Since the clocks changed for British Summertime I have had constant hypos both by day but especially between 01 and 03 am. The same thing happens in the autumn. I have reduced insulin doses, decreased both insulatard and actrapid and even eaten extra carbs before bedtime but this week for instance, I have been hypo EVERY night and it is driving my husband and I insane as well as exhausted. This has been happening for about ten years and no one has given me any answers.
Constant hypos
- Thread starter TerriH
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Thank you but I do all this. When I go hypo however I lose consciousness and my husband has to try and feed me glucose tablets until I come round. These tablets are always at our bedside as well as other carbs but what else can we do????
Ziggy2017
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I’m sorry I have no idea what else you could do maybe your dr can give you a cgm (continuous glucose monitor) hopefully it’ll stop you losing consciousness because cgms like dexcom alarm when low
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Hi @TerriH ,
Let's see if we can save a little sanity in your household.
First is a link to basal testing. https://mysugr.com/basal-rate-testing/
The second. Might sound like a silly question. But worth asking...
Your insulatard. Do you make sure the cartridge/vial contents is mixed consistently from the very first use? (Gentle rolling, do not shake.)
This could change the potency & how it performs if a good mix isn't followed....
Let's see if we can save a little sanity in your household.
First is a link to basal testing. https://mysugr.com/basal-rate-testing/
The second. Might sound like a silly question. But worth asking...
Your insulatard. Do you make sure the cartridge/vial contents is mixed consistently from the very first use? (Gentle rolling, do not shake.)
This could change the potency & how it performs if a good mix isn't followed....
kitedoc
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TID 52 years: Teri, I used to have a similar problems with changes in time settings here in Australia. I offer my experiences but emphasise that this is not medical advice or opinion, just my experience.
To me the reasons for the hypos were not clear but I have wondered if the change in sun exposure is involved plus the taking of evening insulins earlier or later than the previous months.
What i did was to firstly not mix my insulins in one. I know that meant more injections but made things easier to work things out. I figured that my Isophane (a form of Insultard) would have peak effect at some 4 to 8 hours after injection. whilst the Actrapid would have finished being active after 8 hours, but peaking about the 3 hours mark. So for a 1 to 3 am hypo with insulin being taken at say 6 pm, (but actually at 5 pm by the before Summertime time) I would expect a possible hypo at 1am onwards, particularly as the Actrapid would deal with the meal of 6 pm wish and would also account a little for the supper as well. Also I was taking Actrapid and Isophane (Insulated) morning and night. What I did with my doctor's blessing, was reduce my Isophane( Insultard) by 20% as a first step. That helped and I was able to ease back the extra supper carbs a bit. Then we talked about changing the timing of the evening isophane(Insultard to 10 pm at night. This would hopefully move any hypo type trouble from 1 am to nearer 5 am and later. At around 5 am or slightly earlier my doctor said the body becomes more resistant to insulin as the body prepares for the day and cortisol is released, something he called the 'dawn phenomenon. That change to 10 pm isophane(insulated) dosing helped greatly. In the end I had to reduce my 10 pm evening Isophane(insultard) by 25%). My doctor and I discussed this further and as soon as Levemir (determine) came on the market I was changed from Isophane(insulated) to Levemir. From what I have read, Levemir has very little peak effect and I certainly did not have hypo trouble on Levemir when I tried it at 6 pm or 10 pm at anytime of the year.
To me the reasons for the hypos were not clear but I have wondered if the change in sun exposure is involved plus the taking of evening insulins earlier or later than the previous months.
What i did was to firstly not mix my insulins in one. I know that meant more injections but made things easier to work things out. I figured that my Isophane (a form of Insultard) would have peak effect at some 4 to 8 hours after injection. whilst the Actrapid would have finished being active after 8 hours, but peaking about the 3 hours mark. So for a 1 to 3 am hypo with insulin being taken at say 6 pm, (but actually at 5 pm by the before Summertime time) I would expect a possible hypo at 1am onwards, particularly as the Actrapid would deal with the meal of 6 pm wish and would also account a little for the supper as well. Also I was taking Actrapid and Isophane (Insulated) morning and night. What I did with my doctor's blessing, was reduce my Isophane( Insultard) by 20% as a first step. That helped and I was able to ease back the extra supper carbs a bit. Then we talked about changing the timing of the evening isophane(Insultard to 10 pm at night. This would hopefully move any hypo type trouble from 1 am to nearer 5 am and later. At around 5 am or slightly earlier my doctor said the body becomes more resistant to insulin as the body prepares for the day and cortisol is released, something he called the 'dawn phenomenon. That change to 10 pm isophane(insulated) dosing helped greatly. In the end I had to reduce my 10 pm evening Isophane(insultard) by 25%). My doctor and I discussed this further and as soon as Levemir (determine) came on the market I was changed from Isophane(insulated) to Levemir. From what I have read, Levemir has very little peak effect and I certainly did not have hypo trouble on Levemir when I tried it at 6 pm or 10 pm at anytime of the year.
Terri, that sounds very frightening and surely if it's happening every night, that is a potentially life threatening situation? Going unconscious???? I would be down that Doctors pronto for extra testing or whatever. Then at least they can try different insulin or help you adjust or whatever, your poor husband too!!! x
Hi Terry, what are your before bed, sugar levels. I would , not go to bed,with sugars below 8mml, and would be reducing insulin even more. Been there, done,that. Many years ago, before blood was around.
Do you use A viva testing strips. They have recently recalled certain batches of strips,for giving excessive highs&low readings.
Do you use A viva testing strips. They have recently recalled certain batches of strips,for giving excessive highs&low readings.
donnellysdogs
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I used to get bad night hypos. With insulatard by itself.
Now I have tresiba and insulatard!! I have just 1.5 tresiba late afternoon and and odd routine compared to most by using insulatard at 3.30am and 7/8am.
However its the best regime I've had. It was me that suggested it after basal testing and then lining up actions of various insulins peak acting times against what I needed...
I have 1.5 of tresiba somewhere between 4-6pm. Insulatard is split in to two doses and equates in total to 15 units, plus I also need a bolus to get up out of bed...
Now I have tresiba and insulatard!! I have just 1.5 tresiba late afternoon and and odd routine compared to most by using insulatard at 3.30am and 7/8am.
However its the best regime I've had. It was me that suggested it after basal testing and then lining up actions of various insulins peak acting times against what I needed...
I have 1.5 of tresiba somewhere between 4-6pm. Insulatard is split in to two doses and equates in total to 15 units, plus I also need a bolus to get up out of bed...
donnellysdogs
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My consultants could not help with levels to be honest... there actions are from text books and manufacturing recommendations.
The pump for me, worked fantastic for 5 years and then my skin started to block cannulas when first put in. So I had no alternative but to go back to mdi, which didnt work well for me as I was put on pump when they werent freely given to T1 s.
After researching my needs then it was me that found this alternative. Staff not like split insulatard, not like tresiba as well... but I wasnt happy. So looking at how various insulins work and graphing them on greaseproof paper and laying them over my good n bad times for levels I figure this was best way for me.
Last appt with consultant and he said that I was just to carry on playing around with the various insulins myself.
I have been lucky that I have had a funded CGM and tjis has allowed and still allows me to have a much better idea about changing doses etc...
For me insulatard is pretty much out of my body by midnight, which is when it needs to be gone... but without something in a small dose running in background then from midnight I would climb and 3.30 onwards was just dire. Tresiba by itself was not an option as it was so flat in delivery. So insulatard given at 3.30 keeps level... and is working at its peak for 4-8 hours when I need it. Having a further 1/3rd of total dose at 7/8am allows for my activitys to change from mornings to afternoons. I always need less in afternoons.so splitting it made sense to me.. and to put majority of dose of insulatard when I needed it. Still need 1 or 1.5 bolus to get up but that is then also out of my body by afternoons when I dont need it.
We are all individual and consultants/staff cannot fine tune our needs in a 15 minute appt... no hope....
Working/ weekends etc are less of a problem now too.
I agree but here in S E Wales I do not even have a diabetic consultant and practice nurses who carry out the Annual Reviews know next to nothing so I completely understand you trying different things re. insulin on your own. Thank you for your thoughts and Good Luck!!
TerriH
TerriH
donnellysdogs
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I lived in S Wales for 3 years in Carmarthen. I had one particularly good dsn and a temporary pump consultant.. and 1 horrible consultant!!
Personally I prefer finding my own way
.. I see consultants as people that can give some rext book knowledge and change insulins/give pumps/ and back you for CGM funding but day to day we are the people that have to find our own ways...
A great person on here when I have struggled with consultants or diabetes educators told me the best way to think... and spot on..."they are the specialists, but we are the experts"... absolutely the best confidence giver to me... gave me the confidence back again that I had lost...
Good luck, but dont give in. You know your body....
You should have a consultant though... a consultant specialising in diabetes is a must.. even if they have no answers... they have the ability to prescribe and give pumps etc which gp practices and nurses dont..
LooperCat
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I’m in South Wales, under the Cwm Taf board. If you ask your GP to have your care at a hospital because you’re having these hypos, they have to transfer you. You definitely need more than a DSN.
I agree entirely but it is 2 years since I saw a diabetic consultant and if I get to see one within 2 years I will be very surprised as the waiting list is 2 years now.. To illustrate how bad the situation is I have spent 3 hours trying to speak to my GP without any success at all and I feel that if I did or could not self manage as best I can, I would be long since dead.
I agree but with the new system of "askmyGP" which has recently been introduced here, I can stay on the telephone (and already have done) for 3 hours trying to speak to my GP, turn up at the surgery and get nowhere fast. Since there is a 2 year wait to see a diabetic consultant, I HAVE to manage as best I can on my own.
LooperCat
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