My first hypo - what to look out for with hypos

[SOTR]

I have been a Type 2 for over 10 years. Recently I have sorted out my diet and have a personal trainer.
I find the Freestyle Libre 2 invaluable. Last night around 10pm the device registered a hypo alarm. I have set the level to 3.5
Durring the night the phone said it lost connection - which is a concern as it was right beside me.
On scanning the Freestyle there were two short spikes into the 3.5 level.
sorted the hypo at 10om with a couple of spoons of jam. I did not feel woozy, but had been drinking Gin and Tonics

Should I be very concerned aboutt hypo episodes?
What should I look out for?
Are hype episodes when asleep very serious?

ps. I would discuss with my GP. I used to have a dedicated GP in the practice, but no longer. Also it is well nigh impossible to get a face to face GP appointment.

 

[ElenaP]

I have been a Type 2 for over 10 years. Recently I have sorted out my diet and have a personal trainer.
I find the Freestyle Libre 2 invaluable. Last night around 10pm the device registered a hypo alarm. I have set the level to 3.5
Durring the night the phone said it lost connection - which is a concern as it was right beside me.
On scanning the Freestyle there were two short spikes into the 3.5 level.
sorted the hypo at 10om with a couple of spoons of jam. I did not feel woozy, but had been drinking Gin and Tonics

Should I be very concerned aboutt hypo episodes?
What should I look out for?
Are hype episodes when asleep very serious?

ps. I would discuss with my GP. I used to have a dedicated GP in the practice, but no longer. Also it is well nigh impossible to get a face to face GP appointment.

What medication, if any, are your taking for the Type 2 diabetes?

 

[EllieM]

On scanning the Freestyle there were two short spikes into the 3.5 level.

Cgms can sometimes under read if you are lying on them - so called compression lows.

Did you check the readings against a glucometer?

Likewise did you check the 10pm one? While cgms are marvellous devices, they aren't always as accurate as a glucometer...

 

[KennyA]

I have been a Type 2 for over 10 years. Recently I have sorted out my diet and have a personal trainer.
I find the Freestyle Libre 2 invaluable. Last night around 10pm the device registered a hypo alarm. I have set the level to 3.5
Durring the night the phone said it lost connection - which is a concern as it was right beside me.
On scanning the Freestyle there were two short spikes into the 3.5 level.
sorted the hypo at 10om with a couple of spoons of jam. I did not feel woozy, but had been drinking Gin and Tonics

Should I be very concerned aboutt hypo episodes?
What should I look out for?
Are hype episodes when asleep very serious?

ps. I would discuss with my GP. I used to have a dedicated GP in the practice, but no longer. Also it is well nigh impossible to get a face to face GP appointment.

It's unusual for T2s not on glucose lowering meds to get hypos. You don't say if you're on any medication.

I've had one hypo, due largely to alcohol (which will turn off the ability of your liver to regulate blood glucose) and not eating. The physical effects were unmistakeable, and I was incapable of doing a blood test or anything sensible.

CGMs sometimes read low, and some of us (including me) get temporary lows during the night, or more correctly very early morning - mine are marked by sweating, nightmares etc. I don't think of these as hypos because my liver always naturally corrects it within minutes. The main problem is waking up soaked in sweat at 4.30.

 

[SOTR]

Thankyou. Medications: Gliclazide and Sitagliptin
I do not use a finger prick glucometer - I have never been organised enough to use one effectively
Also my GP only prescribed a set of lancets over 10 years ago.

I do wake up in the small hours with anxiety and sometimes sweating... hmmm
Also the hypo events I saw last night were indeed quick dips to 3.5 and a swift climb

 

[Chris24Main]

As long as you are not on any medication that will lower blood glucose (or have a history of hypos), you are in no more risk of low blood glucose events than the general public - the risk involving sleep interruption is significantly more than the risk of the low level alarm telling you anything that you actually need to do anything about.

Primarily, the low level alarm is for type 1 diabetics who are at that level - and heading down fast (it's the direction of the arrow as much as the number, at least it was for me when I was managing type 1) - in other words, for anyone with a functioning pancreas and not on anything designed to lower blood glucose, your CGM is for information only. Being around 3.5 is not anything to worry about, certainly not anything you should wake yourself up about. Similarly - a Type 1 critically needs to know that the CGM is in range all the time. As a type 2 it's a convenience - so you can safely turn off those alarms.

 

[Chris24Main]

Also the hypo events I saw last night were indeed quick dips to 3.5 and a swift climb

Right - so the situation you learn to fear as a type 1 is when you are at that level and falling fast... the alarm is there to give you a chance to act while you still can. It really does not apply to us Type 2s.

Dipping down and back up again is just what your body is doing.. you are better off with as much sleep as you can get

 

[SOTR]

Thankyou all for the helpful replies

 

[lovinglife]

Hi @SOTR

One of your meds is Gliclizide which CAN cause hypos so it’s very possible you were in hypo territory and you were right to treat it, when I was on Gliclizide and had alcohol I used to experience hypos after a couple of drinks without having a small amount of slow acting carbs with it. Usually a bag of salted nuts. I’ve been as low as 2.1 whilst on Gliclizide- horrible feeling and it came on quickly

If you begin to experience hypos regularly on those meds it may be worth speaking to your GP or HCP about reducing your dose, it’s better to not have the hypos than to feed them

When I had hypos I would treat with a couple of glucose tabs and follow up with a 10g carb snack of slow acting carbs, I would test every 15 minutes to make sure it had evened out and if I got a couple of tests above 4.5 then I knew I’d got it sorted

I’ve no experience of a CGM but I’m thinking that you wouldn’t need to test for the rise as your CGM would give you that information, could the swift rise you saw be because you treated the hypo

Edited to add a bit more info

 

[Chris24Main]

@SOTR - just a quick update to back up what @lovinglife says - Gliclazide is definitely one of the meds which CAN generate a hypo situation, so you do need to be careful.

Gliclazide will spur on your pancreas to generate more insulin, so to some extent you do need to think about it in those terms.
When I was being treated as a type 1 - initially - I was put on Gliclazide for a while (thought was that my pancreas may be on it's way out, so whip it while it was capable..) - so I can only say with any confidence that for me, the one "proper" hypo that I experienced using insulin (took the injection, didn't take the food, like an idiot) was on a whole other level than anything while taking Gliclazide, but that was me, and I cannot read across my experiences to anything that would be helpful for you.

Maybe what you could do though, is discuss the pros and cons of using your Libre in this way with your support team, along with the advice above about reducing dosage - it’s better to not have the hypos than to feed them; I totally agree with that...

 

[EllieM]

Thankyou. Medications: Gliclazide and Sitagliptin
I do not use a finger prick glucometer - I have never been organised enough to use one effectively
Also my GP only prescribed a set of lancets over 10 years ago.

I do wake up in the small hours with anxiety and sometimes sweating... hmmm
Also the hypo events I saw last night were indeed quick dips to 3.5 and a swift climb

Is your libre on prescription? If not then glicazide is grounds to ask your GP for a glucometer. Though I am on an insulin pump with a cgm I still need a meter to check my hypos, and for "bad" sensors. . Unfortunately I can't be 100% confident in my cgm when it reads low, so need a back up.

 

[Le Duan]

It's unusual for T2s not on glucose lowering meds to get hypos. You don't say if you're on any medication.

I've had one hypo, due largely to alcohol (which will turn off the ability of your liver to regulate blood glucose) and not eating. The physical effects were unmistakeable, and I was incapable of doing a blood test or anything sensible.

CGMs sometimes read low, and some of us (including me) get temporary lows during the night, or more correctly very early morning - mine are marked by sweating, nightmares etc. I don't think of these as hypos because my liver always naturally corrects it within minutes. The main problem is waking up soaked in sweat at 4.30.

Now that's interesting - the nightmares bit. I'd never considered a possible link between blood glucose levels and dreams/nightmares - or indeed, Nocturnal Panic Attacks. Also - re thresholds - my diabetic nurse tells me that 'Four is the floor' yet the default low setting on Libre 2 is 3.5? Thank you

 

[Le Duan]

Is your libre on prescription? If not then glicazide is grounds to ask your GP for a glucometer. Though I am on an insulin pump with a cgm I still need a meter to check my hypos, and for "bad" sensors. . Unfortunately I can't be 100% confident in my cgm when it reads low, so need a back up.

"...glicazide is grounds to ask your GP for a glucometer..." I am on Gliclazide but my GP said I couldn't have a CGM on prescription, because I was not on insulin. Should I challenge this, and if so - what would be my justification? Thanks in advance.

 

[KennyA]

Now that's interesting - the nightmares bit. I'd never considered a possible link between blood glucose levels and dreams/nightmares - or indeed, Nocturnal Panic Attacks. Also - re thresholds - my diabetic nurse tells me that 'Four is the floor' yet the default low setting on Libre 2 is 3.5? Thank you

The nightmares are not pleasant. I also didn't associate them and the sweating etc with my BG until I tried a CGM. Up until then, I'd always read 9and believed) that T2s did not get significantly low blood sugar. It seems however that a number of people (some of whom aren't diabetic) report just this - a sudden drop in BG levels in the early morning followed by a quick rise which will continue for ome time. I have no idea what causes it - others have suggested short-term insulin over-supply, which might have that sort of impact, but I really don't know.

I can be fairly sure it's not caused by current high blood glucose. It started in about 2014 when my A1c was probably around 43/44, and has continued while my BG was higher and for the last four or five years while I've been at normal BG levels. It's possible of course that it was caused by high BGs, and it's now permanent damage. I've tried a lot of things in the hope of finding something that either triggers or suppresses it, but it seems to come and go of its own accord. There doesn't appear to be any relevant research either, which is probably not that surprising.

 

[SOTR]

Now that's interesting - the nightmares bit. I'd never considered a possible link between blood glucose levels and dreams/nightmares - or indeed, Nocturnal Panic Attacks. Also - re thresholds - my diabetic nurse tells me that 'Four is the floor' yet the default low setting on Libre 2 is 3.5? Thank you

default alarm setting is 3.9 I decided to set it slightly lower

 

[Lamont D]

If we still had the blogs forum (mods, admin?????) I used to blog my dreams, that were not nightmares but they would be in Technicolor, vivid, and be similar to a story.
And through the many (lots) of similar repetitive dreams, even serialised. But the rd during ones were very disturbing.
After consideration and noticing that I would have these dreams, occurences, was when my BG levels were higher or lower than normal levels.
I do think in most cases it is food related as well.
I also believe that, once your BG levels are imbalanced by your individual metabolic issues, the dreams can become more memorable.
Before my diagnosis. My BG levels were rollercoastering for most of the time, high then low, high again, then low. This was one of the most specific periods of these types of dreams.
Others have been when ill or in extreme anxiety of stress periods.
Of course, there could be hormonal effects as well.

 

[Jaylee]

Hi @SOTR

One of your meds is Gliclizide which CAN cause hypos so it’s very possible you were in hypo territory and you were right to treat it, when I was on Gliclizide and had alcohol I used to experience hypos after a couple of drinks without having a small amount of slow acting carbs with it.

Yep, even on insulin.
With alcohol in the mix it keeps the liver busy from dumping glycogen, which can bring a low on quicker.
Providing the Libre was correct?

 

[EllieM]

"...glicazide is grounds to ask your GP for a glucometer..." I am on Gliclazide but my GP said I couldn't have a CGM on prescription, because I was not on insulin. Should I challenge this, and if so - what would be my justification? Thanks in advance.

I don't think you'll get a cgm, but you should be entitled to the glucometer. If you keep it by the bed you could double check those suspected night time lows. Compression lows often feature brief sharp dips, so it's worth checking. Also, I personally find that cgms lag a bit on reporting hypo recovery, so I do use my glucometer then.

 

[Jaylee]

I don't think you'll get a cgm, but you should be entitled to the glucometer. If you keep it by the bed you could double check those suspected night time lows. Compression lows often feature brief sharp dips, so it's worth checking. Also, I personally find that cgms lag a bit on reporting hypo recovery, so I do use my glucometer then.

Depending on how low I might have gone.

A good 40 minute delay with a sensor.
So I need my meter even to back up the hypo symptoms no longer felt after 20 minutes of the treatment?