What's a reasonable number of (mild) hypos to expect

[LaughingHyena]

I've pretty much accepted that taking insulin means I'm going to have some hypos. Unfortuantly my diagnosis of diabetes didn't come with a second one of "super human powers of carb counting" :lol: and the odd miscalculated meal is inevitable.

My issue is more with excersie, not going to the gym type planned excersise, just the everyday tasks which turn out to be more energetic than you thought they might be.

I've recently upped my levimir as I was running too high most of the day, it's impoved my levels in the morning but now leaves me on the low side in the afternoon. The knock on effect is my needing to be pretty careful of what excercise I'm doing or I end up dipping below 4 and needing a couple of jelly babies.

It's the same overnight, having upped the levimir leaves me OK in the morning more often but means any evening activity risks a hypo overnight.

I know long term that having lots of hypos is said to reduce your awareness of them, but then being high also causes problems long term. What's the balance? How many hypos is lots? Is this something which a pump would be able to even out a bit more?

 

[noblehead]

A pump would be ideal, however have you thought of changing your basal insulin?

I've tried levemir and found it too unpredictable, lantus on the other-hand has a flat(ish) profile and exercise in moderation requires no adjustments to it, I inject it once a day as where levemir I needed to inject twice daily.

 

[LaughingHyena]

Thanks

I changed basal insulin just over a year ago. Lantus didn't seem to suit me that well and I was ending up with a lot of overnight hypos (more nights than not) and rising levels in the afternoon. I was told levimir would be a better choice for a split dose, though I see a few people mention splitting thier lantus which is something I haven't tried.

 

[Stefano]

Hi I am using since October an insulin pump. I am 33 years diabetic and I never wanted a pump in the past.
Then last summer I decided to give it a try. I was having too many hypos, especially in the night but I needed more lantus or levemir at the same time. The lantus and levemir were so unpredictable although they are supposed to be flat.
The biggest achievement with the pump is the strong reductions in hypos. I can go now to sleep without any fear as the pump works only with fast acting so it is so much predictable. Hypos are also never as strong as before.
Bear in mind I never wanted a pump now my only regret is I didn't do before!


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[tribby1]

:idea: I have had diabetes type 1 for 22 yrs and still counting, I hate it.
My first few years was not too bad as I was on Monotard slow acting Pigs Insulin and Actrapid fast !
I mixed the two twice daily, then I was put on a Pen with Actrapid and Lantus, I had 2 - 4 hypos day and night, I did not report this for some time even though the Paramedics knew me very well I felt I had no help.

Once I fell Pregnant 8 yrs ago things started to settle, then once the baby was 1 yrs old my hypos came back with force, I now have the Pump and I am insulin sensitive but I have now started hypoing again.

When doing house work or shopping lower your before meals insulin or even the one before that, this does work trying with a small amount ie minus 1 - 2 units test after the event then keep a record according to the number.

I will add that ,all Type 1's must go on the DAFNE course, if I had had this when I first become a Diabetic it would have helped my understanding,I really never knew how important carb counting is and what we do in a day can cause highs and lows.

My lowest is the reading of LOW or sometimes I get 1.1 but I don't know that I'm hypo, if I'm 3.1 then I sometimes get a warning so no two days or hypos are the same.

 

[noblehead]

Thanks

I changed basal insulin just over a year ago. Lantus didn't seem to suit me that well and I was ending up with a lot of overnight hypos (more nights than not) and rising levels in the afternoon. I was told levimir would be a better choice for a split dose, though I see a few people mention splitting thier lantus which is something I haven't tried.

No experience of splitting lantus I'm afraid, very few people do this although we have had members on the forum who have done so successfully.

Normally it's not recommended to split lantus as its a 24 hour insulin, in my own experience I can be 1-2 late at injecting and still not see a rise in my bg readings, if I were you I would look for an alternative or ask your DSN for advice on getting your levemir dose right.

Once you get your basal insulin right you should see a big reduction in your hypo's, there's was a guy on my DAFNE course who was having hypo's everyday and couldn't work out why, after discussing matters with the nurse he reduced his lantus from something like 66 units daily to 42 over a period of weeks, at the 12 week follow-up to DAFNE he did say that the daily hypo's were a thing of the past, they say when your basals right your 50% there...which I agree with!!!

 

[LaughingHyena]

I've got another appointment witht he DSN and dietitan next week so I'll be discussing it then. Trouble seems to be that 14 units in the morning leaves me with high BGs all morning, but 15 leaves me too low in the afternoon. Similarly overnight 9 is not enough but 10 often seems to be too much.

When I saw the consultant a couple of months ago she thought a pump was going to be the way forward, but wanted me to try a coupld of changes to ratios and doses before going ahead. Well I've managed to make some improvements over the last couple of months but still not getting the results I would like to see so I hoping we can go forward with the pump.

 

[smidge]

Hey Laughinghyena!

I've got another appointment witht he DSN and dietitan next week so I'll be discussing it then. Trouble seems to be that 14 units in the morning leaves me with high BGs all morning, but 15 leaves me too low in the afternoon. Similarly overnight 9 is not enough but 10 often seems to be too much.

Use a half unit pen? I take 6 units Levemir in the morning and 4.5 in the evening. I use a beautiful (sad I know!) red Novopen Echo. Works really well for tight control without hypos. At first the nurse at my GP wouldn't let me have the haf-unit pen for Levemir as she claimed no-one needs to adjust basal in half units. My consultant at the hospital over-rode her decision and wrote to my GP saying I need a half unit pen.

Alternatively, you could try changing the times of your injections to change to change the overlap a bit. Levemir seems to last about 14 -16 hours for me, so a split dose will always give an overlap somewhere and a single dose at other times. I suspect your lows are hitting the times when you have both of the split doses active. Charting it out helped me to put my 'double-dose' times at a more convenient time - and then have a biscuit with my morning tea to ensure no hypo. It takes a bit of work but it's worth it.

Final suggestion is to reduce your carbs if possible. It doesn't stop this altogether, but basically the lower the carb intake the lower the doses you need and the lower the doses you need, the fewer and milder the hypos.

Take care

Smidge

 

[hale710]

I use a beautiful (sad I know!) red Novopen Echo.

I'm off topic a bit here, but I too have a love for my half unit novopen echo. Mine is turquoise-ish in colour

 

[LaughingHyena]

Funnly enough I've just been given a red echo for the levimir, I already have a blue one for novorapid Half units here I come.

The overlapping sounds like it could be part of the problem, I also wonder if I haven't got the split right. I'm not quite sure where to start experimenting with that one. It's not going ot be this week though, routine is probably out of the window as it's half term.

The more I read about pumps and being able to change basal rates for different times of day the more it sounds like the best option. I hate the idea of being attached to it though. I managed to knit my drip into the thing I was knitting on one hospitat trip. who knows what I'll managed to get tangled up in. I'll definalty be keeping it under clothing as much as possible.

 

[noblehead]

My Echo pen is blue too!

The one thing that takes some getting use to with a half unit pen is the double click to dial up one unit, with my old Novopen I'd just turn the dial till it clicked 5 times if I was injecting that amount, with the Echo it's 10 clicks and I must admit I've nearly under-dosed on a few occasions at the start, make a habit now of watching the little window rather than listening to the pen dialing up :crazy:

 

[LaughingHyena]

Having used one for Novorapid for a while I'm just about used to the double click thing.

My bigger problem is that I liked having different pens for the two insulins. I know they are still different colours but the different click and feel are part of my sense of having the right pen. Quite a few times I've picked up the wrong pen and it's only when I come ot dial up the dose and it feels wrong that I notice what I've done.

So far I've never used the wrong pen but I fear it is only a matter of time. I suppose at least with the memory of the last dose I'll be able to check.

 

[hale710]

Having used one for Novorapid for a while I'm just about used to the double click thing.

My bigger problem is that I liked having different pens for the two insulins. I know they are still different colours but the different click and feel are part of my sense of having the right pen. Quite a few times I've picked up the wrong pen and it's only when I come ot dial up the dose and it feels wrong that I notice what I've done.

So far I've never used the wrong pen but I fear it is only a matter of time. I suppose at least with the memory of the last dose I'll be able to check.

My pens used to be blue and silver, now they're blue and turquoise. I too am waiting for the "mistake" to come!

 

[Thundercat]

I would love a Novopen Echo (my wants are small!) but they are not available in Ireland yet and no sign on the horizon. Both my pens look completely different as they are from different companies but I have on occasion caught myself about to inject the right dose with the wrong pen! How do you combat 'flaky brain' syndrome???

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[pippaandben]

I would love a Novopen Echo (my wants are small!) but they are not available in Ireland yet and no sign on the horizon. Both my pens look completely different as they are from different companies but I have on occasion caught myself about to inject the right dose with the wrong pen! How do you combat 'flaky brain' syndrome???

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In the second week of injecting I did use the wrong pen - luckily it was the basal and it just meant using it 3 hours early so no harm done. After this I have put a little note on my bolus pen saying "Meals only" right under the window so I can't miss it. A senior moment I can't risk repeating :roll:

 

[LaughingHyena]

I would love a Novopen Echo (my wants are small!) but they are not available in Ireland yet and no sign on the horizon. Both my pens look completely different as they are from different companies but I have on occasion caught myself about to inject the right dose with the wrong pen! How do you combat 'flaky brain' syndrome???

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For me it's been about making the different jabs feel as different as possible, so I inject novorapid into my tummy, levimir into my leg. Novorapid is usually done at the table with the meal where my beditme levimir is usually in another room.

In the morning when I need to do both I put needles on both pens, then when I've doen the first and put the needle in the sharps bin I can see which I have left. Otherwise I question which one I've just done :crazy:

There have been quit a few times I've caught myself dialing up a dose on the wrong pen (usually novorapid when I want levimir :shock: ) but so far it's always triggered something in my brain and I've stopped. I think it helps that my doses tend to be quite differernt, it would be pretty unheard of for me to need 15 unitls of rapid actiting so it feels wrong to dial it up on the blue pen.