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Seeing red - sugar levels 32 -hypo

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Karenhopes4

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hi, I am writing as a seriously concerned daughter. My Dad is 70 and genuinely a well, healthy able man however he is type 1 diabetic and has in the last 6 months put on an even stricter diet. He isn't allowed to eat very many carbs and has become very sensitive to small changes in his diet. He keeps having small hypo in the night, yet has eaten what he is told during the day and checks his levels before bed. He lives in Spain so things might be different there but he is told to try and get his sugar levels at 100. He can go to bed with it near that and wake up (he may have had a hypo in the night) but they will be down at 75, if not lower. He then had breakfast. Anyway that a bit of background!! Last Thursday he was in his office and said he felt a little odd & knew he needed to eat something but just wanted to finish something off. He then went to kitchen to make some lunch but from making his lunch to walking up the 3 stair to the lounge he was swaying. My mum then got him to sit down and with minutes he turned in what can only be described a lunatic. He threw his lunch at her, she was trying to get him to eat some chocolate - wouldn't tak it. He was punching out, eyes like a mad man, swearing and wouldn't do anything she asked. They live quite remotely but have a neighbor who used to a nurse, she came over and then they called an ambulance. His sugar levels we to 32. He wouldn't let anyone near him, he was making no sense.They tried to give him a sugar syringe, he spat it out. In the end they injected him and he started to calm down. The whole thing was like nothing my mum had seen or experienced before and it scares her to imagine if she wasn't there he'd be dead because he wasn't at all aware of what he needed to do - completely confused. She also couldn't get near him to give him what he needed. Is there anything out there, like epi-pen for people with nut allergies, that she could 'stab' him with to get the sugar into him if he ever gets into this state again. He can't remember anything about it and knows he can no longer leave it if he's feeling odd and that he need to carry glucose tablets with him at all time. But we are wondering what options you have as a carer in that situation, assuming you don't have a nurse available or a ambulance. Is there anything my Dad can do to prevent this as we are now scared to leave him on his own, yet he is a very able person outside of this - sorry for the long message!! He does she a diabetic nurse on a regular basis but has to speak through translator.
 
There is something called a glucagon pen for treating hypos. It is prescription only.

As a T2 I won't offer any advice, but it sounds that the insulin doses are not matching his carbs. Wait for other T1s to ask you the right questions.
 

Hi @Karenhopes4 ,

Welcome to the forum,

Your father (from what your telling us.) seemed to delay the treatment of quite a low episode. Firstly delaying taking fast acting carbs to treat it by finishing something off. Then the making of lunch. He'd probably dropped lower by the time lunch was prepared & the carbs in the lunch may not have been fast acting enough to immediately treat the hypo.

Low blood sugar levels can make us T1s act out of charactor. From my own experince it almost feels like a form of dementia?

If your father has been instructed to change his diet? There does need to be a review of his insulin dosage.

It would be helpful if you let us know what insulin/s your father is prescribed.?
 
Going below 40 is an unpleasant experience. I've done it a few times and the rage you describe is typical. So is the feeling that people are trying to hurt you when they're trying to help. It's a good idea to agree with your partner that if they ask you to test your blood sugar, you do it regardless of whether you think it's fine or not. It could help your mum feel more comfortable.

How's your dad monitoring his blood sugar? If he can get the Freestyle Libre it's great for catching mild hypos before you go too low. It also lets other people scan you while you're asleep or if you go low and refuse to test the blood. Again I'm thinking it might help your mum, my boyfriend loves the "scannable girlfriend feature" as he calls it.

I bring my meter and hypo treatment with me around the house if I'm sitting down at my desk, reading a book or watching a movie. It's so easy to get caught up in what you're doing and the interruption of finding your diabetes kit is annoying. If it's right there I'll test, whereas if it's in the other room I think I'll get it in a minute...before you know it an hour has passed.

How many carbs is your dad eating? If he's low carbing with bolus insulin it might be an idea to split the dose to avoid hypos. It's something he'd have to discuss with a medical professional, but it's worth keeping in mind.

You should keep a glucagon kit if you take insulin, in case you go unconscious or can't hold down food. However I'm not sure it's the best idea to jab a paranoid diabetic who's mid-hypo refusing sugar tablets with a syringe. It could backfire.
 
Speaking as someone who has been jabbed with a glucagon pen, it is a very large, sharp and long needle. If I'd have seen it coming, in that mood I'd have kicked my husband's teeth out. Certainly a first option for an unconscious diabetic though.

As a carer, what does my husband do? Mostly he stays calm, which stops me from escalating. He phones the ambulance and pre-warns them they have an aggressive hypo-ing patient, so they come in knowing glucagon is probably needed, and he distracts me from seeing the needle. Don't keep pushing the same sugar option (this may just be me, but that drives me crazy. Crazier?).

Prevention really is the way to go, and, alas, that means lots of testing, and recording the results, and working to figure out why the bg is doing what it's doing.
 
Speaking from experience as a T1 diabetic, I lose hypo awareness if I keep my blood sugars too low. I am puzzled as to why his team is encouraging a level of 100 (that's 5.5 in UK units) if he is losing hypo awareness on it, unless he has issues with kidneys?
I would hope that as a T1 he knows how to adjust his insulin doses (clearly down if he is experiencing lots of hypos) rather than just depending on clinic advice?

I second the recommendation of a continuous glucose monitor (libre or Dexcom). The Dexcom can send alarms to a smart phone if he goes too low (eg below 80) so that he can act before he goes hypo, and there are add ons for the libre to make it do the same thing. Severe hypos are to be avoided at all costs, and spending the night "Low" is only going to decrease his hypo awareness.

Good luck. Sounds like he needs an urgent appointment with his team.
 
You could always attempt to offer a hot drink and put sugar in this (put some cooler water in so it can be drunk straight away) if possible? Sort of like “fancy a cuppa?” Then it seems less threatening if he is lashing out he may not see this as an “attack”. I’m the same when I am hypo sometimes, my parents are besides themselves trying anything, they even resort to bribery or making “deals” with me like a small child just to get some sugar in me!
I hope you manage to find something to help!!!
 
A glucagon injection is not practical because it needs to be mixed and then injected. Very difficult to do if the subject is not cooperative. The perfect solution would be the new glucagon nasal spray but at over £100 it is very expensive and may not be available yet in Europe. https://beyondtype1.org/nasal-glucagon-baqsimi-approved-by-the-fda/

I am exactly the same, so people say. I don't know, because with a severe hypo there is never anything to remember.
 
tom58 said:
I am exactly the same, so people say. I don't know, because with a severe hypo there is never anything to remember.
Click to expand...

Indeed, rational thought is just not possible with a severe hypo. I concentrate on minimising the occasions when one occurs (ideally down to zero). If that means I have to run a little bit higher than ideal, so be it.
 
Hi,
Has your father read "Dr Bernstein's Diabetes Solution: A Complete Guide To Achieving Normal Blood Sugars". Dr Bernstein was diagnosed with T1D at age 12 and devised his own low-carb solution. You'll find the book on Amazon.
Hope this helps.
 
Hi, I've been type 1 for 52 years.
There is a new glucagon which is nasal and you only have to sniff it.
It's called Baqsimi, although I'm not sure of its availability as yet. Otherwise it's the syringe glucagon mix.
Janis
 
Firstly, if your father is 70, T1 diabetic and in good health there is a lot to cheer about. Well done!

I think @Karenhopes4 nailed it - the real lesson here is that when you start feeling hypo you cannot delay treating it.

I know that I can also get aggressive when in the hypo “no mans land” - not unconscious, but conscious enough to be a danger to those around. You would need two people to turn me over, pin me down and a 3rd to administer a glucagon injection for everyone to be safe - Not practical in the normal course of events, so focus on early treatment.

if your father’s overall control is good, then focus on faster treatment of hypos. It sounds like he is having some repeat hypos, so he needs to check his insulin levels. CGMs are also a great help if you are having more frequent hypos, especially if your hypo awareness is going.

Has he done a DAFNE or similar course? These help individuals manage their own insulin doses without as much dependency on diabetic nurses. Definitely worth considering if he is struggling to control things properly on his new diet.

hope that gives you some things to consider.
 
I commented on another thread earlier on but the message would apply to him as well as the other person. I've had diabetes for 25 years and eventually went onto insulin but I would have quite a few hypos but haven't had any for a long time because my diabetes nurse said that the "normal" figures they quote are for younger people but when you get older, I'm 74, then I should aim for 8-9 (roughly 140-160) before meals and 10-12 (roughly 175-200) before bed because, as she said, the damage will already have been done to a certain extent so it was better to avoid hypos by running sugar a bit higher. Some people stick rigidly to what they are told to eat and how much to inject but I adjust my insulin, Novorapid and Lantus and I also test a lot and haven't had a hypo for a long time. I have been given lots of conflicting advice over the years that I control my sugar levels as I think rather than what I have been told. I believe the solution is to aim for slightly higher sugar levels and don't stick strictly to the prescribed diet.
 
 
This issue compounded by a manager with lack of understanding and cause of career damage to me - I’ve been trying to get right for years but only after it was too late have I found a solution to the hypo and night time lengthy low blood glucose issues. It is very worrying that the brain loses control, but that normality can be restored quickly if the right carbs are given in an easily absorbable form. Glucagon pen is useful but requires the person giving the jab to mix the solution up by adding a vial of distilled water to a powder vial and then injecting the mix - many worried relatives fail in this activity - it needs to be made simpler.
 
Hi Karen. It sounds to me like his Basal insulin might need to be decreased. They usually suggest to do a basal test during the night where your dad sets an alarm for 3 or 4am and tests his sugars then. If the basal (background insulin) dose is correct, there should not be a dip during the night from what his bedtime blood sugar reading is.
And he should do this over two or three nights then bring the results to his next doctors visit. Obviously a doctor has the final say but if he’s cutting out carbs maybe the background insulin needs to be reduced and then the can take the fast acting insulin with meals. If they’re reducing the carbs in his diet then he might just need less insulin too. Re emergency injections for hypos, I have a Glucagen Hypo Kit (its an injection of glucagon) to be given in emergency and that will bring the sugars back up if they’ve gone to a dangerously low level. Hope this helps
Sue x
 
Hi yes typical symptoms of serious, possibly acute hypoglycemia. This results in acute neurological dysfunction, the patient is aware many functions are failing, the body puts out huge amounts of adrenaline in an attempt to raise blood sugar. They are afraid, trying to protect themselves, aware of multiple sudden deficits. So in this case: glucose or sugar needs to be given quickly, (not too much, say) followed by digestive biscuits, oatcakes, baked beans, egg. Why? Because if a large amount of only glucose is given it can result in the blood sugar going very high only to drop below the original hypo level! This particularly happens when there is a reactive hypoglycemia aspect to diabetes. In the long term try a low carb diet, and if you find you are mildly hypo have an oatcake. However in an acute hypoglycemia give glucose as described, resolved in water has a faster absorption. X
 
Seems like he could do with a system called a Dexcom. If it's not free in his country (I believe it is free in countries like Germany, UK and some others, but possibly not the US), he needs to take his pin-prick readings very very seriously and act immediately when he's going hypo. Not to do so is irresponsible. If he's that casual about hypos, he should obviously not be allowed behind the wheel of a car.

It's worth mentioning that it's very common for Type1 diabetics to become obstinate when they're seriously hypo. Another problem is they're completely oblivious to the trauma inflicted on their family members during a hypo episode. A third problem is hypos do damage brain cells; and thus will seriously compromise cognitive function in the longer term (tell him that!). And a fourth and obvious problem is hypos can be fatal.

There's a variety of common high-sugar liquid remedies for treating hypos rapidly. CocaCola (original) or Fanta (original) both have 10g glucose per 100ml; i.e. 50g per 1/2 litre bottle. If he's working in an office, it suggests that he still has a functioning brain, so you would need to strongly advise him that it's VERY irresponsible and unfair on his family members not to take better care of his hypos. Maybe advise him to have a screw-cap bottle of Fanta on the desk beside him in future and not to postpone hypo treatment.
 
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