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what happens with a hypo

Discussion in 'Type 1 Diabetes' started by durwyn, Jul 15, 2010.

  1. durwyn

    durwyn · Newbie

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    I was wondering if folk with bit more experience could give me some advice please. I'm in my late 30s and was diagnosed with type 1 a couple of years ago. I fairly frequently find my blood sugar levels around 4 - when this happens I feel a bit shaky, eat something and everything's ok.

    I've just been on holiday and was on a long walk with the family - had been carrying my 4 year old son on my shoulders. Realised my blood was low and we didn't have any food with us. It all worked out fine but it made me realise I don't really know how dangerous a hypo is and what's involved. Is anyone able to explain please? I guess at some point unconciousness will kick in - what kind of blood glucose level will this occur at? How long does it take? What further symptoms? If I'm out on a long walk am I best trying to get quickly to some food or sitting down and waiting (e.g. letting my wife go off and get something).

    thanks

    Durwyn
     
  2. cugila

    cugila · Master

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    There are many posts on the Forum about this subject and it is well you know as much as you can about it. Here is a link to a very informative Tayside NHS site about it:

    http://www.dundee.ac.uk/medther/tayendo ... caemia.htm

    any further questions just ask or do a search with the keywords hypo etc on the Forum.

    Ken.
     
  3. Lynne C

    Lynne C · Member

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    Hi Durwyn, you must take a cereal bar or some sweets or chocolate when you go out walking as your blood sugar can drop suddenly with walking. I keep Nature's Best bars in the pockets of all my jackets as I have also been caught out with a hypo when walking so prevention is best.

    No hard and fast rule as far as how low your blood glucose can be for you to feel hypo, it varies from person to person and how well you control your BG. I can feel low at 3.0 some days but have been as low as 1.4 and been aware I needed lucozade, was quite lucid and able to sort myself out. You can only manage this by taking note of your BG when you start to feel low, but this will also vary from day to day and with the activity you are doing.

    Walking can drop your blood glucose levels as it tends to be exercise over a prolonged period, hence the need to take sweets or something with you. I go running before I have had breakfast or any insulin and have never had a hypo or been low, in fact I run better if my blood glucose is low but running is under an hour whereas walking can take several or many hours.

    Take care!

    Lynne C
     
  4. durwyn

    durwyn · Newbie

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    Thanks for the replies Lynne and Ken,

    I have read resonably widely (I checked out the link Ken) and do normally carry a cereal bar etc with me. However I've realised I need to know more. Will I just keel over? At what point ? Will I just drift slowly towards unconciousness or literally fall over? When does brain damage kick in? If I find myself low (say around 4) and starting to feel shaky, how long have I got? I realise there's no straight answers, but some indications would be helpful....

    thanks

    Durwyn
     
  5. moonstone

    moonstone · Well-Known Member

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    From the DAFNE course, I was taught that at 2.8 your brain can literally freeze, and anything can happen from that point on - I think the term is "neuroglycopenic effects", ie the brain is starved of fuel and it can all go very pear-shaped after that.

    From my own reading - I'm 2yrs into it like you - 2.1 or 2.2 is the level where fits can start, and 0.55 is when coma sets in. Having said that, as others have noted, it's different for everyone, and I remember reading a paper about a man who was perfectly lucid and had no cognitive impairment at all with sugars of 0.5, so he was written up in the medical literature. For brain damage, I think you might need to be in a coma for a really long time, so don't panic too much about that. Having said that, people can easily damage themselves during a hypo even if the hypo itself caused no harm, so you should take care not to let it happen as far as humanly possible. When I was diagnosed an old Type 1 friend came over (he's had it about 30yrs) and told me it's not usually the hypo that hurts you, it's what you do on the way down. So you should aim for prevention rather than cure.

    My lowest was 1.9, it was only an hour after injecting, I'd even knocked a unit off my normal dose for that amount of carbs to be on the safe side, as it was near bedtime. An hour later and there I was. Over the next 20mins I drank about 3/4 a litre of Lucozade but only made it up to 2.1. I didn't know it was 20mins until much later though, because my consciousness was so impaired that I could read the time but not subtract the time of one reading from another and work out how long this had been going on for. It was the middle of the night, I was alone, I tried to call my neighbours unsuccessfully and took the decision to call an ambulance because I was losing my ability to keep going and for all I knew I'd been like that for hours. They arrived within about 10mins, and it was only as I saw the paramedic that I finally felt my brain 'click' back into reality, and I tested at 6.1. At the time I was mortified but in hindsight I'm so glad I did it, as I was in danger. It took me half an hr to be able to string a full sentence together even though my sugars were constantly rising and to this day I don't know how I made it down the stairs to open the door for them - I remember blanking out briefly a couple of times on the way down. I apologised to them a lot, and I asked basically the same question as you - did I call you too soon, is it normal to feel that bad at that level - and they said it differs from person to person and they've seen people flat out on the floor with sugars in the 3s. They were extremely kind and assured me that they were here for people like me, and no I wasn't stopping them from dealing with things like heart attacks and all they'd been called out to so far was two drunks so they were more than happy to look after me.

    Some hypos will hit you really slowly and are very easily sorted, and some really quickly. You'll probably know when you're dropping really fast - you might get all trembly inside + outside, or very very shaky indeed and be unable to get the lid off a bottle, and feel like Alice in Wonderland after drinking out of the magic bottle, see lights, have your vision go weird, feel sick, start crying, or sweat profusely for example. Sometimes you might not recognise you're going low until you're already quite hypo - I've discovered I was at 2.4 before when I went to wash my hands and they seemed a bit odd-looking(!) so I tested cos I thought that was weird. Only then did I get the full-on symptoms - it's not the first time that has happened to me and I've heard others say similar things have happened to them. I've had all kinds of symptoms, a whole raft of them - they're not only different for everyone but for me they're different every time.

    Four is the floor - ie, if you're at 4 you need food, now - and if you find yourself between 3.5 and 4 on testing it can be classed as a 'borderline hypo' - ie, forget cereal bars and go straight for the quick-acting carbs - Lucozade or coke or orange juice (refined and simple carbs work very quickly compared to complex carbs) and when you're back up to 4 or above then eat something else like the cereal bar to keep yourself stable. One hypo can lead directly to another if you don't bump up your levels appropriately with long-acting carbs. Remember that quick-acting carbs are quick-in and quick-out - so if you've had too much insulin their effect won't necessarily outlast the effect of the insulin, depending on how much you had when. So eat when you're above 4 again. When you're below 3.5 you need to sort it out with no messing around. And you can sometimes be fooled into thinking you're dropping slowly, but testing reveals you're not, so please always take it seriously.

    As regards sitting down and waiting for someone to get food for you - no, never. That shouldn't happen. You are the diabetic, and it's up to you to be prepared. Don't go anywhere without Lucozade, Glucogel (you get it on prescription), a mini can of coke or two, or some other kind of quick-acting carbs. It is your responsibility to carry this with you at all times and if you fail to do so and something serious happens, it's 100% your fault, like it or not. Put it this way, if your wife had severe asthma and went out of the house routinely without her inhaler, then ended up in hospital after a massive and life-threatening asthma attack, what would you think, how would you feel, how annoyed would you be? To be honest I am upset on your behalf that you have not been told this by your diabetes team as it is basic rule number 1 and you're really lucky not to have been caught out by it - I had this drilled into me the day I was diagnosed and several times since, and it's information which has essentially saved my life. Please put Lucozade in every room in your house, and always but always carry something with you. I've discovered the joys of little packets of fizzy cola bottles for those hypos between about 3 and above that I don't think are going down too quickly - otherwise, I scrap that and go straight for the liquid. The little packets of sweets squash down easily into pockets and bags and take up almost no room.

    If you go to wikipedia and look it up there's lots there. My manager is Type 1, he's had it most of his life, and he's never passed out yet; I've only had it 2yrs and had a couple of scares, but I've also never passed out yet. Both of us always have Lucozade everywhere and in our bags/rucksacks at all times. To get to the point where you 'just keel over' you've probably got to have hypo unawareness, which is when your HbA1c is so low that you lose your symptoms or sometimes it happens when you've had diabetes for a couple of decades or so - and from what you've said, it doesn't sound like that's any kind of problem for you as you have symptoms around the 4 mark.
     
  6. victry77

    victry77 · Well-Known Member

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    Couldn't agree more with both statements. Also, like moonstone, I regulalry keep bottles of
    lucozade & coke in various rooms. I absolutley never leave the house without a bottle or some glucotabs (preferably both - but I much prefer a drink if I'm hypo unless I'm only dipping under 4.0). A lot of people seem to think they should have a sandwich or a bar of chocolate for a hypo, but these are really no good to get you up quickly (the bar of choccie will probably just make you sky-high an hour or two later).
     
  7. cugila

    cugila · Master

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    Excellent information from moonstone and as Victry also says, fast acting carbs are what is needed to counteract a hypo. Only when the levels are back up again should a small carby snack or something similar be used to stabilise the levels. There are many previous posts about this on the Forum, the choccie bar or sandwich was the old advice which has now been changed, at least by HCP's who are knowledgeable.

    Ken
     
  8. barney06

    barney06 · Newbie

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    i have seen me sitting watching tv when a hypo happens with me i get the shakes and i start to sweat and i am very tired as i have problems with my feet and my legs i can't walk very far or very much but as some of the ppl have said keep a bar of choc or some glucose sweets in your pocket if i don't have any of these i keep little packets of sugar in my pocket but your levels don't necessarily need to be low to take a hypo they can go dangerously high like mine are doing at the moment cause all i am doing is sleeping an hr after i get up and take all my med which i take quite a lot of for different conditions which i have
     
  9. cugila

    cugila · Master

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    What are your Bg levels when this happens ? As has been previously stated a bar of chocolate is NOT what you should use to initially treat a hypo, it is not fast acting enough. Glucose or sugar is what is needed, fast acting carbs......only then might a bar of chocolate be useful once your levels are back to more normal levels. Glucotabs or Dextrose tabs are quick, convenient and easy to keep in your pockets or bag as they are wrapped or in tubes.

    A hypo is a term used to describe any levels below 4 mmol/l......it is called Hypoglycaemia.

    I am not sure what you mean when you stated in your post (underlined) "your levels don't necessarily need to be low to take a hypo they can go dangerously high like mine are doing at the moment."
    If your levels are dangerously high that is called Hyperglycaemia and is due to the high Bg levels. The symptoms of which can be any or all: increased thirst, pasing a lot of urine, large amounts of sugar and ketones in the urine, weakness, abdominal pains, aches, sweating, loss of appetite, feeling and being sick etc.

    It is not the same as a hypo (Hypoglycaemia) so the statement is not correct. To be suffering from a hypo you need to be at low Bg levels.

    Maybe you were talking about 'false hypo's......it isn't very clear ?

    Ken
     
  10. iHs

    iHs · Well-Known Member

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    Can I just say that although chocolate might not be the favoured medical way of heating a hypo, but that's not to say that it doesn't work. In fact it works extremely well and has bought me out of my hypos fairly quickly. When I was younger I nearly always used 4 squares of Dairy Milk and it took no more than a few mins to have its effect.

    It's no good trying to coax someone who is very hypo to take glucose tabs, Lucozade or any other glucose type liquid if they are not going to comply because they don't realise how hypo they are and have possibly become argumentative, BUT give them a piece of choccie, swiss roll, bread and jam and they will most likely jab it from you. The issue of hypo compliance is never fully discussed amongst HCPs but should be.
     
  11. cugila

    cugila · Master

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    iHs.
    Of course you can......however as Monitor's of this Forum we tell new and even old members what is the recommended method for treating a hypo, the current medically approved method. Members are then free to make their own decisions about whether to follow the information or not. Chocolate is the 'old' method and is not now recommended as it is known to be not fast acting because of the fats in it slowing down the absorption. Apart from which, carrying a choccie bar around in this hot weather isn't really an option.......makes a terrible mess of your pockets ! :(

    If you wish to use another method that is your choice. I have had a choccie bar myself when I have been out without the Glucose or Dextrose tabs. Not often. It will work....eventually ! :wink:

    As for not being able to coax someone who is having a severe hypo to take things or drink etc I think that's a given. We are really talking about just when you get hypo symptoms....there should really be plenty of time for anybody to treat themselves if they are hypo aware and the levels are not too low.

    Obviously a severe hypo in someone would have to be treated very differently. As for discussion of hypo's and their treatment I agree with you totally that it is not discussed enough with Patients and HCP's, although mine always made it very clear what can and should be done.

    As I am sure you know there have been many posts on here where new members and even some older ones have no idea what the recommended method of treatment is supposed to be. We even had one poster a while ago suggesting to a new member that a slice of bread would do the trick.....!! :roll:
    Fast acting....NOT !.

    Ken
     
  12. Debloubed

    Debloubed Type 1 · Well-Known Member

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    Hi Durwyn, tip from me would be to carry fruit pastilles or jelly babies. x5 fruit pastilles or 3 or 4 Jelly babies are 15g fast acting carbs and they bring me back to normal in no time at all. In fact, whilest training with some marines for the 3 peaks challenge, I loved that they advised us all (I was the only type 1!) to use jelly babies for a quick rush of sugar!! I prefer the sweets as they taste nicer than the glucose tabs and they are lighter to carry than a bottle of lucozade :D I guess the best thing to do is give some of the options a try and see what works best for you. Some chocolate with caramel I used to find worked better, mars bars for example? but they would leave me hungry which meant I over corrected. With the Jelly sweets I find I'm back to normal within 15 mins or so, which is great as who has the time to wait for an hour to correct a hypo?! :p
     
  13. iHs

    iHs · Well-Known Member

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    Bang on correct there Debs :mrgreen: Couldn't have put it better myself :mrgreen:
     
  14. cugila

    cugila · Master

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    Well said Doublebed.
    I too keep Jelly Babies to hand.....fast acting as you say and also convenient. An alternative to the Glucotabs at times. Taste good and I like to bite their heads off first...... :twisted:

    Ken
     
  15. sgtchilco

    sgtchilco · Member

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    hello,

    I have read this thread with great interest and there is a lot of good advice here. I myself have been insulin dependant since childhood and I am 42 now. I have to admit I was a little taken back by moonstones comments and the universal agreement for them,

    It implies that there is never any excuse for an unplanned hypoglycaemic excursion but I don’t think things are any way as black and white as this. This seems to me to be very judgemental.

    During the late 1980’s I was placed onto the new range of synthetic insulins and unfortunately I was one of those people who had a reaction to it. Regardless of the sugar I had filled my pockets with I had a number of (but infrequent) sudden disabling hypos that arrived so quickly I went from conscious to unconscious within seconds. We had an ambulance out to the house twice. At first any link with the new drug was dismissed, but quickly there were many reports of people finding themselves in difficulty.

    The modern drugs, for example Nova rapid are very powerful and should be treated with great respect. Sudden hypos are a risk that need to be managed, but are always a possibility, I have read on this forum how people have inadvertently doubled up on dose, taken Nova Rapid instead of Basal or have had adverse effects due to pregnancy, unrelated underlying illness, even adverse effects due to anti-sickness drugs or cancer treatments etc etc. I have known people who have been prone to very sudden hypo with no warning signs at all and there is nothing they can do about it!

    I agree with your point that it is essential to always have quick acting carbs, But to say if “something serious happens, it's 100% your fault, like it or not” is very harsh indeed. I know that some people live in a blame culture, but most people manage their diabetes as best they can - after all the post contained the admission of a level of 1.9, from my own experience that can be, under the wrong circumstances, a small step away from a life changing disaster.
     
  16. moonstone

    moonstone · Well-Known Member

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    Hi there,

    I understand what you're saying, but I think you might have missed the original poster's question and therefore why I was saying that in the first place - he asked, if he's having a hypo should he just sit down and wait for someone to go and get him some food? No, he needs to be prepared, it's not in question. If he's unprepared and something serious happens, yes it's his fault, of course it is. If you're prepared, yet unable to control the situation through no fault of your own, then of course you can't be blamed. I'm not talking about blame culture, I'm talking about going out with no sugar on you, ie putting yourself in a situation where disaster can happen. This is why people have been agreeing with me.

    I hope you understand what I mean now, as I said I also understand what you're saying, and the night I called the ambulance I'd had about three-quarters of a litre of lucozade and it had only got up to 2.1 from a low of 1.9, and I was losing consciousness... so I know that you can be covered in sugar and still be in trouble. But if I had no lucozade/glucose at home, and just expected someone to go off and find me something sugary in the middle of the night....? No way, that's an abdication of all my responsiblities to myself and my loved ones to keep myself safe and not waste valuable NHS time + money with what could have been a perfectly avoidable hypo. I'm not being harsh at all here, just stating the truth. If you help yourself and do what you can yet it's still uncontrollable, then no-one's saying you did anything wrong, least of all me.

    Moonstone.
     
  17. nikkihc

    nikkihc · Member

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    Hi guys,
    I know this thread is 6 months old but wondered if you could help settle a secret argument I'm having with my boyfriend about hypo's...

    On a long term basis, is it not better to have the odd hypo and have your hba1c closer to 6.5 / 7 than trying to manage constant high bg levels?

    I do appriciate lots of hypo's aren't good from a becoming immune to the symptoms.

    I get "told off" by my loving and caring boyfriend, for hypo'ing. Probably happens max once a week, just when I get too busy with DIY, gardening etc. (lowest ever is 3.0)

    I say I'd rather deal with the odd hypo than struggle to get my levels down all the time and deal with the hyper effects and the long term major problems such as heart, feet, kidney problems....

    Whats are your thoughts?
    Nikki
     
  18. moonstone

    moonstone · Well-Known Member

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    Hi Nikki, You're absolutely right. Completely, 100%. In fact, if you go on the DAFNE course which is currently recognised as best practice and is being slowly rolled out across the UK, they ask you to aim for the HbA1c levels you quoted and tell you to expect about 2 mild hypos a week whilst aiming for that type of control. If you've never been below 3.0, you haven't had a moderate or severe hypo unless your symptoms were so severe that you had to have help from someone else to get the sugar into you.

    You win, hands down, no question! Your boyfriend's just scared, because he cares about you. He's going to have to learn to deal with that, because the implications of being too high all the time are equally as scary and much worse for you in the long-term.
     
  19. nikkihc

    nikkihc · Member

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    Moonstone,
    Thank you. I was beginning to think I was bonkers for having this train of thought!!

    A great bit of ammo for me !! lol !

    Big big thanks!!
     
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