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Frequent hypos

9

95michael

Member
Messages
12
Hey guys,

I'm at my wits end. So for nearly 10 years I did no blood sugar monitoring because I was so fed up from the diabetes. However, during those past 10 years my hba1c was between 6.8 to 7.5 despite no glucose monitoring.

I only began measuring earlier this year and got a grip on my condition and latest hba1c was 6.3. However, whereas before I'd get something like 1 hypo every 2 weeks now I get them almost every day, sometimes as much as two times.

I've began lowering my insulin dose but I'd still get them ! For instance yesterday I had a 3.2, this evening a 3.5. It's frustrating me and the worst problem is that only after I tested the 3.5 did I feel the low blood sugar with my body as well. You could argue my awareness is compromised.

I'm not sure what to do anymore. Any advice is welcomed
 
I think your previous posts indicated you were using a CGM, are you still using it and do you get warnings from it?
 
Hey Jonathan, thank you for your post! My CGM has finished and because it's expenisve I haven't purchased a 2nd batch. The NHS won't fund it but whilst using it for 30 days, I was in range 82% of the time (3.9-10.0), 11% high (10.1-13.9), 0% very high, 5% low (mainly whilst i was asleep and 3.1-3.8) and 2% very low.
 
Have you had any advice from your medical team about approach and are they aware of increased hypos and hypo unawareness ? not sure what the criteria are for CGM funding and whether they will consider doing it short term to help you stabilise blood glucose.
 
Sadly I've not had the chance to see my medical team. It has partially to do with the fact I recently moved address and GP subsequently. Still waiting to get included in the list of the new GP practice so I can book an appointment.

Jonathan, out of curiosity, do you have your glucose under control and do you carb count? I guess I need to implement carb counting.
 
95michael said:
I've began lowering my insulin dose but I'd still get them ! For instance yesterday I had a 3.2, this evening a 3.5. It's frustrating me
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How are you deciding on your insulin doses? Are you using an insulin to carb ratio or using a fixed dose for every meal?

At what point are you getting those hypo's? Around the same time of day? How long after your last dose of insulin? Can it be connected to physical activity? Any other patterns you can think of?
 
Hey Antje!

Having used the CGM and having tested extensively in the past half a year I'd say I get them around the 6 to 8pm mark and around 3-4am in the mornings.

I do try to carb count but it boils down to actually guesstimating. I am physically active and do take that into account ie have an additional carb before venturing out or doing a lower dose than I'd normally do but I'd still get unaccounted hypos.

Even last night I took the decision to lower my basal lantus from 24 to 22 units to no avail.
 
95michael said:
I'd say I get them around the 6 to 8pm mark and around 3-4am in the mornings.
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You need to connect this info to how long before you injected and ate, and to what you ate.
The 3-4 am ones, may suggest your basal is a tad high, but this also depends on when you last ate and injected, we don't know at what time you go to bed.

It's all about finding patterns.
For instance, I know I drop when swimming at about 35 minutes from entering the water. So that's when I do a check on my bg, and eat something to prevent a hypo if needed.
I swim late morning, two days a week. However, if I would only tell my consultant I regularly go low at around 11:30am, without mentioning the swimming, she would have no way of guessing those lows are connected to something in my daily routine.

What about keeping a diary, noting insulin, food, activity and blood glucose on a timeline? Log insulin doses and either carbs or simply the kind of food you had, so you can find those patterns.
 
95michael said:
Sadly I've not had the chance to see my medical team. It has partially to do with the fact I recently moved address and GP subsequently. Still waiting to get included in the list of the new GP practice so I can book an appointment.
Click to expand...

If you're not currently on a GP list how are you getting prescriptions? When I was a T1 in the UK all my diabetic stuff was handled by the hospital, but my GP did scripts.

95michael said:
You could argue my awareness is compromised.
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That has happened to me a few times (two pregnancies and more recently when I kept my bgs too low while on a cgm). My current endo advised that I aim to keep my bg between 6 and 12 for a while the last time it happened, and this worked to return my awareness, though I stress that I am not a doctor and so this example is ancedotal. Though I do currently have hypo awareness I am lucky to be able to afford to self fund a dexcom, so I get warnings before I go hypo.

Hypos twice a day is too often in my opinion (oh how I hate hypos), I would urge you to reduce your insulin (if you think you know how to) and/or push for an appointment with an NHS doctor. As a T1 you absolutely need to be on a GP's list.

There is a UK phone helpline for insulin dependent diabetics, though I have no personal experience with them.
Diabetes helpline
Diabetes UK has a confidential helpline for questions about day-to-day management.

Call: 0345 123 2399 Monday to Friday, 9am to 6pm

Good luck.
 
95michael said:
Jonathan, out of curiosity, do you have your glucose under control and do you carb count? I guess I need to implement carb counting.
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I'd say reasonable control ... but think my body may still be producing some insulin which I believe is supposed to help with control (I think the idea is your body can still do fine adjustment for small high or low doses).
I'm low carb and was already doing low carb before I started on insulin - which I think helps with the control. Smaller insulin doses mean smaller errors in desired vs actual achieved insulin effect. I know what a hypo feels like but have been fortunate not to have had any severe hypos so far ... crosses fingers & touches wood

I found Dr Bernstein's diabetes solution very useful.

I've never eaten enough carbs while taking insulin to get a carb ratio ... but do need bolus to deal with protein.

I'd say getting insulin right is much more difficult than non-diabetics realise. My suggestion would be to drop units quickly and add them slowly and try to keep as many things constant/stable while trying to sort things out. I'd extend that to eating the same things at same time each day for a couple of weeks ...

Hope you get things back to normal quickly.

Ed: I also find keeping a log of food, blood glucose and insulin helps work out what is going on. I started that when I was first diagnosed and kept it going since.
 
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Reactions: ert
Hey guys, thank you all for your answers! I am indeed grateful for this community and the chance for being able to converse to fellow diabetics.

@Antje77 I think you're right! My basal seems to be a bit high. Last night I lowered the dose by a further 1 unit to 21 and went to bed with a reading of 7,8 mmol/L. Due to the fear of another hypo I stuffed myself with 30g of carbs and woke up with 10.3 mmol/L. Lunch was 7.6 mmol/L. I had 13 units of NovoRapid for 95g of carbs !! before I'd used 15 units for same meal but I am so fed up with these low readings that I reduced the fast acting by a whopping 2 units. The results:
1h after eating 11 mmol/L
2h after eating 14.5 mmol/L yikes !
3h after eating 9 mmol/L
4h 8 mmol/L
5h 7.5 mmol/L

Can it be deduced from this test that my basal is more or less now correct and that I infact need less fast acting? What worries me is the spike post 2h. I on purpose try to keep them a bit higher than normal as @EllieM suggested! Also @EllieM I have a stock of 15 cartridges worth of both Novo and Lantus to cover me for the transitional period. And it might be a good idea to indeed invest in CGM since it's such a life saver.

@jonathan183 thanks buddy for the suggestion, I'll have a look in this diabetic solution and like you I might consider going on a low carb diet just to avoid the spikes but also to further investigate the ratio carb to insulin.

Yes, guys, it's difficult to get the dose right all the time! and frustrating at times . Before I'd inject 14 to 18 units and won't do any finger pricking. I used to eat everything and anything, didn't care about spikes or whatever. But now I want things to get back to normal.
 
Carb counting is very important ; I always say if you can’t measure it you can’t manage it.
 

I believe Dr Bernstein started on his quest to normalise blood sugars because he was having lots of hypos ... he's a type 1 diagnosed when he was 11 and is now in his 80's. He was also suffering from a number of complications caused by high blood glucose - most of which he managed to reverse

I'd say I'm working towards the level of control he and people following his approach have been able to achieve but still have quite a way to go
... a target 83mg/dl +/- 10mg/dl is still like a moon shot for me maybe I'll get there one day ... till then I'm a work in progress

All the best

P.S. the book I mentioned is this one
 
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coz53 said:
Carb counting is very important ; I always say if you can’t measure it you can’t manage it.
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I agree a blood glucose meter is essential.
Carb counting might be important if you eat enough of them ... for me not so much.
 
Thank you Jonathan and everyone who chipped in oncea again!

In regards to the hypos, I think after numerous tests I have finally gotten the dosage right for both slow and fast acting insulins.

Let's see the coming days.

Haven't had a hypo in over 50 hours! Current blood readings are between 6 and 10.
 

Has your diet changed for some reason? Less food for example;
 
@Erin yes diet changed massively. I went from one extreme to the other ie from eating too many carbs to eating 3/4 of what my insulin would handle. This was with the intention of lowering my hba1c. However, in september, my endo told me that having frequent hypos especially after the fact i've been diagnosed 22 years ago, isn't good and she'd much rather see 6.8% hba1c with minimal hypos than 6% with many hypos. Her advice was no more than 2 hypos a week.
 

My dr. also did not like the hypos (first year or two more frequent until sufalamydes adjusted and with good reason). Age is something to consider for A1C numbers I think. The older you get the more dangerous an ideal A1C becomes because of the hypo risk.
 
Hey @Erin yes you're right. I learned it through numerous self studies and reading diabetic literature. Uhmm it's an interesting one. But yes, I think a general rule would be hba1c between 6.5 and 7. There was a Swedish study conducted on the matter that produced those figures and what they cited was the fact that hypos should be avoided.
 
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