lost the will to live.

[paganlass]

hi everyone, ive posted before about my mum who has type 2 with insulin. iam currently trying to get mums bg levels down and the low carb diet is working and her bg,s have come down from highs of 15 to 27 to a low of 9.6 and 11.1. but she has had some unusual lows of 3.9 which made her ill and i cannot figure out why it dropped so low! it upset her so much and caused sympeoms of severe wobbles and sweating then freezing and blurred vision that in the end we had to call the doc who,s usual response was, phone the ambulance they will sort her out! when the ambulance came her bg had risen to 7.8 which is ok but i had given her some gloucose tablets and then did another bg check and gave her a snack . we waited at the hospital for 6 hours, then they sent her home with no treatment, saying that there was no diabeteic team on ,on the weekend.my mum has gone downhill since then and although her bg levels are beginning to level out, she has lost the will to live and i am at my wits end as to how to help her further! her doctor doesnt want to know . she is becoming more and more depressed.she has never been a worrier but now she wont even go to bed she sits in her chair all night because she thinks she is going to die in the night!! what can i do!!
please any suggestions would be greatfully recieved.
p.x

 

[sugarless sue]

I'm not an insulin user but if you have got her BG down then maybe her insulin needs to be adjusted to reflect this.Please get on to her doctor/nurse asap to see what the adjustments would be.

 

[hanadr]

Request an urgent appointment with the diabetes consultant and GO WITH HER. Keep a log until then.

 

[fergus]

Hi paganlass,

I'm sorry to hear about your mum.
She has suffered a hypo and it can be very unpleasant indeed. It doesn't sound as if your medical team has been much help either :evil:
As an insulin user myself I would suggest the following.

Her blood sugar dropped because either she took a little too much insulin, or too little food.

Don't be discouraged, because she is making great progress in reducing her blood sugars and it's very important to her long term health that she continues to do it.

Buy some packets of Dextrosol glucose tablets from your local pharmacy. They come in a range of fruit flavours and will raise her blood sugar very quickly if they drop too low again. They will also raise it controllably, by around 1mmol/l each so she will be less likely to 'overshoot' when correcting a hypo and have a high blood sugar instead.

Long term, she would benefit from using as little insulin as possible, while maintaining a blood sugar in single figures at all times. This will make future hypos much less likely.

Actually, 3.9 isn't that low a blood sugar! It's not an uncommon level for non-diabetics, but your mum will be accustomed to much higher levels, so for her it will have seemed pretty scary.

The symptoms she sufferred aren't uncommon either. They will have frightened her, but they are actually a pretty effective early-warning system to make sure she takes the right action.

Keep an eye on her blood sugar levels by testing a number of times each day. That way she will develop some confidence about her blood sugar levels and their trends, up and down.

Good luck, and let us know how she gets on

fergus

 

[paganlass]

hi thanks for replying, sugerless sue i have reduced her insulin to reflect her food type and amount . thats why i couldnt understand the sudden drop.
hanadr, i have tryed to get medical help but noone gives a ****.
furgus, i always carry glucose tablets and i did give them to her when she had this sudden drop, i cannot understand it. the doctors really do not care! i know it sounds unusual but they just say phone an ambulance all the time. i am reall on my own here. im teaching myself about diabetes.
what ratio of food to insulin is it? is there a rule of thumb here?
last time she ate for instance she had
2 pieces of sliced beef with asparigus spears 1oz of mash and green beans and tomatoes. her bloods before was 12.5. so she took 22 units of insulin.
does this sound about right? :shock:
p.x

 

[fergus]

Hi paganlass,

That's a very large dose of insulin. How did you/she work that out?

fergus

 

[phoenix]

Hi Paganlass,
I've just been looking at your past posts and its not really clear what type of insulin she is taking. As she is taking insulin before her meal I'm assuming that she is taking a rapid acting insulin such as Novorapid or Apidra, is she also taking another type of insulin (lantus or levemir)? I ask because this does make a difference, particularly as to how to deal with fears about nighttime hypos.

As Fergus says, it is a large dose of insulin (for comparison for that meal from a normal BG I would probably take less than 2 units, in addition to lower the high BG perhaps another 5)) but what she needs will be very different since as a type 2 she most probaly has insulin resistance and may need much more.
What you can do is test 2 hours after her meal, and see how much the insulin has reduced the BG and use it as a guide when dosing next time.
Hopefully, you will be starting from a lower level so can ajust the dose downwards. One point to bear in mind is that quite frequently higher BGL need proportionately higher amounts of insulin.

The meal itself had very few carbs, say 5 for the potato and maximum 10 for relatively large portions of veg that is only 15gms carbs so most of the insulin taken would have gone to reducing her high BGL.

Advice on adjusting insulin over the internet isn't really a good idea (particulalry since we don't know what insulin) and it should be your doctor doing this, I really do think that you should press for an appointment. Hana's suggestion of a log is important, as it will help you/your doctor work out patterns. You need to ideally include the meal and its carb content, pre and post meal BG readings, any other things that might affect BG ( exercise, emotions, other drugs etc).


As others have said, 3.9 isn't low but the difference between that and the levels of over 20 to which she is accustomed would have given her the hypo symptoms. She certainly won't feel well bouncing between normal BS and very high ones no wonder she's feeling depressed. If her blood glucose levels become more stable she may feel better and less depressed. The depression is another reason to seek an early doctors appointment.

On the other hand it may be that part of the depression is perhaps a feeling of losing her autonomy. (please accept that I don't know your Mum or anything about your relationship and please ignore the following if its totally wide of the mark!).
She has already lost some independence with the arthritis and as you said hadn't really accepted her diabetes and need to take injections. You have been very proactive in trying to help her, certainly her BGL were far too high and perhaps she didn't realise how dangerous in the long term this was. However this change of diet may be rather too drastic if it is not her own choice and if from her point of view it's making her feel ill. I'm not that much younger than your Mum but I've learned about my own diabetes, and am therefore empowered to make my own decisions. I think I'd be unhappy if my daughter decided to take me in hand by changing my diet. The low carb option is not the only option, there are people with type 2 on this board who use a low GI approach which might be a more moderate approach. Perhaps you could do some reading about this (google glycemic or glycaemic index) and share your findings on the pros and cons of the various approaches with her.

 

[paganlass]

hi fergus and pheonix,
the dose of insulin was worked out by a diabetis nurse 6 months ago and it was higer than that, i thought it was high before, she told her to take 24 units morning lunch and tea and then 42 units of lantis at night!
she never told her to alter the amount for the type of food she ate or the amount and she told her to check her bloods AFTER taking her insulin!!
as for the type she takes pheonix, she is on nuvorapid during the day and lantis at night.
she was really struggeling and she was on a high carb diet and her bloods were in the highs of15 to 27 consistently and she couldnt get them down at all on her own. so i started to help her and her bloods have come down , the other day they where down to 6.7! and are staying around the 10 to 11.2 now which is really good for her. she does feel as though she haslost control of her body but i hope when she understands her bg levels more she will feel more confident in doing it herself which is what im aiming for.
p.x

 

[phoenix]

I'll try to explain about the difference insulins.
Lantus is a basal insulin. Its purpose is to deal with the glucose released by the liver outside of mealtimes. It is supposed to last 24 hours and shouldn't really alter the glucose levels at all. If its adjusted correctly and there are no other variables you should be able to miss a meal and the blood glucose level should remain within 1mmol of where it started. This is perfection and often doesn't happen. (more later)
Novorapid is a rapid insulin. Its purpose is to counter the glucose rise from eating. Its onset is very quick and most of its effect takes place within 2 hours.
Thie graph below shows the way the two insulins work together
BOLUS
The amount of the bolus insulin needed is very individual. It depends upon the persons insulin resistance, meal eaten ie the grams of carbohydrate, and to a lesser extent the protein, the level the blood glucose was before the meal, the amount of exercise either done previously or planned. As your Mum has reduced the amount of carbs she is eating, it is quite probable that she will need less insulin than before, particularly now she is starting from lower levels. By logging BGL results before and after meals ,the amount of insulin needed to 'cover' a set amount of carbs can be eventually calculated. One tip is to try to keep the carbohydrate content of the meals fairly consistent(ie the same amount for each breakfast, similarly lunch and dinner) then you have less to consider and can make small adjustments gradually. ( I'm a little concerned about making rapid changes without proper advice but am concious shes already changed her meal content, so do please try to discuss it with your nurse, I was originally told not to alter my more than 1u at a time but my doses were far lower and had been correctly worked out to start with)
In the meantime, as she is already taking fairly large doses but with newly reduced carb content meals she may go too low and need to treat a hypo. The standard treatment is 15gm fast acting glucose (dextrose tablets, lucozade etc , test again at 15min, if blood glucose levels not raised repeat. If its more than an hour to the next meal then eat a small snack of slower acting carbs or carb + protein.

Basal insulin
As you can see from the graph this is what should be keeping her levels steady between meals and
during the night. If her blood glucose levels fall 3 or more hours after eating then it is probably too much lantus rather than novorapid that is causing it, if the levels rise the dose may be too low.
Your Mum was fearing night time hypos. If she goes to bed with a within target blood glucose level * at least 3 hours after her mealtime (when the action of the novorapid has tailed off) and if her lantus is correctly adjusted then she should be able to sleep without fears. However, to find out what is happening during the night the only way is to test. Normally at 2-3am! and again on rising. Its a hassle, but only needs to be done when for some reason you are making changes or having problems.

*again I can't really give a figure as we're all very different, please ask the nurse. Mine when I was first diagnosed was not below 6.6mmol, if lower, I ate a snack. Now I go to bed with a lower figure but at the moment my BG is very stable overnight.

 

[paganlass]

hi pheonix, thanks for replying.i have been chatting to mum and have gleaned some extra info from her that she has just remembered! originally when she went to see the diabetic nurse she was put on 14 units of nuvorapid and told to adjust this amount for the size of meal and meal content, however because she did not understand what the nurse was saying her she has gradually increased the amount until it has got to 22 units! what she failed to understand ( i think ) is that she was suppossed to go back to the original amount after that initial meal and then adjust from that base number of 14 again.instead she has gone up an up!
what i would like to know is if she goes to bed with a bg of 7.8 why does it rise to 11.8 in the morning and should she take more lantus or less? since i have been helping mums bg levels have been falling at tea time around 5pm her bg has been 6.2 for three days on the run . however this frightens her as she is so used to it being higher. but in the morn it is 11.8 and also at lunch time 11.8, then it falls. she doesnt feel well when it falls but i put that down to her body fighting the low suger content. i am now thinking that she is taking too much insulin fullstop!! but how do i lower it without scaring her to death! i think she should be on about 14-15 units. q? what is a unit and how much insulin is it? p.x