Hypos

[LWood88]

Hello everyone I’m newly diagnosed about a month ago. Type 1 but they’re trying medication first before insulin. So I am on Metformin 2000mg and gliclizide 320mg daily. My levels keep on dropping to around 3.6-3.9 is this considered a hypo and where I’d need to use glucose tablets to bring my levels back up? I do get shaky, sweaty, and racing heart when it drops. Just wondered what everyone’s experiences were? Thank you x

 

[Deleted Account]

Anything below 4 is considered a hypo.
So any BG below this level, should be treated with fast acting carbs such as glucose tablets.

 

[LWood88]

Is that 4 exactly or say 4.8 etc?

 

[Celsus]

Is that 4 exactly or say 4.8 etc?

The glucose level that defines 'hypoglycemia' is variable for different reasons. However the medical professionals uses a set bg value for adults with diabetes and defines a bg below 3.9 mmol/L (70 mg/dL) as diagnostic for being in hypo for us.

 

[Scott-C]

@LWood88 , there's medical evidence indicating that, generally speaking, when bg falls below 4, the body's autonomic responses (the network of systems which automatically tweak various things to keep us living) kick into action to raise bg to above 4, mainly by releasing adrenalin to tell the liver to release stored glucose.

The sweating/tremors isn't really anything to do with the low bg, it's a side effect of the adrenalin rush, just like you see some people shaking after a fright or car accident.

That's why below 4 is generally regarded as hypo.

One thing to be aware of is that over time, if you hypo a lot, the autonomic response can become blunted, so you might not be aware of being hypo until much lower levels, 2 or 3. The danger with that is that once you start getting down to very low levels around the sub-2 mark, the brain, which relies on glucose to work properly, just stops working and, as @catapillar once memorably put it, "normal, normal, unconscious".

Not saying that to scare you, just a side note of something to be aware of. It's early days for you and it can take several years for that sort of hypo unawareness to develop, so it's not something which is likely to happen to you any time soon. It can often be mended by deliberately running higher at 8 or 9 for a few weeks.

There's always a temptation to over-treat a hypo because of the panic, which can lead to insanely high bg. There's only about 5g of glucose in an average person's bloodstream in total, so if levels are dropping, a surprisingly small amount of glucose will usually fix it. I've got cgm so can see things happening in more or less real time. If I see it trending down to 4, a mere 5g is often enough to nudge it back up by 1 or 2, but if it's a proper hypo with active insulin still on board 10 to 15g is a safer bet.

 

[LWood88]

You’ve all been amazing and so informative. Thank you all so so much!! xx

 

[Alison Campbell]

If you have been confirmed type 1 now, please can you change your profile information which is showing as type 2. This will ensure you get the best suggestions for your type.

 

[catapillar]

Hello everyone I’m newly diagnosed about a month ago. Type 1 but they’re trying medication first before insulin. So I am on Metformin 2000mg and gliclizide 320mg daily.

That's very unusual. Type 1 isn't treated with oral medication, it's treated with insulin. Gliclizide isn't recommended for a type 1 who wishes to extend their honeymoon period because it forces your pancreas to make more insulin and will more quickly see off the beta cells.

On what basis have they diagnosed type 1? As you aren't on insulin I assume a cpeptide test will show your producing plenty of insulin to keep you alive so will be rather useless diagnostically. A month post diagnosis with diabetes is rather soon to be receiving the results of antibody tests.

 

[LWood88]

I’m not sure, I asked them at my last appt which type they think I have as I’m a complex case, and they said 1 but wanted to see if medication will help. I’m due to see them again on June but they do ring me weekly for an update. I’ve got blood tests in May as well.

 

[Lamont D]

I’m not sure, I asked them at my last appt which type they think I have as I’m a complex case, and they said 1 but wanted to see if medication will help. I’m due to see them again on June but they do ring me weekly for an update. I’ve got blood tests in May as well.

Why do you say you are a complex case?
FYI,
Type 1, a hypo is basically anything under 4.00 mmols
Type 2, a hypo is anything below 3.7 mmols higher (Ish), because some T2s can be okay even lower.
There are others that considers a hypo below 3.5.
But all should be treated accordingly
You can also have the same symptoms if your blood glucose levels fall rapidly. That is called a false hypo. Again with rapid fluctuations in blood glucose levels, will cause similar symptoms.
That is why testing at the first onset of symptoms is important.

Best wishes

 

[LWood88]

Hey, that’s very useful, thank you for that. I’m complex because I’m on medication that has potentially caused the diabetes and I can’t come off those meds unfortunately. Main one is quetiapine

 

[Alison Campbell]

Medication induced diabetes is mostly put in the type 2 category.

Type 1 is where the body attacks and destroys it's own insulin producing cells.

You can find out about the different types of diabetes here https://www.diabetes.co.uk/diabetes-types.html

 

[Lamont D]

Hey, that’s very useful, thank you for that. I’m complex because I’m on medication that has potentially caused the diabetes and I can’t come off those meds unfortunately. Main one is quetiapine

Ah! I see, that does make a difference.
And the symptoms you describe of the side effects are very similar to types of diabetes and endocrine conditions.

Have they give you any dietary advice?

I would hazard a guess that helping you to lose weight would benefit with the symptoms.

 

[catapillar]

I’m complex because I’m on medication that has potentially caused the diabetes

Diabetes caused by medication is NOT type 1 diabetes. Type 1 diabetes is autoimmune attack on the insulin producing beta cells and no one knows what causes it.

A risk of many anti-psychotic medications is type 2 diabetes.

 

[LWood88]

I’ve also had bloods done that have tested me for genetics which shown up the diabetic gene. I’m only going on what I’ve been advised

 

[Celsus]

Hey, that’s very useful, thank you for that. I’m complex because I’m on medication that has potentially caused the diabetes and I can’t come off those meds unfortunately. Main one is quetiapine

Hi @LWood88 , yeah that is quite a tricky situation that you are in!
Just to answer the question you also posed earlier today after our first exchange. Yes, its advisable that you treat your hypo bg when under 4 mmol/L with a bit of sugar to get up above 4 again. That will typically make you feel all OK rather quickly.

Good news is that the type2 style diabetes medication that you are on now indeed seem to suffice to keep your bg low enough. So that is promising in the sense that insulin injections are then most likely not going to be required for keeping your bg in range. It even appear that your diabetes medication is just a bit too much, reason why you go low with your bg.

If your intake of the quetiapine medication otherwise is fairly stable, it should also be possible to find out what your diabetes optimal quantity of the diabetes medication should be to keep it fairly stable.

The quetiapine do for some cause a never ending sensation of hunger, which of course then subsequently also can make these patients start to eating more and thereby adding to your weight. I don't know where you potentially are on that pathway, but worth noting, as added weight will impact your diabetes situation also. The quetiapine and drugs from same drug family area are frequently observed to cause interruption of the neurological transmitter signals that control our body's metabolism. And this is in itself not dependent on if you are overweight or not. So can be a challenge for all patients taking such drugs no matter if they are skinny, obese or anything in between. So don't blame yourself for that. But as said also by other posters on this thread, being overweight or gaining additional weight when having such diabetic symptoms will not make the bg control any easier, so avoid it if possible. (easier said than done I know... )

 

[LWood88]

Thank you. I’m a little overweight but not massively, which is good. The diabetic nurse is happy with my “size” but will still work towards being thinner. Yes the quetiapine is a pain in the back side. It makes you put on a lot of weight. But it’s a weight vs mental health thing. A very vicious circle! I agree now the diabetic meds are starting to work, might be too strong now! But I worry if they reduce it and it goes sky high again, I’m back to square one. It’s a tricky place to be right now :-(