Type 1.5 Hypo query T1.5 lada third week on insulin

GuidingSenses · Apr 12, 2020

Hi there and Happy Easter!
I had a real bad hypo last night, it woke me up around midnight. Luckily hubby got me jelly babies and then a mini sandwich after but it scared me so much! I couldn’t move, sweated profusely and felt shakey inside.
I’m struggling to know what I did wrong?
I use as advised the carbs and Cals app which I love! Advised 140/150g carbs daily for my weight.

Breakfast: one slice gluten free toast and peanut butter 29g carbs

Lunch: bacon egg mushroom tomatoes (tin) and one slice gf bread 23g carbs

Inbetween snacks: bit of Easter egg 30g carbs

Dinner: gluten free quiche, weighed. Salad and first g&t in ages. 57g carbs.

No other snacks as total carbs 127g yet this massive hypo.

Advice welcomed as cant cope with these hypo. I couldn’t test whilst hyping as my blood circulation isn’t brilliant on normal testing so I waste too many strips with watery looking blood and also I wouldn’t be able to test whilst hyping as too intense.
Worried every evening I’m going to get another.
This is my 4th hypo and always evening.
I’m on humulin m3 14 dose morning and before dinner
My bg level yesterday was 8.5 a.m. and 6.5 p.n.
Thankyou so much x

urbanracer · Apr 12, 2020

GuidingSenses said:
Hi there and Happy Easter!
I had a real bad hypo last night, it woke me up around midnight. Luckily hubby got me jelly babies and then a mini sandwich after but it scared me so much! I couldn’t move, sweated profusely and felt shakey inside.
I’m struggling to know what I did wrong?
I use as advised the carbs and Cals app which I love! Advised 140/150g carbs daily for my weight.

Breakfast: one slice gluten free toast and peanut butter 29g carbs

Lunch: bacon egg mushroom tomatoes (tin) and one slice gf bread 23g carbs

Inbetween snacks: bit of Easter egg 30g carbs

Dinner: gluten free quiche, weighed. Salad and first g&t in ages. 57g carbs.

No other snacks as total carbs 127g yet this massive hypo.

Advice welcomed as cant cope with these hypo. I couldn’t test whilst hyping as my blood circulation isn’t brilliant on normal testing so I waste too many strips with watery looking blood and also I wouldn’t be able to test whilst hyping as too intense.
Worried every evening I’m going to get another.
This is my 4th hypo and always evening.
I’m on humulin m3 14 dose morning and before dinner
My bg level yesterday was 8.5 a.m. and 6.5 p.n.
Thankyou so much x

I added up your carbs to 139g but let's not dwell on that for a moment.

I don't know much about the Carbs and Cals app as I have never used it but I used (Humalog Mix25) mixed insulin for a number of years and I find it strange that you are assessing carb requirements by your weight?

Most insulin users work out what their own personal insulin to carbohydrate ratio is. So for example if your ratio is 1 to 10 ( a common starting point) you would inject 1 unit of insulin for every 10g of carbs.

This becomes more complex with mixed insulin as your M3 is a 30/70% mix of short acting and long acting insulin.

If you took this in the morning using a 1:10 ratio, your 29g breakfast would require 3units of fast acting insulin but you would give yourself another 7 units of long acting insulin by default. (10 units in total with the 30/70 split)

Now, if you actually took 14 units of M3 before dinner then you have approximately 4 units of rapid acting insulin and 10 units of long acting insulin in your dose. So with a ratio of 1:10 you would eat 40g of carbs but you are still going hypo with 57g so it suggests that your own personal ratio is perhaps more like 1 to 15 or even higher. Therefore to stop the hypo's you require more carbs or less insulin.

You should talk to your medical team as soon as you can and discuss the hypo's. They might suggest reducing your doses if you are happy with the food that you're eating.

Jaylee · Apr 12, 2020

GuidingSenses said:
Hi there and Happy Easter!
I had a real bad hypo last night, it woke me up around midnight. Luckily hubby got me jelly babies and then a mini sandwich after but it scared me so much! I couldn’t move, sweated profusely and felt shakey inside.
I’m struggling to know what I did wrong?
I use as advised the carbs and Cals app which I love! Advised 140/150g carbs daily for my weight.

Breakfast: one slice gluten free toast and peanut butter 29g carbs

Lunch: bacon egg mushroom tomatoes (tin) and one slice gf bread 23g carbs

Inbetween snacks: bit of Easter egg 30g carbs

Dinner: gluten free quiche, weighed. Salad and first g&t in ages. 57g carbs.

No other snacks as total carbs 127g yet this massive hypo.

Advice welcomed as cant cope with these hypo. I couldn’t test whilst hyping as my blood circulation isn’t brilliant on normal testing so I waste too many strips with watery looking blood and also I wouldn’t be able to test whilst hyping as too intense.
Worried every evening I’m going to get another.
This is my 4th hypo and always evening.
I’m on humulin m3 14 dose morning and before dinner
My bg level yesterday was 8.5 a.m. and 6.5 p.n.
Thankyou so much x

Hi,

Sorry to hear you have these recurring hypos around midnight? What time did you have dinner? Do you test prior to eating & two hours after?
Did you take a test prior to bed? You may have needed a long acting carb snack to avoid the midnight hypo..

Jaylee · Apr 12, 2020

GuidingSenses said:
and first g&t in ages.

Hello? Just missed this bit..

Firstly, there is absolutely nothing wrong with a little drink.

However, alcahol can keep the liver busy in that it retards glycogen production? Which can affect how quick you drop. If you should.
Some remedy this by acompanying with a snack.. You may also find your FBGs when you test quite good in the morning too?

GuidingSenses · Apr 12, 2020

Jaylee said:
Hi,

Sorry to hear you have these recurring hypos around midnight? What time did you have dinner? Do you test prior to eating & two hours after?
Did you take a test prior to bed? You may have needed a long acting carb snack to avoid the midnight hypo..

I had dinner at 6.30 pm I tested prior yes, see notes. No I don’t test after. Struggling with testing and many strips get wasted as error 4 on my clairsens meter. My blood doesn’t look like blood a lot of the time it looks watery!

Jaylee · Apr 12, 2020

GuidingSenses said:
I had dinner at 6.30 pm I tested prior yes, see notes. No I don’t test after. Struggling with testing and many strips get wasted as error 4 on my clairsens meter. My blood doesn’t look like blood a lot of the time it looks watery!

Hi,

Are you on any other medication that may cause the "watery blood?"

Maybe we could look at your technique on testing to see if there is an easier way for you.

GuidingSenses · Apr 12, 2020

Jaylee said:
Hi,

Are you on any other medication that may cause the "watery blood?"

Maybe we could look at your technique on testing to see if there is an easier way for you.

I’m asthmatic so Qvar inhaler and high blood pressure so I’m on Ramipril and I’m coeliac. Always have cool hands and feet so nurse said it could be circulation.

GuidingSenses · Apr 12, 2020

Jaylee said:
Hello? Just missed this bit..

Firstly, there is absolutely nothing wrong with a little drink.

However, alcahol can keep the liver busy in that it retards glycogen production? Which can affect how quick you drop. If you should.
Some remedy this by acompanying with a snack.. You may also find your FBGs when you test quite good in the morning too?

Thankyou and yes will make room for a little snack

GuidingSenses · Apr 12, 2020

urbanracer said:
I added up your carbs to 139g but let's not dwell on that for a moment.

I don't know much about the Carbs and Cals app as I have never used it but I used (Humalog Mix25) mixed insulin for a number of years and I find it strange that you are assessing carb requirements by your weight?

Most insulin users work out what their own personal insulin to carbohydrate ratio is. So for example if your ratio is 1 to 10 ( a common starting point) you would inject 1 unit of insulin for every 10g of carbs.

This becomes more complex with mixed insulin as your M3 is a 30/70% mix of short acting and long acting insulin.

If you took this in the morning using a 1:10 ratio, your 29g breakfast would require 3units of fast acting insulin but you would give yourself another 7 units of long acting insulin by default. (10 units in total with the 30/70 split)

Now, if you actually took 14 units of M3 before dinner then you have approximately 4 units of rapid acting insulin and 10 units of long acting insulin in your dose. So with a ratio of 1:10 you would eat 40g of carbs but you are still going hypo with 57g so it suggests that your own personal ratio is perhaps more like 1 to 15 or even higher. Therefore to stop the hypo's you require more carbs or less insulin.

You should talk to your medical team as soon as you can and discuss the hypo's. They might suggest reducing your doses if you are happy with the food that you're eating.

Thankyou for your detailed reply. Obviously I’m new and had to re read this to understand but I do get where you are coming from. Yes my error on calculation.
Not understanding the dinner calculation but I’m not great at maths. Understand the breakfast calculation though.
I’m just having 67g carbs for dinner and given myself 12 units as she said to go between 12 or 14 depending on activity and my mistake it’s not weight based the carb calculation it was the nurse saying the units, before dinner today my reading is 5.3 mmol.
Thankyou for your time.

Jaylee · Apr 12, 2020

GuidingSenses said:
I’m asthmatic so Qvar inhaler and high blood pressure so I’m on Ramipril and I’m coeliac. Always have cool hands and feet so nurse said it could be circulation.

Hi,

OK, cool hands. Have you tried washing them in hot water prior? Or possibly loosely shaking the hand to the side? (A little like an improv actors warm up.) before lancing..

urbanracer · Apr 12, 2020

GuidingSenses said:
Thankyou for your detailed reply. Obviously I’m new and had to re read this to understand but I do get where you are coming from. Yes my error on calculation.
Not understanding the dinner calculation but I’m not great at maths. Understand the breakfast calculation though.
I’m just having 67g carbs for dinner and given myself 12 units as she said to go between 12 or 14 depending on activity and my mistake it’s not weight based the carb calculation it was the nurse saying the units, before dinner today my reading is 5.3 mmol.
Thankyou for your time.

Ok well that's cleared up the weight issue anyways.

Do you have a diabetes specialist you can contact about the hypo's ?

Daibell · Apr 12, 2020

Hi. As someone else has said it's not usual to base your carb input on your weight although there's nothing inherently wrong with that. You basically need to match the insulin level to your the daily carbs you choose and see whether your weight is stable. 150g/day carbs isn't a bad target anyway. If you are still in your honeymoon period for LADA then having mixed insulin is probably OK but for T1 it's normal to have the Basal/Bolus regime (see NICE advice) which gives much better control but involves typically 5 injections per day instead of 2. So, you may want to consider changing at some future point and discussing that with the GP. All I can suggest currently is to tweak the insulin levels down a little?

GuidingSenses · Apr 13, 2020

urbanracer said:
I added up your carbs to 139g but let's not dwell on that for a moment.

I don't know much about the Carbs and Cals app as I have never used it but I used (Humalog Mix25) mixed insulin for a number of years and I find it strange that you are assessing carb requirements by your weight?

Most insulin users work out what their own personal insulin to carbohydrate ratio is. So for example if your ratio is 1 to 10 ( a common starting point) you would inject 1 unit of insulin for every 10g of carbs.

This becomes more complex with mixed insulin as your M3 is a 30/70% mix of short acting and long acting insulin.

If you took this in the morning using a 1:10 ratio, your 29g breakfast would require 3units of fast acting insulin but you would give yourself another 7 units of long acting insulin by default. (10 units in total with the 30/70 split)

Now, if you actually took 14 units of M3 before dinner then you have approximately 4 units of rapid acting insulin and 10 units of long acting insulin in your dose. So with a ratio of 1:10 you would eat 40g of carbs but you are still going hypo with 57g so it suggests that your own personal ratio is perhaps more like 1 to 15 or even higher. Therefore to stop the hypo's you require more carbs or less insulin.

You should talk to your medical team as soon as you can and discuss the hypo's. They might suggest reducing your doses if you are happy with the food that you're eating.

urbanracer said:
Ok well that's cleared up the weight issue anyways.

Do you have a diabetes specialist you can contact about the hypo's ?

yes she is the best and due to call me this week. Thankyou

GuidingSenses · Apr 13, 2020

Jaylee said:
Hi,

OK, cool hands. Have you tried washing them in hot water prior? Or possibly loosely shaking the hand to the side? (A little like an improv actors warm up.) before lancing..

Yes will do the shaking Thankyou

GuidingSenses · Apr 13, 2020

urbanracer said:
Ok well that's cleared up the weight issue anyways.

Do you have a diabetes specialist you can contact about the hypo's ?

Just tested 2 hours after a biggish dinner and 30g Easter egg and its 3.2 mmol! Definitely not right, will call nurse tomorrow.

Jaylee · Apr 13, 2020

GuidingSenses said:
Just tested 2 hours after a biggish dinner and 30g Easter egg and its 3.2 mmol! Definitely not right, will call nurse tomorrow.

Hi,

& happy Easter.

Not sure what you had for dinner..? You may have got the low before a delayed spike.? (Higher than desired BG out of sync with your insulin working profile?)
Somtimes timing the metabolism of the food with the insulin helps remedy. (Easier said than done.)

It's great you seem to have the testing sorted. Contact your nurse & discuss this issue.

Type 1.5 Hypo query T1.5 lada third week on insulin

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