First Hypo, Fed Up

[LornaFarrell]

I was diagnosed about a month ago but they still can’t decide if I’m type 1 or type 2, which means I’m not being advised to count carbs and haven’t been offered any training or anything. But I’m on insulin, and I have been told to take extra if my blood sugar is high or less if I’m planning to exercise etc.

I’m getting so fed up with not being able to manage my sugar level.

I seem to be caught in a trap of swinging from too high to too low and I don’t have enough info to break out of it. Like this morning, pre breakfast was 13 so I had an extra couple of units with breakfast (I’ve been told to have 18 with meals). Then 2 hours later I’ve dropped to 3! Had some sugar, ten minutes later still not rising so had more sugar. Now I’ll probably have overcompensated and I’ll get a reading over 20. I just can’t get it right.

 

[Guzzler]

Sorry I can't advise on insulin use as I have no experience of it but I'm sure that those who use insulin will be along shortly to assist. It certainly is a bummer that you have been left in limbo with regards to a firm diagnosis and I hope that this is resolved soon. Hugs.

 

[Deleted Account]

Can you tell us a bit more about your insulin regime?
How often do you take it and how do you work out how much to take?

 

[Circuspony]

So you need to start keeping a diary. Take your BG level before you eat and note it down. Measure the carbs in your meal (read back of packets, weigh everything and Google if it isn't on the packet). Write that down too. Then write down how much insulin you've taken for that meal. 2 hours later measure BG again and write it down. That exercise will start to show you and your diabetes team patterns between carb intake and the insulin you are taking. All is needed for carb counting.

Obviously if you hypo then some glucose tablets or jelly babies are needed - but again, write it down. It'll show you how much you need to address a hypo how much extra insulin to take if you're high etc etc.

 

[piotrek9111]

Hey Lorna,

If your sugars move that quickly up and down I think you definitely should start counting carbs, its affecting your blood sugar heavily if you dont know how much you ate and just put 18 U... For a start, it could be a good idea to start with one meal with same amount of carbs for example 50 grams and then try how much insulin you need to keep your sugar in range ( be extra careful with insulins amount ! ) check your sugar level one hour after meal and 2 hours after meal if its too high then you obviously need more insulin, if too low - too much insulin
whenever it go below 4 - eat some, what I call quick carbs I use Dextroenergy tabs you can buy them at any Home Bargains ( for low sugar eat at least two tabs)

Thats for a start

PS if your sugar levels are moving up and down heavily check sugar level at least 8 times a day and observe where it move

 

[annieblade]

I was diagnosed about a month ago but they still can’t decide if I’m type 1 or type 2, which means I’m not being advised to count carbs and haven’t been offered any training or anything. But I’m on insulin, and I have been told to take extra if my blood sugar is high or less if I’m planning to exercise etc.

I’m getting so fed up with not being able to manage my sugar level.

I seem to be caught in a trap of swinging from too high to too low and I don’t have enough info to break out of it. Like this morning, pre breakfast was 13 so I had an extra couple of units with breakfast (I’ve been told to have 18 with meals). Then 2 hours later I’ve dropped to 3! Had some sugar, ten minutes later still not rising so had more sugar. Now I’ll probably have overcompensated and I’ll get a reading over 20. I just can’t get it right.

I was the same 18 months ago and equally as fed up. After 4 diagnoses I have now been told I have LADA (type 1.5).

You didn't say which insulin you are on but 18 units may be too high now your blood sugars have come down a bit. One thing I have learned is that diabetes management is an art not a science and no two days are identical. As you become more experienced you vary your insulin intake with more confidence. It all seems overwhelming at the start but it gets easier.

if you are dropping from 13 to 3 in two hours your bolus may need reducing, Starting at 13 pre breakfast suggests your night time basal may need to increase. Make sure you get telephone access to a diabetes specialist nurse and ask them for help while you start adjusting doses. If your GP has no specialist (mine doesn't) then get an urgent referral to a diabetes centre or the community diabetic nurse service.

My levels are still erratic (seems to go with LADA) but I have just completed my first ever 5k run - I started running 12 weeks ago - not bad for a 56 year old late onset diabetic!

 

[LornaFarrell]

Can you tell us a bit more about your insulin regime?
How often do you take it and how do you work out how much to take?

Ok, I’m on 28 units of Lantus which I take in the morning. Then 18 units of Novorapid with each meal. Started on lower doses but gradually increased to that (as instructed by the diabetes nurse). On Friday I saw the dietician who said I can vary that amount and take more or less than 18 as I feel necessary. But no actual training on how to calculate doses, pretty much just to use trial and error and figure it out.

Carb counting makes sense to me, my consultant said it “might be a route to go down IF it’s type 1” but won’t give me more info until then.

 

[Deleted Account]

Ok, I’m on 28 units of Lantus which I take in the morning. Then 18 units of Novorapid with each meal. Started on lower doses but gradually increased to that (as instructed by the diabetes nurse). On Friday I saw the dietician who said I can vary that amount and take more or less than 18 as I feel necessary. But no actual training on how to calculate doses, pretty much just to use trial and error and figure it out.

Carb counting makes sense to me, my consultant said it “might be a route to go down IF it’s type 1” but won’t give me more info until then.

I definitely have type 1 and carb counting has been very helpful for me.
I do not understand the regime you have been put on with a fixed dose of NovaRapid with each meal regardless of what you eat. But I am not a doctor and cannot guess what yours has in mind.

It may be useful to focus on your Lantus dose - this is supposed to keep your BG level when you do not eat.
Overnight is a good time to test this. Test before you go to bed and test when you wake up. If your BG goes up, you need a little more Lantus the next time you take it. If your BG goes down, you need less. Lantus may take some time to "bed in" so if you adjust your dose, give yourself a few days to get used to it.

Once you have worked out your Lantus dose, it is probably worth working on your NovaRapid. Like other respondents have said, carb counting seems like a good idea. There is an online course (https://www.bertieonline.org.uk/).

However, managing diabetes is a marathon where you continue to learn along the way. I would not recommend trying to cram learn everything on day one (especially as you do not know if you are type 1 or 2). Take it slowly, expect some ups and downs but expect things to start calming down.

Good luck.

 

[LornaFarrell]

It may be useful to focus on your Lantus dose - this is supposed to keep your BG level when you do not eat.
Overnight is a good time to test this. Test before you go to bed and test when you wake up. If your BG goes up, you need a little more Lantus the next time you take it. If your BG goes down, you need less. Lantus may take some time to "bed in" so if you adjust your dose, give yourself a few days to get used to it.

Once you have worked out your Lantus dose, it is probably worth working on your NovaRapid. Like other respondents have said, carb counting seems like a good idea. There is an online course (https://www.bertieonline.org.uk/).

...

Take it slowly, expect some ups and downs but expect things to start calming down.

Good luck.

Thank you, that’s really helpful. Especially the link, I’ll check that out.

I think the set doses were because I was diagnosed in A&E with really high sugar and ketones so it was an emergency treatment and meant to be reviewed later. But that won’t happen until the test results come in.

 

[Jaylee]

I seem to be caught in a trap of swinging from too high to too low and I don’t have enough info to break out of it. Like this morning, pre breakfast was 13 so I had an extra couple of units with breakfast (I’ve been told to have 18 with meals). Then 2 hours later I’ve dropped to 3! Had some sugar, ten minutes later still not rising so had more sugar. Now I’ll probably have overcompensated and I’ll get a reading over 20. I just can’t get it right.

Hi @LornaFarrell ,

Tracking blood sugars with a meter while low requires patience.. It's easy to panic when bloods don't seem to rise?
Looking at the series of events happening here, you tested at 3, treated then tested 10 minutes later. The problem is the reading reflects what your BG was upto 20 minutes prior. (Like a snapshot in time.) so when you tested 10 minutes after the treat you are probably still seeing your level before any carbs were digested..?
(You may see an improvement testing 30 minutes later?)
You did the right thing sorting it out. Hope you're feeling better now.

 

[LornaFarrell]

Hi @LornaFarrell ,

Tracking blood sugars with a meter while low requires patience.. It's easy to panic when bloods don't seem to rise?
Looking at the series of events happening here, you tested at 3, treated then tested 10 minutes later. The problem is the reading reflects what your BG was upto 20 minutes prior. (Like a snapshot in time.) so when you tested 10 minutes after the treat you are probably still seeing your level before any carbs were digested..?
(You may see an improvement testing 30 minutes later?)
You did the right thing sorting it out. Hope you're feeling better now.

See, that’s exactly the sort of info I need to have! I thought a finger prick gave a current reading and it was only the libre that was delayed (I’ve heard that discussed as a downside to the libre) Knowing both are delayed will definitely help in future, thank you.

So, how long after would you re-test and expect to see an improvement? Assuming you had eaten something like jelly babies, when would you expect to see the full effect? I’m sure it varies, but roughly?

 

[slip]

Lorna - generally if you think you are low or have tested and are hypo, take 3-4 glucotabs (or similar, jelly babies are of much the same carb value) as quickly as you can, then test after 10 mins - with glucotabs et al that are quick acting, the delay is minimal so that 10min delay should be enough to show you are rising, but you also need to consider if and how much Insulin on Board (IOB) you currently have - and take more slower acting carbs if required - depends when your next meal is due. as Already probably pointing out don't panic and over treat with carbs, difficult I know - especially with night time hypos you just want to eat the entire cupboard!

The other thing is if you're finding you're going higher than expected after a hypo and are pretty certain you didn't over treat try not to correct the high with insulin, the likely hood is your liver also did a glucose dump (the bodies natural defence against hypos) but at some stage the liver will want that glucose back, if you correct with insulin......you're heading back to hypo land and the roller coaster will start allover again.

Normally HCPs start people off on a 1:10 ratio (insulin units to grams of carbs) so unless you're a big carb eater 18u for a meal seems a tad optimistic - maybe if your BGLs were high in the first place you could afford to have that much but hopefully your average BGL has come down a bit and the 18u is just too to much.

 

[LornaFarrell]

Lorna - generally if you think you are low or have tested and are hypo, take 3-4 glucotabs (or similar, jelly babies are of much the same carb value) as quickly as you can, then test after 10 mins - with glucotabs et al that are quick acting, the delay is minimal so that 10min delay should be enough to show you are rising, but you also need to consider if and how much Insulin on Board (IOB) you currently have - and take more slower acting carbs if required - depends when your next meal is due. as Already probably pointing out don't panic and over treat with carbs, difficult I know - especially with night time hypos you just want to eat the entire cupboard!

The other thing is if you're finding you're going higher than expected after a hypo and are pretty certain you didn't over treat try not to correct the high with insulin, the likely hood is your liver also did a glucose dump (the bodies natural defence against hypos) but at some stage the liver will want that glucose back, if you correct with insulin......you're heading back to hypo land and the roller coaster will start allover again.

Normally HCPs start people off on a 1:10 ratio (insulin units to grams of carbs) so unless you're a big carb eater 18u for a meal seems a tad optimistic - maybe if your BGLs were high in the first place you could afford to have that much but hopefully your average BGL has come down a bit and the 18u is just too to much.

This is so useful, thank you. So for carb counting do you consider all carbs (like the lactose in cheese for example) or are you just looking at obvious carbs like potatoes or fruit?

It is hard not to panic and overtreat if I don’t see an improvement after 10 minutes or so, largely because I’m usually at home alone all day with a two year old and a baby and I worry about not being able to look after them if I’m feeling weak, shaky, dizzy etc.

 

[slip]

I wouldn't consider cheese as a carb - but it does depend on how much of something you eat even if it's low carb - that cheese example also throws up another factor - fat, which will slow down the absorption of carbs but best not to worry too much about that just yet!

Just try and work out the main carbs of a meal, the bertie online will help you.

As already said keep a log of everything time, meal, an educated guess at carb content, BG result and units of insulin taken, if poss a 2hr bg test after might help - this will certainly help you and your HCPs work out whats best for you. You'll soon get the hang of it.

If you're breast feeding a baby thats something else to consider too - but completely and utterly out of my realm!

It is hard not to panic and overtreat if I don’t see an improvement after 10 minutes or so

you might not be seeing that much of a rise that quickly because you might be having too much IOB, do the 10min test, if it's rising nicely then great maybe eat a slower carb, if it hasn't moved much test again in another 10mins, if its still dropping or not raised much a few more glucotabs, and repeat in 10 mins, if it is back on track then again maybe something slower release to help you on your way.

If you've taken some quick acting it's going to raise you, by how much depends if you have IOB - generally 10g carbs will raise the 'average' diabetic 2-3mmol

 

[slip]

Hope I get this link right, a post by @helensaramay sums things up nicely about treating hypos

https://www.diabetes.co.uk/forum/threads/type-1stars-r-us.150597/page-168#post-1852728

 

[Jaylee]

See, that’s exactly the sort of info I need to have! I thought a finger prick gave a current reading and it was only the libre that was delayed (I’ve heard that discussed as a downside to the libre) Knowing both are delayed will definitely help in future, thank you.

So, how long after would you re-test and expect to see an improvement? Assuming you had eaten something like jelly babies, when would you expect to see the full effect? I’m sure it varies, but roughly?

From my own personal experience. i can recover in 25 minutes. Depending on the severity of the low & what caused it (either a bolus on board or fasting basal?) i can keep functioning..
For instance, i sing in a band & dont eat before a gig. If i was to drop whilst literally doing a show? (it has happened.) I take a sugary liquid drink & plough on.. (That scenario would be a basal issue.)
Of course, the type of carbs used to treat the low are a factor too!

The 3Mmol you saw may have been caught on a drop, descending further? Though you were treating the hypo correctly, the 10 minute later test could have given the "impression" you were still low or possibly lower still? when what was actually seen was probably the point (15/20 minutes ago.) just before the metabolism had taken on the carbs..

It's so easy to panic & over treat.. After 42 years of insulin use, the waking night'ers still push my panic button..