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Asking for someone else (honestly!)

Discussion in 'Type 1 Diabetes' started by WheelyFun, Apr 7, 2018.

  1. WheelyFun

    WheelyFun Type 2 · Active Member

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    I have become somewhat fast friends with someone who is a type 1 diabetic (I am type 2).

    He keeps on being hospitalised because of hypos, BM as low as 1.2 mmol/l. This has happened a number of times recently, and even after eating enough food for 8 or 9 people (7 sandwiches, 6 packages of crisps, a 1l bottle of lucozade, etc...), his BM only comes up to 10.8. That is after glucagon and 4 glucotabs.

    If I ate even one of those sandwiches my sugars would go up to 10 for a long time. So my knowledge is somewhat limited here.

    The hospitals treat the hypos and as soon as they calm down again (it has taken 13 days so far this time to get to this point), they discharge him, only for him to come in within 72 hours with exactly the same issue.

    The doctors seem to be just treating to symptoms and not the cause. He is a young father of equally young children (two children, both under 2) and is scared of being left alone with his children now, because of this.

    Is there anything he should be doing or asking the doctors?

    He simply cannot afford to eat £40/50 worth of food every day just to stay normal, and also he is constantly eating, so there would be no time for him to go to work or anything else.

    When he does go down, he gets no side effects at all, and then everything seems to hit him in around 40 seconds. The sweating, headache, blurred vision, tiredness, etc... he also doesn’t remember some of the episodes.

    Do you lovely people have any advice?
     
    • Hug Hug x 2
  2. LooperCat

    LooperCat Type 1 · Expert

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    He needs to have a good look at his insulin doses with his team. Sounds like he’s taking far too much.
     
    • Agree Agree x 3
  3. Jaylee

    Jaylee Type 1 · Moderator
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    Hi @WheelyFun ,

    What insulin regime is your friend prescribed?

    I would agree his dosage needs a review with his HCPs.
     
    • Agree Agree x 2
  4. EllieM

    EllieM Type 1 · Moderator
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    I don't understand why his diabetic clinic isn't addressing his issue! As the previous poster said, it sounds like a drastic reduction of insulin is in order. It also sounds as though he has either lost hypo awareness or is at risk of losing it, so in his position I would also be trialling a continuous glucose monitor. (Having said that, it's likely he will be get back hypo warnings if he just keeps his blood sugars up for a while.)

    He needs to at least speak to his diabetic team on the phone (I'm assuming he doesn't have the confidence to change his own insulin doses or he would have already done this.)
     
  5. WheelyFun

    WheelyFun Type 2 · Active Member

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    4 units of novorapid depending on levels before food and I think there is some long term stuff.

    But he hasn’t been taking anything since this admission to the hospital.
     
  6. WheelyFun

    WheelyFun Type 2 · Active Member

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    If I am honest everyone, I first thought he must be taking way too much insulin, but he is barely taking any, and eating the way he has been, his levels should be sky high.

    Also; 10 units of Levermir once a day.
     
  7. River83

    River83 Type 1 · Active Member

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    I think he needs to insist on some help from his diabetic team. His insulin is clearly in need of significant changes. If he’s taking 4 units of novorapid before food, this sounds perfectly reasonable, however without knowing what he’s eating, what his insulin to carb ratio is etc. It isn’t really possible to solve. Sounds like his Basel insulin is the problem.
    Please get him to go back to DSN/Consultant and insist on some help.
     
  8. WheelyFun

    WheelyFun Type 2 · Active Member

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    Hi River,
    I may have not mentioned this before, he is not taking any of that at the moment. That is his usual regime.

    He is having 2 or 3 hypos a day and is averaging in excess of 400g of carbs throughout the course of the day, with no insulin he should be going sky high but he is still having hypos.
     
  9. SamElliott1997

    SamElliott1997 Type 1 · Well-Known Member

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    Does he dose before food? He might have digestive issues and need to dose afterwards?
     
  10. WheelyFun

    WheelyFun Type 2 · Active Member

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    The carbs amount is my estimation not his. I have sat there and watched him eat almost constantly all day and then have a hypo.

    He also never seems to go above 18mmol/l and most of the time it doesn’t go above 12mmol/l. I’ve only ever seen it at 18mmol/l once in the past week and he has been eating like that constantly.

    From Monday morning Until Thursday afternoon we were together 24/7 as we both ended up in the same ward (I had to be admitted for a something myself, but on a much less serious scale!)
     
  11. WheelyFun

    WheelyFun Type 2 · Active Member

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    No one has even suggested that he might have. But it’s definitely worth considering at this stage.
     
  12. River83

    River83 Type 1 · Active Member

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    Has he had a diagnosis of T1 confirmed? It sounds very odd. Could possibly be rReactive Hypoglycemia but as I said earlier he really needs to be checked out by the professionals.
    Cutting carbs could assist a lot, what is his diet like?
     
    • Agree Agree x 1
  13. SamElliott1997

    SamElliott1997 Type 1 · Well-Known Member

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    Try buying just one freestyle Libre sensor to use for a fortnight to see what exactly is happening. It will open both of your eyes as to what is happening.

    Also, just checking, is he 100% certain be is type 1? The sensitivity to insulin and blood sugars not reaching over 18 after huge treatments just makes me wonder? Has he had a blood test for the antibodies associated with type 1?
     
  14. catapillar

    catapillar Type 1 · Well-Known Member

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    If you have one hypo, you are more at risk of more. Especially if your hypo was treated with glucagon. Because this tells the liver to release its glucose stores. Once you start eating again your body prioritises restocking the liver glucose stores. So food you eat won't raise blood sugar, it will be funnelled into the liver's glucose stores. Restocking takes time. After a hypo treated with glucagon you should eat some complex carbs, with a reduced bolus.

    Why is your friend treating hypos with 7 sandwiches, 6 packets of crisps? These are complex carbohydrates that won't work quickly to raise blood sugar. He should be treating hypos with dextrose tablets, glucojuice, hypostop gel, lucozade, jelly babies, Coke, fruit juice. Once he takes on 15g of carbs (in these simple carb forms) he should wait 10-15 minutes and then test again. If blood sugar is under 4 he should repeat. If blood sugar is over 4 he should have a complex carb snack like a digestive biscuit or oat cakes and then consider having a complex carb meal with a reduced bolus.

    If he is not currently taking any insulin and still having multiple severe hypos has he had type 1 diabetes confirmed? When was he diagnosed with type 1 diabetes? Has he had cpeptide and GAD testing? Has he had investigations for Addisons? This is an autoimmune disorder that kills your corticosteroid production, corticosteroids usually keep blood sugars up. Addisons in a honeymooning type 1 could cause the kind of severe hypos your friend is experiencing without insulin.
     
    • Informative Informative x 1
  15. Daibell

    Daibell LADA · Master

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    Hi. Some of this has already been said. He must demand more support from his NHS team. It sounds like he is on the Basal/Bolus (aka MDI) regime where there are two insulins i.e. Bolus for meals and Basal one or twice a day. He needs to be taught to do carb-counting which is essential. He needs to ask the team to explain it now and not wait for a training course (my DN explained it in 15 minutes when I started insulin). Basically you adjust the amount of Bolus to suit the carbs in the meal. Do come back here if the NHS team fail to explain it. He is eating far, far too many carbs. These should be below 200gm and preferably below 150gm per day; this also helps avoid weight gain. Insulin should always be matched to the carbs and not the other way round. His Basal amount may need to be adjusted over a few days and this is always done before changing the Bolus mealtime 'ratio'. I'm afraid the amount of knowledge about diabetes in hospitals and some surgeries can be dire hence these forums so do come back for more advice if needed.
     
  16. Jaylee

    Jaylee Type 1 · Moderator
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    Hi WheelyFun,

    Could you clarify. Is this someone currently in hospital supervised by HCPs?
     
  17. WheelyFun

    WheelyFun Type 2 · Active Member

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    Yes they are currently in the hospital under supervision.

    Although he is being discharged today, from what he has been told it is because his hypos are “better” (only down to 2.6 mmol/l instead of 1.2 mmol/l) and he can manage at home.

    The issue is, the only reason that is happening is because he is eating literally over 400g of carbs a day. (I am basing that on 25g per sandwich he is eating, he ate 7 sandwiches in the space of 5 hours yesterday, as well as hot meal, two bowls of porridge, a sausage bap, 4 slices of wholemeal toast, and three 1.5l bottles of lucozade. After all that he had a hypo of 3.2
     
  18. DCUKMod

    DCUKMod I reversed my Type 2 · Master
    Staff Member Administrator

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    @WheelyFun - has your friend been losing weight, or gaining weight, or does he have any other gastric issues, like lose bowels?

    Does your friend have any other conditions like over active thyroid gland or Coeliac disease?

    How old is your friend, and how old was he when diagnosed?
     
  19. WheelyFun

    WheelyFun Type 2 · Active Member

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    Lost significant amounts of weight (10 to 12 stone) since June 2017, put on around 1 stone since first admission (around 25 days ago)

    No bowel issues, a little bit of diarrhoea about three days ago.

    No gastric issues.

    Edited; weight loss information wasn’t accurate.
     
    #19 WheelyFun, Apr 7, 2018 at 12:52 PM
    Last edited: Apr 7, 2018
  20. WheelyFun

    WheelyFun Type 2 · Active Member

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    I agree with all of this, especially the amount of carbs being eaten being way too high, but unfortunately whenever he cuts them down, he goes back to having 3 or 4 hypos a day, down to 1.3/1.2 mmol/l

    He is skinny, he is 6’ 5” and weighs 14 stone.

    I agree the hospital is being very unhelpful. He was seen by two of the diabetic nurses, both of which I know and have found to be helpful in the past, but this is just plain crazy. I have never ever seen anything like this.

    It’s as if his body is producing too much insulin, but the blood tests he has had, repressed a couple of days ago, says he is producing nothing.
     
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