Frequent hypos

[Natalie]

Hi all,

I am a Type 1 on 20 units of Levemir twice a day (morning and night) and take various doses of Novorapid with each meal. My official dose for meals was set at 7 units for breakfast and lunch, 5 units for my evening meal, but now I find myself getting hypos almost daily. After the summer break I returned to university and am now much more active, and I found that after eating breakfast at 7.45am, my readings were below 3.6 or lower at 11am - 11.30am. I have lowered my dose to try and correct this problem and now only take 3 units in the morning rather than the 7 I previously had. This seemed to help, and upon testing at 12/12.30 my levels were perfect, 4.5-6 usually. But for the past week or so I have been getting hypos more frequently and at various points throughout the day. Unless my readings are elevated pre-meal I only take 3 units but hypos are still a frequent thing. For example, last night I had my evening meal at 8pm, which was a stirfry containing egg noodles, so quite carby I thought, but my reading at 10.30pm was 2.2!

I am going to try and get my next clinic appointment moved forward as I'm not due to see them untill the 30th of November, but in the meantime I wondered if anyone had any suggestions about what to do. I'm quite worried about hypos as sometimes I don't notice until it's very low (1-2) and wondered if anyone who's had a similar problem has any advice? I deliberately include a decent amount of carbs with each meal and as I said have lowered my Novorapid doses, but it is very difficult to keep my levels up.

I was wondering if it might be a good idea to lower my Levemir dose, or whether I should further reduce the Novorapid? 3 units seems very low compared to what I was taking, which is why I thought maybe it was the Levemir that needs to be adjusted?
Or maybe there's dietary changes I can make to sustain decent levels?

I'm quite new to this, as I was only diagnosed last December and until August I had very erratic and usually v. high readings, so it's only the past couple of months that I have been having these problems.

Any advice would be very much appreciated, as I've found that this forum is a great source of information and very useful

Thanks,

Natalie x

 

[Natalie]

Hi Sarah,

I started carb-counting about a month ago - for the first couple of weeks this seemed to work quite well; my doses seemed to be quite accurate and my readings were good (4-8 usually) pre-meals. But then more hypos happened, which is when I started lowering the dose by a couple of units, but as I said they have become more erratic and frequent now, despite the adjustments. This is what made me think it was the Levemir, because I think my Novorapid doses were right for what I was eating.

I called the clinic today but there was no-one to speak to, just an answering machine message to call after 9am tomorrow, so I am going to speak to someone and hopefully get some help, but it was just playing on my mind and wondered if anyone had any advice or comments.

Thanks,

Natalie x

 

[sugar2]

HI Natalie,
I would say that if you get frequent hypos, and yourbs is quite low all the time, then your levimir dose is indeed too high. it is tricky to say exactly what you should lower it to...without knowing you, but I would say try 15 and 15 for a few days (it takes a while to see what the change in dose will have...monitor your bs and then go from there. Alas, it is all trial and error. Guidance from the professionals is good though. You do need to do something...while we all know that being too high is dangerous, if you are in danger of having dibilitating hypos, you need to be careful...don't drive etc. Its a tricky tight rope!
Best of luck!

 

[Stuboy]

sounds like your levemir is high...

I was told only a few days ago that typically (and i know, we're all different, but sometimes it helps to go back to those rules of thumb as a starting point) your levemir should be around 50% of your TDD.

with 7, 5 and 5, that only brings you to 17u a day, which would mean that your 40u a day of levemir is massively high... of course that's only by the rule of thumb, we are all different after all... but something to think about? I suspect that your care team might say something similar.

 

[Natalie]

Thanks everyone for your advice and comments, I agree that a lower dose might be the best way to go - I was in hospital in August with DKA (having been taken off all insulin and being tried on byetta by an idiot nurse, but that's another story!) and when I was discharged my prescription said 15 units twice a day, so I checked with the nurses that it was right as I'd been on 20 units; they all agreed I should stick to 20 but now I'm wondering if one of the doctors decided it should be 15 and they just didn't know?
What's confusing to me though is that I've been on 20 units for a long time and it's only the past couple of weeks I've had hypos so regularly, but could it be that my requirements have changed due to the increase in exercise? Previously I did maybe half an hour of walking a day, now with travelling to/from university I walk for at least 1 1/2 hours each day (and more briskly, usually running late and in a rush!)

Thanks,

Natalie x

 

[zeberdee]

:roll: Hi, Well its a strange world isn't it. It must be something in the air cos I have been a Type 1 diabetic for over 40 years and recently have experienced severe hypos. Must admit I am not a role model though as the carb counting goes straight out of the window. However, am a bit reformed now and doing the carb counting but more importantly have reduced the levimir dose that I have twice per day and it seems this is the key. I was experiencing highs of 19.5 then plummeting to 2.4. However, is getting sorted now thanks to a lot of help from the hospital staff and my partner.