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How dangerous are Hypos ?

Discussion in 'Type 1 Diabetes' started by Juicyj, Jul 4, 2014.

  1. phoenix

    phoenix Type 1 · Expert

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    Re DAFNE,
    What level were they giving for hypo? It was 3.5mmol/l , this is of course lower than many use (my doc uses 3.5mmol/l as well)
    Couldn't in a quick search find any mention of changes, did find this interesting study from DAFNE about the problems of severe hypos/ unawareness from a relatives point of view. It makes quite sobering reading .
    http://care.diabetesjournals.org/content/37/1/109.full
    Reducing hypos to as few as possible is I assume the best way to try to avoid unawareness.
    It could be thought that saying that a couple of hypos a week is fine gives a slightly wrong message.
    (and no I don't manage none either, I did when I stopped exercising for a while but I cannot get rid of them entirely during exercise; though I often don't test now, just take the glucose tablet!)
     
  2. michelle lilly

    michelle lilly Type 1 · Active Member

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    hi everyone
    still very poorly and my blood sugars are still all over the place, reading Hi to 24mg/1,4 mmoL had a few days of really high sugars and ketones, drank loads of water and increaced my basal rate on my pump, thankfully this worked and stayed out of hospital, but even though i have changed my basal rate again to the docs recomended dose, am back to having loads of hypos , just as i was writing this my friend popped in to see if i was ok we had a coffee and a biscuit i had checked my sugars and they were normal for once, after she left i started on a bit of a cleaning spree, two teenage daugars in the house is a cause for disaster plus three cazy dogs the girls have been doing there best but its just not the same, i was only cleaning the bloody fridge and started to feel a little odd but thought nothing much of it, then my sight went really blurry so checked my sugars and yes another hypo 30/mg / 1,7mmol , it took me over two hours to feel alright, just dont know what to do anymore i eat well, check my sugars at least ten times a day i feel like am losing it i have so many problems diabetic neuropathy; gastropathy; arthritis, fibromyalgria j(ust to name a few), i'm only 47 but i feel 100 i used to be full of life, worked hard as a carer, then an assistant nurse, then studied for my degree as an occupatiental therapist but sadly i was unable to finish as my health deteriorated an i was unable to finish, i hav'nt worked now for ten years because of the amount of medecince an my diabetes i feel like i am being eaten up bit by bit by this the doctors dont help much so maybe this formum can oh am hypo again so of to sort myself out again !

    ps: what is DAFNE?
     
  3. noblehead

    noblehead Type 1 · Guru
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  4. Juicyj

    Juicyj Type 1 · Moderator
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    To be honest i'm still not convinced either !! Partly due to the fact that my memory has got worse over time (not blaming old age yet !).

    As it can take a while to recover and anything that places a strain on any organ in the body can't be a great thing, although i'm still of the mindset that it's far worse to run high for any prolonged periods.

    I liked the tyre analogy - I liken myself to a Pirelli personally ;)
     
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  5. Juicyj

    Juicyj Type 1 · Moderator
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    Hi Michelle - DAFNE is a course provided by the NHS for dose adjustment for normal eating.

    Can or do you keep a dairy of your insulin intake, carbs eaten with times and doses ? This would help you track trends and monitor patterns.

    It sounds like you are not being properly supported - do you have a care team/nurse who can offer better guidance ?
     
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  6. noblehead

    noblehead Type 1 · Guru
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    Agree with what you say Juicy, better to play it safe with regards to low bg, but that said the article you posted does offer some comfort for those that have had their fair share of hypo's over the years.
     
  7. Shaolindan

    Shaolindan Type 1 · Member

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    Hi Michelle,

    I don't want to speak ill of your health team but it sounds to me like your pump basal isn't right and that you haven't been taught enough to adjust it. I realise that I am incredibly lucky as I am the DAFNE REPOSE trial which got me a pump on the NHS.

    http://www.dafne.uk.com/dafne_gets_pumped_with_repose-I457.html

    DAFNE "Dose Adjusted For Normal Eating" is a different way of eating and taking your insulin. Before when I was taking a set amount of slow acting insulin in the morning - which covered my breakfast and lunch and then a set amount in the evening which covered my supper and sleep time; i had to make sure that I was eating at least a minimum amount of carbohydrates for each meal - which I would need to increase if I knew I was doing any more exercise than normal. So with the 'old' method, I only used quick acting insulin when I was ill and my sugars spiked.

    With DAFNE, on a pump (with Novo Rapid), my basal is set to cover the sugars that naturally occur with my hormone levels that affect the liver. This means if I eat nothing all day - fasting - that I will not have a hypo or hyperglycemia. It is this part that of your regimen, that to me, sounds like it needs to be adjusted. It took me and my team at Kings College Hospital about 9 months before we got it spot on. My basal changes about 6 times over a 24 hour period but keeps my sugars completely flat.

    The 'Dose Adjusted' part of DAFNE means that when ever i eat, I count carbs. This means trying to, as accurately as possible, estimate the grams of carbohydrate in everything I eat. I then can have a 'bolus' of insulin from my pump to correct the sugars my body will absorb from the carbs. This again takes a while to learn and get right.

    I, personally, have had such an improvement in my health and standard of living since going on a pump, getting the basal right and learning DAFNE. I have pretty much stopped having hypos altogether and those I do have I now spot so quickly they aren't an issue - people don't notice and I don't need 'recovery time'. 30 months ago I was sent to the Eye Clinic at the hospital because of shadows indicating retinopathy at DECS. 12 months ago - 9 months after starting the pup and DAFNE the Eye clinic confirmed after a series of detailed retina photographs that the shadows had disappeared completely. The consultant said this was entirely down to my better sugar control.

    One of the other people on the trial with me come up with a great phrase "My sugars now ripple rather than have waves."

    I hope this explains DAFNE to you a little and I hope that your health care team can help you adjust your basal rate on your pump. It may involve you having to fast occasionally in order to check but it is worth it.
     
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  8. PaulinaB

    PaulinaB Type 1 · Well-Known Member

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    I think this is the best explanation of basal-bolus I've ever seen!
     
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  9. iHs

    iHs · Well-Known Member

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    Michelle

    Is it no wonder that you are struggling like you are......but as you have a pump anyway and do a fair amount of bg tests, have you done any basal rate testing lately for 6hrs at a time without eating any food that would csuse yr bg to rise, and then altered the settings according to the bg results which need to be done every hour and also adjusted the carb ratio? Ive got to alter the morning basal myself as Ive had 2 days in a row where my bg is going up even with all this baking hot weather. Also, your correction ISF factor might need adjusting at different times of the day. Cant remember if you use Novorapid or Humalog or Apidra but some find that changing to another insulin enables better bg levels to be achieved. There is also CGM which is gaining in popularity and would help you avoid the bad lows and bad highs. Does sound to me as though yr basal rates possibly need adjusting and yr correction factor and yr csrb ratio.
     
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  10. amberzak

    amberzak Type 1 · Well-Known Member

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    They don't cause any last damage but I was told by my diabetic nurse that she would rather I have highs than lows. This this because a high can be corrected easily but with a low we all can have a habit of over eating to compensate, and the body gives out more sugar stores from the liver to compensate, often resulting in a high after and forming a vicious circle.

    After I changed my thinking (i used to go low all the time because I was so scared of highs) I don't often go too high because I don't often go low.

    Also you got to watch out for hypo unawareness. I was so bad (went low daily) last summer that I didn't even know I was low. I remember one day saying to my friend I was hungry so we went to McDonald. I should have known, I only ever crave mcdonalds milkshakes when I'm low.

    Any way, while in the line I suddenly felt ill. Next thing I knew I was on the floor, and my friend was testing my sugars while a mcdonalds employee was getting me a normal coke. My sugars were 1.1 (40 in US talk), and I hadn't felt a thing other than light headed and hungry. (He told me I was incredibly irritable). So too many lows means you lose the sensation of it (hypo unawareness) and that's when it can get dangerous (and embarrassing).

    But we all do go low. That's a fact of diabetes. Unexpected exercise, miscalculating carbs, anything like that. So don't beat yourself up if you do go low. I would say probably about once a week I will hit a 3 (54 in US language) but that's because I'm trying very hard to keep my sugars down (trying for a baby), and I check my sugars every 2 hours to catch them.





    Sent from the Diabetes Forum App
     
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  11. phoenix

    phoenix Type 1 · Expert

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    Just to add to some of the things said earlier
    In France, you are looking for a stage d' insulinotherapie fonctionnelle. (avec pompe)
    There is no national course like DAFNE and if there is a course, what is taught and how it is taught will depend a lot on local providers and their views. In my part of the world it seems that courses are always as an in patient in hospital.
    Does the prestataire visit you at home ? Mine comes twice a year and I can contact her at any time (there are several firms, I just linked to one of the bigger ones) They are paid a fee to assist you with your pump and certainly I find mine knowledgeable .
    CGMs aren't paid for by the health service as yet .
    I have been able to use one for periods of 2 weeks at a time. The local hospital owns two which are funded by a 'charity'.
     
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  12. jack412

    jack412 Type 2 · Expert

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    #32 jack412, Jul 19, 2014 at 5:34 PM
    Last edited by a moderator: Jul 19, 2014
  13. michelle lilly

    michelle lilly Type 1 · Active Member

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    i feel such an idiot i have never heard abou half the stuff you are all talking about, i have never heard of the basal rate test, or anything, to be honest when they first gave me the pump, i was told not to touch my basal rates at all and wasn't shown how, it was only that i took very ill in England last summer and went into a ketoacidoses coma for three days, i was in hospital for a month, even with them montoring i had another episode in hospital two weeks later, they helped me alot though and taught me so much more of what the pump could do! i didn't have a clue about the bolus wizard or reducing your inslin when using more engery nothing, just how to give a straight foward bolus and that was that, I have another appointment on monday reguarding the abcesses and mouth infections which are not helping me get any control, also the dibetic nurse has mentioned a sensor that goes under the skin i think this must be a CGM also a pasemaker type machine for my stomach that should help the gastopareses however he says there is no point in talking to the doctors about anything untill my mouth is sorted, woke in a haze this morning could barly see and yes i was hypo 34mg/1,7mmol i am going to talk to the nurse about all the things you have menioned thanks so much i am learning so much on here thanks again!
     
  14. michelle lilly

    michelle lilly Type 1 · Active Member

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  15. michelle lilly

    michelle lilly Type 1 · Active Member

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    I am not getting much support to be honest and although i have had this pump for three years i still dont know much at all, once upon i time i was a nurse with a brain now i have no words to discribe, what i have become, my personality has change, but never mind i wont give up looking for the answers, DAFANE sounds great dont think we have this here but mybe there could be somthing simluar, at the mo i have to travel over an hour and a half just to get to the hospital, which in the past has been difficult but because i have the govermznt insurance this pays for a taxi there and back for me, so things are looking up,
     
  16. amberzak

    amberzak Type 1 · Well-Known Member

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  17. michelle lilly

    michelle lilly Type 1 · Active Member

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  18. maskellp

    maskellp Type 1 · Member

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    Auckland Canary, I do quite a considerable amount of exercise and have 1 to 2 hypos a day, I tend to find I worry about having them and over compensate with energy bars/gels etc... then end up with 15+ BG!

    A cheap CGM or one on the NHS would be great! (gonna win the lottery this weekend and self fund one)

    2.2ish for the whole day though I would be talking to diabetic clinic about this!
     
  19. phoenix

    phoenix Type 1 · Expert

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  20. iHs

    iHs · Well-Known Member

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    What pump have you got Michelle? Have you got the pump manual at all?
     
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