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Strange Hypo - Advice/thoughts really appreciated

Paulaah

Paulaah

Well-Known Member
Messages
92
Hi All,

Here I am again, still struggling...... Wonder if anyone could give me some thoughts...

Bedtime reading 10.1
2 a.m. reading 9.4
7.30 am reading 10.2

Took 9 units of Lantus (Full dose - take it in morning)

At this point was contemplating a correction with breakfast which I was having a bit later...

8.30a.m. just before breakfast - 3.6!!! Then shakes started.

After recovering with jelly babies etc, phoned DSN who thought it might be a one off pancreas spurt as only diagnosed in February. I was a bit distraught because I was thinking "what if I'd been driving". It came right out of the blue and my morning routine is the same every day - I get up, have a coffee and come round a bit before I can face food - so nothing out of the ordinary and then .... wham!!

The only other thing I can think of is I've just had a throat and sinus infection and been taking anti-biotics which finished last week, and since the infection has cleared up, my readings and quick acting ratios have been all over the place. I've read on here that your first infection after diagnosis can bring the honeymoon to an end. Is this what happens when the honeymoon is coming to an end??

I can cope with most things to do with this disease - testing, injecting etc,. I'm not a wimp on this front, but this has made me bewildered and really knocks my confidence to just - well - live!!! Daren't get in car now, today, just in case, and scared same thing might happen at any point.

Please help! :?
 
Hi Paulaa

I love your cutting a rug cat :lol: I feel like that on a Hypo rebound :wink:

I think I would be inclined to agree with your DSN in that it could be down to the Honeymoon period ,mine went on for quiet a long time if memory serves me, a good year on and off. Some peole it is longer some people they are plunged straight into it without much of a honeymoon period. In a way it makes it easier when your Pancreas totally kicks it...but insulin needs will increase then ..and BS if you are ever a bit on the naughty side will also shoot up as no background from your Pancreas to take care of spikes.

You also said you had had an infection, this will make BG rise ,so did you have to increase your insulins at all for this? If not, then maybe your pancreas got a little spurt on to take care of it naturally and this was the tail end of it.

If you did have to increase you insulins ,they can have what my DSN called a "stacking up" effect, this happens to me sometimes where I have had to increase my dose at certain times then when my needs have diminished I will get a quick succession of Hypo's.

Hopefully things will settle for you now you are over the infection.

I used to find Lantus could really drop me if I was going through a very insulin sensitive stage , I did find it a strong acting insulin and used to get many more Hypo's on it than I do on Levemir, and sudden ones for no apparent reason. Sometimes it would almost act like a Bolus for me...but never to the degree you have described so I am sure your DSN was right.
 
Hi

My son used to be on Lantus, which he took in the evening. From our experience, Lantus (which isn't supposed to have any obvious peak) causes a dip in blood sugars about 30-60 mins after taking it and again a couple of hours later.

We had all sorts of trouble. We had to avoid him taking Lantus on an empty stomach (before evening meal). We also had to avoid the Lantus and the Novorapid peaking together and we also had issues with hypos just at bedtime, or him waking with a hypo not long after going to sleep. It seemed to us as though a hypo caused by Lantus took longer to treat too (than say, a hypo caused by activity, or too much Novorapid etc,).

In fact, there never really seemed to be a good time of day to take the Lantus without creating hypos, so it was really one of the main reasons we switched to a pump.
 
Sandra R :D
We may have been Typing at the same time. That is interesting to me ,what you say about your son's experience on Lantus. All of it really struck home to me ,as that was my experience also on it...but the bit about the Hypo's on it taking longer to treat..Wow yes!

Since being on the Levemir I have noticed that sometime after exercise and just before a meal if I have tested and my BG has been 3.8 I have been able to now easily make the meal and potter a bit knowing that it will stay around that for quiet some time...infact a good 3/4 of an hour the other day.

Now, on Lantus if I ever dare let my BG go beneath 6 it was a risky thing for me...if I ever tested and it was around 4 mmol it was panic stations . I could be 1.3 in minutes, or sometimes that low it did not even register on the meter,just came up as LOW :shock: Plunging Hypo's, that took as you say a LOT of glucose to treat.

Levemir is like a breath of fresh air for me now after struggling with the Lantus for so long, phew! So glad your son has a pump now and I hope he is a lot more settled with his control.

sorry to hijack the thread Paalau and I'm sure you will be fine on Lantus a lot of people are :D
 
Hi Fallenstar and Sandra R,

Lantus sounds to be a bit of a issue for a lot of people. I have kind of questioned the choice over Levemir with my DSN but she thought it was better because of the one injection. Having said that, if I could get it back under control, I'm happier with 1 injection too!

I had marvellous control before my infection. Latest HBA1c 7.4. (Am aiming for 6.5). But Endo really happy with me. Then - and I know you will know what it's like - something else comes along and rocks the boat.

Fallenstar - My BS increased during the infection so i upped it by one unit, and then when I'd recovered it was hypo city - My weekend was a disaster. Watching "Strictly" and X Factor took about 15 hours because I had to keep pausing to test - LOL !!! (but not funny at the time). I dropped it back to 9 on Saturday and I guess it takes a few days to bed in. So your stacking theory is a possibility.

PS how r u getting on with your Novorapid after moving off Apidra?

Sandra R - Your theory is also possible. It was an hour after taking. Did it in my bum cheek, but I often do. Either there or thigh. I def get a peak with it at 2.30p.m. in afternoon when it's allegedly full strength, but never had morning prob. I suppose I'll have to wait and see what happens in the morning.

In the meantime, I'm going very cautiously in case something else happens.
 
Hey P
Thanks for asking :D Yes the Novo rapid again is much better for me than the Apidra, during my training or races I used to have to start off with my BG either very high and dwindle it down or just continuously chase my blood sugars up with Glucose during my runs because of the Apidra . Even a half dose with the appropriate amount of carbs would just send me low very quickly maybe within 15 minutes of starting my training. And VERY low.
I can do entire training sessions now starting with my BG at 8 mmol on the Levemir, and a 10 mile run will just bring my BG down to about 6 mmol with no need for any Glucose. This is after my breakfast and with the appropriate amount of Novo to carbs, which to be honest is 2 units for me, most days :lol: I have 12 units of Levemir AM and 8 units PM.
The Apidra coupled with the Lantus was where all my problems were regarding difficult to obtain control.
The Novo rapid is more like the Humalog, which I was on before the Apidra, it has a much slower slightly longer action than the Apidra . When I was on the Humalog I was still was on the Lantus so again did not have great control due to the action of the Lantus. I do not think it was the Humalog as I found that a good insulin for my needs.
The Levemir, I'm sure with the Humalog would now be just as good for me but I do like the Novo rapid, it seems to really suit me so I will stick with this.

I find the flexibility of 2 injections works for me because if I am on target at bedtime with my BG and I don't want to eat anything, which a lot of the time I don't as I eat late then I can reduce my second injection of Levemir and I stay steady all night.
I wake up a unit or two off what I went to bed with. My usual waking BG on the Levemir is between 4.9 and 6.3 mmol.
Where as on Lantus ,I had to eat supper as I would go Hypo a lot during the night on it, so I had to get my BG up into the teens to go to bed with and may still hypo at that, it was a nightmare.
So I would go to bed in my teens, drop low, rebound and wake up high, usually around 13/14 mmol a lot of the time higher from a rebound. Also, I had to run them on the high side a lot during the day because of the drops.
On Levemir, I just have a good steady profile all the time and no night time Hypo's and hardly any during the day. In fact one Hypo since starting on it weeks ago which is a miracle for me...So I'm hoping for a much better HbA1c this time as my overall numbers are so much better :D

Glad you are over the infection Paulaa, I'm sure things will settle back down for you if you had good control prior to this.
Take care xx
 
Hi Fallenstar,

Thanks for all that info. It's all good knowledge to have. I think we've spoken before about Apidra and I agree with you, a bit too pokey for me!! It's brilliant to hear you are so stable and particularly with your training. I even have trouble going for a walk at the moment!!!! :roll:

It was absolutely plain sailing for me before the infection, and that makes it much easier - when it's more predictable. But this last week has been an absolute nightmare. For the last two afternoons my insulin to carb ratio has been 1 to 28g carb, whereas before, it was 1 to 15g carbs. So, today I've applied 1 to 28g (scared of another hypo so being cautious) and before my dinner tonight I've ended up on 11.9 - you guessed it - 1 to 15g carb ratio! :x So, here's the thing - what do I do tomorrow afternoon? It's a total lottery!!! and for me, trying to eat 28g carb every day with lunch is a nightmare, as I'm happier with 3 crispbreads and a salad as I'm finding that low carbing helps. (apart from the odd treat!!!)

Looking on the positive side, I'm hoping my pancreas had a final spurt of activity this morning, gone back to sleep or packed in for good, so I can get back to my normal stability. As todays ratio might suggest. Fingers crossed :lol:

Anyway, wish me luck. I hope I don't have a repeat of this morning tomorrow. It's doing my biscuit (low carb :lol: ) in!!!!
 
Hiya all!

Paulaa - I had a really weird hypo on Saturday evening too! Missed most of the X-Factor running around testing, eating chocolate, drinking orange juice etc etc. Ate a meal I've had many times before and took same Apidra dose I've used many times before to cover it. Dropped down to 3.8 after 1 hour, so had some chocolate (like Fallenstar, I don't worry about going a bit low because it usually stays put there and comes back up very quickly with half a kit kat finger - I'm very sensitive to both carb and insulin - anyway, I digress!) Tested 15 minutes later - 2.9 - PANIC!!! Drank about 100ml orange juice - tested 15 minutes later - 4.1. Tested again 15 minutes later - 3.8! Drank the other 100ml orange juice, waited, tested - 4.7. Ate a slice of bread - 11.2!!! Gave up :roll: Next morning - 4.1 (I never have fasting levels that low!) I just don't know what was happening! Trouble is my pancreas is still producing insulin, so it is very unpredictable - I've just learnt to live with each day being a surprise :roll:

Fallenstar - glad the NovoRapid is suiting you. I'm still clinging to the Apidra :lol:

Smidge
 
Hi Smidge,

That must have been really awful for you, and you don't seem to have had a liver dump to help recover you from the hypo and indeed increase your bg into double figures which is usual what happens after a hypo. Must have been very frightening and frustrating. Another chap called Tom was saying exactly the same thing the other week on this forum. He was on mixed and couldn't get the carbs in quick enough to help him recover. He was newly diagnosed like me.

When were you diagnosed if you don't mind me asking, and what basal are you on?

Now that you've said it - digressing or not :lol: I am also very sensitive to both carbs and insulin. So in other words, practically sniffing a bowl of pasta can send me high, and one click too many (or even just rounding up!!!) can have me hypoing.

Why they call it a honeymoon I will never know. It makes me question whether it's me, but I keep having to remind myself that I've had periods of smooth running since diagnosis and that must prove I can do it if it's a level playing field!!
 
Speaking as a DAFNE graduate, I would say that you should not adjust anything yet simply because you're possibly still recovering from your illness. I am understanding you correctly that the only insulin working at the time of the hypo was your background of Lantus? No fast acting at all?

The fact you're still honeymooning is also another complication that does not help keep a clear picture generally. If your honeymooning period has now finished, this may be a good thing because you'll have a less unpredictable picture to work with. I was diagnosed when I was 5 years old so I cannot remember my honeymooning period at all.

Try not to let it knock your confidence, just remember that you need to be a bit more accommodating at this time. Make sure you check yourself before you do anything like driving (which I'm sure you do anyway!) and if you don't feel right, just stop and do what you need to do - take control of the situation as soon as you're aware of it! You can still control the situation after all so don't lose confidence over it, okay? You're doing a great job from the sounds of things - don't be too hard on yourself!

Best wishes and get well soon!
 
Good morning Otenba,

Thanks very much for your reply. I'm on the waiting list for a place on DAFNE and I thinks this will be really beneficial.

You are quite right - I only had Lantus in me when it happened and by my reckoning that would have dwindled down in the lead up to my injection time at 7.30a.m. (I find it runs out in the last hour for me.) The hypo occurred 1 hour after my Lantus injection for the day at about 8.30a.m.

So far this morning everything looks normal, so I'm hoping it was a one off wonder!!

Otenba said:
Try not to let it knock your confidence, just remember that you need to be a bit more accommodating at this time. Make sure you check yourself before you do anything like driving (which I'm sure you do anyway!) and if you don't feel right, just stop and do what you need to do - take control of the situation as soon as you're aware of it! You can still control the situation after all so don't lose confidence over it, okay? You're doing a great job from the sounds of things - don't be too hard on yourself!
Click to expand...

Thanks for this advice. It's made me feel a lot better. :)
 
Hi Paulaah!

Paulaah said:
When were you diagnosed if you don't mind me asking, and what basal are you on?
Click to expand...

I was diagnosed two years ago, but they misdiagnosed me as Type 2 originally and then rediagnosed me as Type 1 (LADA) just over a year ago. Well, to be honest, they put me on insulin just over a year ago as they suspected I was Type 1, but we didn't confirm it until a few months ago.

I'm on Insuman Basal - it's an intermediate acting basal that has a peak about 4 to 6 hours after injected - this usually works really well for me as it means I can avoid lunchtime injections by having e.g. chicken salad and a few strawberries - the Insuman I inject (4 units) in the morning is at its peak at lunchtime and supplements the basal I still produce. I have recently (about 6 weeks ago) started injecting a single unit before bed to help control the fasting levels as they were starting to rise a bit overnight. The consultant believes I'm producing quite a bit of basal still, but he doesn't know how long that will last. I've gone from 3 units at bedtime a year ago to 4 in the morning and 1 at night now. I guess I'll just increase it as required and see how I go. It all seems pretty hit and miss, but I guess it's bound to be a bit unpredictable when your pancreas has good days and bad days :roll:

I've done really well controlling my BG without many hypos, but last Saturday was a bit scary. I'm wondering if having a Saturday morning lie-in might have contributed to the problem as it meant I took my Insuman a few hours later than usual, so maybe it was still a bit strong during the evening and then I took Apidra to cover the meal. It's the only thing I can think of - or my pancreas just had a really good day and didn't need the help :lol:

Smidge
 
Hey Smidge
What dose per carb ratio of Apidra are you on?

Paula, What basal are you on and which bolus? what is your unit to carb ratio?

It is not easy when your pancreas is still kicking out, I mean how do you ever start to gauge it, I will say though, that I did used to have very good HbA1C's during the honeymoon period , so I think that the pancreas turning out a bit of insulin ,though sporadic, did make up for any little mistakes that were made....which could be as sad as a small blob of brown sauce with my bacon, now :roll: :lol: So make hey while the sun shines peeps :wink:
 
Morning Fallenstar and Smidge,

I'm on 9 units of Lantus and I take it at 7.30a.m. I started on basal/ bolus in April and was on 6 units Lantus and getting good control. I've steadily upped it as my needs have increased gradually.

I'm on Humalog now and prefer it to Apidra which I was on before the production thing. My ratios are:

AM / Breakfast - 1 unit to 18g carb
PM / lunch - 1 unit to 25g carb
Eve/ dinner - 1 unit to 10g carb

But it is a moving goalpost. A couple of weeks ago before the infection I was 1 unit to 15 g carb in the morning and afternoon and 1 to 10g in the evening. But suddenly I've gone quite sensitive during the day and I'm still not fully up to speed with it because it can change daily.

I've just had a bit of an issue this morning.

Woke up on 10.7. Had 18g carb and 2 clicks (1 click to cover carbs and 1 correction) which I thought would take me to about 6.7 before lunch. 2 hrs in and major hypo!!! But other days this formula can work.

Just been brainstorming (as you do!!! :lol: ) with my husband, and we are wondering whether I should be a bit more cautious in the morning. Do you find if you have a dawn rise, that its taken care of with the background, so the bolus is not needed? Looking back on my log books I've had a few similar issues when I've gone all out and corrected in the morning.......anyway, here I am hypoing at the weekend again!!! It will have a knock on effect because I'm now 11.9 and rising thanks to 3 jelly babies and a glass of juice, as well as a liver dump!! Hey ho! :?

Smidge - I'm really impressed that your consultant can tell you kind of how much insulin you pancreas is producing, because mines not sure. In fact, mines not certain I'm still honeymooning at all, so I'm in the dark.

Paula
 
Hi paulaaah,
Noticed your point with fear of going out in the car , I used to think like this too.
Here is a tip that I use to keep myself safer during the day to drive.
Am on split dosed levemir I use a weaker shot of it during the daytime then a bigger dose of it just after my tea.
This way as am indoors for the evenings, the bigger dose cant kick in whilst I AM DRIVING. Remaining at home am playing safe!
For example I would do 30 units levemir in the day, always test before drive anywhere.
Then do 50 units levemir plus victoza straight after my tea. The larger meal time for me too!
Also remaining indoors in the evenings having done all I need to during the day on a weaker dose of insulin.
I was diagnosed 30th dec 2009 at 6.45pm !! Remember it like it was yesterday.
Was gobsmacked too! Took me 6months to get my head round it and accept it too.
Hope this helps?
Anna.x :D
 
Hiya!

Fallenstar - my ratio is a bit variable. If I have any carb for breakfast it hits me really hard so I try to avoid it, but it is about 1:7 first thing in the morning to avoid highs, but then it crashes mid morning aand I end up a bit low. As I say, I try to avoid carb for breakfast. By lunchtime it's around 1:10, but my insuman is at its peak then, so I would normally reduce the Apidra to about 1:12. By evening, it's around 1:12 and the insuman is out of my system mainly. However, all of this changes with my time of month. It also seems to change somewhat randomly at times. Like tonight, same meal as last night, same units Apidra (2.5) and almost the same starting point (5.2 last night, 5.4 tonight) - last night two hours was 4.1, tonight it's 6.6. Who knows?

Paulaah - don't be too impressed with my consultant, there was nothing very scientific in how he decided I'm still producing quite a lot of insulin - he got me to stop the basal for a few days and keep a note of what happened. Basically, my BG stayed pretty constant the first night, rose slightly the second night and rose slightly the third night. The biggest effect was after breakfast and lunch where I ate very few carbs (less than 10g) and took no insulin (the same as usual for those meals), but my BG rose significantly and was slower than usual to come back down - but it did come back down after about 4 or 5 hours without any insulin. The conclusion was that i am producing enough basal to hold my BG pretty steady for a while, but cannot cope at all with food. So I went back to taking very small doses of basal to supplement my own and allow my body to cope with any low carb meals I have during the day (obviously, higher carb meals would have to be covered with Apidra).

Even though it's unpredictable, I still think I'm lucky to b producing some of my own insulin. As Fallenstar says, it makes general control a lot easier even though it makes for some very odd results at times!

Hope you've recovered from your weekend hypo?

Smidge
 
Hey Smidge :D
My ratios are different at different times of the day, like you I need more insulin on a morning, I do sometimes feel it stacks up a bit,that is one of the reasons like you I like to keep carbs to a minimum as it keeps the insulin levels down so less chances of stacking and hypos.

I'm like you two, sensitive to insulin...but also VERY sensitive to carbs too :roll: Well 6.6 two hours after your main meal looks perfect to me...I WISH :lol: You sound like you are both doing great, don't be too hard on your selves chasing perfect readings every time. You will always be running along with a hypo close on your tail and that is a terrible place to be.

Keep on keeping on Peeps xxx
 
Hiya all,

Well, it's been a week since my strange and out of the blue hypo, and I just wanted to thank you all for your kind words of advice and encouragement in that time. This forum is a lifeline at times like this. :D

So I feel like Baldrich in Black Adder :lol: :lol: :lol: as I have a cunning plan this week. It's worked since I put it into action on Sunday morning..... I've taken a step back and a deep breath and this week my goals are :

1) Avoid hypos at all costs
2) Don't chase the perfect reading. (Fallenstar - words of wisdom from you, thanks :wink: )

I have a habit of going for the perfect reading and taking that extra click, and it gets me into trouble. It's also a waste of time, because you end up swinging about from high to low etc.

When I've achieved the above, I'm going to move on to phase 2 of my plan which is to fine tune it.

My average reading over the last couple of days has been 8.2 - not perfect, but not far off where I want to be. So, I'm going to carry on but with caution, stay positive and have a bit of patience with myself.....

Thanks again and look forward to hearing from you soon.

Paula
 
Hi P

I LOVE a cunning plan, I have them all the time, not many come to fruition, but it keeps me young :wink: :lol:

I really understand your extra click ethos, I have been there at times and you are so right in the pendulum effect it then has on your control :roll: I think it sounds like you are on the right track. Let us know how you go on with taking a little step back ,and if it works for you.

Good Luck , and here's to not not living in" Hypo city "this weekend for you,hopefully :D
 
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