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When to seek medical attention?

M

Mungobean

Well-Known Member
Messages
88
Type of diabetes
Type 1
Treatment type
Insulin
Hi, I am newly diagnosed, and I am currently suffering from several hypos per day and most nights I wake up with a hypo at some point. On a couple of occasions it’s taken upwards of an hour to get my sugar back over 4. At what point should I seek medical attention? Is it if I can’t get my levels over 4 after a certain period, or if my initial reading is at a certain level? I use a basal insulin and I have a fast acting one too, but haven’t been using the fast acting one of late as my readings have been low. What level is too low? If I have a hypo I reduce my basal insulin the next day, but then seem to end up increasing it again, as the next morning my levels are too high. The other day I woke at 3am with a level of 3.1. I had some glucogel and then half a bagel, but it seemed to take ages for my levels to get above 4 (90 minutes +) yet when I woke up at 8am, my blood sugars were 17. It all just seems so erratic!

Thanks in advance.
 
I presume you are familiar with this advice:
https://bnf.nice.org.uk/treatment-summary/hypoglycaemia.html

I am not an insulin user myself, but it would seem to me that a reading of 17 is not yet an emergency, a level below 3.9 could be, I suspect you are reacting too quickly to the high values and hence overcompensating. Basal insulin takes time to bring sugars down during which it reduces the problem, but don't be impatient - it is not an emergency, The risk of DKA only happens when the insulin is missing. or so I understand it.
 
You really need to get your basal insulin dose sorted out and not keep adjusting it day by day. I adjust mine occasionally based on any overnight lows I encounter. But when I do make any adjustments I wait for a few days to assess the results. Recently I increased my basal to 14 units as I found I was a bit on the high side overnight, but I’ve had three nights on the trot with a couple of lows (below 4.2) so today I reduced basal by one unit and will see how that impacts.
During the day your basal insulin gives a fairly steady insulin background, but you’ll need bolus doses too and these can be quite difficult to judge as there are a host of factors at play such as time of day, exercise, ambient temperature ,carb intake and GI of the food.
It takes a long time to learn good insulin management and one thing that could help is keeping a diary of carb intake and insulin doses this would enable you to identify patterns and act on them. If you are using a Libre CGM and uploading the data you can also ask your diabetes team to look at the data and advise you.
Managing diabetes with insulin is very much a game of snakes and ladders, but with a bit of experience you’ll win more often than you lose.
 
@Mungobean sorry to read of your plight.
How do you test your blood sugars.
I ask because, if you are using Libre, you need to checking readings with a finger prick.
You mention night time hypos. If these are Libre reported hypos, they may be compression lows (sensor reporting false lows when you apply pressure by lying on them).
Likewise, if Libre is telling you it is taking a long time to recover, this may be because Libre is at least 15 minutes behind the true blood reading as it is using interstitial fluid.
 
HI @Mungobean are you able to treat hypos? (Given that you have a jejunoscopy). Given your unusual medical situation I wouldn't hesitate to hassle your medical team for help. Do you have a T1/T2 diagnosis yet?
 
Hi, you need to do a basal test. Your basal rate should be based on a dose that you don't get a hypo on. It's supposed to only cover what your liver decides to put out. It should not cover random increases, food etc.

You might be getting what's called DP Dawn Phenomenon. Around 5 in the morning your liver gives some people a blood sugar rise in preparation for awakening. And it can be irregular. One night it helps a lot, another night not at all . Usually there is a bare minimum that it rises each day, but sometimes it can just vary. But that high in the morning can just as easily be the extra food to treat a hypo every night.

If you are on MDI shot you should not be increasing it to catch the varying amounts because then you end up too low when DP didn't act up or you didn't eat as much at dinner. Usually you test for DP by waking up at 4 am and checking your BG level, which should be around your "normal" level. And then when you get up you are higher. Most people on MDI either wake up to give a corrective (fast acting) shot around 6 am or give themselves a correction when they get up. The new Libre's have an alert that you can set at what level you want so you can awaken when you go too high and give a correction.

But going too low constantly is not what we aim for. If you stopped using your fast acting because you were going too low it sure sounds like your basal is too high for during the day too. So start with a basal test and then do a correction with fast acting when needed for DP. You will probably need to do a basal test a few times since it is irregular. Adjusting basal constantly isn't recommended. You really need to carb count and use the fast acting for food and not use the basal to cover everything which I have a sneaky feeling is what your basal is doing right now and when you don't eat as much you are dropping.

Also I want to comment . too low is really subjective per person, you might ask your diabetic team when you should worry. They will not want you to hit 3.1 and will probably tell you an adjustment to your basal is necessary. If I go too low for me I will consume some fast acting carbs in something like pineapple or OJ and usually only treat it with anywhere from 4-10 carbs..

I would not consume a half of a bagel which is about 28 carbs and after glycogel, which also has carbs. For one thing a bagel is not fast acting, hence the slower rise and then a really high number when you awake. Usually you would use more of your quick carb to bring it up enough, then maybe a complex carb in a small amount to retain your levels. If your daily basal is off it would make sense you drop each night as it is too high and covering food during the day, so then a drop at night when you are not eating and then you have to eat a larger amount of food.




https://integrateddiabetes.com/basal-testing/
 
EllieM said:
HI @Mungobean are you able to treat hypos? (Given that you have a jejunoscopy). Given your unusual medical situation I wouldn't hesitate to hassle your medical team for help. Do you have a T1/T2 diagnosis yet?
Click to expand...

No diagnosis yet Ellie. Been feeling unwell all weekend so not been feeding. Had a bad episode today. Went for a walk. Felt a bit wobbly so stopped for coffee. Couldn’t read open my eyes.

Prick tested - 2.8. Ended up with 4 lots of rescue gel down the tube but got up and couldn’t walk in a straight line. Had some sugary water down the jej while my Husband fetched the car. Sugars up to 6. I can feel it’s getting low again now but then if I’m not getting the nutrition I guess it’s going to. I just don’t like waking up in the night sweating and shaking.
 
I’m finger pricking. The promised Libre has not yet materialised.
 
EllieM said:
HI @Mungobean are you able to treat hypos? (Given that you have a jejunoscopy). Given your unusual medical situation I wouldn't hesitate to hassle your medical team for help. Do you have a T1/T2 diagnosis yet?
Click to expand...
It’s difficult. I can physically swallow food - it just causes me pain and makes me vomit. So I can shove a cracker down the hatch or a biscuit but it causes me so much pain. I feel like I’m in a vicious circle at the moment. Not getting the nutrition until my bs goes so low I have to do something and then I have the odd cracker it rescue gel or sugary water, when I’ve run out of gel.
 
Last edited:
Can you consume protein drinks? There are dairy free ones if you can't consume dairy. Watch out for the low carb ones because they usually have sugar alcohols which might upset your digestion even more. There are a few of those without sugar alcohols.

But please check with your diabetic team about your basal settings. You don't want to keep dropping.
 
No they just come back up - I can put the, down the tube tho. I’m finding out that I can put all kinds of things down the darned tube! How long u til I manage to block the thing!!
 
An update. I spoke to my GP for a long time this morning and he got the community diabetes team to call me. They are loaning me a Libre swiper for a couple of weeks, which is good, as I am thinking of funding it myself, so it will be good to see how I get on with the stickiness and also I would need to upgrade my phone, so I can see if I feel it’s worthwhile.

While I’m not getting any nutrition, I’m going to stop the basal insulin and they can see how my numbers look and I have to ring them if my sugars get to double figures.

I like the idea of getting an alarm if my numbers get too low, although I am presuming (hoping) that if I’m not getting the nutrition, my sugars should be fairly stable, especially if I’m not having the insulin. None of this is going to work in the long term though, because I can’t go without nutrition forever and the feed really does make my numbers rocket.

Still, I feel as though I got somewhere today.
 
EllieM said:
HI @Mungobean are you able to treat hypos? (Given that you have a jejunoscopy). Given your unusual medical situation I wouldn't hesitate to hassle your medical team for help. Do you have a T1/T2 diagnosis yet?
Click to expand...
I treat them by putting rescue gel down my tube for starters, or some sugary water and maybe a biscuit or a cracker. I can’t work out what the best kind of biscuit to use is.
 
Mungobean said:
I treat them by putting rescue gel down my tube for starters, or some sugary water and maybe a biscuit or a cracker. I can’t work out what the best kind of biscuit to use is.
Click to expand...

Does the different types of diabetes react in different ways, or should my sugars remain fairly stable without the insulin, if I’m not eating, regardless of the T1/T2 diagnosis?
 
Have they done the tests for type1or 2? You need to find out. A type 1 loses the ability to make insulin, when you get it as an adult it commonly is referred to as LADA type 1. The difference is as an adult you lose the ability over time, years even, to completely lose the ability to make insulin. A type 2 still makes insulin, they just don't utilize it right. So a type 2 usually is making extra insulin to make up for it.

A c-peptide test tells you how much insulin you are making. Low or low normal is a sign of type 1, high or high normal is a sign of type 2. Also an antibody test, which if you have antibodies it's a sign of type 1 although a few type 1's don't have antibodies but don't make insulin and they don't know why. There is also MODY and Reactive Hypoglycemia forms of diabetes.

During the honeymoon phase of a type 1, which is the period of time your ability to make insulin is stopping, your insulin production can be irregular your BG levels can vary a lot, as sometimes you make insulin and sometimes you don't. But stopping insulin if you are a type 1 can be dangerous, it can lead to DKA, which is caused by a lack of insulin in a type 1. A type 2 can get a form of DKA, but it's much rarer because they still make insulin but it still can be very dangerous. Higher BG levels show a lack of insulin or insulin being used, so you should check for ketones to know if DKA is starting.

So in answer to your question, stopping food in a type 1 means your sugars will continue to go up. Your liver continually feeds an amount of glucose to your system and if you are a type 1 you don't make the insulin to deal with it. If you are in the honeymoon phase of type 1 some people stall off needing insulin as you still make some. But it can be touchy. A type 2 is more likely to level off with less food as they still make insulin, so it's usually there, they just don't use it well. But that can vary too as once your system is out of wack, you can have varying results with BG levels.

Diagnosing Type 1 Diabetes - JDRF

https://www.diabetes.org/diabetes/complications/dka-ketoacidosis-ketones
 
Mungobean said:
Does the different types of diabetes react in different ways, or should my sugars remain fairly stable without the insulin, if I’m not eating, regardless of the T1/T2 diagnosis?
Click to expand...

As @Marie 2 says above, your diabetes type can make a big difference. New T2s are usually producing plenty of insulin, so much less likely to go into DKA, though I should point out that long term high blood sugars can damage insulin producing cells so long term (eg ten years) T2s often find they don't produce enough insulin. New T1s often get diagnosed via a DKA because even without food they don't have enough insulin to cope.

Also, NHS funding rules are such that it's better to be a T1 if you are on insulin (eligibility for pumps and libres) so it's worth getting the correct diagnosis because they'll probably label you T2 unless proven otherwise. (Though honestly given that T2 is way more common than T1 and that you are forced onto quite a high carb diet, it's still quite likely that the tests will show you are T2. We can't diagnose on the forums.) But if you have a definite T2 diagnosis you'd be able to investigate eg the possibilities of reducing the carbs in your feed and you'll also know that your body can help out with some of the insulin you need. With a T1 diagnosis you'd know that it's lack of insulin that is the problem and just inject for your nutrition.

And there are some people who never exactly fit into a neat diabetes type box (T1., T2, MODY, T3c etc) and have to just play it by ear....

But it sounds like your team are looking after you so hopefully you'll get some answers soon. Good luck.
 
Thank you for that response - really helpful. I need to push to get the ‘proper’ diagnosis, rather than the gp just assuming T2.
 
Thank you, that is so helpful.
 
The last figure is 40% of type 1's are misdiagnosed as a type 2 at first. A few things that lead to that misdiagnosis is the fact that medications, lifestyle changes will work at first because you still make insulin for a while. Until it doesn't. A lot of people find out because they end up going into DKA or they just keep getting sicker and the changes don't work anymore. Needing insulin within the first 3 years is one of the signs of being a type 1. There is still a high prevalence of automatically diagnosing you as a type 2 at first because a majority of people with diabetes are type 2's.

So it's best to know, as treatment is different. A type 1 ends up needing insulin to survive. A type 2 might be able to make changes to control their BG levels. I'm not saying which you are, I have no idea, but it definitely is best to know, especially since you are trying to stop your insulin use and your numbers have gone up. Then you can figure out , the why and what needs to be done better hopefully.
 
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