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Night time hypo recovery

Discussion in 'Type 1 Diabetes' started by NIck68, Jan 11, 2019.

  1. NIck68

    NIck68 · Newbie

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    Hi,

    New to the forum but 25 years with Type 1.
    Have suffered from night time hypos on and off over the years, after which I always feel terrible - limbs like lead, unable to think clearly or string a cohesive sentence together, headache, total lethargy - the full hypo hangover.
    This used to last for a day, after which I felt fine. As the years have passed however, I'm finding that I am taking longer to fully recover; I am currently still suffering from lethargy and an almost constant, nagging headache - like someone has put a clamp on my forehead - 3 days after the hypo on Monday night/Tuesday morning.

    Is this common and just down to the advancing years?

    Any reassurance welcome!

    Nick
     
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  2. slip

    slip Type 1 · Well-Known Member

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    Hi Nick, Welcome! You've got only a few years on me and we;re similar age, but I've never suffered from hypo hangovers so I can't really comment other than one statement that caught my eye.
    To, and for, me this is a classic symptom of high BG, what are your numbers like after a hypo? Just wondering if you're over treating which I know is really hard not to with a middle of the night kitchen cupboard hypo raid! Just a thought.
     
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  3. Knikki

    Knikki Type 1 · Well-Known Member

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    Hello @NIck68 Hypos effect us all in different ways and night time ones can be a pain which does make me wonder what insulins you are using?

    But I do agree with @slip some of the symptoms you describe do sound like a Hyper almost as if you have over done the carbs to get yourself out of the hypo.

    Don't worry we all so it at sometime or other.
     
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  4. helensaramay

    helensaramay Type 1 · Well-Known Member

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    Hi @NIck68
    Sorry to read about your nasty night time hypos.
    I wonder if the thing to do is to work out why you are having these. For example, is it related to exercise?
    And then, work out if there is anything you can do to avoid them.
    How are you treating and monitoring your diabetes.
    If you are using a pump, you could adjust your basal at night.
    If you are using a CGM (or Libre with a blutooth attachment), you could set it to alert when you go low and wake you to correct and avoid the very lows which cause a problem.
     
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  5. slip

    slip Type 1 · Well-Known Member

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    :hilarious: like avoid the exercise :hilarious: (sorry Helen couldn't help myself)
     
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  6. helensaramay

    helensaramay Type 1 · Well-Known Member

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    That may be your approach:rolleyes:
    But I think I would feel worse without exercise even if I had less hypos.
    I don't think I am addicted to exercise but if I have a day of sitting still, I am grumpy.
    Even when I had surgery and was told to take it easy for a couple of months, I jumped on the comment "but you can do some walking" and was trudging uphill for 5 miles within a fortnight.
     
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  7. Juicyj

    Juicyj Type 1 · Moderator
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    Hi @NIck68 and welcome to the forum :)

    Are you testing when you are feeling like this and if so what are your results like ?
     
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  8. kitedoc

    kitedoc Type 1 · Well-Known Member

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    Hi @NIck68, Welcome. And you have raised a good question. My thoughts as a T1D, not as professional advice or opinion:
    Night time hypos are scary because one is likely to miss the early warning signs due to being asleep or very drowsy.
    Some used to knock me for six, others less so. And I agree with @Knikki, the aftermath can be made worse by the rebound in BSL leaving one with the lingering effects of the hypos whilst feeling under thew weather with the high BSLs later.
    This scenario also can set up a type of see-saw. Hypo leads to hyper, leads to more insulin to bring levels down which increases the risk of another hypo ad infinitum !! Gaining weight was one symptom/sign I latched onto as an indication of this situation.
    If you have a bed partner or a pet astute enough to wake you before the hypo gets too severe , and someone who could give you a shot of Glucagon if you are unable to swallow ,they are your lifeguards. Of course you need to know that if you happen to drink alcohol and then go hypo, glucagon will not work and you need an ambulance asap for some iv glucose.
    As @helensaramay suggests the cause or causes for the hypos needs exploration otherwise you could be trapped in a vicious cycle.
    So an idea of your insulin types, timings and doses, your food intake and timing, and your daily activity such as exercise etc are key data.
    Whether you wish to discuss those here or leave that to the important discussion you need to have with your doctor is up to you. The bottom line is that night hypos are dangerous, and as you describe, debilitating.
    You might be at risk of losing your driver's license as there is no guarantee that they will always occur just at night and driving after a hypo does not sound too safe from what you describe either.
    So in fairness to yourself (from road safety angle, risk of litigation and risk of brain damage from hypos) and to others on the road you need this hypo business sorted NOW. Some problem solving, suggestions and thoughts here if you wish but to your GP as soon as possible. That is a personal duty as well as a civic one.
    In short order if you have tried every way possible to stop/prevent these hypos, including seeing a consultant endocrinologist if need be, then you may be eligible for going on an insulin pump to better control your BSLs and prevent the hypos.
    After 45 years on insulin I was suffering with night hypos despite intensive monitoring and 8 plus injections of insulins per day.
    I was about to lose my driver's license and have my work hours and scope curtailed. I had also suffered one hypo where my wife found me unconscious and about to stop breathing. Her care was all that saved me. So yes, you can die from these low blood sugar thingies !!!!
    Going on an insulin pump saved the day and 7 years on it is still keeping me away from the bogeyman hypos of yore.
    Please try not to be offended by what I have written. I have been where you have in some respects and all the stubbornness I had used over the years to keep my diabetes under control could not surmount this obstacle.
    I had to think not just of myself but others as well.
    Best Wishes for every success and soon. :):):):):)
     
  9. kitedoc

    kitedoc Type 1 · Well-Known Member

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  10. NIck68

    NIck68 · Newbie

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    Many thanks for all your replies.

    In no particular order...

    yes, I do test during and after; BG has been pretty good since.

    I didn't particularly overdo it with the Lucozade this time, but I don't normally get headaches with hyper BG in any case.

    Definitely not exercise related! :p Really should start doing some!

    The cause is almost always a miscalculation, having too much short acting before bed, to make sure I don't have a high BG in the morning.

    Using novorapid and levemir.
     
  11. kitedoc

    kitedoc Type 1 · Well-Known Member

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    hi @NIck68, I used to increase my evening Levemir slightly to deal with worries about high BSL over night or first thing in the morning. Much less risk of hypos. Your doc can advise on whether this might work for you.
    But I still urge you to get things sorted asap, if only for legal reasons (suggested as as TID, not as professional advice or opinion).:):):)
     
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  12. NIck68

    NIck68 · Newbie

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    Thanks @kitedoc. No offence taken! Can't disagree with anything you say. Fortunately, I do get good warning signs that wake me up. The levemir adjustment is definitely worth trying. I'll mention that to the nurse when I see her.
     
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  13. evilclive

    evilclive Type 1 · Well-Known Member

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    I had a problem with night time hypos. Lost my driving licence, though the rules have now changed in the UK so night-time hypos don't count and it's now back. Getting an alarm based on a Miaomiao + libre has been the best thing for me for this.

    Re glucagon + alcohol - a couple of those hypos were after a bit of alcohol (2-3 pints worth is enough for me - I can't do paralytic :) ). The glucagon worked fine. It may be a problem if one is completely off one's face, but at more sensible amounts it seems to work.
     
  14. kitedoc

    kitedoc Type 1 · Well-Known Member

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    Hi @evilclive. Not as a comment directed at you.
    In Oz someone with persisting night time hypos would either not have a license if the hypos were severe enough,
    or they would have a provisional license banning them from driving in the night time, say between 9pm and 9 am.
    Until their physician certified them safe to drive day and night.
    Personally I think the motor authorities over there are bonkers when it comes to road safety in this regard.
    If someone wants to drink alcohol and risk a hypo which may or may not respond to glucagon that is up to them but how much brain damage are they prepared to risk that is the question?? I have seen the results so may be biased by that - but it is not pretty.
     
  15. evilclive

    evilclive Type 1 · Well-Known Member

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    Interesting. For me, the night time hypos weren't a feature of the night, they were a feature of being asleep and being unable to tell when a hypo was coming on. As such, I considered them pretty irrelevant to driving, and was quite annoyed when they became counted a few years ago. That changed back a year ago - hypos now only count if they're "while awake".

    Re drinking alcohol and glucagon - that's got to be a matter of quantity surely? You've seen how much the various posters to this forum drink - surely a moderate amount, such as I have discovered doesn't affect glucagon, will be fine?
     
  16. kitedoc

    kitedoc Type 1 · Well-Known Member

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    Hi @evilclive, There is another thread where a son describes his father rolled the car at night-time because of a hypo.
    Does anyone really think that in a court of law that saying hypos only occur whilst falling asleep in going to get someone off the hook,? What if that person was falling asleep at the wheel, was it a hypo or not?? The car still rolled over. There was ever reason to suspect a hypo was involved. And what will the judge be asking about?
    Whoever advised the DVLA about night-time hypos and whoever in DVLA accepted such advice - they have gotta be dreamin'.
    I state the above because I am concerned that the DVLA's reasoning and ruling and the advice that lead to this is flawed (just my personal opinion) and again, as a personal concern, that a legal case might come along to challenge and overturn it.
     
    #16 kitedoc, Jan 12, 2019 at 6:36 AM
    Last edited: Jan 12, 2019
  17. evilclive

    evilclive Type 1 · Well-Known Member

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    "What if that person was falling asleep at the wheel, was it a hypo or not?"

    It doesn't matter - if a car is crashed through falling asleep or having a hypo, the driver has screwed up badly and shouldn't have been driving at that point. There's no "getting off the hook" to be had. Neither being too tired nor too low in blood sugar are excuses. Gary Hart discovered the former at Selby - a conviction for death by dangerous driving, though he denied being sleepy.

    Maybe it would be better to stop thinking about "night-time hypos" and instead consider the words "hypos while awake" (obviously this has the opposite sense).
    I have problems detecting hypos while I'm asleep. (it's why I like the miaomiao based alarm I now have). But I'm tucked up in a comfy bed at that point. I do not have a problem detecting hypos while awake.
    When I'm driving, I'm awake - as per DVLA rules, if I'm too tired to drive safely, I'll not be driving. That's what the rules say too do, that's what happens.
    That means it should be obvious that a hypo while asleep is not going to affect my driving, and hence the problem I have detecting them should not apply to my driving licence. Fortuanately the DVLA now seem to agree with me.
     
  18. kitedoc

    kitedoc Type 1 · Well-Known Member

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    Hi @evilclive, You make good sense and thank heaven for CGM and alarms. On another thread someone had connected his CGM to the car's speakers so he had a audio output!
    Perhaps there could be a fitting put on the car which measures one's BSL and will only start if the BSL is above x mmol/l.
    Of course there would need to be an override in the system for real emergencies but all this would be logged.
     
  19. Cobia

    Cobia LADA · Well-Known Member

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    Personally I think the driving rules were written in the Jurassic period. :)

    A blood test every 2 hrs one issnt good enough.... it can't prove wether the levels are stable of screaming up or down.... with CGM you have some sort of idea.... which would be better than a car that won't start because the diabetic in it issnt high enough...

    Lot of vechicles here im the only one using insulin...
    Just my thoughts......
     
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  20. Blackers183

    Blackers183 Type 1 · Well-Known Member

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    I notice in the 2019 Standards of Medical Care in Diabetes by the American Diabetes Association that hypo’s in over 65s should be avoided in all patients. S140 notes that ‘severe hypoglycemia has been linked to increased risk of dementia (20).’ This is the first time I have read of this and could find any mention in the UK or Australian Standards. The standards make for an interesting read.
     
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