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hypos at work / losing awareness

S

scorpius14

Well-Known Member
Messages
64
Type of diabetes
Type 1
Treatment type
Insulin
Wondering if i should raise with my GP that I have hypo's occurring more than 3 times a day, and i'm losing the ability to have symptoms until they go down to the point that I get vision loss, stumbling and drowsiness. Libre won't read below 3.0 and i just see it as a flat line.

This has only become a problem due to having a different line of work than i'm used to, i find myself undertaking intense manual labour for a small part of the day. I heard some people would run it high before working to stop them going too low when doing high intensity labour, i'd have to drink a can of regular coke ( lack of options in staff area and chocolate acts too slow). But having at at a high of 10-13mmol/l can also affect my ability to do the job, and I won't always be doing hard labour.
 
Hello @scorpius14

Do you see a diabetes specialist team, consultant or nurse, I would personally be contacting them to review my daily insulin requirements instead of a GP.

Few questions - are you getting an alarm to a low ? are they any special measures in place at work to allow you to monitor your condition, so a quiet place to treat a hypo and time allowed to treat ? Are you ok with reviewing your own insulin ratios in light of your frequent hypos ?
 
I haven't told them specifically but I always disguise it as a need to go to toilet, which they seem to be alright with and about 5-10 mins to correct my levels, its a fast-paced environment so have to get back on the floor to finish my tasks as soon as possible. If they raise it as an issue that i'm taking too much time out, I will tell them about the diagnosis, i've always had issues with disclosing to employer, not the best at explaining anything. Libre alarms largely go unnoticed due to the noise of the workplace but I am allowed to take my phone out to test as I have adequate space.
I take the long-acting insulin before bed or late evening (whichevers the earliest) and wake up normal most days, will note down my typical day below regarding fast-acting.

It seems that I start off with normal bg waking up, but anticipate my bg going down during the commute (adjusting based on mode of transport, bus+walk/car) and breakfast to normalise, I might take some fast acting carbs before I start work, morning break I check my bg (between start and break usually consists of light work), on occasion it will be around 15mmol/l, in which case I will bolus 1 unit per 1.5mmol as per DSN instructions plus any for food I eat at break, at 1 unit per 15g. Going off figures from my libre, it should probably seem obvious that I need to eat more carbs at my break and eat faster acting carbs to get it around 10 in preparation for the work and slower carbs to keep it at that level.
 
scorpius14 said:
Wondering if i should raise with my GP that I have hypo's occurring more than 3 times a day, and i'm losing the ability to have symptoms until they go down to the point that I get vision loss, stumbling and drowsiness. Libre won't read below 3.0 and i just see it as a flat line.

This has only become a problem due to having a different line of work than i'm used to, i find myself undertaking intense manual labour for a small part of the day. I heard some people would run it high before working to stop them going too low when doing high intensity labour, i'd have to drink a can of regular coke ( lack of options in staff area and chocolate acts too slow). But having at at a high of 10-13mmol/l can also affect my ability to do the job, and I won't always be doing hard labour.
Click to expand...
Hi,

I’ve been known to do the physical job. Can you let us know what basal (long acting) & bolus (one for rood.) you are prescribed?
 
scorpius14 said:
Lantus & novorapid
Click to expand...
When are you taking the lantus? Morning/evening/both?

Before I had a cgm I had several periods where I lost hypo awareness, I believe due to too many hypos. Pre cgm my team and I agreed that it was better to keep my hba1c in the low 50s than try for 48. Last time I had an ambulance inducing hypo (4 years ago?) my specialist told me to change my bg targets to 6-12 for a while, which I did. Now, thanks to my cgm, I do have less hypos and my awareness is back, though it isn't as strong as it was 40 or 50 years ago.

I agree with the others that you should talk to your diabetic team if you aren;t confident to adjust your own insulin doses and ratios. They can and do change with time and can be different at different times of day and activity levels. Here's some things that I would investigate if I were in your position
1) an insulin pump. That might give you more options to reduce basal rates if you need different rates at different times/exercise levels
2) would getting your libre result on a smartwatch make it easier to monitor your levels? Mine buzzes as an alert. (I use a dexcom so am not familiar with the libre tech for smartwatches but assume it's possible)
3) Consider telling your colleagues about your issues. One colleague literally saved my life when I had a hypo during my first pregnancy (I wanted to drive home, and this was 30 years ago and before everyone automatically did bg tests before driving).

Good luck.
 
scorpius14 said:
Lantus & novorapid
Click to expand...
OK? Same here..what my experience has shown is if the dose of Lantus is too high. ( for me.on a physical day.) Treating the lows with just fast acting carbs can cause a recurrence, especially during a hot day? (One dose in the evening.)
Longer acting carbs as a follow up can reduce the reoccurrence..

I feel you should talk with your HCP on dosage. “Basal test.” Then work with what’s happening with the Novorapid for your food from there?

Incidentally. I’m still hypo aware at any time. But find using my Libre with a third party app called “Diabox” gives me a 10 minute “heads up?” Thus minimising the distraction from the professionalism I strive to minnimalise..
 
I use lantus in the evenings because my DSN saw most mornings were giving me high bg readings and i might sneak in a snack late in the evening, I might change it to a lower dosage from 14 to 10 units just to see where it goes from there. Never had a hypo where i've needed assistance and not ready to tell my colleagues. Seeing as the physical demand of the role only takes a couple of hours (around midday) i'm hoping the decrease of lantus will be enough.
 
Hello @scorpius14

Ok going to be devil's advocate here, what if you did collapse due to going low ? How would your colleagues handle this ? I have never required assistance either but I still feel it's important that anyone I work with knows about my t1d. Working in a challenging environment can put you at the increased risk of suffering a low and requiring assistance, and if someone in your workplace knew you needed glucose then it could save the embarrassment of paramedics turning up and trying to treat you and the drama that would cause to your working environment, as an employer myself I would appreciate knowing if an employee had a condition that could be managed in the workplace, there is no legal obligation to tell them, but better they know, unless your worried about discrimination ?

Personally I would be looking to change my bolus calculations around this timeframe than my basal, or having a few biscuits before the busier period to cope better with the increase in activity, also jelly babies in the pocket too for topping up, my personal view is to run high and correct later but Ellie made a great suggestion with the pump as you can change the basal pattern for work as it's only delivering quick acting insulin for both basal and bolus requirements so can be reduced as and when. A garmin watch can be linked to the libre so you could use this to monitor your levels more discretely.
 
scorpius14 said:
I use lantus in the evenings because my DSN saw most mornings were giving me high bg readings and i might sneak in a snack late in the evening, I might change it to a lower dosage from 14 to 10 units just to see where it goes from there. Never had a hypo where i've needed assistance and not ready to tell my colleagues. Seeing as the physical demand of the role only takes a couple of hours (around midday) i'm hoping the decrease of lantus will be enough.
Click to expand...

I’m intrigued to know what the task is. Would you be “handballing” heavy objects with a team? Maybe off loading a shipping container in a loading bay palletising or caging the contents for storage?

I’ve been lucky in the past with jobs like this the team takes “5” for a quick glug of drink giving me a chance to asses my BGs & correct?

I do my Lantus in the evening, certainly the first port of call to se if it needs a tweak. Talk to your DSN.
Lantus lows can creep slowly up on me. But I am aware of the subtle clues.

Here is a link regarding basal testing, which might help. https://www.mysugr.com/en/blog/basal-rate-testing/
 
Juicyj said:
what if you did collapse due to going low ? How would your colleagues handle this ?
Click to expand...
Absolutely! I also think that if paramedics are called out, this would have to be disclosed for a driving licence application, which can make life far more restricting!
 
It's more of a take it in your own stride kind of work which can involve heavy lifting >20kg or light and last up to 10-15 minutes per task as long as its done in a timely manner, so I have the freedom of testing my bg in between as long as my quota is met; just up to now i've been committing to 3 or 4 tasks in a row before feeling a bit off than usual, it can be difficult to distinguish between sweating from hypo or from the lifting / activity.
 
Hi, I too have little hypo awareness so rely on my Medtronic 780g pump which stops my insulin when it recognises a lowering of my blood glucose levels. I always carry carb gels which are excellent for bringing my levels up again.
Diabetes.co.uk advertise GlucoRx Torq Gel packs 3 x 23.5g sachets for £15 which is £5 EACH !!

For years now I have been using these from Amazon :
HIGH5 Energy Gel Quick Release Energy On The Go From Natural Fruit Juice
They are only £11.75 for 20, or 58p each
They have 23g of cabs in each one and I’ve been using them for years to overcome low blood glucose
I highly recommend them
Stay safe !

Jerry Short
 
Hi

Have you set alarms on your Libre? This was one of the
issues that I had with finger prick as I didnt
know what was happening until I was on the floor

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