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Type 2 starting on insulin……how long before your first hypo….are hypos inevitable….

Molly56

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Type of diabetes
Don't have diabetes
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I do not have diabetes
This question is aimed at Type 2 starting on insulin…..and the question is ….how long was it after starting on insulin that you had your first hypo?

Are hypos inevitable as you start on insulin therapy as blood sugar levels fall and your body gets used to the new regime..... or are there any tips to avoid this….


My partner is starting on Humulin 1 today ….beginning on 10 units and increasing by 2 units after 4 days if all blood glucose readings are over 8….his current HbA1c is 86 or 10% and average blood glucose readings are currently 11.4 first thing in the morning / when he gets up and 15.5 before evening meal…..clearly there is some way to go to get these readings down to the suggested readings supplied by the diabetic team.

His current medication for his diabetes is Metformin 2000mg per day and Gliclazide 320mg per day ......these are to remain the same with the Humulin 1 as an additional medication...not sure how this works but is what was advised...

He has been advised to take the Humulin once a day at the moment with his morning medication as the nurse judged this as being the best time for him given his 'normal' routine (not conventional, he skips breakfast and gets up about 11am, having lunch about 12.00).....
.....will the timing of taking the insulin determine the timing of any potential hypo....and if so what time of day would he be most at risk of this....

Sorry for all the questions.....any advice on what I need to look out for and hopefully avoiding hypos would be appreciated, thank you
 
Is Humalin the long acting insulin? I've been put on two different ones, rapid and long acting. I managed to escape a.hypo for a week while my levels were coming down, my hba1c was 10.9 so nor too different from your husband's. It's difficult when you're on insulin because so many factors affect your blood sugars so you can't be 100% correct. For example, I had dinner, took my inulin with dinner but the girls decided to take a brisk walk after so I ended up going low. He will get used to it though. My most likely time to have one is the evening as for some reason it all seems to work a little better at that time of the evening! !

I assume your nurse has talked you through how to treat a hypo? xx
 

@Jaxx01 ....according to the book supplied Humulin 1 is an intermediate acting insulin with a peak after 6 hours and then tailing off over remainder of 24 hours..I think this is just the starting point and regime will change over time, probably to similar as you are on...though I know he will not be happy about having to inject more than once a day....is inevitable though I think...

The nurse did talk through how to treat a hypo but he has it in his mind that he will not have a hypo....is worrying as he won't have anything with him to treat.....am going to buy some glucose tablets and Lucozade today to have in the house so that I am at least prepared for when it may happen.....that is assuming I am around when it happens and not out at work etc.....
..he is also reluctant to test so can see that this may also be an issue if he has signs of having a hypo but will have to cross that bridge when he gets there...

Is good to hear your experience and that of others so that I know what may lie ahead xx
 
It is inevitable that he will have a hypo. He MUST carry something with him. It seems he is in for a.huge wake up call. Does he drive? Does he know the rules about testing before driving? If he ignores the advice he could lose his licence ultimately :/

I feel for you as it must be so worrying to watch someone not take diabetes seriously.

Hopefully, once he's had his first hypo he will realise it makes you feel dreadful, and will be better prepared.

Is he in denial? or does he just jot like the pin pricking? x
 
Hi and welcome. A few points. Having a normal BMI i.e. not being overweight will always hlep to minimise hypos as the insulin dose will be lower and hence the sugar swings lower so do ensure your partner is having a low-carb diet. The NHS recommends having a higher HBa1C than is ideal when on insulin to avoid hypos. My DN this week was really worried that my latest HBa1C was only 6.0% yet I have never had a hypo in 2 years since starting insulin but been near one a few times. Note however that I am on the Basal/Bolus regime which has both 24 hour and fast-acting mealtime insulin and I do keep a close eye on what I'm doing. This regime can give the best control but involves more jabs and two insulins. So, there are options and no right answer. If your partner is worried about hypos and also wants a very good HBa1C then do review the medication after a few months with the GP?
 
The NHS way of issuing advice on how to treat hypos is lucozade or glucose tabs but many hypo diabetics wont like the taste of glucose tabs so dont eat them by choice and will sometimes start arguing with the person who orders them to eat something and tries to force glucose tabs on them without sucess and of course the hypo gets worse until collapse. The trick is is to not order but politely say to someone that they are looking pale and offer something sugary like a cup of tea with sugar or coffee or some chocolate. Even though chocolate is not that fast at raising bg, it does do the job and most diabetics feel ok after eating some. A mini Snicker or MarsBar? Even sugar coated fruit pastels work but they can be addictive whereas JellyBabys arent.

I once felt hypo while talking with some doctors and just hoped that my conversation would stop with them so that I could grab my handbag and get some jellybabies out discreetly but I couldnt in the end and just had to say.......Im really sorry but I feel hypo so could we end this talk please and I eat some glucose? They were so nice and didnt mind one bit. In fact, they went and made me a cup of coffee with 2tsp of sugar and brought out 2 HobKnobs to eat. I only had 1 biscuit though and tested bg level just to make sure that I was ok again which I was by then. So you see, theres no big deal involved.
 
@Jaxx01 @Daibell @iHs .....thank you all for your advice...

Have bought Lucozade and glucose tablets just in case needed but note your comments about whether these will be accepted if having a hypo...is best to have them to hand just in case though....it does concern me though that he will not have anything with him when he is out and driving...I did suggest that he kept something in the car but he wasn't keen on that idea....will see if they move from the kitchen table where I have left them ....will also make sure I keep something in my handbag for when we are out together (just in case)....am a bit wary of buying anything that is too tempting such as fruit pastilles as would be too easy to eat the lot regardless of having a hypo or not (may keep some hidden in my bag as a back up plan/ in case of emergencies).....

@Daibell ...regarding weight he is overweight (BMI over 35) so guess this will affect the amount of insulin that he will ultimately require....his weight has been relatively stable and he finds it difficult to lose weight as unable to exercise due to joint pain....or so he says....will try to suggest keeping carbs down and will reduce where possible with our evening meal ....would also like to encourage him to be more active but it is a battle.....if he doesn't want to do it he won't despite my suggestions that it will help...

Will just have to see what the next few days and weeks bring ......and be prepared for any eventualities.....
 
I'm sure you've been told but he has to inform the DVLA of the fact he is using insulin. He should be testing before every journey and if he has an accident and hasn't tested he could be in a lot of trouble!!! He is quite frankly not only putting himself in danger but others too. He has every right to be selfish when it comes to his own care but to put others at risk is a whole new level
 
@Molly56

Unfortunately, no one knows what the hypo feeling is like until they inject insulin, eat no food or not enough food, and then pick up on the weird strange feeling that comes about. It would be sensible to refrain from trying to a drive a car until a person learns to pick up on the hypo signs first and can deal with them by eating something sugary, but this is where bg testing comes to play. No one enjoys testing bg levels esp when it means pricking the finger for a blood droplet, but its a necessary evil that we do to keep ourselves ok everyday. 4 x times per day is the barest minimum but wont necessarily ensure safety when driving or allow diabetics to keep within the NICE bg targets. In the old days many used common sense and kept driving a car until after food had been eaten and not try to drive mid morning or mid afternoon unless a snack had been comsumed. That way, bg levels would be rising and not dropping due to the way insulin affected. Nowadays, most diabetics will have the sense to test and also make sure that they have some sweets or glucose tabs within easy reach of the steering wheel (not in the glove compartment) so that if they do get caught out, they can shove some sweets in their mouth first and then look to pull over safely to the kerb, switch off the engine and eat some food. Non perishable stuff is a must like a few pks of crisps. The lawful way is to get out of the car to treat the hypo and not stay in it, but unless the police get involved, there isnt really any need
 
having just come off all forms of insulin it took me months to have a proper hypo. I'm T2 for about 11 years.

Started on long and short acting insuman in May 2014, then around August came off the short acting, had my first proper hypo in December walking round tesco. Grabbed a box of jelly babies quickly.

finger prick test was 28 when first started on insulin, and Hba1C was 146, I thought it would come down much much faster that it did and that was also low carbing as well and trying to not use to much insulin. at first was on 24 u long acting and averaged about 8-10u a day of short acting. i was on gliclizide as well 80mg twice a day and the usual metformin.

I went hypo in December because i had brekkie at 6am, then nothing till 2pm, was a Saturday so not as regimented with lunchtime as i am during the week at work. Stomach normally tells me it wants some food.

I also found that on a work day if i had lunch at mid day and didnt get home till 5pm ish, i'd start feeling funny whilst cooking tea and realised to test then and it would be around 4.6, luckily i never got to a 3 reading.

My hypo's affected my speech and i got very hot and sweaty. And developed a funny feeling in my stomach.

When readings were so high in the early days, i did feel a bit yuck and had hot sweats quite often but that was the blood sugars coming down, but not official hypo's because the readings were still so high, plus eyesight went very peculiar then sorted itself out.

I took my long acting insulin and Victoza at night time so it had chance to kick in overnight. and the victoza to try and minimise the side effects.
 
@Bev18 ....thanks for the reply....is useful to hear other peoples experiences and what to look out for...

It's early days as yet and still only on 10 units once a day ...though this will increase I know...he should be taking 12 units from tomorrow and then increasing further if bs levels remain over figure given by nurse.......can also see that it will increase to more than one injection a day including short acting at some point but will cross that bridge when he gets there...so far so good though...despite any reservations that I had..

I did also have the thought that he may suffer from hypo like symptoms as his blood sugar levels come down and his body gets used to dealing with lower levels.....he has been running on high for so long that reducing them must have an impact on how he feels...will watch out for this too...

I was a little unsure about the timing that was suggested but think this is because he skips breakfast....taking it at night initially seems to be the norm....but don't suppose this will matter if as he moves on he is told to have more than one injection a day....at this point they can introduce a bedtime one...
 
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