Very rapid BG drop caused by Glargine

[agwagw]

Morning all.

I had a very worrying episode yesterday. Had my 18 units of Glargine (Lantus) at 08:00 as normal. No Novorapid as breakfast later. BG at 5.6mM (pretty good for me).

20 mins later feeling odd, BG now 3mM and dropping. Chewed glucose tablets (18g), usually would feel difference within 10 mins, but nothing. BG now LO, which for my meter means 1.5mM or less, feeling more and more confused. With help of wife (who had been collected by gallant pooch: "I need your Mum's help") ate more glucose (50g in all) plus honey. At this point became pretty non-responsive.

Paramedics summoned and arrived about an hour later when I was beginning to come round. Checked over and OK, BG up to 3.6 and rising. My temperature had dropped to 33 deg C, which didn't help. Very clammy, shirt soaked with sweat so I guess adrenaline had been released for glycogen breakdown.

This all came out of the blue and was pretty scary for all involved. I've never had to have assistance with a hypo before (on insulin 20 years). All I can think of is that the slow acting insulin went into a blood vessel (or lymph vessel - there was no bruising). I inject in the adipose around my tummy. My Novorapid pen was downstairs so I didn't mix them up (it also has a memory readout that showed my last injection was 1 unit more than 12 hours earlier).

Wonder if anyone else has had a similar experience with Glargine?

 

[Antje77]

Yup, happened to me. Passed out in bed, luckily after already having eaten/drank a lot of sweet stuff. Feeling horrible hot and sweating like a shower so had taken off all my clothes and turned the fan up high. Last thing I remember was thinking 'I shouldn't lay down and close my eyes now' but I did anyway. Woke up about 2 hours later, still hypo. Ate more and eventually managed to get my bg up.
Spent 2 days googling and concluded I had had a 'Lantus low'.

Lantus is apparently the only long acting insulin which can do this. The mechanism to make it work around 24 hours is that it reacts to the fatty tissue under your skin, forming some sort of chrystals which then slowly get broken down by the body. Or something like that. If it hits blood, no reaction, no chrystals, no slowing of action.

Other long acting insulins use different mechanisms so this bizarre quick low isn't possible with them, although I'm not sure about Toujeo, as that's direct family of Lantus.

Phoned my DN and told her I needed a different long acting, as Lantus now scared the **** out of me and I wouldn't take it anymore. Got switched to Tresiba the next day.

Unexpected upside was that the pains and aches in my arms and legs disappeared as well, apparently that's a possible side effect of Lantus too.

Good you had help around! I'm happy to still be here and promised myself that should I ever drop this fast again I'll try to phone for an ambulance before I'm out. 'Dead in bed syndrome' sounds pretty scary to me. I guess I got lucky that I had a heavy meal late in the evening, which I think helped me get out of the hypo, together with all the undiluted lemonade I had drank before passing out.
Happy you're still here too!
Good luck!

 

[kitedoc]

Hi @agwagw, As a T!D, not as professional advice or opinion:
A rapid drop in BSL has been described if one accidentally injects short-acting insulin or glargine ( Lantus/Toujeo or any other brands) into a blood vessel. It is rare that it happens but once in 20 years could be in the ballpark, maybe.
In the 'old old days' before pens, we were taught to draw back on the syringe plunger before injecting. If blood came back into the syringe we knew we had hit a blood vessel and so took the needle and syringe out and tried injecting somewhere else.
With pens and finer needles these days I do not know if you could tell if you had hit a blood vessel.
If the injection went into muscle accidentally the hypo takes longer to happen ? 1 hour +.
Only you could decide whether the risk of it happening again would make you wish to change to a different long-acting insulin.
And both Levemir and Tresiba are reported as safe, even if they were to go into the blood stream.
You did the right thing to summon help.
Most of us feel pretty shell-shocked after a severe hypo and that feeling can take ages to settle. Do not afraid to speak with a counsellor about if it keeps worrying you !!
see diabettech.com/diabetes/ lantus-lethal-or-lifesaver-doc/gbdoc

 

[Antje77]

diabettech.com/diabetes/ lantus-lethal-or-lifesaver-doc/gbdoc

Your link doesn't work.

 

[kitedoc]

Apologies: try - htpps://www,diabettech.com/diabetes/lantus-lethal-or-lifesaver-doc-gbdoc

 

[Antje77]

www,diab

Almost there, now only change the comma to a period and you've got it. But at least I found it this time

 

[Matin]

Morning all.

I had a very worrying episode yesterday. Had my 18 units of Glargine (Lantus) at 08:00 as normal. No Novorapid as breakfast later. BG at 5.6mM (pretty good for me).

20 mins later feeling odd, BG now 3mM and dropping. Chewed glucose tablets (18g), usually would feel difference within 10 mins, but nothing. BG now LO, which for my meter means 1.5mM or less, feeling more and more confused. With help of wife (who had been collected by gallant pooch: "I need your Mum's help") ate more glucose (50g in all) plus honey. At this point became pretty non-responsive.

Paramedics summoned and arrived about an hour later when I was beginning to come round. Checked over and OK, BG up to 3.6 and rising. My temperature had dropped to 33 deg C, which didn't help. Very clammy, shirt soaked with sweat so I guess adrenaline had been released for glycogen breakdown.

This all came out of the blue and was pretty scary for all involved. I've never had to have assistance with a hypo before (on insulin 20 years). All I can think of is that the slow acting insulin went into a blood vessel (or lymph vessel - there was no bruising). I inject in the adipose around my tummy. My Novorapid pen was downstairs so I didn't mix them up (it also has a memory readout that showed my last injection was 1 unit more than 12 hours earlier).

Wonder if anyone else has had a similar experience with Glargine?

 

[Matin]

I am taking levemir, Night time I was taking 27 units and day time 7 units. Recently I had to take ciprofloxacin 20 tablets. It became toxic and started to give lot of extra beats and shaking with odd feeling. I was trying to keep sugar normal as much as possible. I was improving a bit, suddenly I see sugar is dropping at 3 to 4pm from 7 to 5 mmol very quickly. I reduced it gradually 1 point each day. At night time too doing the same thing. Ultimately reduced the levemir dose to 17 and 3 units. But day time sugar has become erratic, after eating sugar goes high but ultimately when humalog ends, sugar comes to normal. Day time sugar is not closer to straight line. Probably there is a solution for this drop is that, fix the time of taking long acting just when you are eating. Do not take it without food and add a little more protein.
I have been suffering lot of symptoms now, Pressure on the eyes, extra bit, carbohydrate intolarance sensation etc, I stopped Cipro in 25th Sept 2018. Sugar is till unbalanced. Please suggest

 

[agwagw]

Yup, happened to me. Passed out in bed, luckily after already having eaten/drank a lot of sweet stuff. Feeling horrible hot and sweating like a shower so had taken off all my clothes and turned the fan up high. Last thing I remember was thinking 'I shouldn't lay down and close my eyes now' but I did anyway. Woke up about 2 hours later, still hypo. Ate more and eventually managed to get my bg up.
Spent 2 days googling and concluded I had had a 'Lantus low'.

Lantus is apparently the only long acting insulin which can do this. The mechanism to make it work around 24 hours is that it reacts to the fatty tissue under your skin, forming some sort of chrystals which then slowly get broken down by the body. Or something like that. If it hits blood, no reaction, no chrystals, no slowing of action.

Other long acting insulins use different mechanisms so this bizarre quick low isn't possible with them, although I'm not sure about Toujeo, as that's direct family of Lantus.

Phoned my DN and told her I needed a different long acting, as Lantus now scared the **** out of me and I wouldn't take it anymore. Got switched to Tresiba the next day.

Unexpected upside was that the pains and aches in my arms and legs disappeared as well, apparently that's a possible side effect of Lantus too.

Good you had help around! I'm happy to still be here and promised myself that should I ever drop this fast again I'll try to phone for an ambulance before I'm out. 'Dead in bed syndrome' sounds pretty scary to me. I guess I got lucky that I had a heavy meal late in the evening, which I think helped me get out of the hypo, together with all the undiluted lemonade I had drank before passing out.
Happy you're still here too!
Good luck!

Thanks Antje, that's very informative indeed! Glad to still to be here too

 

[agwagw]

Hi @agwagw, As a T!D, not as professional advice or opinion:
A rapid drop in BSL has been described if one accidentally injects short-acting insulin or glargine ( Lantus/Toujeo or any other brands) into a blood vessel. It is rare that it happens but once in 20 years could be in the ballpark, maybe.
In the 'old old days' before pens, we were taught to draw back on the syringe plunger before injecting. If blood came back into the syringe we knew we had hit a blood vessel and so took the needle and syringe out and tried injecting somewhere else.
With pens and finer needles these days I do not know if you could tell if you had hit a blood vessel.
If the injection went into muscle accidentally the hypo takes longer to happen ? 1 hour +.
Only you could decide whether the risk of it happening again would make you wish to change to a different long-acting insulin.
And both Levemir and Tresiba are reported as safe, even if they were to go into the blood stream.
You did the right thing to summon help.
Most of us feel pretty shell-shocked after a severe hypo and that feeling can take ages to settle. Do not afraid to speak with a counsellor about if it keeps worrying you !!
see diabettech.com/diabetes/ lantus-lethal-or-lifesaver-doc/gbdoc

Hi Kitedoc, Very good point re looking for a blood trace, but not now possible with pens. Will certainly be discussing a change to a safer long-acting option!

 

[Antje77]

Will certainly be discussing a change to a safer long-acting option!

Be prepared for them not to believe you and insisting you must have taken quick acting instead of Lantus.
My DN didn't really believe me, I think (but she was very polite about it, so not sure). Didn't matter, she was happy to prescribe me another insulin.

 

[Antje77]

Sugar is till unbalanced. Please suggest

I think you'd best start a new thread with your questions, that will give you more answers. You can ask a moderator to move it or start a new thread yourself.
Good luck!

 

[agwagw]

Be prepared for them not to believe you and insisting you must have taken quick acting instead of Lantus.
My DN didn't really believe me, I think (but she was very polite about it, so not sure). Didn't matter, she was happy to prescribe me another insulin.

Yes, will do - good advice! I may take the pooch in to give evidence

 

[Antje77]

Yes, will do - good advice! I may take the pooch in to give evidence

Your pooch is better than mine, diabetes wise (otherwise, my pooches are the best of course!). All 3 of them, plus the cats, were sleepily begging for more treats or whatever I was having when I somewhat reacted again after 2 hours of laying naked in front of the fan. They're completely useless, except for love, and they think all is well as long as they get their liverwurst, nuts, carrots and hummus occasionally.
On lucky days I get to use a corner of my bed. They're pretty nice actually.

 

[Antje77]

(Oh, and yes, I can count to 5. Two of them belong to a friend and are having sleepovers at my place a couple of nights a week.)

 

[agwagw]

What? a whole corner?!

 

[Antje77]

What? a whole corner?!

Last night was sleepover night again and everyone except the cats snuggled under the blankets as the nights are still cold. Which is good because with numerous animals on top of the blanket you can't move at all. The biggest dog usually takes the other pillow to rest his head on and I put my arm around him, like you would with a partner. The smallest found her spot just below the biggest, against my belly and top side of my legs. Her mother against the knee-part of my upper legs and the other two. The kitten wiggled in between the big dog and myself, tickling my nose with his fur. Behind my knees was one of the sleepover dogs and the other slept against the front of my lower legs with one of my feet on top of him. The old cat laid himself down on top of me when I almost slept.
So you see, it easily fits!

 

[agwagw]

Easy Peezy! All the re-manoeuvering when you turn over must be a challenge

BTW my Diabetes medic bod swapped me to Tresiba quite happily. She said it has better profiles then Glargine but it isn't NHS policy to switch everyone to a new medicine when introduced - which I can understand, though for glargine I think it may well be a good idea.

 

[Antje77]

Easy Peezy! All the re-manoeuvering when you turn over must be a challenge

I think I wake up halfway and move very carefully because I don't want to disturb the dogs and it makes me quite sad when one of the cats leaves the bed because I move too sudden
I hope you'll like the Tresiba!