Glucagon or Ambulance? Which is better?

[Anna1]

Hi, sorry to jump in but I'm a type 1 diabetic and have been reading about Addisons recently but the symptoms were quite vague unless you were in serious condition. I have lost 1 1/2 stone in weight over a year (majority out of choice) and the last 3 months I've gone from having 48 units of Levemir in the morning to 17 units of Tresiba at night and my BG always keeps dropping around 5pm right the way through to 3am and I always have to go to bed on 10 or 11 to wake up on 7. I am tired all the time, my last blood pressure reading was 97/71 which is on the low side and I sometimes get dizzy when I stand up quickly after sitting down but this disappears quickly once I start moving around. I have no aches and I don't vomit. I get hot flushes in the morning and my BG does go up when I eat but if I have a hypo it can take a while to register but then my BG will go up from about 4 to 15 but it can take 30-40 min. Could this be the beginning of Addisons as just don't understand why my BG always drops in the afternoon. I am pushing to be tested for that (to rule it out if nothing else) but apparently it takes 2 weeks to get the test and another 2-3 weeks for the result and worried that symptoms will get worse during that time as I live alone as well. Obviously, your conditions before being diagnosed seem a lot worse but just don't know what to do? Hypos at the moment scare me and really having issues living on my own at the moment - Thanks

 

[HOBIE]

Hi, sorry to jump in but I'm a type 1 diabetic and have been reading about Addisons recently but the symptoms were quite vague unless you were in serious condition. I have lost 1 1/2 stone in weight over a year (majority out of choice) and the last 3 months I've gone from having 48 units of Levemir in the morning to 17 units of Tresiba at night and my BG always keeps dropping around 5pm right the way through to 3am and I always have to go to bed on 10 or 11 to wake up on 7. I am tired all the time, my last blood pressure reading was 97/71 which is on the low side and I sometimes get dizzy when I stand up quickly after sitting down but this disappears quickly once I start moving around. I have no aches and I don't vomit. I get hot flushes in the morning and my BG does go up when I eat but if I have a hypo it can take a while to register but then my BG will go up from about 4 to 15 but it can take 30-40 min. Could this be the beginning of Addisons as just don't understand why my BG always drops in the afternoon. I am pushing to be tested for that (to rule it out if nothing else) but apparently it takes 2 weeks to get the test and another 2-3 weeks for the result and worried that symptoms will get worse during that time as I live alone as well. Obviously, your conditions before being diagnosed seem a lot worse but just don't know what to do? Hypos at the moment scare me and really having issues living on my own at the moment - Thanks

Welcome Anna 1. I am sure someone will be along shortly who will know some answers for you. Have you spoken with your DSN or specialist ? 🙂

 

[LorraineP]

Anna, I'm glad you jumped in. I would like to discuss this with you but I've just sat down to eat and my BG is low! Once I get myself sorted out I'll be in touch!

 

[Anna1]

Hi, Yes they think it is unlikely that it is Addisons but have agreed for me to get the test but it means waiting on the NHS to ring me and book me in which apparently will take 2 weeks. My main symptom is the unexplained BG drop in the afternoon but I am not having hypos so severe that I end up in hospital (fingers x it doesn't progress) just a steady drop every evening and obviously a huge change in my insulin levels from the previous 10 years.

 

[LorraineP]

Hello Anna, like you my insulin levels have dropped significantly over the past 2 years. This time two years ago I was on 36 units of Lantus which, thanks to hypos, I slowly had to reduce to 20 units by the time I got my pump a year ago. Since then I've dropped my basal further to 13u, so I'm now on one third of the basal rate I was on two years ago!!! Also my I:C ratio used to be 1:1 across the board. It's now 1u:20g in the morning (sometimes 1:30) and 1:15 at other times. So my insulin needs have changed dramatically but a recent cortisol test showed that my levels were normal. I don't have Addisons.

Like you I have weight loss, fatigue, dizziness on standing up. I also have vomiting.

I've recently been diagnosed with gastroparesis which could explain my hypos but I do cater for slow digestion on the pump by using combo boluses. Also, I often wait until my BG rises after eating before I bolus. These are just techniques I've adopted to protect myself. I'm not saying it's the right way to do things but as you know you have to do anything to stop hypos when you live alone.

However I've also been recently diagnosed with a condition called Pancreatic Exocrine Insufficiency or PEI for short. This is where the pancreas doesn't enough enzymes needed to digest food. Most doctors associate it with heavy drinkers or as a result of pancreatitis or pancreatic surgery or cancer. However none of these factors apply to me.

Last year I did some research because I couldn't understand why I was having so many hypos some weeks then at other times I would have days where my BG would run high. My DSN was very unsupportive. So I went to Dr Google and I came across this article http://www.thejournalofdiabetesnursing.co.uk/media/content/_master/3857/files/pdf/jdn18-8-320-3.pdf which I can't create a link to.

In short the article suggests that perhaps 50% of Type 1 diabetics may have PEI caused by atrophy of the pancreas which in turn could be caused by lack of insulin production. This can lead to malnutrition, sickness and variable blood sugars as well as unpleasant bowel symptoms which thankfully I don't have!!! The research discussed in the article was based on a very small study but suggests that more research should be done and PEI should be considered in diabetics with symptoms.

PEI can be diagnosed by doing a faecal elastase test so I asked my diabetic consultant to do the test. The results came back confirming that my elastase levels were indeed low and so I've recently started taking pancreatic enzymes. The article says that the diabetics in the study found that the number of hypos they had fell after 16 weeks. I haven't been taking the enzymes for that long so I don't know yet if the enzymes will eliminate or reduce the number of the hypos.

I haven't had a chance yet to discuss the recent diagnosis with my consultant. But I'll be seeing him next week and I'll be interested to hear if he thinks the PEI or gastroparesis (or both) could be the cause of my hypos and vomiting.

Once the usual suspects have been ruled out and there is no obvious reason for hypos/falling insulin needs, there are of course a number of conditions that can be the cause such as Celiacs Disease, Addisons, Gastroparesis and possibly PEI. If there are other possible contenders I would be interested in hearing about them I presume that your diabetic clinic has checked you out for these conditions?

 

[Anna1]

Thanks for all that info. I have recently been tested for Thyroid and peri menopause hormones (I am 45) to see if that has anything to do with it. (haven't had results yet) I am waiting on an appointment for a Synachten test for Addisons Disease but have been told that could take 2 weeks and then a further 2-3 weeks to get the results. I have not been tested for Celiacs, Gastroparesis or PEI. The weird thing is my BG only really ever drops in the afternoon after about 5pm. It's as if my basal insulin requirements disappear after 5pm and then the basal just keeps counting down. I wear a CGM at the moment so can see what is going on which is equally terrifying when you see a double arrow going down and then rush to the kitchen to try and eat quickly and then nothing happens for about 30 mins but so far it does eventually go up. Just can't get anything right at the moment. If I reduce my basal further then will go need more novo in the morning and I am already on 1:5 ratio am but then come pm it's more like 1:12. If I take a high dose of novo around lunchtime then it just continues to drop for hours after (over 5hrs). Hope like you I don't have addisons but then again cant work out why I'm tired, have low blood pressure, dizzy when standing up, and hot flushes in the morning. Worried I will get worse before I manage to the the addisons test done as takes so long to get booked in and tested. I have asked about a pump but they want me to stay on Tresiba for longer as they say the pump is the last resort but if my basal needs vary so much I can't see how I am ever going to get on. Yesterday had a hypo after eating 46g of carbs and using the 1:10 ration and my BG plummeted within an hour. At two chocolate digestives and 3 gluco tabs but then didn't see a massive improvement so took about 30g of lucozade carbs and that means I had eaten almost 60g of carbs and after about 40 min it did go up and ended up on about 20. Then made the huge mistake of taking 3 novo shots to get it back down and it crashed straight away again so ate a banana and a snickers bar and finally settled on about 18 around 1am. The thing is it just scares the living daylights out of me when I live on my own as just have such a panic!! My family all live abroad I have great neighbours but don't want to stress them out. I had brilliant control for 10 years and now it's just gone - as I'm scared to go low I end up being high all the time - thanks so much for all your input

 

[LorraineP]

I totally understand your frustration. What you describes sounds very familiar to me. I'm a bit further down the line in terms of completed tests and some knowledge of a screwed up pancreas but I haven't had a conversation yet with a specialist who can explain exactly what's going on. Your hypo that came one hour after eating could suggest slow digestion. You may not necessarily have gastroparesis but anyone can digest a meal slowly depending on how much fat they have eaten with the meal. This is where a pump can be really useful as you can set the bolus to deliver over a longer period.

I hope you get your tests done quickly and all possible causes are checked out to give you peace of mind. It's good that your BG rises fairly quickly when treating a hypo - 30 to 40 minutes to me is positively speedy! 🙂

 

[Anna1]

Hi Lorraine, Thanks so much for all your replies. What's strange is that you've had to reduce your basal so much, if you don't have Addisons then why is your liver producing so little glucose as that's (as I understand it) is what basal is for? Think the recent hot weather is also affecting me as this morning I only took 1 unit for about 25g of carbs and although I ended up on 16 I thought I would go much higher bearing in mind a week ago I was taking 4 units for the same amount. This is why it is so unpredictable all the time. Can't judge it day by day. Does it take a long time then for you BG to rise when you have a hypo? What do you usually take for this?

 

[declan88]

Most definitely, before I was diagnosed I consumed almost 500 carbs in one day just to stay conscious and I had no insulin at all.


That's about the same as me.
I drank 400g of pop a night for 6 months and woke at 3.5-4.5mM before my Addison s was diagnosed
Please do bring this up as a matter of urgency because Addison's is life threatening if untreated.

 

[declan88]

Yes it comes under endo, but in all honesty just like diabetes it's self managing, a GP can diagnose it if pointed in the right direction.
If you have a full blown crisis you can be dead within 20 mins unless treated so please go get your self checked out.
My initial diagnoses came from my veterinary surgeon, we were gelding colts at the time and he suggested I get checked out for Addison's due to my almost constant hypo state with no insulin, the rest is history so they say 🙂

What's the difference between Addisonisn crisis and non-duagnosed Addison's!

 

[daducky88]

Hi Anne

What was your diagnosis in the end and how are you doing now?

 

[daducky88]

H

Hi Lorraine, I used to have glucagon and I live alone. I don't have it now for the simple reason I have Addison's disease so it can not be used. From what you are describing if it hasn't been done yet then please insist your GP tests your cortisol levels as a matter of urgency.

Hi Sue
I have Addison's. I don't think anybody told me not to use glucagon, since I was diagnosed with Addisons. Would mind explaining why you don't use glucagon?
Thanks

 

[daducky88]

@LorraineP

Hi Lorraine

Can I ask you what the outcome? I don't often meet another (potential?) Addison's bod.
I hope you're doing better now either way. 🙂

 

[Pumper_Sue]

H



Hi Sue
I have Addison's. I don't think anybody told me not to use glucagon, since I was diagnosed with Addisons. Would mind explaining why you don't use glucagon?
Thanks

Hello,
it says not to use it in the patient leaflet 🙂

 

[daducky88]

Hello,
it says not to use it in the patient leaflet 🙂

Well i make no recommendations for anyone else, but i used glucagon more than once with no especially adverse side fx re addisons disease or diabetes.

PS i also certainly been prescribed glucagon living along and used it.

 

[Vicsetter]

Just a minor point as no-one has mentioned it, but lucozade isn't much good for hypos anymore, april 2017 they reduced the carb content to 8.9g/100 ml. Full fat coca cola isnt any better at 10.6g /150ml little can.

 

[trophywench]

I know Vicsetter - I thought of swapping to neatish Ribena so read the back of a bottle thinking I wouldn't need more than a dessertspoon - and there's far less sugar in that too! I'd have to drink 'quite a lot'.

I haven't found anything suitable to change over to yet.

 

[SB2015]

I find that fruit juice cartons seem to fit the bill for hypo treatments at home (too bulky to carry out and about compared to JBs) I avoid cranberry as they seem to have halved the carbs in that but apple juice is still very high for the amount I need to drink. Not sure how they explain the discrepancies, but just know that I am after about 10g/100 ml.

 

[Vicsetter]

I woukd have thought fruit juices weren't very rapid as they contain fructose and not sucrose. Also coke is sugar whereas lucozade is glucose.

 

[TheClockworkDodo]

Grape juice works pretty quickly for me, and it's what I mostly use at home - I find 100g of it is about right.