
So even if you had too much carbs at breakfast and lunch, the effect of those carbs (high blood glucose) could have worn off by dinner, giving you a hypo because of the insulin with fewer carbs.

You haven't filled out your profile, are you still on the mixed insulin and how often do you take it?
How often do you test?

 

[EllieM]

Hi, I’m Type 1.5 and prescribed insulin for just one week. Been told to titrate up 2 notches every 2 days to get my high readings lowered. I’ve done this twice this week, today I started on notch 14 of insulin pen and after my very low carb dinner (realised I’d had too many carbs for breakfast and lunch) I had steak and salad, so just 6g of carbs. Three hours later I go clammy and palpitations. Had sweet tea and toast and peanut butter and now calmed. Does this happen when titrating up insulin?

As @Antje77 said, it sounds as though you might have had a hypo, which happens when your blood sugar goes too low. Though there's no way to know this for sure without doing a blood test. (If you've been running high for a while it's possible to get hypo symptoms at normal blood sugars just because you are not used to them yet.)

Hypos are unfortunately quite common for insulin dependent diabetics, you need to do more blood tests to detect and avoid them and always make sure you have some emergency carbohydrate (jellybabies and glucose tablets are popular) so that you can take if you go low. If you drive you should do a blood test before getting in the car, as hypos and driving not only threatens your life but those of others as well. (When hypo you can become confused and even lose consciousness if your blood sugar goes too low).

I'm not a big fan of mixed dose insulin either (was on it for my first 15 years of T1) because it depends on you eating the same amount of carbs at the same times each day. You have to eat to balance your insulin rather than injecting to balance your food. However, I can understand why they might start someone out like that, and it does suit some people.

Good luck.

 

[GuidingSenses]

Thankyou both and interesting as my carbs for dinner were only 6g before I had injected 14 dose ... I was too scared to move so didn’t test and hubby got me a hot sweet tea initially. I don’t have any sweet stuff in the house but will do. Yes I’m on mixed humulin. I’ve informed DVLA and yes know the rulings. I will endeavour to keep carbs similar rather than saving them up for one meal.
I take humulin mix twice day, before breakfast and before dinner.

 

[EllieM]

I will endeavour to keep carbs similar rather than saving them up for one meal.
I take humulin mix twice day, before breakfast and before dinner.

In the long run, if you move to a basal/bolus mix (or even a pump, which I'm not on so can't really comment) you'll be able to choose when to eat (or skip) meals, as the basal covers your insulin needs when you are not injecting, and the bolus covers your meals (midnight birthday cake, bolus here we go). At that point you should be able to use your short acting bolus to
1) correct your bg if it's too high before a meal
2) balance the carbs in whatever you're eating with your bolus.

It requires more injections (generally 1 or 2 basal plus a bolus before each meal) but it gives you much more dietary freedom.

 

[GuidingSenses]

Thankyou I suppose as only one week in they are trying to judge what is best. Specialist nurse did give me a choice but didn’t really understand- just said the one with less injections!

 

[EllieM]

Thankyou I suppose as only one week in they are trying to judge what is best. Specialist nurse did give me a choice but didn’t really understand- just said the one with less injections!

Not an unreasonable choice, specially when you're starting out. Possibly easier to manage a basal/bolus regime once you've learnt to count carbs and have got thoroughly accustomed to injections.

Good luck, again.

 

[GuidingSenses]

Seems to be every evening ,.. pouring sweat, shaky. Wasted 5 test strips on my care sens dual meter as said error 4 so don’t know if bg too low. I had saved up some carbs for an evening snack and had a gluten free berry muffin then wham the sweats and shakes came (previous evenings was before a snack). If these are hypos I’m worried as I’ve just informed DVLA of taking insulin for diabetes and one of the questions was ‘have you had a hypo’ I answered no as I was only day 2 of insulin and hadn’t and still don’t know? Will this stop me driving completely? I’d really like to come off insulin and try with low carb diet now I know carbs but I suppose that’s a no no....

 

[DunePlodder]

Seems to be every evening ,.. pouring sweat, shaky. Wasted 5 test strips on my care sens dual meter as said error 4 so don’t know if bg too low. I had saved up some carbs for an evening snack and had a gluten free berry muffin then wham the sweats and shakes came (previous evenings was before a snack). If these are hypos I’m worried as I’ve just informed DVLA of taking insulin for diabetes and one of the questions was ‘have you had a hypo’ I answered no as I was only day 2 of insulin and hadn’t and still don’t know? Will this stop me driving completely? I’d really like to come off insulin and try with low carb diet now I know carbs but I suppose that’s a no no....

What you are describing is definitely a hypo. I think you need to have an urgent chat with your diabetes nurse. In the meantime as others have said, make sure you have some fast acting carbs available. My usual choice is jelly babies.

 

[Antje77]

Wasted 5 test strips on my care sens dual meter as said error 4 so don’t know if bg too low.

Can you look up a video of how to use it? It may be you put the blood in the wrong place like I did when I got a new meter
This was a bit long but at 3 minutes in it shows taking a bg test quite clearly.

etited to put in a link to the video I found.

 

[Diakat]

It is important that you test when feeling like that.
Also as a type 1.5 ultimately diet alone will not control things, you do need to find a way to balance insulin and food. Testing is the key to understanding that relationship.

 

[GuidingSenses]

Yesterday was the first time no hypo! I titrated down 2 notches before evening meal and had no food after evening meal.... I’m now down to 8 mmol and hoping things will now settle, Thankyou all.

 

[GuidingSenses]

Can you look up a video of how to use it? It may be you put the blood in the wrong place like I did when I got a new meter
This was a bit long but at 3 minutes in it shows taking a bg test quite clearly.

etited to put in a link to the video I found.

Yes I am doing it correctly but always have to squeeze finger as hardly any blood, also often I can see my blood colour is pale like watered down and that’s when Error 4 appears.

 

[Antje77]

Yes I am doing it correctly but always have to squeeze finger as hardly any blood, also often I can see my blood colour is pale like watered down and that’s when Error 4 appears.

For me it works best when I start at the palm of my hand and squeeze upwards in a quick motion to my finger. If you squeeze the tip of your finger right next to the hole you cut off the blood from lower in your finger so you'll have to make do with what little there was in your fingertips to start with.

It also helps to have warm hands and to swing your arm like you're marching before testing.
Hope this helps!