Bad, long hypo

enzina · Aug 19, 2019

Morning all,
Last night i have experienced the most scary hypo since i started insulin. I have noticed during the whole day i needed a bit less insulin. For lunch around 1.30 i took 3 units Novorapid and for dinner at 6pm i took another 3 units. Half an hour later i noticed to my horror levels of 2.1. It must have happened very suddenly because i couldn't even feel the hypo coming on. I treated the hypo as always: half a glass of orange juice, 3 dextro energy tablets and one piece of fruit. Usually my levels go up after 10-15 min and i very often overtreat. This time i stayed in the 2-3 range for a whole hour although i kept on drinking juice, taking dextro energy and ate two more (big) plums. I felt aweful and scared, was very exhausted. At 3am i woke up and the levels dropped again to 4. I have tested during the whole evening and night with test strips to confirm Libre readings. In the night i had to eat a few more glucose tablets to stay in the 5 range.

This morning i have reduced the Lantus to 12 from 16. I don't think it makes sense to call my hospital because at the moment i don't even have a DN. I have no idea what to do.

enzina · Aug 19, 2019

Oh, thanks so much @Knikki! I'm very grateful for your quick answer and feel a lot calmer now because the incident seems to be not so uncommon.
I'm in London and my hospital is the Royal Free. Will try and call there although i will only get switchboard.

enzina · Aug 19, 2019

Knikki said:
Alas Diabetics on Insulin will at some point hit the Hypo and Hyper phenomenons (Hyper when you over correct and go higher than 10) the only advice I can really give is don't fear them, learn about them, respect them, learn how to deal with them.

Not in London Village myself but I guess the Royal Free is a big over stretched place, all you can do is keep trying or see if you could get a referral form your local GP. Or maybe the local practice has a DSN a lot seem to these days might be worth a call .

Take care

No, DSN at GP is not an option. GP and DSN were the ones misdiagnosing me for years! I just saw my consultant at the Royal Free, she just asked me what's my secret about the "excellent control" although i do have at least 3-4 hypos every week.

enzina · Aug 19, 2019

I have pointed out the hypos to the consultant, she had a look at my Libre history but obliviously wasn't concerned at all. a1c now 6.6 and she even said jokingly "i wouldn't need them anymore."

When i still had a DSN at the Royal Free she said, she would want me to stay in the 9s in the evening and generally just go a bit higher because of the hypos. I should also stop the Novorap if there are hypos..but then i would go sky high.

Scott-C · Aug 19, 2019

Hi, @enzina , when you have a bad hypo like that, your liver will have released a lot of stored glucose to raise your levels, so it will spend the next day or two taking back glucose from blood to restock, which may cause further lows, so it's usually a good idea to eat more carbs than usual to make up the deficit.

enzina · Aug 19, 2019

Scott-C said:
Hi, @enzina , when you have a bad hypo like that, your liver will have released a lot of stored glucose to raise your levels, so it will spend the next day or two taking back glucose from blood to restock, which may cause further lows, so it's usually a good idea to eat more carbs than usual to make up the deficit.

Thanks @Scott-C , that's good to know. The levels are at the moment 9.5 although i haven't eaten anything, just had three coffees with milk.

enzina · Aug 19, 2019

helensaramay said:
@enzina I am glad you are feeling better today.
There is some great advice from the lads above.

The only thing which struck me in your first message is that you hypoed very soon after injecting for your evening meal. There are few things which may be worthwhile considering
- what was your BG before injecting? Have you been advised about testing before meals and taking your current BG into consideration before dosing? For example, if you tested and your BG was 12, you may want to add extra insulin to your meal dose, whereas if your BG was 4, you may want to reduce your meal dose.
- As I guess you know from your hypo treatments, not all carbs are equal - they work at different speeds. For example, a fatty meal can slow down your carb absorption. This can lead to a hypo followed by a high because your insulin starts working before your carbs are absorbed. The classic "problem meal" is a pizza because it is high carb but with the cheese (and maybe meat) on it, a pizza is high fat so the carbs are absorbed very slowly. Some people delay or split their insulin when eating a high fat meal.
- If you had a fatty meal before your hypo, the fat may have contributed to slowing down the absorption of your hypo treatment and lead you to experience the longer hypo.

I think you have recently been diagnosed with LADA. It may be useful for you to attend a DAFNE course to learn about carb counting and the affects of different foods on insulin and carb absorption.
Something else to ask your consultant about.

Take care.

Thank you @helensaramay! That's very good advise but i ate the the same carbs as usual. In the evening i'm eating two slices of rye bread with butter and cheese, tomatoes etc because i have my main meal at lunchtime. Bg levels before injecting were 6.5, everything completely as always.
I would love to do a DAFNE course, i forgot to mention it to my consultant although the Royal Free doesn't offer them. The closest hospital to me is the UCLH and they have courses. I have looked it up but couldn't apply because i'm not patient in the their diabetic department.

enzina · Aug 19, 2019

Yes, i had to walk home at lunchtime from my hairdresser because they had closed the bus route. I walked the mile very fast and then went straight with the dogs on a walk. The dog walk was slow because the two are old.

I will do the online course, thank you!

Bad, long hypo

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