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Type 1 Understanding results and a hypo

C

C96

Member
Messages
15
Type of diabetes
Type 1
Hello folks, hope someone can help here because I'm getting really confused with what's happened last night and hope someone can help so it doesn't happen

My wife is on novorapid and levimir, she takes levimir 9 units at 9pm and 13 units at 9 am

Last night she ate at 7pm her readings at about 9pm where 5.2 she took her levimir and was going to have a snack so she doesn't go low in the night she went downstairs and was downstairs for about 5 minutes doing the vacuming this was very light using a dyson handheld vacuum and just 5 mins she came up and she was 2.8 she had some glucotabs and waited she got it to 5.6 when she was 4+ she had some transformers crisps anyway it was 5.6
At around bedtime 11pm it was 4 she had 3 jaffacakes bringing it to 6 before she slept... at 1am I scanned her and she ended up being 16 she went back to sleep and at 5 am she was 15 she got up and took 6 units of novorapid
She woke up at 7 and it had dropped to lo it wouldn't read I gave her some juice and after she had some glucotabs but she could barely move it's now 7.7 and rising...

I'm a little stuck and confused on the readings I'm thinking the hypos are causing her body to react and produce more sugar that's why it's going high after she's had a low I'm trying to stop her going low but then she ends up high she's pregnant with our first baby and docs have told her to he 5.4 I'm just really confused and don't understand what's happening
 
Hi,

Regarding your wife's pregnancy, I'll tag in @azure @catapillar knows her onions too..
Personally? It looked like your wife went low on the bolus for her evening meal? Then over treated the hypo..
The correction dose at 5am dropped her blood by 7. There does tend to be a peak in the profile after two hours with me on novorapid.
I'm going to stick my neck out and suggest the 6u of novo was a slight over reaction to the 15mmol?
I would have administered 3..
But that's just how I deal with it as a fella...

I hope your wife's OK now..?
 
@C96 What a nasty rollercoaster - I hope your wife is ok now.

Important question: How many weeks pregnant is she?

Pregnancy can cause sudden and fierce hypos. That could have contributed to your wife's problems (depending on what stage of pregnancy she is).

I agree with @Jaylee that the 6 units correction sounds like too much. Correction ratios can change during pregnancy too.

The continuing drop after her evening meal does sound like a bolus issue. Has she checked her ratios now she's pregnant? They can change too.

The trick to pregnancy control is lots of tests and lots of little,adjustments - tiny corrections, if needed, small food top ups if needed.

You mention 5.4 - is that the fasting target your wife was given?

Would you like me to move this to the Pregnancy section for you?
 
Hi @C96 . Hope your wife is feeling better now.
It appears that you found yourselves yo yo ing. You go low and over correct, you go high and over correct, a bit like being on a see saw.
My one concern would be your choice of hypo treatment. Glucotabs 1st . Great, but personally would follow this with something more along the complex carb foods, maybe some cereal, a sandwich but not crisps.
Before bed 3 Jaffa cakes? Probably not the ideal food to go bed on, especially with sugars at 4. Again something a bit more complex carb maybe. 3 digestive biscuits would have been far better.
6 units of novorapid at 5 a.m. Does your wife carb count and have a correction dose ratio? Basically you injected bolus insulin 6 hrs after last consuming food, that's a very risky option.
At 7 a.m. Obviously the 6 novorapid was doing its job. Juice and Glucotabs best thing to do but it needs following up with a good carb breakfast, toast ,cereal etc and . The important thing to remember is the 6 novorapid at 5a.m. This is insulin on board for another 3 hrs possibly taking you up to 10 a.m. Taking this into account maybe half your normal dose of insulin at breakfast would have kept things stable, but regular checking of sugars is essential to keep your wife safe.
Hopefully some of our wonderful T1 mothers will be along soon who may cast more light on what's happened, I'm sure pregnancy can wreak havoc with sugar levels. Not my field of expertise thankfully.
Good luck.
 
You mentioned scanning so I assume she has a libre. If so, there's a book I found quite useful, Sugar Surfing by Dr Stepen Ponder. It's on kindle and paperback. He's an endo who is also T1. Lots of tips on getting the most out of cgm.

Has she done a DAFNE course? Good for fine-tuning even for old hands. There can be a long waiting list, though, depending on area. Mine's was over a year!

As a very general rule 1u lowers by 2 to 3, and 10g raises by 2 to 3.

So, my take on it is that the meal bolus combined with albeit modest exercise (you should be doing the hoovering from now on, dude!) was too high, hence the drop, liver probably started producing glucose in response, and then by 11pm, the meal bolus is practically worn out (novo tends to last 3 to 5 hours) so there'll be very little or no bolus left to deal with the crisps, say 25g, and the jaffas, say, 30g, so there's 55g of unbolused carbs kicking around, sure some of that'll be used to recover from the hypo but, even so, let's say there's 40g in free play, so 4 times 2 to 3 means an easy 8 to 12 rise, giving you the 16.

Likewise, 6u correction might be expected to drop by 6 times 2 to 3, so 12 to 18 drop, so lo result isn't a surprise even though it's accepted that the 2 to 3 generallity often doesn't apply that well at high levels. There's a chance the liver might also have been pulling back some glucose to restock after the earlier hypo. I'd have been more cautious with a 3u correction.

Both DAFNE and the book are pretty good at pointing out how little is needed to correct a hypo. It was a mistake I used to make a lot in my early years - all too easy in the panic of a hypo to overfeed. I'll tend to use no more than 10 to 15g now for common or garden hypos, although will obviously increase that if it's clear that there's a harsh and continuing drop with lots of peak insulin still kicking in.

When I see a slow slide now on libre, it still amazes me what a mere 5g will do to tail it off and nudge up by 1 to 2 whereas before I might have been inclined to hoover down a whole twix and then wonder why I ended up too high - duh!
 
Hello thank you everyone for your replies

She is 12w 5d pregnant, she was told to have levimir 13 units at night and 15 units during the day, at night she was going too low all night and I was having to prick her finger or scan her with freestyle libre during the night every 1 hour I get up to do that I got her the smartwatch set up with xdrip which checks every 10 mins but she can't wear that at night as she finds it too uncomfortable.

She is supposed to take 1 unit of novorapid to every 10g of carbs and 1 unit of novorapid to reduce every 1 unit of her levels so she worked out it was 14 to take 7 units to reduce it down to 7, hours later it was so low the libre wouldn't even take a reading and her finger prick test showed she was 2.0 I think
 
She did the daphne course which showed her go count her carbs and weigh her food and take the correct insulin I already taught her all that before as she was uncontrolled before and was in denial that she even had diabetes every thing seemed ok before and her levels where normal and seemed in control before however since being pregnant it does seem to defy logic and just be all over the place... she never had hypos before she was always high all the time she loves her carbs now she is going high and low I don't understand why she went to 16 at 1am docs told her to treat hypos under 4 by the glucotabs and above 4 to have a snack hence the jafacakes lol

Other things don't make sense like she is having her levels shoot up even after she has taken enough insulin the correct balanced amount and her levels seem to just shoot up for some reason ie a couple of days ago she was 6.7 she had 30g of carbs she took 2 units so she is a bit high before bed her levels just kept going up after that 3 hours later she ended up being 18 :(
 
The crisps she had are 11.3g the so I assumed it would have made her 4 into 5.1 she ended up being 5.6 then she dropped again to 4 by 11pm so she had 3 jaffa cakes 8.7g each so I assumed she would have gone to 6.1 :(
 
C96 said:
and 1 unit of novorapid to reduce every 1 unit of her levels
Click to expand...

Yes, these things are always messy! We're supposed to get a nice tight balance all the time, but they don't tell you the scales are set up on a shoogly trolley cartwheeling down a rusty track!

We can't advise on dosing but 1u will generally drop a lot more than 1 on the meter, normally it'll take it down by 2 to 3. But there might be some stuff going on which makes 1 to 1 true for her, I simply don't know. The fact that 1 to 1 led to an unreadable lo suggests the advice you've been given is wrong.

One thing which is quite useful to do if on libre is to wait until relatively stable kicking around the 6 to 8 area when there's no active insulin or food on board, then take 1u then just sit back and watch what happens over the next few hours.It should dip down and then level out again and you should be able to see that on the graph. It'll give you a clearer real world idea about what 1u does in practice than any advice you'll ever get from a dsn.

Personally, that sort of test doesn't work that well for me with 1u, I'll normally run it on 2 and then do the arithmetic after that.

Likewise for raising. Wait till stable, try 10g unbolused, wait for an hour or two, see how much it raises by.
 
That sounds like a good idea she's never been told to do that or try that she was just told to wake up and keep 3 days of 3am readings and then tell them those readings they didn't really make any changes after that. It was supposed to be 15 levemir in the morning and 15 before bed but we learnt that 15 at night was too high and she was having hypos so slowly reduced it to 9 the day before she was 6.7 at night and 5.4 in the morning which I think was perfect

Also we found that after the 10 hours or so of her taking the levemir levels seem to rocket out of the blue for no reason so she takes it 12 hour exactly apart every day so 9am 15 and 9pm 9 units and that seems to give the best results
 
Actually to be honest I've been keeping a spreadsheet on her lol and when I've looked at it when everything is normal it does seem to all tie up if she's 9, 2 units will take her to 7 about 10 to 12g of carbs take her up one unit biggest obstacle is she's a carbaholic and then these weird things happen that end up not making sense or dont seem measurable
 
With the libre do you use the smart watch with librealarm and xdrip??? How do u find that I found it was quite useful to me her having that on

Its mainly at night things mess up during the day breakfast and lunch she has perfect results and mid afternoon I've got her to eat every 4 hours during the day so she doesn't go low and all day it's 5 to 7 it's the evening meals when she is at home that seem to cause the most problems
 
Hi @C96

I hope you are both okay now.

I'm no expert and not pregnant but just a thought on food type when treating hypos. I tend to have 100ml juice (works quicker than tabs for me) and something to maintain levels like half an Alpen light bar or some kind of cereal bar - just be careful as the carbs vary drastically!

Something similar happened to me which I couldn't explain at the time. It was also highly embarrassing as it was my hen do, right in the middle of a meal!

Pre-meal my BS was normal and I did an estimated carb count and pretty much soon after my meal I was dropping uncontrollably to the point of almost fitting. When I fed this back to my DSN she explained my insulin had hit my system way before the food (it was some kind of pasta dish). Pregnancy will complicate readings as mentioned in this thread but just a bit of advice re: food type - be careful with pasta.

I also try to avoid crisps and chocolate at night because it seems to have a strange effect on my BS. I tend to go for a cereal bar, nuts or Greek yoghurt. Maybe try cereal or toast too?

Hope this helps a little :)
 
Thank you tiredoftrying 2017

Agree with you on the chocolates and things before bed problem is wife went to daphne they said weigh ur food eat health eat mixed healthy meals, work out the carbs and u can eat what u like lol my wife got from all of that u can eat what u like and guess the carbs lol I have to text her all day every meal everything she eats how much to take and how many carbs I'm now making a giant list of foods she has eaten how much she took and how much it actually affected her lol

Now the nurse has said to her if ur below 4 treat with glucojuice and gluco tablets if 4 or above have a snack lol my wife has got from that don't have the measured and weighed alpen bars in bags I have placed by the bed for u dont have the dextrose measured juice i made for you myself instead have a packet of crisps and a handful of jafa cakes lol
 
Ahh I see! I'm not familiar with the Daphne course to be honest, just experience.

It will depend what phone you have but have you thought about downloading any of the diabetic apps? I download one yesterday for free called One Drop. You input your BS levels, exercise, insulin and food and it shows the tends. I like you can search from the food library too and it shows you the carbs.
 
We have tried most of the apps daphne I think has their own app which is quite good and it shows the carbs and amount of insulin you have to take for loads of different foods however she doesn't use them after a day she stops inputting anything, she has xdrip which checks her levels every 10 minutes and then let's you enter the carbs and insulin you take its a great app and it's helpful to me but it's incomplete because she doesn't input the carbs or insulin

She found them too complicated I even made her an app that simply asks her to enter what she's doing so it asks her are u eating, are u taking insulin, are u checking ur levels? It then stores that in a db and I can plot how some foods have affected her with enough data it would be quite useful to me because we would know exactly how much each thing affects her but I only have about half a days worth of input from her lol that's why I'm now just keeping a simple long list of everything she eats and how it impacts on her levels
 
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