Advise needed: Hypos from hell

[Omnipod]

This is the 3rd time that this has happened. I am concerned because the last 2 happened to me this week.

I would feel normal. I would test my BG, take insulin and then eat a meal. Within minutes after eating, I would feel really nausea and strange. I would scan my BG and the arrow would be pointing straight down. After dinner last night I was 9. The arrow was pointing down. Bearing in mind I had green leafy salad with a piece of baked salmon, I thought I would have a small glass of fresh orange just so that the arrow was not pointing straight down and I thought that it may make me feel better. (Usually when the arrow is pointing straight up or down, I feel strange)

Within 10 - 15 mins, my BG was 3. (I had only taken 3 units of insulin before dinner)
All the while - while my BG was dropping, I sipped on lucozade and ate approx 6 jelly babies but my BG was still plummeting fast.

I had to vomit everything out before my BG would start rising again.

This has now happened to me 3/4 times that I have had to vomit so as in order to get my BG to start going up again. It seems that my body does not absorb any glucose unless I vomit. Im not sure if this is down to a bit of food poisening?

I did tell my diabetic consultant about this after the first and 2nd episide but he just said it was strange and left it at that.

Has this happened to anyone else?

It is very scary when it happens..... so much to a point where I am ready to jab a glugagon injection into my leg if I drop into the 2's. Vomiting when your BG is 3mmol and youre alone in the house is a nightmare.

Not sure what to do about this because most times I am back to normal by the time i see a doctor.

 

[PseudoBob77]

Seems like you react very sensitively to insulin, if 3 units are dropping you that low causing severe adverse reactions can't you halve that dosage to 1-1.5 units for dinner, check your insulin to carb ratio. Better to go a bit higher for a while to avoid catastrophic lows.

 

[Omnipod]

i have my ratios right. This has only happened 3/4 times where Ive had to vomit first before my body absorbs any glucose.

 

[CarbsRok]

Try doing a basal test and see what's going on, would be the first on my list to do. Liquid glucose would already be absorbed before you vomited so being sick wouldn't have raised your blood sugar.

I wonder if the drop was so sudden that's what has made you vomit. You also have to remember watching your CGM drop like that even after you hypoed is a bit misleading as it measures about 20 mins behind a normal finger poke.

 

[Omnipod]

Try doing a basal test and see what's going on, would be the first on my list to do. Liquid glucose would already be absorbed before you vomited so being sick wouldn't have raised your blood sugar.

I wonder if the drop was so sudden that's what has made you vomit. You also have to remember watching your CGM drop like that even after you hypoed is a bit misleading as it measures about 20 mins behind a normal finger poke.

true... but i was finger pricking
it may be the drop

 

[CarbsRok]

true... but i was finger pricking
it may be the drop

Ah ok, sorry just assumed you were using a cgm due to the mention of arrows going straight down.

 

[noblehead]

Also bear in mind that you drank a small glass of orange juice 10-15mins before you vomited which would still be raising your bg levels, but liquid glucose like Locuzade works extremely fast as @CarbsRok mentioned earlier.

Scary experience just the same @Omnipod and it's not nice when it happens.

 

[CarbsRok]

Within 10 - 15 mins, my BG was 3. (I had only taken 3 units of insulin before dinner)

Rereading your post again I have to wonder why you bloused so much insulin upfront for a carb free meal. That's a recipe for disaster for 99% of type 1's I would have thought. Many which includes me have to bolus for protein but not upfront like that.
I would also query your basal if you were 9 after your meal as in how long after your meal were you at 9

 

[Bluemarine Josephine]

I think it isnt a case of your body absobring sugar after you vomit.

Because vomiting is a very strenuous process for the body, when you vomit, your liver releases glycogen which is the energy that your body needs (in order to push food/liquids out). Therefore, the reason why your blood sugar goes high after you vomit is because your liver has released all this sugar in your blood stream.

If this sugar (glycogen) is not used and is left in your blood stream then, the liver will take it back and "store" it (in order to use it next time that it will be needed.) Because of this reason, many of us can have hypoglcemia, then hyperglycemia, then again hypoglycemia (when the liver takes back the glucose that it has released, leaving our blood stream without any sugar.)

You had a meal consisting of green salad and salmon.
And you bolused 3 units for what reason?
It is a huge insulin amount for a correction whilst salad and salmon do not require any insulin (even for the diabetics who do add those as carbs, 3 units would be too many, I suppose).

If you were at a level of 9, bolused 3 units which accounts around 3 mmols each meaning 9 mmols overall, and had a no carbs meal, I think it is normal that you would hypo. In the case, there was some kind of activity prior to your meal, (or throughout the day, which expresses as delayed onset hypo after exercise) you would hypo even faster... therefore, a small glass of juice is hardly enough to treat (considering some 15 grams of carbs in a small glass of juice.)

I am also thinking of the possibility that your insulin needs may change throughout the 24hrs. If you are on a one basal injection, then maybe your basal units are fine for your during the day but, too many during the evening... I would suggest that you consider a basal test (to check if you may need to split your basal into 2 injections).

 

[RuthW]

Sorry, I think it is nonsense that it had anything to do with a liver dump. The mythical liver dump gets used as 'deus ex machina' all the time on these boards.
You don't say what your reading was before the meal or which way it was traveling, so there is some guesswork involved. But you had a high fibre, high fat, high protein, NO carb meal. You had a slightly high blood sugar afterward and you knocked it out of the park with a normal bolus, instead of a split bolus or an extended bolus, which would have been suitable for your situation. I don't see anything puzzling at all. But it wasn't a sensible bolus, was it?
And you needed to vomit before absorbing glucose because you had too much fat and protein in your stomach to be able to absorb it quickly. That's normal too.
Overall, I agree with Bluemarine, though.
LCHF's advantage is slow absorption. Sometimes that can be a disadvantage too. Combining fat and carbs is always tricky, especially for Type 1s who have to deal with insulin timing too.