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Multiple Hypo's

Alisonjane10

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England. (North East)
Type of diabetes
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Tablets (oral)
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Hello folks,

I'm having a problem with multiple Hypo's. Saw my DN yesterday who increased my Metformin & decreased my Gliclazide. Had 2 further hypo's since then. I've even halved my dose of Gliclazide again to 40mg before my evening meal. (DN advised 80mg twice a day.) My Metformin was increased to 1GM twice daily from 500mg twice daily. Would this increased dose cause such a difference so quickly? Also, 2 hours after my evening meal, my BG was 4.2 & I felt dizzy/spinny, which are my warning signs that I'm heading for a hypo. I ate a banana to help. Still a tad "foggy" though. I'm following a LCHF eating plan but wonder if I need to introduce more carbs in my main meals. This evening I had a cheese & ham omelette, 2 prime meat sausages & a mixed salad, tea with cream. Do I need to eat more snacks? I get bored of eating the same things & I'm tending to snack on pistachio nuts or almonds. All advise gratefully received.

Just checked my BG. 3.5 & that's after a banana & 6 cherries. Help!
 
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Metformin is unlikely to lead to a hypo.
You are going through fluctuating blood glucose levels. Up and down, as you get used to low carbing.
Reduce your carbs slowly, have a little often until you get very low. If the feelings of hypos which are probably false hypos as that reading is not In the hypo range.
You should talk to dsn if your symptoms persist.
It's a marathon not a sprint.
 

Thanks nosher. I'll try doing what you've suggested. Guess I just want everything waaaay too quickly. My DN tells me "4 is the floor" when it comes to hypo's. So what is the hypo range? Goodness, this can be a complicated business. Good job it's a marathon and not a sprint. LOVE that quote.
Ali. X
 

Hi Alison,

I understand that you got the Hypo warning signs at 4.2, but are you actually getting problems? (i.e. loss of brain function). The warning signs can start to appear at normal blood-sugar levels, if the levels have been higher for a period of time.

I use the Ketogenic (LCHF) diet to manage my levels. Over years I've needed to accept that my levels tend to stay somewhat lower than what are accepted as "normal".

For information, I use the excellent book "The Ketogenic Diet - A Complete Guide for the Dieter and Practitioner" by Lyle McDonald. The book explicitly states that those on a "normal" diet (whatever that is) can expect blood-sugar levels in a range from 80mg/dl - 120mg/dl (4.4mmol/l - 6.7mmol/l), whereas those in Dietary Ketosis can expect blood-sugar levels in a range from 65mg/dl - 80mg/dl (3.6mmol/l - 4.4mmol/l).

I'd say that if you are maintaining Dietary Ketosis then you may find quite often that you are below 4mmol/l. Certainly that's the case for me. The important question is whether you are experiencing any loss of brain function, or feeling unwell?

Recently I read through a 1970s medical case of an obese man that fasted, with medical supervision, for an entire year. In the last 8 months of the fast he consistently maintained blood-sugar levels of 30mg/dl (1.7mmol/l) without any problems. Being in Ketosis, via Ketogenic diet or by fasting, changes the situation for blood-sugar levels. Diabetes Doctors and Nurses are very unlikely to be familiar with this.

Technically, Hypoglycaemia is defined as "abnormally low blood-sugar". But what is "normal"? I'd say that depends on your diet, as described above.

Regards
Antony

(I have the guidebook mentioned above as a PDF file. I'm happy to forward this to you if you are interested).
 
3.5 is the level given nowadays for hypo's, but this can differ from person to person, and if your BG's have been running higher, it's possible to feel hypo at levels that are none hypo, if that makes sense? It's the brain adjusting to newer glucose levels.

I' m wondering if your dose of Gliclazide is still too high ? It's possible that further down the line you may not need this anymore, for for now it's worth checking with your DN/GP if this can be reduced further.? I wouldn't have thought it necessary to introduce more carbs, but perhaps experiment a little with what you can and cannot eat for variety ? Your meter is your friend in doing this

Signy
 


Hi Antony

That's a very thorough, informative & helpful reply to my post. And yes, I'd be delighted if you could send me the guidebook PDF. Can I pick your brain a little more...how can you tell if the diet you are eating is putting you in ketosis? I don't use calculations of any kind to measure nutrional intake (protein etc.) But I do avoid carbs & eat no more than 50g a day, usually much less. I use the LCHF information on this site to guide me in my food choices and have a book called "Carbs & Cals" which I frequently refer to. I'm building up a list of foods that I can't tolerate due to BG spikes & these foods I avoid completely. As for my hypo warning signs. Once my BG drops below 3.8 I get a headache & feel dizzy/spinny. I don't have loss of brain function...thinking process is a little slower if that's what you mean, but this doesn't impede my abilities. One other thing that was different yesterday was starting a 7 day course of Doxycycline. An antibiotic for a sinus infection that didn't clear following a course of Amoxicillin. The first dose of Doxycycline is a double dose (200mg) then you take one 100mg tablet per day after that. I know many medications can interact with other prescribed medication & cause a lowering of BG. Don't quite know where I'd find that information, but there was no warning about lowering of BG on the patient leaflet accompanying the antibiotics. My DN is calling me on Monday, so I'll raise my concerns with her. In the mean time, I very much appreciate you giving me your time & providing me with such a clear answer to my question. You're very kind.

Ali. X
 
Hi. It will be the Gliclazide causing the hypos. I suspect you may need to reduce the dose a bit further. Do discuss with the GP.
 

Hi Heathanlass

Good advice, which I very much appreciate. I'm hoping that at some point in the future I won't need to take Gliclazide. It's a drug that frightens me a tad, eventhough it probably saved my life when I was first diagnosed. May I ask, how do you keep the variety in your diet. I must admit I'm struggling with this & any advice from members like yourself following an LCHF eating plan might make it easier for me. I'm still new to all of this & have still got to learn the fundamentals before I will feel better able to manage my T2 effectively and without having to constantly think about it.

Ali. X
 
Daibell said:
Hi. It will be the Gliclazide causing the hypos. I suspect you may need to reduce the dose a bit further. Do discuss with the GP.
Click to expand...

Hi Daibell

Thank you for replying to my post. I was aware that Gliclazide could cause hypos. In a space of 4 weeks, I've had it reduced from 160mg twice a day to 80mg twice daily. Though I must admit, I only took 40mg this morning. My Metformin has been doubled since Friday to 1gm twice a day from 500mg twice daily. I am hoping to stop taking Gliclazide completely at some point in the future & be on Metformin alone. Perhaps I'm being over-ambitious thinking this way so early into my diagnosis...and maybe I shouldn't be so cavalier by playing around with my dose of Gliclazide. But to be honest, I didn't feel it was safe to take 80mg of Gliclazide yesterday when my BG was already low. I'll be feeding back to my DN on Monday though. Once again, thanks for taking the time to answer my post.

Ali. X
 

Hi again . . .

I'll send you a Private Message regarding the PDF.

(edit: just noticed I cannot PM you . . . so please send me a PM)

There are several methods to test whether you are in Ketosis.

Some of the blood-sugar testing machines are also able to test for Ketones, using different test-strips. These test-strips are quite expensive.

Ketostix are little strips that test for Ketones in your urine. There is a simple colour chart on the box; you can see from the colour that the strip turns, whether you have Ketones. These are available from the chemist/Amazon without prescription.

Finally, there is the Ketonix monitor. This is a little breathalyzer that you blow into for 15 seconds. Level of Ketones is indicated by the colour of a flashing LED light inside the monitor. This is available over the Internet. Expensive one-off cost, but then you can test forever without any further cost.

I use both the Ketostix and Ketonix just to keep track of whether I am in Ketosis. I find it really useful to know if I am in Ketosis or not. When I'm in Ketosis, I find my experience of low blood-sugar levels is totally different, and it's useful to be aware of which status I'm in.

Regards
Antony
 
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Hi Antony

Thanks for explaining that to me. As it happens, my DN prescribed me Ketostix on Friday when I had my meds reviewed. She told me to test my urine periodically to check for ketones. I've done so, & the colour change showed "trace" reading. So, I presume this is ketosis. Anything much higher could indicate a problem I'm guessing. You're very kind to explain the sciency bits to me. It can all be very overwhelming. May I trouble you with another question once more. Would you mind telling me your typical daily meals & snacks. I'm struggling with a varied LCHF diet. It would be most helpful. Many thanks.

Ali. X

 

Remember that the urine test for Ketones will always be 4 hours out-of-date, because this is how long it takes for Ketones to filter through your waste system. Blood- and Breath- tests will give you an up-to-date measure.

From McDonald's book again . . . Ketone concentrations on a "normal" diet can be expected to be 0 . . . in Dietary Ketosis they can be expected in the range from 4mmol/l - 10mmol/l. It only makes sense to be concerned about Ketones at all if you have high blood-sugar at the same time. This means a danger of Ketoacidosis, which is very different from Ketosis. (A tsunami rather than a gentle wave).

Yes, I can give some info about my typical meals in our PM, but I fear you won't learn much from me!
 
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