Daughter hypos after dinner - advice please

Good morning,

Firstly what a shock that must have been, I was 17 when I was diagnosed so not much older. I also lost a lot of weight and had a massive appetite. Is she injecting for her meal and then injecting separately for the snacks/puddings. Also once she treats the hypo is she then seeing her blood sugar raise higher than it should be? If her blood sugar is where it should be after treating the hypo it would suggest to me that her fast acting insulin intake is too high. If her bloods are going high after treating a hypo it would suggest she maybe needs to alter the time which she is injecting. I personally inject directly before a meal. If I inject too early I will find myself going hypo but then will see my blood sugar raise after. Also if she us having two injections close to one another the insulin could potentially be 'stacking'

What are her fasting blood sugars like? Is she able to go bed at 7-8 and wake up in the normal range? If so it would suggest there isn't a problem with the background insulin. If she is having hypos between meals and upon wakening you may need to reduce the background insulin

Regarding the amount of food she is eating, I understand it is difficult to control the intake after being given a life changing condition however if possible I would try and restrict too many snacks. I try and limit to one snack after each meal and inject for the snack at the same time as my meal and then have my snack not long after eating so I don't have to inject again.

Hope this all makes sense and helps

@Cupoftea&sliceoftoast why do you think she needs the carbs? Are you thinking that for weight gain purposes? If so then that isn't strictly true, I lost weight prior to diagnosis and even more after due to developing an eating disorder (irrational fear of carbs) so I couldn't eat many carbs without a meltdown etc, I gained weight by snacking on things that didn't require insulin, mainly cheese and eggs xx

Cupoftea&sliceoftoast said:

Thank you so much for your detailed reply. She injects separately for her pudding. Sometimes she needs one or two treatments for the hypo, but by bedtime she is 7 or 8 and remains consistent through the night and wakes roughly with the same numbers.
We try to inject 15 minutes before the snack, but I was wondering if the fat content of the meal was delaying the carbs being broken down. Perhaps we should try giving the insulin at the time she starts eating as you suggest.
I will eventually change her eating habits but I don't want too much to change for her all at once. I thought we might do some cooking together over half term and introduce some low carb options without drawing attention to the fact they are lower in carbs.

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No problem

Her background insulin seems to be correct then so can rule that out.

Does she have any snacks after lunch and injects separately, if so how are her blood sugars when doing this? If her bloods are okay when doing this it may mean the carb counting is slightly out or the ratios may need adjusting.

I know most diabetics can use the same rarios for each meals whereas others like myself are sensitive!

I inject 1:5 for breakfast, 1:8 for lunch and 1:6 for dinner. If I was to inject my bfast ratio for lunch my blood will plummet like anything.

The only other problem too is that she will still be in the honeymoon phase. I vaguely remember having this issue. Unfortunately it isn't consistent, some days I would need barely any insulin and some days i would have to go back to normal ratios.


I agree the fat content could be slowing down the absorption of the carbohydrates. I also find this happens when I eat pizza McDonald's Chinese (any takeaway really) when eating fatty foods like this i'll always inject after eating. However if my blood sugar is running high I will inject directly before to avoid going any higher before coming back down.

The first year is the most difficult and it is a case of trial and error and perseverance, try not to be too hard on yourself, easier said than done i know.

As long as you're avoiding night time hypos which it looks like you are and avoiding massive highs you will be okay.

Best of luck and feel free to ask any other questions

@Cupoftea&sliceoftoast
First, when you drop too low, you get ravenous, it's something you mostly end learning (hopefully) to control. But as a teen and a newbie, I'm not sure it's even fair to get her to try to learn too strictly yet. But as a newbie she was probably used to numbers being too high and she could be feeling what we call false lows which is feeling low at higher than "normal" numbers because she is not used to "normal"numbers. To compound that with the fact she is dropping too low at times.

But first you usually want to try to work on basal doses. A basal test might be needed. Basal needs allow for what the liver puts out in glucose without eating and not for food. A lot of times drops can be from too strong of a basal dose which then makes your bolus look like it is too strong. And while she is waking with the same number as when she has gone to bed, that doesn't rule out basal levels being too strong during the day. Plus, being a newbie her needs can be variable, it's what we call the honeymoon phase. She might still be making some of her own insulin sometimes, which might make any of her dosing too strong.

But bolus doses can change during the day, at night I get more insulin sensitive and need half of what I take for carbs during the morning. Plus as a woman your menses can increase your needs of insulin, which means when you are not hormonal your needs are not as high the rest of the month.

kaylz91 said:

@Cupoftea&sliceoftoast why do you think she needs the carbs? Are you thinking that for weight gain purposes? If so then that isn't strictly true, I lost weight prior to diagnosis and even more after due to developing an eating disorder (irrational fear of carbs) so I couldn't eat many carbs without a meltdown etc, I gained weight by snacking on things that didn't require insulin, mainly cheese and eggs xx

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I tend to do this too, I was slim before diagnosis, very slim when diagnosed and also slim now!So I found it difficult to cut down my carbs when I had lived a life of eating whatever I wanted without seeing weight gain. I Will now try and eat non carbs if I'm feeling particularly hungry after a meal

I think by having pudding 2 hours after dinner you've got an 'insulin stacking' issue - so basically the insulin you injected for dinner is still working in her body at pudding time. Novorapid lasts around 5 hours in the body.

It's probably worth adjusting the ratio for her dessert so she has less insulin for it and seeing how she does.

Cupoftea&sliceoftoast said:

@kaylz91 unfortunately she's never eaten cheese and eggs, but I have been giving her cold meats as a carb free snack between meals, which she loves. I just feel that she needs carbs for energy and to help her gain weight. We can't inject in her arms because she is so thin, and her stomach is painful too because she has no fat. Thank you for your response.

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It is advised not to inject in arms so that isn't too much of an issue, what size of needles are you using? I can't say I felt any pain with my 4mm even at my lowest weight and I was very slim for a 5ft 5" 26-27 year old female

Of course it will take time but please try and rotate injection sites as not doing so could end up causing issues too
xx

[edited by moderator.]

Cupoftea&sliceoftoast said:

oh goodness. Hormones effect bs too!?!

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Unfortunately yes and in fact lots of things do affect BS - a few off the top of my head - hormones, illness, stress, anxiety, the weather (many find when its hotter we need a different amount to when its cold - some more some less), exercise, different times of the day (many have different ratios dependent on the time of day)

Cupoftea&sliceoftoast said:

@kaylz91 unfortunately she's never eaten cheese and eggs, but I have been giving her cold meats as a carb free snack between meals, which she loves. I just feel that she needs carbs for energy and to help her gain weight. We can't inject in her arms because she is so thin, and her stomach is painful too because she has no fat. Thank you for your response.
@dani96xx Her bloods are stable throughout the day, she is 1/14 for all meals. Her dinner 2 hours before her pudding is absolutely fine at this ratio, but pudding at this ratio gives her a hypo. I've heard mention of "the honeymoon phase". It's all so complicated! Just wish there was a pill instead of all these injections. My daughter has always had a huge appetite and remained lean throughout, and at 5,7 and still growing I'm sure she still needs carbs, but will try to cut down over the next few weeks. Thank you for the information. Very helpful.
@marie2 oh goodness. Hormones effect bs too!?! The next few years are going to be interesting then. My daughter's periods stopped a month or so before being diagnosed, so I'm hoping with weight gain they will start again, but not looking forward to the swings in bs. I will speak with the diabetes nurse about her bolus dose. Thank you for the information.

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If she is consistently dropping at the same time of day I would definitely reduce the fast acting insulin.

Unfortunately many factors can affect your blood sugars. Luckily for me my hormones don't so fingers crossed your daughter may be the same.

Unfortunately no day is the same and as long as what you're doing works the majority of the time that is the important thing. Whilst diabetes is an overwhelming condition it can be managed and lead a normal healthy lifestyle.

Also eating extra carbohydrates is not going to do any harm short term and as long as she is injecting the carbs it shouldn't have an impact on blood sugars.

Cupoftea&sliceoftoast said:

Thank you so much for your detailed reply. She injects separately for her pudding. Sometimes she needs one or two treatments for the hypo, but by bedtime she is 7 or 8 and remains consistent through the night and wakes roughly with the same numbers.
We try to inject 15 minutes before the snack, but I was wondering if the fat content of the meal was delaying the carbs being broken down. Perhaps we should try giving the insulin at the time she starts eating as you suggest.
I will eventually change her eating habits but I don't want too much to change for her all at once. I thought we might do some cooking together over half term and introduce some low carb options without drawing attention to the fact they are lower in carbs.

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Hi,

If your daughter rapidly lost weight prior to diagnosis. (I did as a kid. A 2stone 7/8 year old isn't great.)
Pretty much starving the body due to the lack of insulin dissallowing the body to utilise what's eaten thus burning body tissue for fuel.. (Layman's terms.)

At a guess, your daughter maybe injecting into muscle tissue? Which could cause the insulin to kick in faster..

It seems to me she's doing great so far. It may get a little easier with the bolusing when she regains what weight was lost?
From personal experience, novorapid can still have a kick in the tail 4 hours later. Some of the carb content of the pudding could have been enough to catch a drop that may have been happening anyway??

I suspect your daughter does need to reduce the carbs and increase fats and proteins. The latter two help reduce hunger and carbs are not needed for 'energy' despite the adverts saying so (unless she is an athlete). It looks like carb stacking may well be happening. It's very difficult to work out the right bolus timing when the meal has a lot of carbs and fats.

I also suspect insulin stacking is largely to blame for your daughter's hypos. It is always unwise to inject a new lot of insulin when a previous lot is still working and we cannot tell exactly how much further our BS is going to drop because of the first injection. In addition, we are all rather more sensitive to insulin in the evenings than we are in the mornings anyway. You sound as if you are both on top of the situation generally. Just avoiding injections that are too close may solve the problem completely, or at least move things in the right direction. Good luck. With type 1, there always seems to be something new to learn.