First Hypo?

[Calf00]

Hello friends

I had my first Hypo last night I think.

Looking back, my own fault I think.

I’m v newly diagnosed type 1 and have been on insulin for only four days.

i wasnt v hungry last night at supper time and I think I left my meal time too late. I ate around 8pm and I didn’t eat enough carbs now looking back ....

Around midnight I started to feel unwell. Palpitations, going v pale, pins & needles in my hands & feet, anxiety, trembling and tightness of breath/chest. Body temp dropped to 35.9 and my BP and pulse higher than normal (BP: 136/86 and pulse : 89).

BG was 7.9. On admission to hospital I was told I could have a hypo around 7 initially as I’d been so high for so long. Hospital said if BG under 4 then use fast acting sugar immediately & retest but if at 7 then have carbs and retest.

I had some carbs and retested after 15 mins. BG has raised to 14.2 but I didn’t feel any better if anything I felt worse. All same symptoms as above but worsening.

I think I made things worse because of the shortness of breath & tight chest that came from nowhere. I panicked because of Covid-19.

Nowhere in my diabetes literature could I see anything about tightness of chest/breathing issues.

I took my ventolin inhaler but that didn’t help (except to add to palpitations).

An hour later and BP & pulse had increased (151/88 and 102) and all of the symptoms were still there. I’d been expecting them to have gone after an hour. BG by this time was 21.4 and ketones were 1.

it was 0230hrs by this time and I was feeling v alone. Im looking after my 91 year old mom at the moment and no point waking her or calling my partner so I decided I was making things worse by focusing on it and i Put some rubbish TV on and tried to do some nice gentle relaxing breathing.

Woke a couple of hours later much improved. Temp ok, BP still high but not as high and pulse 71.

So, I think I had a hypo didn’t I? I also think I exacerbated it by panicking when my chest tightened and I was a bit short of breath.

Breathing is fine, good and steady today. No issues at all

Can breathing issues be a symptom of a hypo please or did I panic and cause that.

Also, should Hypo symptoms ease after 45 mins etc? Mine seemed to last way longer or again was that just me with newbie angst?

Sorry for the long message

Thank you

Jan

 

[Inka]

Hi @Calf00 Your avatar is still saying Type 2 so you might want to change that to avoid any confusion.

A hypo is roughly a blood sugar less than 4. However you can have what are called ‘false hypos’ where you feel hypo symptoms at a higher level because your body has been used to higher blood sugars thus any drop feels like a shock to it.

What insulins are you on?

 

[Calf00]

Hello Inka

thanks v much for replying. I’ve tried to change my avatar but I can’t seem to change it on my iphone (im not at home at the moment as i’m Looking after my mom). I did change my signature and put my insulin doses on there. Can you see my new type 1 signature please or has that not updated either?

 

[Calf00]

Hi @Calf00 Your avatar is still saying Type 2 so you might want to change that to avoid any confusion.

A hypo is roughly a blood sugar less than 4. However you can have what are called ‘false hypos’ where you feel hypo symptoms at a higher level because your body has been used to higher blood sugars thus any drop feels like a shock to it.

What insulins are you on?

I’m on 4 units of NovoRapid 3 times daily and 4 units of Lantus once daily

 

[Inka]

I can see your new signature now @Calf00 🙂

When you say you had a late evening meal, do you mean you left too big a gap between your Novorapid injection and the time you ate?

And do you count carbs?

When I was first diagnosed, I found it helped a lot to keep meals very similar in the early days so I could see how my insulins worked. I also did lots of blood tests and also wrote down what I ate so I could spot any patterns and learn from them.

Regarding your breathing issues, I’ve had palpitations and felt a little breathless when I’ve had bad hypos (ie a number well below 4) and I’ve also felt similar when my blood sugar dropped very quickly, even if the number it ended up at wasn’t too low, if that makes sense. It was the quick drop that made me feel bad.

Perhaps this is what happened with you?

 

[Bruce Stephens]

Regarding your breathing issues, I’ve had palpitations and felt a little breathless when I’ve had bad hypos (ie a number well below 4) and I’ve also felt similar when my blood sugar dropped very quickly, even if the number it ended up at wasn’t too low, if that makes sense.

And panicking is normal in that kind of situation (especially now, when we're all unusually alone).

 

[Calf00]

I can see your new signature now @Calf00 🙂

When you say you had a late evening meal, do you mean you left too big a gap between your Novorapid injection and the time you ate?

And do you count carbs?

When I was first diagnosed, I found it helped a lot to keep meals very similar in the early days so I could see how my insulins worked. I also did lots of blood tests and also wrote down what I ate so I could spot any patterns and learn from them.

Regarding your breathing issues, I’ve had palpitations and felt a little breathless when I’ve had bad hypos (ie a number well below 4) and I’ve also felt similar when my blood sugar dropped very quickly, even if the number it ended up at wasn’t too low, if that makes sense. It was the quick drop that made me feel bad.

Perhaps this is what happened with you?

Hi Inca

There was only about 10 mins gap between my NovoRapid last night and my meal but it was quite late at night (8.30pm) & I wasn’t v hungry and so I had a big portion of mixed nuts, a yoghurt and an apple (goodness knows why! I haven’t fancied an apple for decades!). Too low on carbs.

I have palpitations again now and im registering 21.1 BG two hours after breakfast. My breakfast was two pieces of seeded wholemeal bread and two tbls spoons crunchy peanut butter. Approx 42 carbs according to my “carb & calorie counter” book. I hoped for better numbers today but my waking BG was 16.2 so I suppose it’s not gone up too much with that meal.


Jx

 

[Thebearcametoo]

Hi, you’ll be feeling rough with those numbers. Did they talk to you about how to adjust your insulin to your carbs? When you’re newly diagnosed they often don’t want to bring your glucose levels down too quickly into the 4-7 target range as your body has been used to running higher but you will feel better if you can stay around 10. Anything over 16 should be treated to bring you down into that 4-10 range. Novorapid peaks around an hour after injecting and whilst there will still be some effect for a couple of hours after that you’re still not having enough insulin for your carbs & starting glucose level to correct it down to a good level. Do you have a diabetic nurse who you can call? Being over 16 for any length of time may be a sign that your insulin levels aren’t right or it may be a sign of impending illness. Either way you need a little more support to get those numbers down so you feel better. If you can call your nurse then do so.

 

[Inka]

Hi Inca

There was only about 10 mins gap between my NovoRapid last night and my meal but it was quite late at night (8.30pm) & I wasn’t v hungry and so I had a big portion of mixed nuts, a yoghurt and an apple (goodness knows why! I haven’t fancied an apple for decades!). Too low on carbs.

I have palpitations again now and im registering 21.1 BG two hours after breakfast. My breakfast was two pieces of seeded wholemeal bread and two tbls spoons crunchy peanut butter. Approx 42 carbs according to my “carb & calorie counter” book. I hoped for better numbers today but my waking BG was 16.2 so I suppose it’s not gone up too much with that meal.


Jx

As said above, you need to strike a balance between getting your numbers down and not getting them down too fast. I’d speak to your DSN, ask them:

1) what your target blood sugar levels are?
2) ask if you should correct high blood sugars and if so how much 1 unit of Novorapid will lower your blood sugar?
3) and also tell them your morning blood sugar level (before eating) and ask if your basal insulin should be increased eg they might suggest you up your Lantus to 5 units.

The easiest thing to do, for breakfast and lunch at least, is to eat pretty much the same for each of those every day so you can see how your insulin works. This will help you and your team work out appropriate doses. So, boring as it is, don’t swap your food around. Stick with say, 2 Weetabix for breakfast plus 150ml milk, and then a sandwich for lunch (look at the bread carbs on the packet as it can vary) with various non-carby fillings and a piece of fruit like an apple (approx 15g carbs for one medium apple). Those are just suggestions. Keeping those meals the same will help you gradually get your doses right by removing a big variable (the food you eat).

If you can do the same with your evening meal, that’d be good. Although in the future you’ll be able to be more flexible, in the early days keeping things simple and regular helps a lot.

 

[Inka]

The 10 min gap between your Novorapid and eating should be fine. Your blood sugar levels are quite high so this will be making you feel rough. That’s why it’s important to know what level you’re aiming for initially.

I’m not sure about your palpitations. If you’ve been checked over by medics then you should be ok. Starting insulin is a big change for your body physically and mentally, so it could be that. Test your blood sugar lots, try to get a routine for food as above. Keep hydrated - especially if your blood sugar is high. It is scary to start with but you’ll gradually get the hang of things. X

 

[DaveB]

Hi. It sounds like you are not carb counting i.e. adjusting the Bolus insulin to match the carbs in the meal. For some strange reason the NHS delays providing this advice leaving patients at risk of having a hypo. Do ask the DN to explain it to you if needed.

 

[trophywench]

At a guess I'd think it more likely frankly that to begin with 4u of Lantus is not likely to be sufficient to do very much at all for you! We're all requiring insulin dripping in every minute of every day and night and that's why we use basal insulin as well as bolus.

Ring your diabetes clinic nurse pdq and ask how much to increase it by - usually I'd suggest trying 1u at a time, or a mx of 10% of the dose, but that's for people who are already taking more - at least in the teens if not more.

If you can't quickly get hold of anyone medical who can help, I'd ask you to basal test, as follows -
https://www.diabetes-support.org.uk/info/?page_id=120 - and see what you discover your BG is actually doing.

 

[SB2015]

I started on fixed doses when diagnosed, but was soon pestering my lovely DSN to help me work out how to make adjustments to suit what I was eating.

Well worth talking to your DSN, as I suspect that you are feeling rough because of high levels.

 

[Deleted member 25429]

At the beginning my DSN said if I was above 8 in the morning increase lantus by one unit, she said this was a general rule . It is all trial and error and confidence. You’ll get there and with the knowledge and support from this forum you will get control you want

 

[Calf00]

Thank you v much Freddie. I managed to speak to the Diabetic Nurse at the hospital yesterday and he suggested exactly that.

I’m now taking 5 units of Lantus in the morning. Four units of novorapid before before breakfast and lunch and two units of novorapid before dinner.

Not feeling great today I must admit. BG was 8.2 on waking and has gone up since breakfast. It’s the tingling in my hands and feet and the palpitations that are so unsettling. BP is going up too. Will try to speak to the nurse again.

thank you.

jan

 

[Deleted member 25429]

Thank you v much Freddie. I managed to speak to the Diabetic Nurse at the hospital yesterday and he suggested exactly that.

I’m now taking 5 units of Lantus in the morning. Four units of novorapid before before breakfast and lunch and two units of novorapid before dinner.

Not feeling great today I must admit. BG was 8.2 on waking and has gone up since breakfast. It’s the tingling in my hands and feet and the palpitations that are so unsettling. BP is going up too. Will try to speak to the nurse again.

thank you.

jan

Are you carb counting ? That will help adjust your novarapid to your actual need . Have they told you that you need to adjust doses based on what you are eating . In the morning I always need more insulin due to the dawn phenomenon. This is all trial and error as we are all different. Keep testing and you will see what each good group does to your levels . Potatoes in any form I avoid now as they just spike my bg levels and then drop off really quickly . But I can eat pasta and rice easily although I don’t choose to eat it very often . It’s very tiring when you have high sugar levels and you just feel drained. Hope things improve for you x

 

[Calf00]

Thank you Freddie

yes, I am carb counting. I started when I thought I was type 2 and im having about 130/140 carbs daily. Because I was only diagnosed type 1 a week ago ive not really had any diet advice or education from the hospital Other than to split my carbs evenly throughout the day (40/50/50) etcetera and if i want a snack to make it a 10 carb snack or lower.

thank you for your kindness

jx

 

[Deleted member 25429]

Thank you Freddie

yes, I am carb counting. I started when I thought I was type 2 and im having about 130/140 carbs daily. Because I was only diagnosed type 1 a week ago ive not really had any diet advice or education from the hospital Other than to split my carbs evenly throughout the day (40/50/50) etcetera and if i want a snack to make it a 10 carb snack or lower.

thank you for your kindness

jx

The first thing my consultant said to me was ... low carbs = less insulin= less chance of an error . In time you’ll be able to match your insulin to your eating . ( by the way Freddie is my dogs name I am a woman x)

 

[Inka]

@Calf00 Getting your basal dose right is a good first step. It might need to be increased more (gradually). Once you have that at a more suitable dose for your body’s needs, you can then work with your DSN to sort out your Novorapid doses and work out your insulin to carb ratio for each meal. This isn’t as hard as it might sound.

The tingly hands and feet could be related to your blood sugar. Did you mention the palpitations to your nurse? Could these and your blood pressure be being made worse by understandable anxiety? If so, then know that Type 1 is stressful early on, but that it does get easier. You learn what works for your own body - how much insulin you need, how exercise affects you, etc We have to learn to basically be our own pancreas. Take each day as it comes and go slowly. It’s far better to be cautious than panic and change things quickly and all at once.

 

[mikeydt1]

just saw this, i am type 2 on medications and got so used to my BG been in the highs when i did have a hypo i simply thought my BG was high but the symptoms were wacky to say the least. i was very fortunate that a NHS nurse was here when it was happening and knew what to do.

got say that that the swing from high to low did catch me out.