Lots of hypos...

[Catsymoo]

Hi guys, as of late I'm having a lot of hypos and it's really distressing as they are happening at work. I am not very good at seeing my diabetic nurses as I have a phobia of blood tests and get sick and tired of seeing doctors lately for unrelated reasons, and I'm too busy so I'm just looking for a little bit of insight online.

I'm on Novorapid and Lantus. I have 28-30 units of Lantus anywhere between 5pm and 2am depending on work. I know that sounds bad but my work schedule is hectic and I have tried to change it to just evenings so I have some sort of routine. I am supposed to take Metformin twice a day, and I probably manage it once a day. I try to manage my Lantus at 5pm-6pm but sometimes at work people get annoyed with me if I have to go off the shop floor to take my medication, so I might just leave it and take it when I get home...

Putting that aside, I'm having problems with my insulin. My blood sugar seems to be always too high or too low. Not catastrophically high, but I am seeing a lot of 12s and 14s and 15s. I'm not very adventurous with food, most the carbs I eat are.. I eat brown bread, I eat pasta and I eat chocolate. I stay away from really high GI foods unless I'm hypo. My insulin needs just change all the time and it's really annoying. Yesterday at work for example, I had a sandwich before I left for work, and I took 10 units of insulin. In the car about an hour later, my sugar was 14.6. I took 2 units to try and get it down a little, I had a yum-yum at work as they were offering them, didn't take any insulin as I was doing physical work. 45 mins later I start going hypo, drop to about 5 and I can feel it coming. I eat 2 more yum yums and half a sandwich and only go up to 6.9.

Is my basal the problem or is it the bolus? It's like the bolus isn't enough at first... then it's too much. And on my days off I sometimes need up to 20 units just for a not carb heavy meal... I sometimes have hypos in the middle of the night too or early morning. I'm wondering if it's my basal and not being strict enough to take it at the same time every day because I'm too scared of being a burden at work?

 

[TheBigNewt]

If you take 10 units for a sandwich and your blood sugar is only 14.6 an hour later don't take more insulin. That's asking for a hypo. See what your sugar is like 4 hours later. To me it almost sounds like 10 units was too much, and then you took more. I call that "stacking" which is many times an invitation to get low.

 

[Catsymoo]

If you take 10 units for a sandwich and your blood sugar is only 14.6 an hour later don't take more insulin. That's asking for a hypo. See what your sugar is like 4 hours later. To me it almost sounds like 10 units was too much, and then you took more. I call that "stacking" which is many times an invitation to get low.

But it's not supposed to go that high, no? Normally 10 isn't enough for me. I need quite high doses. I know it's supposed to be below 10 2 hours after food, but I never really looked into what blood sugar actually goes up to right after eating. Like, is it supposed to go that high before the insulin slowly brings it down? I don't like my sugar to be above 11 ever.

 

[karen8967]

i agree with thebignewt do you carb count as 10 units for a sandwich seems an awful lot my bgs spike after 2 hours of eating but are normally back in range by my next meal and as for people getting annoyed at you for leaving the shop floor to take medication is a disgrace hope you get it sorted

 

[Catsymoo]

i agree with thebignewt do you carb count as 10 units for a sandwich seems an awful lot my bgs spike after 2 hours of eating but are normally back in range by my next meal and as for people getting annoyed at you for leaving the shop floor to take medication is a disgrace hope you get it sorted

I have insulin resistance so 10 units is actually a very low dose for a sandwich for me. Normally I would take about 12-15 for a sandwich. I used to need low/normal doses but about a year ago I had an allergy, and got put on some steroids for 4 days, ever since then my doses have doubled. I had a stomach ulcer before Christmas and I think I've lost weight so it's also not helping (even though it's good in the long run that my doses are coming down) with the hypos lol.

 

[TheBigNewt]

As my sig says "you're either on your way up or on your way down". And I think you were on your way down after the sandwich at 14, and you were only an hour into 10 units. You don't take more insulin an hour after a dose (unless you're eating some more food). I'd quit worrying about postprandial blood sugars (I don't hardly ever check mine, just before meals/bedtime/ awakening).

 

[Catsymoo]

As my sig says "you're either on your way up or on your way down". And I think you were on your way down after the sandwich at 14, and you were only an hour into 10 units. You don't take more insulin an hour after a dose (unless you're eating some more food). I'd quit worrying about postprandial blood sugars (I don't hardly ever check mine, just before meals/bedtime/ awakening).

Thank you. I don't test often either, but lately I have been because I'm back at work and where I've been ill in December my insulin needs were all over the place and I have really bad hypo anxiety, especially if I have a 3 hour drive to work and it's embarrassing. I will try lowering my doses and checking after 3-4 hours.

 

[Jaylee]

Hi @Catsymoo ,

Let's start from the base line..?
You seem to have allocated yourself a 9 hour window in your schedule for your Lantus..?
If you were to inject your "28-30 units" of basal at 1am, then the following day at 5pm? You could be stacking your dose as the cross over a little? Which may not help regarding contributing to the hypos..
In the same respect injecting at 5 then leaving the next dose for 28 hours? Could leave you running too high as the Lantus tails out, without basal for a few hours. You need to allocate a time (or at least an hour in the day for basal & stick to it? It only works for 22/24 hours.

Here is a link with info on basal testing. Hope this helps!?
https://mysugr.com/basal-rate-testing/

 

[Antje77]

I took 10 units of insulin. In the car about an hour later, my sugar was 14.6.

With novorapid I had to pre-bolus up to 45 minutes, as the food started working faster than the insulin. Pre-bolusing worked pretty good for me, but please be careful if you want to try it: use your meter a lot and keep quick acting glucose handy. And don't experiment when you're about to drive. I'm on Fiasp now, which I like a lot better as I can eat directly after injecting without spiking much after an hour and then waiting to see if it comes down by itself.

For your long acting: Lantus doesn't give you as much leeway with timing as you take. If it really is such a problem taking it around the same time everyday you could ask for Tresiba. You take it everyday around the same time, but it works for 40 hours or so, so you can easily vary the timing by up to 6 hours I think.

 

[donnellysdogs]

I will go back to the very basics here:

You do need to get back to see a consultant at hospital.

You say you arent testing that much... you may be able to get a Libre......

As your lifestyle is not conducive to exact(ish) timings of your current basal.. perhaps switching to Tresiba could help... this again needs really to be authorised by a hospital consultant.

You are T1, your colleagues at work arent... so, you need medication at a set time (currently). No matter what employers need to ensure that you can take it.. your health is far more important than what colleagues think.

I would really beg you to talk with hospital staff. After my going through hell with a particukar op and care I lost all confidence in Nhs.... but believe me, honestly.. you do need them.

 

[EllieM]

you say you arent testing that much... you may be able to get a Libre

I was just about to suggest trialling a libre - I believer there is a smartphone app that can replace the scanner so that the cost would only be for the sensor???
Do your work know you're T1? Giving you a 5 minute break so that you can dial a lantus dose shouldn't be that big an ask, aren't you even allowed toilet breaks? (No, I'm not suggesting that you inject in the toilet, but you can inject lantus much more quickly than the time needed to visit the loo..
Good luck

 

[stewpid]

I think the advice given here is spot on but the one thing that stood out for me is that your employers get annoyed when you leave the shop floor to take insulin.

Diabetes is covered by the DDA (Disability Discrimination Act) and as such employers have to make "reasonable adjustments" to enable employees to cope with medical conditions.

They're breaking the law if they don't allow you to take medication when you need it. Suggest you have a word with somebody who has HR responsibilities.

 

[mentat]

Hi Catsymoo,

Have you considered getting an insulin pump? And then decided not to because having something attached to you sucks?

Look, they are annoying at times, but they can make diabetes much less annoying. Not only would you be able to take insulin discreetly whenever you wanted, and your basal would be delivered at the right time, but you would also have a much higher chance of getting your unpredictable insulin needs under control.

Now let's get onto your problem:

Yesterday at work for example, I had a sandwich before I left for work, and I took 10 units of insulin. In the car about an hour later, my sugar was 14.6. I took 2 units to try and get it down a little, I had a yum-yum at work as they were offering them, didn't take any insulin as I was doing physical work. 45 mins later I start going hypo, drop to about 5 and I can feel it coming. I eat 2 more yum yums and half a sandwich and only go up to 6.9.

I'm going to work with what I've got here (which isn't much - varying your Lantus so much is an "all bets are off" situation, really).

These are problems I can think of:
- Physical activity at work is making you very insulin sensitive
- NovoRapid is working quite slowly
- You are digesting lunches quickly

The first thing to be said is that One hour after eating is a very unreliable time to test. It is hugely affected by changes in digestion rate or insulin release rate. If you are 14.6 after 1 hour it doesn't mean you didn't take enough insulin. It sounds like you took enough, but it is acting slowly in comparison with digestion.

There are ways to increase the rate of insulin release, such as bolusing a bit earlier and massaging the injection site. I have used intramuscular injections in the past to great success. Your body may have developed a specific reaction to NovoRapid, in which case you could try switching insulins. (Especially Fiasp.)

If it's just an exercise thing, you will need to find a way to manage that. Maybe have lunch an hour earlier, or use one of the above techniques, or eat more before/during your activity. Maybe a larger lunch will help (I find that eating more means it takes longer for the whole meal to digest).

If your body is having an unusually slow response to NovoRapid, this will throw everything off, especially if you change your dosages based on what you eat, because you may have unpredictable amounts of insulin lingering in your system from 6 or more hours ago, and this will vary day to day. It would also explain your overnight hypos.

Finally - are you on the extended release Metformin? If not, try to get on it. That way your day-to-day sugars will be less affected by forgetting a dose.