Loosing Control and anxiety

Hi All, Ive been a Type one for around 14 years, since i was 11, however in the last year i have really cracked down on my control and have resorted to a low carb Diet and manged to get great control of my diabetes.

However about 3 months ago i have a really bad Hypo in the middle of the night, i woke up with a BS of 1.9, drank about a liter of coke and 40 mins later i was still 2.1 it took a lot more sugar to get me up from that and i was on the edge of loosing consciousness, i have no idea what caused this as the only insulin that should have been in my system was Levmir. my Doc suggested maybe i hit a muscle and this is what caused the Hypo.

Before this i had never really been scared of Hypos and always just delt with them, ever since this incident now anytime i feel my BS dropping or even going remotely low i start to feel very anxious and cant sit still fidget and start to get a tight chest and generally panic. often testing every few minutes or eatting sugar when im not low yet or just generally overdoing the amount of sugar i eat.

on top of this i feel recently the action of my Novarapid has changed, previously it would peak at around the 2 hour mark and that would be it, now however im noting significant drops in blood sugar around the 3 hour mark and slow drops all the way to 5 hours.

ive also split my dose of Lemir from 48 units in the evening to 14 units in the morning and 21 units in the evening.

my NovoRapid requirements have dropped off a lot i was taking 14/16 units per 30G carbs i now seem to be taking 6/7 units for 30 grams of carbs but due to the delayed action of the novorapid my BS stays above 10 untill the middle of hour 3.

i have lost around 4/5 stone since starting to low carb an i imagine this is reducing any insulin resistance ive built up.

i recently was on holiday to spain that caused me so much stress i nearly broke down, the first day there i suffered a awful hypo in the evening that required me to use Glucogel and several other forms of sugar. the rest of this holiday i spent bouncing low and high because i just couldnt manged my sugar levels outside of my routine, i had no idea how many carbs were in my food and no idea what my insulin ratio was, and was purposely doing low. this has caused my anxiety to get worse, since coming home form holiday and into my routine ive stabilized my blood sugar levels again, but have been having trouble sleeping and have found my self staying up every night till 1 or 2 am to check my blood sugar isnt going to plumet again.

the worst part is the anxiety i feel seems to manufator a feeling of a hypo in me, which then increased the worry i feel about going low.

the last Hypo i had i over tested duing it and couldnt stop eatting. a question i have though is how long is sugar supposed to take to act. i was 5.3 and dropping and i drank make 2 mouthfulls of lucosade and 10 mins later i was 4.6, i only had 8 units of insulin in me at the time and had ate a full 30 Carb meal, so i had some more sugar, and it wasnt until 40/50 mins later i seen my BS spike high and fast, seeing this has only increased my worrying about going low, surely this means if i caught myself hitting around 3.1 i could drop to under 2 before i see the sugar start to work?

im supposed to go on a honeymoon in april and this is causing me a lot of stress as im not sure i can handle 2 weeks out of routine. if anyone has any advice id really appreciate it.

Thanks

SamJB said:

I too suffer from hypo anxiety, or at least I used to. When I was first diagnosed I had a couple of really bad hypos that led to fits and trips to A&E. I was never anxious before that, but I became terrified of hypos and went through exactly what you're going through; feeling hypo, when I'm not and it's just the anxiety; anxiety about going on holiday; panic attacks. It really wore me down and you become your own worst enemy, because it's all in your head.

I actually controlled my hypo anxiety much better when I switched to low carb because the hypos were less frequent and much more mild (i.e. high 3s). When I do have hypos now, I have to fight the anxiety, because each hypo I have I think is going to be the one that finishes me.

My control is always rubbish on holiday. I try my best to low carb, but temptation kicks in and it is often inconvenient. When I have low carbed successfully on holidays, I'm much less anxious that I know my levels will be stable and any hypos small. I reckon your levels were yo-yoing on holiday because you weren't low carbing. If I were you I'd try your best to low carb as much as you can. Persist in your routine and always carry a bottle of Lucozade with you.

I think you're right when you say that your insulin sensitivity has changed. Maybe it's time to dig out a BG diary again. Eat the same food for a couple of days and you'll soon spot the patterns. Personally, I think you need to figure out your insulin doses. Sounds like your bolus is too high and your basal might be too. What are your overnight fasting results like?

With the action rate of sugar, it depends really. Dextro tablets are around 10 minutes. Lucozade around 5. Sucrose (what is in coke) is terrible, around 15-20 minutes because your body has to convert the sucrose to glucose, so go for anything thats got glucose or dextrose in.

Most of all, try not to be anxious, after all, you've successfully dealt with every hypo you've ever had, haven't you? And how many of those have you had, a few hundred, maybe a thousand?

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Thanks for that, before i was on holiday last week i tried to aim for a blood sugar of around 10 before i went to sleep, normally this just held all night and id wake up at 10, though i was having some issues with the dawn phenomenon which seems to have now stopped.
Now when i still try aim for a BS of around 10 going to bed but when i get up in the morning ive dropped by up to 5 so i am waking up around 5/6 in the morning, which is a good result but it has made me more nervous to go to bed with a bs of anything lower than 10, so if im 8 i try to correct by having some long lasting carbs but even a small amount of carbs overnight seems to rocket me in the other direction and ill wake up at 16.

alaska said:

First up, congrats on the 4/5 stone weight loss.

Losing this much weight will have had at least a modest effect on your insulin sensitivity, so just as your meal time ratios have changed, I suspect there'll also be some change needed to your basal insulin (albeit perhaps not to quite the same extent). If you've not had a review of your basal insulin recently, now would be a good time.

You may also benefit from having a trial on a continuous glucose monitor, particularly given the anxiety you're feeling. It's possible that a continuous glucose monitor may not be available but there's no loss in asking.

In terms of sudden, hard to correct hypos, the times I've experienced these are following intense exercise (eg lifting or prolonged digging, sawing etc). A period of strenuous exercise can dramatically increase insulin sensitivity for up to 48 hours. Could this explain some of the stronger hypos you've had?

I find holidays to be tough to manage as the diet as is usually substantially different, so often is the climate (usually much warmer) and then there's any alcohol to take into account. I personally try not to get to hung up on achieving such great control when on holiday. As long as my control is better on the other weeks of the year, a short blip shouldn't hurt things too much.

Ed

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Thank you,

i was fitted with a CGM last October however they didnt give me the device to see the results in real time, and they only gave me the results last month (typical NHS) so by the time i had the outcome the results were useless to me. i feel i would love a CGM for the confidence it gives, however the NHS Dont really supply them and the cost without the NHS is far far to high.

in terms of exersize no, i lost the weight just with diet control and i have to admit that i really dont exercise that much, im now in a healthy BMI but am still unfit, i enjoy swiming but being separated from my blood meter and acess to sugar makes me to anxious to do this that much.

The other issue i have is my meter can give me wildly diffrent results. (accu-chek mobile) i can wash my hands and test and get 12.3 then test using a diffrent finder on the same hand and get 9.0 which leads me to distrust my meter and increase testing, i love the meter due to how easy it is to bring out and test when you have shakey hands but i fear i may need to switch if accuracy is an issue

SamJB said:

The drop in overnight levels that you are experiencing is almost certainly down to incorrect basal. The overnight drops you see, would certainly give me drops in BG between meals too. I change my basal nearly every day because it is very sensitive to exercise and sometimes I can be ***** to exercise, sometimes not. So I need to be dynamic with my doses.

In Gary Scheiner's Think Like a Pancreas book, his method of calculating and changing basal works perfectly for me. For every 1.6 mmol/l change in overnight levels, adjust your basal by 10%. Make sure that you don't eat or inject within 4 hours or so of going to bed. How this would work with split Levemir, is a bit beyond my experience sorry, as I use single dose Lantus. But I'd guess that maybe your total daily dose needs to reduce by the amount that comes out of the calculation.

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I will give that a go over a period of a few days and see what effect is has, im confused as to which dose the morning or the evening would be causing the overnight drop though .

alaska said:

Levemir can be a pain to balance right if you find it doesn't last a full 24 hours. I find Levemir lasts me about 18 hours which seems to be about average.

On a single daily dose, this of course means 6 hours of the day will be covered by no basal and therefore is ketoacidosis waiting to happen.

If split 12 hours apart, you won't get the high ketoacidosis risk but what you will get is 2 periods of overlapping basal doses a day. Take this example:

00:00 - Pre-bed Levemir dose taken
12:00 - Midday Levemir dose taken

If your Levemir indeed only lasts for an 18 hour duration you'll have:

00:00 to 06:00 - both bed-time Lev and previous days midday Lev doses acting
06:00 to 12:00 - just the bed-time Lev dose acting
12:00 to 18:00 - both midday Lev and the previous bedtime Lev doses acting
18:00 to 00:00 - just the midday Lev dose acting

So, in this case you'd have two different 6 hour periods in which two basal doses are acting at the same time and another two 6 hour periods whereby just one basal dose is acting.

About 3 years or so ago I was getting frustrated with having some areas of the day when I was going too low and other periods of the day where I kept going too high. Having worked out the above, I decided to go onto 3 basal doses per day split 8 hours apart. My consultant think it's unusual but it's worked for me. However, this certainly won't be for everyone and could be hard to manage.

If you're finding you're getting a similar pattern of high levels before a basal dose and low levels within a 6 hour or so period of taking a basal dose, it could be brought on by the split Levemir doses. The easy option out of this is to request to go onto Lantus as that insulin usually has a 24 hour duration in most people and therefore doesn't need to be split.

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Thanks

i take my evening dose around 10PM at night then a morning dose at around 7am, this is what my doctor suggested but from reading this i feel that this may be to close togeather? thought if i take it any later ill have to carry 2 pens with me to work.

OK tonight I had another werid one. Ate 40g of carbs for dinner starting at around 7pm took 6 units of insulin 2 hours later I was 14. I took my levimir reduced it to 18. At hour 3 I was 12.4 and hour 4 7.7 I seem to Still be dropping so I ate a belvida breakfast biscuit . 8.4 carbs 3 of which are sugar. So hoping it keeps me up throughout the night

Ment 7 mmol not pm