New dimension to hypos pls help me somebody

Trez said:

Hi every1,
i've been type1 dbtic for 10yrs now. Wen i was 17. Over there yrs i've used porcine,and bovine animal insulin and have changed to humulin 70/30 (isophane zinc insulin). I've had hypo's wt both insulins but i'm worried now that of late my hypo's come without warning. I could be talking to some1 and just sleep off and there i'm gone. It wld take i.v solutions to get me back up. I'm scared of afternoon naps cos most of my hypo comes wen i'm sleeping in d afternoon or night. B4 i used to get signs now NONE. I JUST GO. Don't know wat to do. Any adjustment of my regime wld lead to severe hypers which is also a problem . Where do i go from here.

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Hi,

sorry to hear your having a rough time!

after you've had a hypo do you adjust your insulin doses for your next injection? and maybe for the following day too if there is a pattern to your hypo's?

what are your BG readings like throughout the day? do you usually run at low BG's as this could be a reason for your lack of hypo awareness?!

You need to adjust your insulin if your having frequent hypo's expecially if they are leading to to falling unconcious!

Do you keep a diary of your BG's throughout the day? this could help you spot any patterns in what could be causing this..

Have you spoken to your diabetes specialist about this as this is a problem you really need to address quickly!

Maybe a continuos glucose mete would be a good idea if you hospital lends them out for 24 hours, then you could get a bigger picture of what happens when your sleeping...

Sorry for all the questions, just your post is a bit vague so things in more detail would help suggest ways to give you some helpful advice

Trez

If you are hypoing at similar time of day, look at either you carb content of your previous meal or your previous dose,

Looking at when you are going hypo, afternoon's and you'll of a pre-mixed regieme, then either your lunch carb intake is out or you are missing a snack of carbs in the afteroon..

I am surprised that you are on a pre-mixed regieme, as at 27 years old you can't have or want the regimented lifestyle that this type of regime requires to get it to work effectively... Every day, same meal and snack times, indentical carbs allowence for each meal (i.e breakfast 30g, sanck 20g etc)

I would have a chat with your diabetic team, ask about MDI where you use two seperate insulin, a background and a quick acting insulin, combine this with carb counting, so you can adjust your insulin dose quick to suit your choosen meal or snack with any exercise taken into consideration, once your background insulin is set correctly then you can alter times of meals, and even miss one if you'll feel like.. A much more flexible regime for an active diabetic..

Hi Trez
I'm with Jopar on this, a basal bolus regime would probably suit you better.
Two things surprised me reading your post. Firstly that you'd been on animal insulins when you were only diagnosed ten years ago; and secondly that you are so young and a 30/70 mixture can be quite restricting. I was on a 30/70 regime when first diagnosed 21 yrs ago and what a nightmare it was. I was always going hypo before meals, especially lunch and having to eat at exact times was a pain. A basal /bolus regime aka MDI will give you more flexibility, and on the correct insulin, should also mean less unexpected hypos. When you were on animal insulins were you also on a mixture?
As for hypo-unawareness, it can be associated with synthetic insulins and perhaps a change back to animal insulin on a basal/bolus regime might solve both problems.
best of luck
Jus

Hi again Trez
You say you were on Lente 80 units, were you on any other insulin, a short-acting before meals?
Bovine Lente is a long-acting insulin which lasts up to 30 hours (according to chart) and peaks at 8-12 hours and tailing off after 18-20 hours. Not an insulin to be taking on it's own, as it does not cover you for meals. 80 units sounds like a huge amount aswell.
Jus

Hi Trez, sounds like your doc made a bad decision, are you still with the same doctor??
Lente needs to be taken with a short-acting to cover you for meals, and presumably been on such a large dose of long-acting contributed to your hypos. Similarly being on a 30/70 mix is prob not the best regime for a young active person like yourself.
Most people on animal insulin take Isphane, some split the dose morning and evening, and use Neutral (short acting) to cover meals.
Are you in the UK?
Jus
ps just realised may have got wrong end of stick from your previous post, can you clarify plz

Hi Trez
If your blood sugars are swinging high to low, that can make you feel ill and tired. Does sound like either the insulin or insulin regime is not working for you. As I said previously taking a long acting like Isophane and a soluble insulin such as Porcine Neutral or Humulin R before meals would give you better control than a mixture or a long-acting on it's own. Hope that makes sense. MDI(multiple daily injections)/ Basal-Bolus regimes are standard treatments for type-1s here in the UK. Maybe you could bring it up at your next doctors appointment.
How often are you checking your BG throughout the day, and do you do any carb-counting?
Jus

Hi Trez
Carb (carbohydrate) counting is not about weight loss, I think you're getting confused with calories.

Carbohydrate counting is crucial to diabetes management, as it's the carbohydrate in foods that causes our blood sugar to rise. Sugar is a carbohydrate, high carb foods include rice, potatoes, pasta, bread, etc. We need to know what amount we are eating to adjust our insulin dose accordingly. This link might explain it better http://www.diabetes.org.uk/Guide-to-dia ... -diabetes/ I don't know how this would work with the insulin regime you're on, your doctor should be able to advise, hopefully.

Many people don't count the exact amounts, but learn to roughly calculate what works for them, that's what I do. I hope that helps explain it a bit, I'm no expert, but I've been type-1on insulin for 21 years and had pretty awful control at times too.
Jus

janabelle said:

Hi Trez, sounds like your doc made a bad decision, are you still with the same doctor??
Lente needs to be taken with a short-acting to cover you for meals, and presumably been on such a large dose of long-acting contributed to your hypos.

Hi, I used Lente insulin just once a day back in the mid 1960's. It does not need a fast acting insulin to be taken with food. By using a fast acting insulin, Lente will go into overdrive and cause hypos. It releases its action on bg levels over a time period (usually about 20hrs) and is balanced by eating food at specific times with specific amounts of carb according to what someone's blood sugar level is. In other words, the 'little and often' way of eating is what is needed similar to using the twice daily insulins. Lente can though be injected twice a day if needed.


Similarly being on a 30/70 mix is prob not the best regime for a young active person like yourself.
Most people on animal insulin take Isphane, some split the dose morning and evening, and use Neutral (short acting) to cover meals.

30/70 insulin is fine as long as you are able to balance its effects on your blood glucose levels with sufficient amounts of carbohydrate at set times of the day.

As Jopar has said the reason for your hypos in the afternoon are due to not eating enough carbohydrate at lunchtime (if you are going hypo early afternoon) or not eating sufficient carb snack mid afternoon (if your hypos are very late afternoon).


Are you in the UK?
Jus
ps just realised may have got wrong end of stick from your previous post, can you clarify plz

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It must be baking hot where you live so that might also be a reason for the hypo feeling. Insulin when it is injected in large amounts will form a depot so in hot weather the insulin will be used up more quickly. If you are not already doing it, try doing your morning injection in your backside as that will slow things up a bit better than using your leg.

All the Best