Advice on low BS level please

[Bazzlejet]

Hi all, yesterday i was pottering around indoors, did some house work, nothing strenuous, but i felt a bit 'different'. I did a test and it read 4.0 - this is the lowest i've had. I kinda panicked a bit and dug through the cupboards to find a packet of salt & vinegar crisps and a few Jaffa Cakes. Then, hiding at the back of the cupboard was a bag of Skittles, so i necked a handful of them too (i remember reading on here that someone carries them whilst out on walks).

The issue is i have no idea why my BS dropped that low. I am religious with my diet now, which is pretty regimented and seems to be working well, as my readings are now within range. After physical exercise, I've not had a problem at all. I was concerned that staying on Gliclazide might keep lowering my BS, but my Dr wants me to stay on it for the next 2 months 😱

Any thoughts and suggestions would be much appreciated. Thanks for reading.

PS i'm on 3 x 500mg Metformin (soon to be 4) + 2 x 80mg Gliclazide

 

[Inka]

Hi @Bazzlejet Gliclazide can cause hypos so you did right to treat it. You probably over-ate treating it - understandably because you were worried. The best thing would be to go for something sweet eg Dextro tablets or a couple of jelly babies then retest after 15mins.

I’d make a note of this so you can tell your doctor if it keeps happening. So note down the day, time of day, and when you’d last eaten and what you’d eaten, along with when you last took the Gliclazide.

You did absolutely the right thing testing.

 

[trophywench]

Well - were you not already diabetic, 4.0 wouldn't be anything unusual but you are correct in wondering about the dose of Glic. Since no-one knows when it will cause your pancreas to chuck out more insulin or how much extra it will produce - it's difficult. I'd highly recommend testing your BG a bit more often after the two meals when you take it.

You know after your little carb fest, how long did it take your BG to increase and how much higher did it go?

 

[Kaylz]

Well Glic can cause hypo's so if they do occur just treat it and move on, you may get away with just 15g fast acting carbs and test after 15 minutes but you may find you need more after those 15 minutes, skittles alone as the first treatment would have been a better idea, if low 4's you may get off with taking say 1 Lift tablet to stop you going lower or even just a biscuit

Hope your feeling better, "hypo hangovers" can be dreadful xx

 

[grovesy]

From experience it is very is overtreat, so I used to do the bare minimum and check after 15 minutes.

 

[Ljc]

Yes I agree it is very easy to over treat a hypo , I call it the hypo hunger.
In my early days on insulin I have been known to feed from the fridge and cupboards when hypo which if course sent my BGs hyper (high)

When hypo it’s best to treat with 15 ish g of fast acting carbs , wait 15 minutes then test again , if still hypo treat and test as before till you reach 4.0 . Yes it can mean you sit there chewing your nails rather than stuffing down too many carbs , I’ve got the T shirt , I guess that all of us on insulin have lol.
Fast acting carbs include things like , glucose tablets jelly babies, a small (mixer can of full sugar coke, about 150 ml of juice
Anything fatty is not good as it slows the absorption of carbs down.

For 4.0 I would have tried a biscuit .

 

[Ljc]

Oops meant to say , if you keep having hypo’s, you may need to reduce your Glipizide but this should be discussed with your nurse first,

 

[everydayupsanddowns]

Well done for treating your low BG promptly @Bazzlejet, but yes the ‘15 rule’ is a good thung to have in your mind when the hypo munchies strike, as your brain will most likely be screaming at you for food.

I agree with others that starting with skittles would be better. A small handful 12-15 would be plenty, then recheck in 15 minutes.

Hope you can get to the bottom of it, and manage to chat things through with your Dr or nurse.

Have you lost weight since your last checkup?

 

[Bazzlejet]

Hi all, many thanks for your replies.... much appreciated. And thanks for the tips, i've taken them onboard.

Just for clarity, i'm pretty sure i didn't have a hypo, as i had no symptoms and felt fine, i just 'knew' my levels were low, if that makes sense. I tested through the night last night, as im on night shifts again, and the lowest i hit was 4.6 at midnight and with a high of 6.7 at 6am as i got ready to leave work. So i think everything is working well ?!

Unfortunately i haven't got a diabetes nurse, i've only spoke to my GP nurse who gave me some leaflets and a website link. I will contact them today and ask for a number for the diabetes nurse.... i feel this is quite an important contact that i'm missing !

You know after your little carb fest, how long did it take your BG to increase and how much higher did it go?

I didnt know about the 15 rule, so i didnt test until hours after, me bad - so the sequence was @ 16:00 i tested 4.0, had my binge, then tested @ 20:00 with a 7.2 (2hrs after my evening meal). Before bed i tested again @ midnight with a 4.7.

Have you lost weight since your last checkup?

Yes, i have, but that was one of the issues that triggered me contacting the Dr - since before Christmas i've lost a smidge under 2 stone without trying, and infact was eating and drinking more than ever over the Christmas period. I've had other tests and scans which have come up clear, so the Dr thinks its just down to the diabetes.

Thanks again everyone for your advice and help 🙂

 

[stillgoing]

Suggest you bring the skittles if that is your choice to the front of the cupboard or somewhere where you can get to easy. Brain doesn't work very well when hypo. Do resist eating your hypo food though🙂

 

[rebrascora]

I would go so far as to bag them into 15g carb portion sizes (I do this with jelly babies) and stash them in various places throughout the house, particularly the bedside cabinet and of course in the car and coat pockets etc. These small packages of skittles or jelly babies are off limits to anyone else in the household and should be considered much like medication in that they should only be eaten by the diabetic person when the need arises, whereas Skittles in their original bag in the cupboard are fair game to anyone finding them. You can even mark the bags "Hypo treatment" "For emergency use by "Bazzlejet" only!" so that anyone finding them isn't tempted. It is critically important to have some handy wherever you are as hypos can creep up on you suddenly and you don't want to be negotiating stairs in the middle of the night whilst you are disorientated by a hypo, looking for something to bring your levels back up.

 

[stillgoing]

My wife has placed jellies in easy to open plastic boxes. Unless I am walking around I can reach a box! I also have dextrose sweets in my pocket. They tend to go out of date because I rarely have a hypo. I think they taste terrible. Not sure if this is because they are out of date or because I'm in hypo. I also dislike jelly beans. I think that it is the fine sugar coating so I tend to have Sainsburys jellies which have a courser sugar on them in my boxes. Anyway as long as you have something to hand and you can resist eating them when not needed.

 

[Kaylz]

Just for clarity, i'm pretty sure i didn't have a hypo, as i had no symptoms and felt fine

4.0 is the floor as the saying goes, also if you spend a lot of time in the 4's etc (I'm assuming it would be the same for a Type 2 on Glic anyways seen as it can cause hypo's) then you can develop loss of hypo awareness, been there a few times myself, functioning normally at 3.0, sleeping through lows etc, certainly not what anybody wants!

I've had other tests and scans which have come up clear, so the Dr thinks its just down to the diabetes.

The Dr thinks what is just down to the diabetes? Type 2 isn't generally associated with weight loss, what made it a Type 2 diagnosis? xx

 

[grovesy]

See, this is what puzzles me about my particular situation. I went to my GP because of unexplained weight loss and when my results came back and I saw the DN she said I was presenting as Type 1, but she wasn't sure and sent me away with a prescription for Metformin. Fast forward 6 weeks and she says my BG is looking good and I can stop taking it and see how I get on with just diet. Well, as it's turned out, I'm getting on just fine and I stopped losing weight despite going low carb. I'm still on file as Type 2 but I sometimes wonder if I'm actually in some sort of diabetic No Man's Land, if there is such a place. My DN certainly made a couple of big calls.

Some with LADA or 1.5 seem to initially respond to Type 2 management, some for even a few years, before they can no longer control.

 

[Inka]

See, this is what puzzles me about my particular situation. I went to my GP because of unexplained weight loss and when my results came back and I saw the DN she said I was presenting as Type 1, but she wasn't sure and sent me away with a prescription for Metformin. Fast forward 6 weeks and she says my BG is looking good and I can stop taking it and see how I get on with just diet. Well, as it's turned out, I'm getting on just fine and I stopped losing weight despite going low carb. I'm still on file as Type 2 but I sometimes wonder if I'm actually in some sort of diabetic No Man's Land, if there is such a place. My DN certainly made a couple of big calls.

How long ago did you first go to your GP? I know a lady who was diagnosed as Type 2, treated it with diet for years, had some Type 2 meds added - then went into DKA and was diagnosed as Type 1.

Have you had the antibodies test and C peptide?

 

[Inka]

Two years ago come March and no, I haven't had the GAD or C peptide tests. I did ask my GP about them back in June 2019 but he didn't see the need. He sent me for a CT scan on my pancreas, though. It got a clean bill of health, if that means anything.

I don’t know if the pancreas scan means anything or not as regards diabetes, but it’s good it’s healthy anyway 🙂

With your history and slim weight, I’d be pushing for the antibodies test (I had one that looked for 4 antibodies) and the C Peptide test personally. Partly because I’d want to know for sure what type I had, partly because it would inform the way I moved forward with regard to meds, and partly because it would prepare me for the future. Some Type 2 meds are not a good idea for Type 1s. There’s also some evidence that early introduction of insulin preserves remaining beta cells longer in Type 1s.

 

[Kaylz]

@Anitram to be honest I have always wondered about you as your hba1c was so high, higher than mine so I have often wondered if you were LADA, sorry for the late response been busy lol xx

 

[trophywench]

Wouldn't surprise quite a few of us, Kaylz!

 

[rebrascora]

@Anitram I'm another one who has always doubted your Type 2 diagnosis and silently half assumed LADA.

The only thing that would make me wary of GAD and C-peptide at the moment is that you manage your levels very well on a moderately low carb diet (rather than very low carb) so I am guessing you are producing a reasonable amount of insulin still and it may be that you will not show GAD antibodies either at this stage, so you might find both tests inconclusive at this time. That might mean you have difficulty getting them repeated at a later date when/if things progress, so personally I would hang fire with asking for them now unless your levels start to slide. Also, GPs are unlikely to be able to interpret the results of those tests unless they have a lot of experience with diabetes because they are not always clear cut, particularly in borderline cases like yours. I know one of mine came back borderline.
Personally, I would continue as you are doing and keep monitoring so that if things change you will spot it quickly and then be in a position to ask for further testing at a point when hopefully the result will be more likely to yield an outcome....
.... just my thoughts.

 

[Docb]

The way I look at it is that people like @Anitram, myself and others who are not overweight and keep their diabetes under control by diet, exercise and possibly low level medication, is that our pancreatic function is impaired for some reason or other. Maybe due to auto immune problems, maybe due to ageing, maybe due to something else.

What is going on may well be far more complicated than the simple labels imply. As such I am, as you all regular readers will be aware, very wary of attaching simple labels to things.