A few questions related to hypos

[Haggar]

Hi, I myself don't have diabetes but my father has type 1 which was diagnosed 3 years ago. He gets very confused about the hypos he has and things that effect his readings. He always comes to me with questions but I can't always answer them and so desperately want to help. We don't get much medical support where we live you see. For example it took a year of frequent visits to the doctor before he ended up being hospitalised for 10 days and the diagnosis came out. So I was hoping to find some support and pick your brains (if you don't mind!).

- When on holiday his readings go low very quickly. Why does this happen simply from getting hot when he is not moving?

- How low do the blood sugars go before coma is induced? This evening he was 1.8 but he has had other hypos with far worse symptoms which makes me think on those occassions he was much lower. I am therefore curious as to how low they go before he would fall into a coma...it scares me to even think about it!

- Also, the other night he went to bed with a reading of 8, was sick, then woke up in the morning and was 11...why would this be? I would have thought it would decrease. Is it to do with the bodys reaction to being ill and under stress, with stress causing an increase in blood sugar?

Sorry for the questions! I hope I am asking them in the right place.

 

[Copepod]

Welcome to the forum, Haggar - and your father would be most welcome, too.

- Hot weather increase the speed at which the body absorbs insulin (probably because blood flow to sub cutaneous fat (just under skin) increases, and that's the layer into which insulin is injected. Many people do reduce their insulin doses in hot weather.

- Severity of symptoms (which a person feels themselves) and signs (which can be observed by another person) do not exactly correlate with blood glucose levels - many people find that they feel worse when blood glucose levels fall rapidly than gradually, and others find that gradual drops mean they may not notice until they get lower. So, basically, most people notice before they fall into coma - but might need help to get sugar into their hands then mouths, and if semi conscious (able to swallow, but not able to open packet) might need a glucose gel. If unconscious (unable to swallow), they might need glucagon injection, which can only be given by another person. Personally, I've never needed help from any other person to dea lwith low blood sugar, which is good, as needing help has implications for driving licences.

- Yes, stress and infection both increase blood glucose, which is why it's important not to stop taking insulin, even if not eating - adjusting dose might be needed. For further information, search for type 1 diabetes sick day rules

 

[Northerner]

Hi Haggar, welcome to the forum 🙂 I would suggest a great asset to you would be a copy of Type 1 Diabetes in Children, Adolescents and Young People by Ragnar Hanas. It doesn't matter what age your father is, it is relevant to all Type 1 people - I'm 53! - and it covers just about everything.

What insulin regime is he on - how many injections and which insulins? If he is having such drastic hypos (and a 1.8 is very drastic 😱) then he must be injecting more than he needs for the food he eats, or eating the wrong food at the wrong time. Hypos are almost inevitable if you want to keep good control, but they should only be mild and infrequent if you learn how to match your insulin doses to the carbohydrate in your food.

I don't know how low you need to go to fall unconscious, I suspect it can vary to some extent and can depend on whether your body is able to stop the fall by reacting and releasing stores of glucose from the liver. I've had a 1.7 and felt fine, but last week had a bad one where I almost collapsed. Do you have a glucagon kit in case he does fall unconscious? How old is he?

Heat often makes people go low because it allows faster absorbtion of the injected insulin. Illness and stress usually raise blood sugar levels because stress hormones make the liver release glucose into the blood.

Sorry for all the questions, hope I have been able to answer some of yours!

Please ask any question here - nothing is considered 'silly' and there will always be someone to help 🙂

 

[Mark T]

Welcome to the forums Haggar 🙂

Hopefully someone more knowledgeable will help answer your questions.

I can however confirm that stress does make your BG readings go up and since illness causes stress it will cause them to go up.

Although, there is a bit of "Your Milage May Vary" here - when I had a bug that gave me a fever for 24 hours (norovirus?) I actually found myself going low!

 

[everydayupsanddowns]

Hello Haggar

Another welcome to the forum!

The unexpected rise overnight could well be stress related (adrenaline promotes the release of stored glucose in the body), but it is also not uncommon for people with diabetes to notice a general 'boost' in BG numbers in hours around dawn/rising, often referred to as Dawn Phenomenon.

 

[Haggar]

Thank you all so much for responding so quickly!!

I think all my questions have indeed been answerd! It is so wonderful to get some answers coming from first hand experiences (although obviously it is not wonderful having the experience, lol).

He is 58 and so was diagnosed when he was 55 which is really strange. He eats 3 times a day with an afternoon snack. He has 17/18 for an overnight injection and takes 6 breakfast, 6 at lunch then 8 at supper. His readings average a 5 I think. But sometimes he has highs which indicate the injection didn't work. These are rare though! There have been two hypos that stick in my mind as the worst - he was unable to walk and unable to open his lucazade. His mouth hung open, he was pouring with sweat and he couldn't speak properly. This is when I get scared. For these situations would I need to have the injection handy? Where do you get them from? normally I make him sit, drink a sugar solution, eat 3-5 jelly babies then give him something more substanial so he doesn't crash. Oh yeah, and I try to cool him down.

Thank you all again for the welcome and answers!!

 

[MaryPlain]

Thank you all so much for responding so quickly!!

I think all my questions have indeed been answerd! It is so wonderful to get some answers coming from first hand experiences (although obviously it is not wonderful having the experience, lol).

He is 58 and so was diagnosed when he was 55 which is really strange. He eats 3 times a day with an afternoon snack. He has 17/18 for an overnight injection and takes 6 breakfast, 6 at lunch then 8 at supper. His readings average a 5 I think. But sometimes he has highs which indicate the injection didn't work. These are rare though! There have been two hypos that stick in my mind as the worst - he was unable to walk and unable to open his lucazade. His mouth hung open, he was pouring with sweat and he couldn't speak properly. This is when I get scared. For these situations would I need to have the injection handy? Where do you get them from? normally I make him sit, drink a sugar solution, eat 3-5 jelly babies then give him something more substanial so he doesn't crash. Oh yeah, and I try to cool him down.

Thank you all again for the welcome and answers!!

Hello Haggar, you get the glucagen injection on prescription from your GP. They last quite a while if you keep them in the fridge, I've had mine put on my repeat prescription, but they keep taking it off on the grounds that I haven't ordered one for a year! It is worth asking your Dad's diabetes nurse if you can have an out of date one to practise with, this will make you more confident that you could use it in an emergency. My husband only had to use one once with me and he was trying to read the instructions and work out what to do while I was thrashing about in a hypo-induced frenzy! It sounds funny when he relays it but I'm sure it didn't feel that way at the time!

In practice when I've had bad hypos in the past my husband can usually get me to sip ribena through a straw - it's only when completely unconscious that he had to resort to the glucagen.

Just one thing though, apologies if you already do this but I wasn't sure from what you said: when following up your Dad's jelly beans/sugar, make sure you don't give him the longer acting carbs until he's fully recovered, as these can slow down the action of the fast acting ones.

It sounds as if your Dad is on fixed injections to cover his meals, which means that unless he always eats the same amount of carbohydrate for each meal, he is bound to have highs and lows. The references you've been given by others are a great way to find out how to do match insulin doses to carbs and give better control. Good luck!

 

[Northerner]

...He is 58 and so was diagnosed when he was 55 which is really strange. He eats 3 times a day with an afternoon snack. He has 17/18 for an overnight injection and takes 6 breakfast, 6 at lunch then 8 at supper. His readings average a 5 I think. But sometimes he has highs which indicate the injection didn't work. These are rare though! There have been two hypos that stick in my mind as the worst - he was unable to walk and unable to open his lucazade. His mouth hung open, he was pouring with sweat and he couldn't speak properly. This is when I get scared. For these situations would I need to have the injection handy? Where do you get them from? normally I make him sit, drink a sugar solution, eat 3-5 jelly babies then give him something more substanial so he doesn't crash. Oh yeah, and I try to cool him down.
Thank you all again for the welcome and answers!!

I was 49 when diagnosed - it's not as unusual as you might think 🙂 I think, as Mary suggested, the main problem is that he is taking the same amount of insulin for his meals, regardless of carbohydrate content. If, fr example, I have curry and rice there is quite a lot of carbohydrate there in the rice, but if I have a cheese omelette then there is virtually no carbohydrate - if I gave myself the same insulin dose for both meals the omelette would certainly result in a very low blood sugar. I would suggest asking the DSN what education is available in your area so that he (and you!) can learn how to 'carb count'. This is a method of varying your insulin doses to match the carbohydrate content of your food. Diabetes UK have a free Carb Count e-book which should give you a good idea of what it is all about, but it is best if you can attend a course so that you can ask questions and tailor things to your father's requirements (they usually let a partner or carer attend also). DAFNE is one of the best-known courses, but there may be different ones in your area. There is a full online course available (free) at:

http://www.bdec-e-learning.com/

This will make such a difference to your father giving him a lot more flexibility and understanding and should save you a lot of worry by hopefully making hypos few and far between, and when they happen quick and easy to treat 🙂

 

[Haggar]

Thank you once again! All these sources are great, wow. My daddy eats pretty much the same thing every day! He has the same breakfast and lunch but he does change his insulin for supper sometimes. He has been on a day training about carb counting but he didn't really understand. I was unable to go as I am studying in London and he is up in Durham. When I am home I cook all his suppers and make special snacks for him but when away...well it can fall apart.

Maryplain - I didn't know that! I usually give him some brown bread once his is able to speak normally but in hindsight I think I have been doing it too quickly.

Northener - I will definately look at the online course and carb counting book, thank you.

Having more knowledge really does help dispel worry! I am so glad I found these boards.

 

[Northerner]

Thank you once again! All these sources are great, wow. My daddy eats pretty much the same thing every day! He has the same breakfast and lunch but he does change his insulin for supper sometimes. He has been on a day training about carb counting but he didn't really understand. I was unable to go as I am studying in London and he is up in Durham. When I am home I cook all his suppers and make special snacks for him but when away...well it can fall apart. ....

Part of the problem might be taking into account pre-meal levels then, plus other variables such as prior activity levels (going for a long morning walk before lunch, for example, would make him more sensitive to his insulin, so he might need less), or whether he plans post-meal activity (doing the garden in the afternoon always means I need less insulin at lunch or I will drop low). It can all appear very complex to begin with, but once it clicks you soon get used to making the necessary tweaks in doses and it becomes second nature (most of the time! 😉)

 

[PattiEvans]

Haggar

When your daddy has these snacks are they very low carb? Otherwise they are likely to send him high if he doesn't inject for them.

 

[everydayupsanddowns]

Interesting point Patti. It occurred to me that when you mentioned injections 'not working' that might just be a higher than normal meal carb-wise. Not to say that some injections don't work in some people (if they hit scar tissue for example) but the lack of measured-carb meals seems more likely somehow.

 

[schmeezle]

Hi and welcome Haggar,
I can only effectively comment to one of your questions.

In higher-than-normal heat, I think it's a cooling problem for the body. In it's attempt to cool because of high temps, the body burns more carbs - if this hasn't been accounted-for in insulin dosage (reductions - there are options), it could explain the holiday lows.