Worried about Type1 husband

daisyduck said:

My husband has been type one for about 20 years now. He is on several pills and injects twice daily.
He had a stomach bug last week which sent his BG soaring way over his normal range.. It was up to 22.3 at one time.
He still isn't fully recovered from the bug but is feeling a bit better.. however his BG has been dropping steadily all day and it seems whatever he eats it is still dropping.
He started at 6.2 at 9.20am this morning and has gone down 3pm 5.8 .. 6.15pm 5.7... He was 3.9 at 8.30pm so he had a couple of chocolate digestives and a cup of tea.. Just did another test at 9.45pm and it's only 3.3.
He normally takes a Metformin 850 pill before he goes to bed.. will this lower his BG even more ? ( his last injection was at 7pm after tea.)

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The T1s will have specific knowledge about using insulin but I want to say I think he should see his diabetes team about these issues. Although he has had T1 for 20 years he may find it helpful to ask for a review of his current needs. Recently updated guidelines now say all T1s should be offered an insulin regime that involves a long acting insulin once or twice a day and a short acting insulin to be taken with meals. This regime requires calculations and so on, and they teach this at a free DAFNE or FEFI course.

We can't give advice on whether or not he should take his metformin tonight but he could call the NHS non emergency line on 111 for advice. My guess is that the insulin has been lowering his blood glucose more than the metformin would. From what others have said on the forums, I think he should test before going to bed and make sure he is above a certain level, to prevent hypos during the night. I don't know what that level is but the T1s will be able to share what their own threshold is.

Infections can send BG levels haywire for a while, for T1s and T2s.

daisyduck said:

Thank you CatLadyNZ. The doctor came to see him yesterday and was aware of the high readings. He said the same about the infection affecting BG levels.
It's only today that they have dropped so much. His normal range is 6-14 depending on what he eats.
He says he feels tired but OK and has gone to bed.. It's just me worrying that he'll have a hypo in the night.

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I can understand the worry, I would be the same. If he has a hypo while asleep, does it usually wake him up? That might provide some reassurance. You could make sure his meter and something to treat hypos is sitting beside the bed. Fingers crossed they won't be needed.

daisyduck said:

I've never known him to have a hypo problem. Probably why I'm panicking so much.
Occasionally he has got up in the night and eaten a biscuit but said that he just felt a bit hungry. There are biscuits and orange juice beside the bed.
I'll be keeping a very close eye on him !

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It may be that when his BG was dropping during the afternoon, dinner was not high enough in carbs to match the insulin dose he had. Being able to adjust the insulin dose can help at times like that. What type and dose of insulin did he have?

daisyduck said:

The packet says Humulin M3 and he dials his injection pen up to 44. Sorry if that's a bit vague.

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I'm sure the T1s will find that info helpful when they are making suggestions to you. They will know how the pens work and whether that equates to 44 units of insulin.

Humulin M3 is a mix of short and long acting insulin, and this will affect how much it reduces blood sugar and over what time period.

daisyduck said:

Thanks again.. I just checked on him.. snoring !
Did a test and it's now 4.7 so I'm a bit happier about that

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Lol, glad he's getting some sleep... and amazed he can stay asleep while being finger pricked.

4.7 is still not much of an increase, I think. I am loathe to suggest this because you need your sleep too, but if you test in, say, an hour, you may find out if his level is rising or dropping. I have read T1s saying that they sometimes set an alarm so they can check BG at around the time when they think it may be lowest. This time is harder to estimate with mixed insulin, I believe.

Another thing to note is that while his BG may drop during the night, it may increase before waking, and this is normal for everyone - it's called the Dawn Phenomenon or Liver Dump.

I'm really hoping someone with insulin experience comes along to correct me if I'm wrong and share their experience, as I would hate to put you wrong. I see that @azure is online at the moment.

daisyduck said:

He did wake up and mumble a bit about me making too much fuss. I'll check him again when I go to bed.. thanks for all your help

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Yeah, it seems common for partners/spouses to say that... but on the other hand it's natural to worry, and checking a BG is a good way to relieve this kind of worry. Hopefully he won't remember waking up, lol.

How is your husband this morning? I hope he's feeling better.

When his blood sugar was high because if the infection, were his insulin doses put up? If they were, now the infection is going that could cause drops in his blood sugar. If that's the case, you should check with his team about whether his insulin needs adjusting.

The other thing is, has he lost weight? Sometimes weight loss can mean someone needs less insulin. Was he able to eat his normal meals?

Keep testing over the next few days and see if his blood sugar settles down. If he's still having lows, then see if there's any pattern to them - ie if they're always happening at a certain time.