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Help me understand last night's horrendous hypo

EllieM

Master
Retired Moderator
Messages
10,353
Location
New Zealand
Type of diabetes
Type 1
Treatment type
Pump
Dislikes
hypos and forum bugs
Uggh. I hate hypos.

I finally took the plunge and invested in a trial of a Dexcom g6 (started 3 days ago on Monday). The alarm possibly saved my life last night.

So, I went to bed as per usual at 11.30pm, and took two glucose tablets with my lantus, because my bg was at 4.7, rising from low warning territory of 4.4. I also increased my lantus to 17 from 16 because all my nightly figures show a gradual rise overnight. An hour later I started to go hypo and had to give myself more and more glucose to keep my levels up (kept heading down into 2 territory). After about 50g of glucose levels finally went up to 8 at 2am, but then headed straight down again and at 4am I had another 20g of carbs to haul myself back up from high 3s to an eventual steady level of around 7.5 which finally started rising at 7am (dawn phenomena?).

I am pretty insulin resistant (1 unit of insulin for 3g of carbs) so did I just accidentally take Humalog instead of lantus? If so, why the new hypo at 4am? (Or was that the tail end of the Humalog?). Could the lantus have acted as a short acting insulin instead of a long acting one? I guess I'll have to inject multiple doses of Humalog all day if that is the case, but the Dexcom will let me know.

On the plus side, I used my glucometer a lot last night as my blood sugar stubbornly kept dropping, and it matches very well with the Dexcom, giving me more confidence in said device. (When I used the libre I developed an allergy and its results became completely erratic and/or random so I've spent the last couple of years fingerpricking 8-10 times a day.)

It's not the first time I've done the Humalog/lantus mix up, but I really don't think I did this time, and the relentless plunge of my blood sugar was terrifying. (I am used to 1 or 2 glucotabs being enough to pull me out of a hypo).
 
EllieM said:
Could the lantus have acted as a short acting insulin instead of a long acting one?
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Yes. If you hit a very small blood vessel with Lantus it can act as a very quick acting insulin. It has to do with the way Lantus is made long acting. It needs to react with subcutaneous fatty tissue to slow it's action. Get some in your bloodstream and things go wrong.
Very glad you're OK now, and that your Dexcom saved you, together with good preparation on the fast glucose front!

This possible effect Lantus can have is the main reason I switched to another long acting insulin (Tresiba, but Levemir is safe too, in that it can't suddenly act as a quick acting insulin). It happened to me once, a couple of years ago. I remember my last thought before losing 2 hours being 'don't close your eyes now or you won't wake up again'. Obviously I did wake up, thanks to the massive amount of glucose I'd already taken, and the late meal with lots of carbs and fats likely helping as well.

This might be of interest to you. I'ts scary. https://www.diabettech.com/diabetes/lantus-lethal-or-lifesaver-doc-gbdoc/
 
EllieM said:
Thank you, that's very helpful. Do you know whether there is any way to tell if I injected humalog rather than lantus? If I didn't then I think I need to ask about changing my long acting insulin.
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No way to tell. Keeping your insulin in separate places may help in the future to prevent mix ups. Something like the Lantus in the bathroom, to be taken when brushing your teeth. The Humalog is pretty close to where you are most of the time, I think.
 
EllieM said:
Thank you, that's very helpful. Do you know whether there is any way to tell if I injected humalog rather than lantus? If I didn't then I think I need to ask about changing my long acting insulin.
Click to expand...

No way unless you can get them in pens which tell you when you last injected. I use Novopen Echo for my Fiasp and Levemir and it will tell me when I last injected with one up to 12 hours. I think there are addons you can get for pens of other brands which will do similar.

I'll echo @Antje77 and say it's possible to get a quick acting effect from Lantus. I experienced this once whilst on it before asking to switch to Levemir (for a different reason; I was already splitting the Lantus).
 
Lantus works by being slightly acidic (ph4.5?) and the body's neutral ph allows the insulin to be taken out of the solution over time and sub cut injections keep the needle away from blood vessels, or that's the theory if you spike high all day you perhaps took the wrong one.

Saying that Lantus is an odd one so you could have used a 'fresh' site near capillaries as mentioned, or some from the day before's still working, hope today's not a painful one.
 
I used to have serious problems with a dip in blood sugars around 2:00am when using Lantus. Strangely varying the injection time didn't make much difference. It was something that became clear when I started using a Dexcom. The answer for me was to move to Levemir which was a big improvement.
I now use a pump which is even better.
 
If in doubt, I use the electronic display on Novoecho pen to check if I have or haven't taken my insulin and how much. I have a red one for fast-acting and blue for long-acting.
 

Well, actually I haven't spiked high all day, though it may be that I've taken enough extra humalog to keep me in range. But I certainly haven't had enough extra to compensate for zero lantus….

Maybe some of the lantus is still acting???

ert said:
If in doubt, I use the electronic display on Novoecho pen to check if I have or haven't taken my insulin and how much. I have a red one for fast-acting and blue for long-acting.
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Unfortunately I don't think novoecho is available in New Zealand?

Sigh, I'll just have to keep injecting the lantus and see what happens at night - I have the Dexcom alarm to save me if all goes horribly wrong again...

Thanks for all the comments (and moral support). Though my partner is very understanding you have to be diabetic to appreciate a hypo....(Though to be fair, he's had some really bad experiences in the past when I was so hypo that I remember nothing.).

But honestly, a plummeting blood sugar is terrifying.
 
EllieM said:
Thank you, that's very helpful. Do you know whether there is any way to tell if I injected humalog rather than lantus? If I didn't then I think I need to ask about changing my long acting insulin.
Click to expand...

You could get yourself a Timesulin pen top. It goes on the top of your pen and when you take the lid of to inject it starts a timer. You can then check the last time you took your shot
 
EllieM said:
Unfortunately I don't think novoecho is available in New Zealand?
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There are a couple of pens with timers on (the Novopen 5 does I believe as well) - you should ask your doctor/DN/consultant which are available where you are.
I actually found Timesulin caps, they fit on the disposable pens, after a quick Gooogle I can see they deliver to Australia, not sure about NZ - you'd have to check - whilst it doesn't show how many units you've used, it does show the last time you used it.

Edit: @porl69 just beat me to it
Edit 2: added extra words to make it more readable, and corrected some entirely wrong words - trying to write this whilst in a con call at work may not have been the best plan ever!
 
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porl69 said:
You could get yourself a Timesulin pen top. It goes on the top of your pen and when you take the lid of to inject it starts a timer. You can then check the last time you took your shot
Click to expand...

That looks awesome, and it seems that they ship to NZ.
Thank you.
 
Oh flip, I can't believe this. It seems they only support disposable pens. Not sure whether disposables are available in NZ but I don't think I'm willing to do that to the environment. I'm just going to have to be more organised…..

Thanks for all the comments though.
 

Maybe worth sending them an email......they may do one for a non disposable pen?
 
porl69 said:
Maybe worth sending them an email......they may do one for a non disposable pen?
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They specifically say not on their website, but encourage readers to send requests. It can't hurt to email.
 
There have the pens now.
https://www.diabetes.org.nz/diabetes-supplies-insulin-pens
 
Hi,

My experience with Lantus lows are they can recur if I only use fast acting carbs to nip them up.

Was this a fresh cartridge you used, perchance?
 
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