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Lost my job because of Hypo's

P

puppy

Member
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8
Im not having a good week. I have been type 1 for 8 years and have been on a pump forthe last yrbecause of hypo's. I have no hypo awarness at all and after my 11th collapse requiring a ambulance at work in the last 5 months. I am now considered a health and safety risk (teaching). I went to see my diabetic nurse who was very good but informed me as My pump has not improved or stabilised my condition that It will not be funded any longer. I am desperate for a sensor to go with the pump so that I know what my blood sugars are doing. I regulary test my BG and often it is 1.4 or something. I have been told The PCT say this is a luxury and not a neccesity for me. So I now face paying privately each sensor is £50.00 and lasts 6 days only. However that is not going to be an option if I have no job. Seeing Human resources next week. Has anyone any advice for me....
 
If you’re BS are often around 1.4 you need to test more and eat more to stop this from happening. With reading like those it's only a matter of time before something major happens to you.

11th collapse wow that’s a lot :?

I hope you get sorted and soon!
 
Is a feasable solution for you to have a hypo awareness dog? If you look at the "cancer and biodetection dogs" website you can find out more information. A dog obviously isn't a solution to everyone but it's something that might help you.

There must be somewhere you can get further advice and I'm sure someone will be along to tell you where. I would have thought that dismissing you on the grounds of a chornic illness would raise questions about unfair dismissal. And I would have also thought that repeated hypo emergencies should unlock funding for a blood glucose sensor. It seems wrong that you can't get the support and funding for this tool if it will help what obviously must be quite a distressing hypo problem for you. And even worse the threat that you might lose your pump is not helpful to you at all. I wish you luck and really hope that you can find a positive solution.
 
1) if you are teaching you are hopefully in a union. Contact them.
2) If you are working for an LEA, you should be talking to the occupational health dept.
3) if you have been in post for any length of time then you have will have good sickness entitlement.... use it. With the support of your GP you should be able to have enough time off to work on gaining control. (hopefully with your pump)
4) If it isn't too late and you haven't done it already read basic books like John Walshe's Pumping insulin. Try to regain awareness by raising your overall levels.
If the worst comes to the worst, do not resign, you will have far more 'balls in your court'.
 
As much as I agree with everyone else here about unions, and employment law matters etc regarding your job, I think you really ought to try to raise your levels as a priority.

Pre pump, I know that I had a hypo (that I treated myself) infront of elderly 'vulnerable' persons, and the council made me see a Occupational Doctor. It was seen by the COunty Council as serious, as I was in charge of helping the vulnerable persons, and there was no way that they should have to help me out of a hypo. I spoke to a barrister through my household insurance about the matter, and I would not have had a leg to stand on-so to speak. Due to other illness I no longer work, but it was a very, very hard time, and I was fortunate that I did actually recognise the hypo. You do need get some professional advice about just how you stand legally.

Regarding your levels......Are you okay with changing your basals and bolus's to get your levels up? Do you need some help regarding the management of the pump? A continuous monitor will help - yes....but testing your blood every 1-2 hours should also give you a pattern as to what is happening....you have to get the levels up. I had a spate of being hypo's very often during the day due to different medications that my GP has been giving me. I lowered all my basals for the whole 24 hours initially by 0.05. Are you a pe teacher that unsettles your levels, or is there a pattern when they are occuring. Many of us haven't had CGM's-even now 6 months on I am still testing a minimum of 10-12times a day.

I'm really concerned for you.....
 
I agree with what the others are saying about getting a handle on your levels first. Has anyone discussed with you the rationale behind aiming for higher levels for several weeks in order to regain hypo awareness? Maybe you already tried that, I don't know, but it's supposed to work, I hear. But in general, something is wrong with the insulin vs carbs intake if you're getting to 1.4 in the first place, never mind whether you feel it or not (unless you are in fact a PE teacher, in which case of course things will go woolly). Have you signed up for, or been on, the DAFNE course?
 
What sort of insulin are you on? There are certain ones which are more associated with loss of hypo symptoms than other. I have been on animal insulin for 24/27 years (3 years on human loss of all symptoms, 3 comas and they switched me back) and still have all my hypo symptoms. I'd recommend talking to IDDT - Jenny is a good listener and has years of experience in all aspects of diabetes. If you list out doses and diet here people may also be able to advise you on what could cause the particular problem although that won't get rid of the loss of awareness.

Could you ask for a sabbatical period to allow you to concentrate on sorting this out?
 
Hi puppy, sorry you are having problems.
I use to work as a teacher and had frequent hypos, so I know where you are coming from.
My diabetes team also felt that the pump was not a good choice for me because I needed to manage my insulin dose on a regular basis. Stress and other factors like the weather (I jest not) can alter the insulin I need.
OK, I think if I were you I would use the half term to constantly test your b/s so that you can try and see if there is a pattern in dips of low glucose levels.
Also, are you on other medication. An under active thyroid and addisons will also cause frequent hypos, I dont know about other conditions but it is worth looking into if you think necessary? If you are well apart from these hypos then I wouldnt check these out, its just a suggestion on my part.

As your hypos awareness is non existant, have you tried, as someone else suggested, going higher in your blood glucose levels for a couple of weeks to see if this can develop a hypo sensation?

Failing this, I can only suggest that you keep monitoring your glucose levels, inbetween lesson time, and depending on your readings, bring your insulin dose down where necessary. Also, it goes with out saying, see if your diabetes team can come to some conclusion. Best of luck.
 
Thanks for all your support guys
My employer is trying to help me with this and arranging Occupational Health referal. I am incontact with access to work for advice and assessment. My blood sugars are very unpredictable I can be fine for 10 days then all of a sudden I can wake up with a BG of 11.4 then eat 2 slices of toast which I calculate as 30g of carbs, have insulin of 2.1 for that and then 2 hours later I will be 1.7 or something. I can take about 4hours to then bring my BG back up to normal. I have been accepted for a Hypo dog by medical detection dogs but am now on the waiting list for an available match. I have done the DAFNE course prior to the pump and I see the diabetic team every few weeks. The doctors have even seen my blood sugars drop rapidly whilst in hospital and have no idea why or how it happens. I am on Novorapid and I take thyroxine for an underactive thyroid. I may look into this to see if this is effecting my BG at all.
Thanks for all your advice and suggestions
Sue
 
Sue

Just as a point though, when you wake up to 11.4 are you doing a correction bolus.....your correction bolus rate may be wrong if you are doing a correction.......1 unit of insulin may be bringing you down far more than you have set up on the pump.

Also, how soon after you get up do you have your breakfast? What time is your active insulin time set up to?

To be quite honest, my best advice I have received is from a fellow pumper, I have a great DSN and Conusltant -don't get me wrong, however they are not with me 24/7/365 when my GP is trialling different painrelief tablets etc on me, and they aren't around when these tablets and treatments alter my blood tests and I have to end up lowering all of my basals for whole 24 hours.

May be that other things are affecting levels every 10 days, I certainly haven't managed yet to go 10 days without altering something on my pump......have you looked at every single aspect of the pump management that could be affecting things??

You have probably tried all of the above, but I really am glad that you are getting the help from work, OH and HCP's, as you really do need to get this resolved, it must be a huge stress time for you........
 
Hi Sue,

My BG does this too...massive variations for no obvious reason. Not sure if this will help....or rub salt in your wounds, (I hope the former!) but I have allevaited this slightly, as I have noticed that my insulin carb ration changes through out the day.....in teh evening I am on a 1 unit to 10 g carbs...but in teh morning it is more like 1 to 15 grams, I am lucky, as I do have hypo awareness, and kept crashing mid morning. It is also very time of the month dependent...and not just the week og my period, but each week of my cycle effects me differently. This has been more pronounced since having children.

LIke others have said, have you tried to "run hogh" for a few months? We were told on our Dafne (esque) course that the way to help with loss of hypo awareness was to run your blood sugars high for a couple of months...I think they siad aim for 10 m mol. The thing I do remember clearly though was thatthis should be done woth your Drs help.

Wishing you well.
 
puppy said:
Thanks for all your support guys
My employer is trying to help me with this and arranging Occupational Health referal. I am incontact with access to work for advice and assessment. My blood sugars are very unpredictable I can be fine for 10 days then all of a sudden I can wake up with a BG of 11.4 then eat 2 slices of toast which I calculate as 30g of carbs, have insulin of 2.1 for that and then 2 hours later I will be 1.7 or something. I can take about 4hours to then bring my BG back up to normal. I have been accepted for a Hypo dog by medical detection dogs but am now on the waiting list for an available match. I have done the DAFNE course prior to the pump and I see the diabetic team every few weeks. The doctors have even seen my blood sugars drop rapidly whilst in hospital and have no idea why or how it happens. I am on Novorapid and I take thyroxine for an underactive thyroid. I may look into this to see if this is effecting my BG at all.
Thanks for all your advice and suggestions
Sue
Click to expand...


Hi

Not sure what pump you are using but the Combo can be set to a higher bg target if need be. By default it is set to between 4mmol - 8mmol so it goes to the middle and uses 6mmol but by altering it to 5mmol - 9mmol would use the target of 7mmol which should stop some of the hypos. Also, as mentioned on another thread, the acting time of bolus analogue insulin is normally set to 4hrs but that can also be altered to a lower or higher figure which will affect bg levels.

Although it's not widely available, some PCTs are now funding cgm so I think you sound like a really good candidate for this and would discuss it seriously with a consultant. Some diabetics at my hospital have been able to get PCT funding for cgm because of loss of hypo awareness although I don't know what was involved. I also think that you should have some tests done to see if you have Addisons as it should not take 4hrs to bring yr bg level up from 1.4mmol.

Hope you get somewhere as it must be somewhat worrying for you.
 
Thanks for all your ideas and help on this, It does seem that advice on here does seem to come from people who do actually live with diabetes on a day to day basis. My active insulin rate is set at 6 hours to prevent hypos, although I know it is more like 4.5 hours. As if it eat 4.5 hours after a bolus My BG can rise quite rapidly. I will try to alter the pump to between 5-9 as that will effect the bolus wizard if it is only trying to bring me back to 7 instead of 5. I get up at 6am even at weekends to avoid to many changes and eat by 6.15am. I test every 2-3 hours (approx 10 tests a day) although Then I get told off by the GP for doing too many tests and using too many strips. I will only give a correction dose If I am above 15.5 and then I only calculate 1 extra unit of insulin for every 4 , so At 15.5 I would take 2 units. My basal rates are
00.00 0.625 u/h
04.00 0.650 u/h
09.30 0.675 u/h
14.00 0.600 u/h
18.00 0.650 u/h
My only hypo pattern was at about 5-6pm so thats why it is adjusted at 14.00. however the rest of them are very random, If I do the supermarket shop or walk for more than 15mins, or am really busy, then I crash very quickly indeed. I dont do housework anymore, My mum and my sister do it for me, Otherwise That always made me collapse without fail. I will look into this Addisons though as this looks interesting although very rare, however im sure my blood pressure is nearly always fine.

Thanks guys I have a lot to raise at my DSN meeting on Friday.
 
puppy said:
Thanks for all your ideas and help on this, It does seem that advice on here does seem to come from people who do actually live with diabetes on a day to day basis. My active insulin rate is set at 6 hours to prevent hypos, although I know it is more like 4.5 hours. As if it eat 4.5 hours after a bolus My BG can rise quite rapidly. I will try to alter the pump to between 5-9 as that will effect the bolus wizard if it is only trying to bring me back to 7 instead of 5. I get up at 6am even at weekends to avoid to many changes and eat by 6.15am. I test every 2-3 hours (approx 10 tests a day) although Then I get told off by the GP for doing too many tests and using too many strips. I will only give a correction dose If I am above 15.5 and then I only calculate 1 extra unit of insulin for every 4 , so At 15.5 I would take 2 units. My basal rates are
00.00 0.625 u/h
04.00 0.650 u/h
09.30 0.675 u/h
14.00 0.600 u/h
18.00 0.650 u/h
My only hypo pattern was at about 5-6pm so thats why it is adjusted at 14.00. however the rest of them are very random, If I do the supermarket shop or walk for more than 15mins, or am really busy, then I crash very quickly indeed. I dont do housework anymore, My mum and my sister do it for me, Otherwise That always made me collapse without fail. I will look into this Addisons though as this looks interesting although very rare, however im sure my blood pressure is nearly always fine.

Thanks guys I have a lot to raise at my DSN meeting on Friday.
Click to expand...

Hi Puppy

I altered my target range today just to see if my bg levels were better and they were. It does make a difference but what you could do is alter the target to 7 - 10 and then pump will try to correct you back to somewhere like 8mmol instead of 4 which is too low really. Also you could alter the correction factor from 1u to make you drop by 4mmol to 1u to 5mmol. The pump will then work a bit better for you and you'll be able to do some activity without the feeling that you are going to go low all the time. I have a feeling that the settings on the pump are not quite right so now that it's half term, play around with them and of course have some sweets or glucose tabs handy just in case.
 
I've just noticed that you are using about 15u of basal per day. Is this yr fasting levels and if so,is yr fasting bg level set too low? Do you balance up by using the same amount as the bolus? I also notice that yr carb ratio is 2u to every 10g carb, so with the amount of insulin you are using as the basal it's no wonder that you are going low fairly quickly with the carb ratio you are using.
 
Agree that altering the target range is a good thing to do...mine has been set to 5.5-7.8 for at least the last 3 months. It hasn't stopped my hypo's but it has stopped me crashing from over bolusing on corrections....good thinking iHS!!!!!

If you have problems getting strips from your gp moaning then ask for your DSN to write to your gp. My Consultant and DSN wrote telling my GP to give me more strips, and he has never mentioned it again. In fact now I have a pump, he will not ever ask me anything about managing my diabetes at all because he says I am his only patient with a pump and doesn't know enough about the management about them-so he therefore can't comment on the strips I need!!!!! It would be worth asking if the hospital could write to your GP asking him to give you 350 strips per month.....

If you know that some physical housework or shopping etc can crash you out, why do you not give yourself a temprorary basal rate starting a couple hours earlier to after you finish? You have to be able to do this type of living without crashing out with hypo's. Why not set yourself for a few weeks an allocated time each weekend to do something and monitor yourself very closely. I cannot vary my routine from walking my dogs too much, so I just have to keep to a routine rather than giving up doing it. If I keep to this routine I can manage my dog walks. If I had to have a routine for doing things like housework, or shopping etc I would do it, monitor and adjust until I had my levels ok.

There are definitely ways to stop hypo's on these pumps, just as there are ways to stop our high's, it's just exploring the things that could help and giving them ago....don't give up, and I do hope that you also manage to resolve things with your work, as that too will be adding to stress, which again can affect levels.....please keep positive, as there are ways to manage this and you can do it.
 
Hi Puppy,
Go back 25 yrs and your post would have floored the medical profession I'm sure. I was shocked to read you're suffering no hypo awareness after just 8 yrs! As Tigger previously stated, it's most lkely that the synthetic insulin you're on is the cause, not only of the hypo unawareness, but it's also rapid-acting and works nothing at all like natural insulin. In my view analogue insulins should be marketed under the term "blood-sugar lowering drugs" rather than the easily misunderstood "analogue insulins" label -perhaps people would understand the difference then, and treat them as they would any other drug with respect to side-effects, problems etc;.
You need a break from work to sort things out, and in my opinion you would be wise to consider changing to an animal variety of insulin and start from scratch. Hopefully you will not only get more control over your diabetes but your hypo-awareness will return.
Contact the IDDT plz http://www.iddt.org/here-to-help/contact-us/
Jus :)
 
Hi Puppy,

Hope all goes well with he nurse. Any type of exercise causes ,e to crash...so I have to alter my basal rate all the time....supermarket shopping driving fo rm ore than 10 minutes,,,,like you the "exercise" if actually geeting to a hsopital appointment has made me hypo on many occasions! Do you use your temporary basal rate at all? Just a thought!
 
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