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Looking for help with Hypos...

L

Linzistar

Newbie
Messages
2
Type of diabetes
Treatment type
Insulin
Hello, First time poster here and looking for some help!

Ive been diagnosed for just over 2 years, HBA1C is generally still fairly high and up until recently Hypos were virtually non existent. I have just moved house and currently staying with in-laws so don't get much say in food etc but am having a bout of really nasty night time hypos! My blood sugar went down to under 2 one night last week and (as you can imagine by the time I'm posting this) its has gone low again tonight, though not quite as low at 3.5.
Luckily I am waking with symptoms or the symptoms are waking me, but still is quite scary. The Problem I have is that during the day my sugar is generally fairly high, regardless it would seem of the amount of insulin I take, but then drops off after evening meal and I'm then battling to keep it up during the night. Yesterday was a typical example:
Morning Reading 11.3 - Took Lantus 30 units (no Novarapid as didn't have breakfast)
Lunch time reading (12:30 pm) 9.3 - Took 20 Units Novarapid & 2X Metformin
Dinner time reading (6:30) 9.1 - Took 15 units Novarapid & 2X Metformin
By 9 pm by blood sugar then dropped to 3.4, took action and drank a can of coke and had a snack of a slice of bread with marmite, before bed my level had gone up to 7. Now I still then had my second (and prescribed) dose of Lantus, though reduced this to 25, as I know my body enough to know that if I don't have this my sugar will be through the roof by morning. Have now been woken up at around 1am with blood sugar of 3.2.
This is happening at least twice a week that I am being woken with very low levels (as I said when my sugar went down to 1.8 last week it was particularly scary) but the low levels after dinner and before bed is happening nearly every night! I have no idea if this is relevant but when I am having the lows that are waking me in the night they are nearly always accompanied by a really quite badly upset stomach, which makes me feel even worse!
I know that moving house is a big change and am sure that stress changes my blood sugar levels but for someone who can probably count on 1 hand the amount of hypos I had in the year preceding this it's quite a scary time!!
If anyone can help, has experienced something similar or just has any suggestions I would be grateful!
Thank you
 
Sorry to hear that, it sounds unpleasant. A few questions to help get a handle on this -

-presume you are Type 1 diabetic?
-are you carb counting and giving a variable amount of Novorapid per meal, or is it a fixed amount per meal?
-do you not do correction doses of Novorapid for high readings (eg your morning reading)?
-please describe the evening meals at your in laws, and your own typical meals, particularly in terms of carbs and fat

At this stage it's hard to guess but it could be that your food at home is higher carb or higher fat than the in laws food, so that your evening blood sugar rise from food at home goes higher or lasts longer. That would explain the evening hypos.

Another possibility scenario is that you Lantus is too high and your Novorapid is too low. Paticularly your night time Lantus. This tends to cause hypos whenever meals have less carbs than usual.

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Hi Spiker, Thanks for the reply,

In answer to your questions:

- Sorry I didn't specify, I am type 2 not type 1
- Although I roughly adjust my dose based on whether I can tell a meal is particularly high in carbs I do not carb count
- I do not have Novarapid unless I eat, and with the amount of Hypos I am having at the moment I would rather be a bit higher and not risk having one while I'm at work.
- Regarding meals. We are having a lot more processed food at my partners parents house, I would generally make things from scratch so would be lower in fat and not have the hidden carbs that processed food tends to have in it. As I said I do not count carbs, and so my own evening meals would generally consist of some form of protein, a whole heap of vegetables and some carbs in the form of potatoes, rice etc. At my in laws I am generally getting a LOT less vegetables, and generally food that comes out of the freezer and heated in the oven.

I have reduced the amount of Novarapid that I have with my evening meals to try to combat this, the only reason I have left my Lantus the same is that this appears to not be doing very much during the morning when I take it and when I have reduced this previously it has led to even higher morning readings!

Being type 2 I don't have the dangers as with type 1 when I go too high and at the moment it is a real struggle not to just stop the insulin all together!! It is really only the presence of background retinopathy that has stopped me before now, and with the hypos on top it is feeling very tempting!

Thanks again!
 
I can see the temptation to reduce the Lantus and if I were you, I would be thinking in terms of dropping both the morning Lantus and the evening Lantus quite significantly. They say not to make significant changes more than once every three days and do it gradually. That makes sense, and particularly with Lantus it can take a few days to make a difference. Still if you are having hypos frequently that's quite urgent.

Your morning high blood sugar was just a consequence of taking hypo treatment the night before I guess? So your blood sugar is relatively level during the day until it starts to crash around 9pm. It's hard to say if that's due to the morning Lantus, or due to a mismatch between carbs and Novorapid on your evening meal. It would be really good if you could sneak a look at the packets and get an estimate of the carbs in the meals your inlaws are making.

Another possibility as you are Type 2 is you are getting reactive hypos due to higher carb and GI content of your inlaws' meals. The alternative explanation is that they are making lower carb meals than you are used to, which doesn't match what you said. If it is a reactive hypo then you would need to lower the evening meal Novorapid.

Sorry to give you two possible explanations. Try one and then the other I guess. The Lantus reduction may be a safer thing to try than the evening NovoRapid reduction. On the basis that you are getting hypos around 9pm and also in the wee hours of the morning, I would reduce both Lantus injections, may cut back about 20% to around 24 Lantus morning and evening and then don't change the Lantus for 3 days. But if the 9pm hypos continue, then reduce the evening NovoRapid.

As a Type 2 I am surprised that you are on basal insulin and bolus insulin only 2 years after diagnosis. But I am not Type 2 so maybe this is more common than I thought. I know that Dr Bernstein is actually in favour of Type 2s having insulin sooner rather than later, in order to preserve health and preserve their own insulin function. Do you know the reasons why you were put on insulin - was it because of the background retinopathy? When you say your HBa1c is high, how high are we talking?

By the way as far as I know, a high blood sugar level is every bit as dangerous for a Type 2 as for a Type 1. I don't think there is any difference in terms of the risk of complications. But I could be wrong.
 
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