Aggressive / violent hypos

[sammymodo]

My husband has been type 1 diabetic for 35 yrs and his control is pretty stable. But over the last six months or so he has begun to have more aggressive / violent hypos during the early hours. This has coincided with him losing over 3 stone in weight and attending the gym for regular excercise sessions. During this time he has reduced his lantus dosage from 40 units at bedtime - 20 units and his novo rapid to an average of 7 - 8 units per meal as he has cut down his dietary intake. One factor we cannot understand is that occasionally after tea meal his blood sugars spike into the high to mid 20s and no extra food has been consumed.
Does anyone have any experience of this any advice greatly appreciated.

 

[Margi]

I can't begin to guess at the cause of the spike to 20+, but the early hours hypos are most likely to be caused by still too much lantus.Weight loss combined with exercise will have made an enormous difference to his insulin and food needs. Don't be afraid to cut the Lantus down even more than you already have. I find that one single unit difference in Lantus dose can make a huge difference in BS. I don't now if that's just me, or if other people find that too, but that's my experience.

You say his short acting dose is average of 7 -8, but does he use a ratio of insulin to food to work out how much insulin to use? If not, then, with his new, more active lifestyle, it might be a good idea to see if he can get on a DAFNE (or local equivalent) course to learn how to adjust his insulin scientifically instead of by guesswork like I did for years and years. The course changed my life after thirty years of struggling with 'unpredictable' hypos: I learnt how to avoid them.

Also, does your husband test before bed? And if so, does he act on the result?

 

[noblehead]

Sammy,

Your husbands after tea readings are extraordinary high and this would point to his insulin to carb ratio being totally wrong by a long way, ask him to look at his ratio again and make adjustments to prevent these spikes.

The night time hypo's would normally mean his basal insulin dose (lantus) is to high and needs cut back, this is provided he is sure that there is no quick-acting insulin still active in the body when he goes to bed as some QA insulin can remain active for up to 4-5 hours after injecting.

Another explanation for the night hypo's is his exercise, intense exercise can deplete the bodies glycogen stores and this can lead to possible hypo's over the following 12-24 hours as the body replaces its stores.

Aggressive hypo's means his blood glucose has dropped to a dangerous level and he is not in control, if he has lost his hypo awareness it is even more important to test and make adjustments to his insulin and talking to his diabetes nurse or consultant about these hypo's and restoring his hypo awareness (if lost) is highly recommended.

Nigel

 

[donnellysdogs]

Just may also be worthwhile doing a couple night time readings to find out what is happening during the night, and this may involve doing a couple tests say at 2am and 6am-(not after having alcohol though-unless this is an everyday glass of red that might be drank for medicinal purposesd!!!!). Then you will haev a better idea of what is happening during the night, and so will the DSN.

Everything else has been said here, regarding teatime insulin, and nighttime insulin and altering them.

Also, depending on when partner exercises, whether it is before the spikes, or what his BG's are before he exercises etc. Or does partners levels spike on an evening when he hasn't perhaps exercised.

To get an insight in to what is happening, and what the cause can be-all the facts have to be looked at, and then more than likely a pattern will establish itself, and something can be done about them.