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Hypo unaware then high BG?

Discussion in 'Type 1 Diabetes' started by tinyfilosofer, Jul 20, 2016.

  1. tinyfilosofer

    tinyfilosofer Type 1 · Well-Known Member

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    Is it possible to hypo unaware and then show a high bg 2 hours later?


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  2. GrantGam

    GrantGam Type 1 · Well-Known Member

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  3. catapillar

    catapillar Type 1 · Well-Known Member

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    Yes, although it really depends on what happens in between the hypo and the hyper.

    Hypo unawareness = no warning symptoms of your hypo. So you can drop below 4 with no symptoms.

    If you had a symptomless hypo and treated it, perhaps the high blood sugar was caused by eating a few too many carbs to treat the hypo - it's very easily done!

    If you have a symptomless hypo and don't treat it (don't do that, always treat your hypos, if you test and your under 4 have some carbs even if you aren't feeling it, if you didn't test and had no symptoms, how do you know you were hypo?) hopefully your liver will release some of its glucose stores to bring you back up. Your hypo causes a hormone called glucagon to prompt that liver dump and that hangs around in the system for a while after the hypo. So the liver dump could have caused a recount hyper. I would have thought that if you get to the stage where your body is triggering a liver dump and you are concious you will have some symptoms - I'm completely hypo unaware and, unfortunately, can drop under 2 while functioning fine but I will notice something is going on if I get under 1.5, which I think is how low I need to go before my body does anything (no this was not an experiment done on purpose and you should NOT try it at home - I strongly recommend against trying it glucogon + liver dump is the thing that keeps you alive, not a thing to be played with and also you feel awful afterwards).
     
  4. Bobbin

    Bobbin Type 1 · Well-Known Member

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    Yes, it's possible. I didn't know I lost awareness and kept having random highs in the 20s. Kept upping insulin trying to sort it. A CGM for a week revealed I was having hypos and luckily my liver was kicking in before I hit 3 or below. Left me with huge highs though and felt ****.
     
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  5. tinyfilosofer

    tinyfilosofer Type 1 · Well-Known Member

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    Oh no. Then the liver must be exhausted! I'm wondering if it is the same with me. I keep eating less and less and still in my teens.


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  6. noblehead

    noblehead Type 1 · Guru
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    Always best to start with the basics and conduct some basal tests, getting the basal dose right is the foundation to good bg control as the following article explains:

    http://integrateddiabetes.com/basal-testing/
     
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  7. tim2000s

    tim2000s Type 1 · Expert
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    The only way to find out is to undertake a regular testing regime or to get hold of a continuous monitor somehow.
     
  8. catapillar

    catapillar Type 1 · Well-Known Member

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    What is making you think you are having unnoticed hypos? Because maintained high blood sugar is not traditionally a sign of this. Somogyi effect high blood sugar on waking can be a sign of hypos in the night - you would need to set alarms and test in the night to see if that is happening.

    Are you testing in the day? Is this showing hypos? Do you usually have good hypo awarenes?

    In my experience I think it is possible to drain you liver of glucose stores if you have multiple severe hypos in a short space of time. It would be highly unlikely that the only indication you would get of this is sugars staying in the teens. When this happened to me I had 3 very low hypos in a week, one with absence seizures/going in and out of consciousness, I had hypo hangover symptoms following the hypos and I really struggled to then maintain sugars over 4 for the next 24 hours, despite eating a lot of hypo treatments.

    It sounds like you might need to do a bit of testing to exclude the possibility you are having unnoticed hypos - maybe test every two hours for a 24 hour period.

    If this does suggest you are hypo unaware and you are driving in the uk you will need to tell dvla and surrender your driving licence. And make an appointment for review with your consultant/DSN to discuss ways to avoid the hypos.

    If it doesn't suggest you are hypo unaware (which would be much better news for your well being) then you can investigate basal testing, correction factor and carb ratios - eating less won't make your blood sugar go down if your ratios are wrong, just like eating more wont make your blood sugar go up if your ratios and bolus timing are correct.

    Good luck with a bit of testing :)
     
  9. tinyfilosofer

    tinyfilosofer Type 1 · Well-Known Member

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    Bg 8 at 9am, no food no insulin, at 1pm becomes 9.5.


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  10. GrantGam

    GrantGam Type 1 · Well-Known Member

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    It's extremely difficult to try and keep a stable BGL. Especially when you're relying on just your basal insulin to do all the work, as you missed breakfast and took no bolus insulin.

    As everyone has suggested, have a look as your basal insulin. It's a total pain but is well worth the effort if good control is what you're aiming for. An additional link to the ones already provided to help with this:

    https://mysugr.com/basal-rate-testing/

    And btw, 1.5mmol/L rise in BGL over 4 hours on only basal insulin is pretty good. If you went from a 5 to 6.5 you wouldn't be concerned would you? If you'd had breakfast, bolused for your meal and then taken a small correction dose to take you to around 5/6mmol/L from that initial 9am reading of 8mmol/L - then at 1pm your BGL would probably still be in range.

    If like me, you don't eat breakfast - then you can take a bit of insulin without food on waking if you know the following:

    -How much your BGL will rise over a typical morning.
    -How much 1u of bolus insulin reduces your BGL by. If you don't know, this is normally around 2-3mmol/L.

    Grant
     
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  11. tinyfilosofer

    tinyfilosofer Type 1 · Well-Known Member

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    Bg will rise even without food? Where did the sugar come from?


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  12. GrantGam

    GrantGam Type 1 · Well-Known Member

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    BG will rise without food yeah, more often in the morning.

    A natural response by the liver when you wake up. Gets your body ready for the day basically.

    http://www.diabetes.co.uk/blood-glucose/dawn-phenomenon.html

    If not that then you may need to fine tune your basal as suggested. All in good time though:)

    Grant
     
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  13. catapillar

    catapillar Type 1 · Well-Known Member

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    That isn't a rise. That is entirely normal. Blood sugars do not stay absolutely still all the time because you are a living breathing human. Things to bear in mind:

    • If you were to test one finger now and another finger immediately after, you would get different readings. Monitors are allowed a 15% variance and blood sugar in different bits of the blood can look different as it travels round and evens out
    • You don't need food to raise your blood sugar. As @GrantGam1337 says, that why we take a background insulin. You liver has a store of glucose and it trickles it out to keep us going when we aren't eating. Loads of other things apart from food impact on blood sugar - food and insulin are not the only things - stress, illness, exercise, hormones, the list goes on.
    The rise you have mentioned does not give any suggestion there is anything weird going on with unnoticed hypos. It's normal.

    I would highly recommend having a read of "think like a pancreas", gary scheiner, to help you understand what's going on in your body - the body is a really complex, intricate bit of machinery, we could really do with a manual!
     
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  14. tinyfilosofer

    tinyfilosofer Type 1 · Well-Known Member

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    Thank you!


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  15. tinyfilosofer

    tinyfilosofer Type 1 · Well-Known Member

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    My understanding for when there is a sugar dump from hypo is, treat the high blood sugar by injecting bolus, then eat to replenish sugar in liver. Not sure if that is right.
     
  16. tinyfilosofer

    tinyfilosofer Type 1 · Well-Known Member

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    Friend of mine skipped dinner and then had readings in the twenties the next day.
     
  17. catapillar

    catapillar Type 1 · Well-Known Member

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    That sounds like a sure fire way to end up with yoyoing blood sugar. If you have had one hypo, you are more vulnerable to another. If you have had a liver dump and there's nothing left in your liver, another hypo is potentially rather dangerous.

    Instead of blousing to correct a liver dump, I would suggest:
    1. Avoiding getting to the point of liver dumping by treating your hypos with fast acting glucose Asap. I know that circumstances don't always allow, but try and make it easy for yourself by always keeping hypo treatments available. If you find you are frequently dropping so low that you are having liver dumps, you might want to look at you ratio/basal
    2. If you are having a prolonged high following a liver dump, cautiously correct with a meal including some long acting carbs and continue to keep a close eye on your blood sugar.
    Did you do any testing to try to figure out if you are having hypos/liver dumps?
     
    #17 catapillar, Aug 10, 2016 at 6:15 PM
    Last edited by a moderator: Aug 10, 2016
  18. catapillar

    catapillar Type 1 · Well-Known Member

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    This sounds potentially, more like dawn phenomenon than somogyi effect - you can put both in the search box or google to get a better explanation than I am capable of :)
     
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  19. tinyfilosofer

    tinyfilosofer Type 1 · Well-Known Member

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    Thanks for the advise. So much to learn!
     
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