Controlling yourself during a severe hypo?

[nonethewiser]

Well Your Diabetes May Vary, but many members find their insulin needs ebb and flow during the year, and often warmer months and longer days seem to associate with increased insulin sensitivity and a need for lower doses. Like many things with diabetes, it’s very individual though. 🙂

That's me, less insulin in warmer months than colder ones, isn't big difference probably reduction of 4u or so per day.

 

[Proud to be erratic]

Me too, I need less insulin as the warmer weather comes along (or when staying with my family in Gibraltar). Its extremely noticeable on my Tresiba basal, albeit the change is modest: 8.5 units for the warmer weather and 9 for the colder weather is my current trend.

A bit harder to identify from my bolus doses, since they are very variable anyway as I let my G7 app tell me where I am and correct accordingly with snacks, activity or bolus. No dog to take for walks and no other noticeable repeat activities - so better weather = incentive to be outdoors and more active. But I'm invariably doing something at least mildly physical most waking hours; hence spotting a bolus change pattern is not straightforward.

Returning to your original post, @Austin_98, I spent much of my first 12 months on the hypo/ hyper roller coaster, with very little time in between. No CGM, so only FPs to know where I was BG-wise. I found when hypo there was a fairly desperate internal demand to eat - something, anything. Which I did and that of course worsened the severity of the roller coaster. I suspect I also worsened my roller coaster effect by over correcting my hypers; it does take time to get corrections right anyway and I think trial and learning is essential.

But, once I had CGM, I realised that:

Even when hypos were deep, frightening and horrible - I was still alive afterwards; i.e. I WAS able to stay in control.​

That helped me calm myself and make a determined effort to resist that urge to binge eat as a hypo response. I made the 15/15 rule become more of a 12/20 process: 12 gms of carbs and wait a full 20 minutes. Then assess and repeat if necessary.​

Then as the hypo rescinded and while still in the 6s I made myself get a bit active indoors and gradually outdoors walking for lengthy periods.​

Consequently hypers became far less frequent and the roller coasters hugely reduced.​

I had also read a comment that one hypo could so easily be followed by a 2nd hypo and kept that firmly in mind. This often happened after I started my longer walks, but I was hypo aware, picked up the symptoms, had my low alert at the top end of 5.6 and got the alert in plenty of time to take a small snack.​

​

I was definitely leaning on my CGM to make decisions about hypo / hyper responses. I'd had 12 months of relative blindness from 12-15 fps daily. Trial and learning was working and I noted on my Libre app whenever and whatever I ate, or brief notes about activity. The LibreLink app is really friendly for that in comparison to the G7 app, both for recording and for reviewing. My big challenge then became an increasing realisation that Libre 2 and my body were incompatible: 50% failure rates from sensors dying or hopelessly out of sync with actual BG. That was hugely frustrating, but I knew I had to work with my L2 because the trend arrows were even more important than the nos displayed and fps could never give me that insight.

You mentioned having zero pancreatic function:

That's interesting about the liver, but don't think that's what's happening with me. I have zero pancreas function, so my pancreas can't send the signal to my liver to release glycogen. That's why hypo's can be really bad with type 3C as you don't have that "safety net".
🙂

I surrendered my panc'y 4 yrs ago, but still get unwanted glucose dumps at different times of the day. There definitely can't be any glucagon messages from my non-existent pancreas; I'm too old to have any significant growth hormones (I don't know when they appreciably diminish to near nil, but you at age 25, @Austin_98, might still have a certain amount of that going on); so adrenaline and cortisol remain for me as 2 hormone triggers for the liver to be stimulated into releasing glucose.

I think I have some control over adrenaline, by trying to stay calm and not allow myself to get flustered (easy said, very difficult in practice for me) and I'm not sure I can alter cortisol releases; but cortisol is also a stress hormone - so perhaps trying to stay calm helps with that as well. I'm of course also missing the hormone somostatin which plays a part in regulating between insulin and glucagon activity for others; along with various peptides such as amlyn (a digestive regulator apparently) and pancreatic polypeptide (that apparently raises its game when a lot of protein is eaten!). So all-in-all the loss of pancreatic functions is a deceptively pretty big deal.

My D is described as brittle, ie my BG can experience big changes very rapidly and I sometimes see that on my CGM graph during as well as after those changes. It was more apparent when I had L2 being monitored by the unofficial Diabox app which could display data updated every minute. That level of apparent detail needs to be viewed with due caution, however.

Because the sensor mechanism for measuring interstitial bg is in practice a complex use of physics and chemistry on a micro scale to create a "number" on a screen and then some very human influenced maths to regulate, adjust and smooth the generated "numbers" (using algorithms) - I think its very important to keep ourselves grounded. We are seeing nos to one decimal point that are tinkered with (for good and fair purpose) trying to keep us informed so that we can stay safe. We must be our own adjudicators over how much we should react to displays, be alert to how accurate that last decimal point isn't (accurate) and how much we might be better to pause, see repeats and then respond in our own measured manner as appropriate.

Do consciously try to resist that binge eat response to hypos. Use your CGM alarms as ALERTS. Let the tech tell you that going low is likely - before it happens - then gentle snack response can and ought to keep you above the 4 mmol/L 'bottom' and 2.9 need never appear! Sometimes, just sometimes, a below 4 will happen. But we have the tech to prevent that almost all of the time. Good luck.

 

[Austin_98]

Me too, I need less insulin as the warmer weather comes along (or when staying with my family in Gibraltar). Its extremely noticeable on my Tresiba basal, albeit the change is modest: 8.5 units for the warmer weather and 9 for the colder weather is my current trend.

A bit harder to identify from my bolus doses, since they are very variable anyway as I let my G7 app tell me where I am and correct accordingly with snacks, activity or bolus. No dog to take for walks and no other noticeable repeat activities - so better weather = incentive to be outdoors and more active. But I'm invariably doing something at least mildly physical most waking hours; hence spotting a bolus change pattern is not straightforward.

Returning to your original post, @Austin_98, I spent much of my first 12 months on the hypo/ hyper roller coaster, with very little time in between. No CGM, so only FPs to know where I was BG-wise. I found when hypo there was a fairly desperate internal demand to eat - something, anything. Which I did and that of course worsened the severity of the roller coaster. I suspect I also worsened my roller coaster effect by over correcting my hypers; it does take time to get corrections right anyway and I think trial and learning is essential.

But, once I had CGM, I realised that:

Even when hypos were deep, frightening and horrible - I was still alive afterwards; i.e. I WAS able to stay in control.​

That helped me calm myself and make a determined effort to resist that urge to binge eat as a hypo response. I made the 15/15 rule become more of a 12/20 process: 12 gms of carbs and wait a full 20 minutes. Then assess and repeat if necessary.​

Then as the hypo rescinded and while still in the 6s I made myself get a bit active indoors and gradually outdoors walking for lengthy periods.​

Consequently hypers became far less frequent and the roller coasters hugely reduced.​

I had also read a comment that one hypo could so easily be followed by a 2nd hypo and kept that firmly in mind. This often happened after I started my longer walks, but I was hypo aware, picked up the symptoms, had my low alert at the top end of 5.6 and got the alert in plenty of time to take a small snack.​

​

I was definitely leaning on my CGM to make decisions about hypo / hyper responses. I'd had 12 months of relative blindness from 12-15 fps daily. Trial and learning was working and I noted on my Libre app whenever and whatever I ate, or brief notes about activity. The LibreLink app is really friendly for that in comparison to the G7 app, both for recording and for reviewing. My big challenge then became an increasing realisation that Libre 2 and my body were incompatible: 50% failure rates from sensors dying or hopelessly out of sync with actual BG. That was hugely frustrating, but I knew I had to work with my L2 because the trend arrows were even more important than the nos displayed and fps could never give me that insight.

You mentioned having zero pancreatic function:

I surrendered my panc'y 4 yrs ago, but still get unwanted glucose dumps at different times of the day. There definitely can't be any glucagon messages from my non-existent pancreas; I'm too old to have any significant growth hormones (I don't know when they appreciably diminish to near nil, but you at age 25, @Austin_98, might still have a certain amount of that going on); so adrenaline and cortisol remain for me as 2 hormone triggers for the liver to be stimulated into releasing glucose.

I think I have some control over adrenaline, by trying to stay calm and not allow myself to get flustered (easy said, very difficult in practice for me) and I'm not sure I can alter cortisol releases; but cortisol is also a stress hormone - so perhaps trying to stay calm helps with that as well. I'm of course also missing the hormone somostatin which plays a part in regulating between insulin and glucagon activity for others; along with various peptides such as amlyn (a digestive regulator apparently) and pancreatic polypeptide (that apparently raises its game when a lot of protein is eaten!). So all-in-all the loss of pancreatic functions is a deceptively pretty big deal.

My D is described as brittle, ie my BG can experience big changes very rapidly and I sometimes see that on my CGM graph during as well as after those changes. It was more apparent when I had L2 being monitored by the unofficial Diabox app which could display data updated every minute. That level of apparent detail needs to be viewed with due caution, however.

Because the sensor mechanism for measuring interstitial bg is in practice a complex use of physics and chemistry on a micro scale to create a "number" on a screen and then some very human influenced maths to regulate, adjust and smooth the generated "numbers" (using algorithms) - I think its very important to keep ourselves grounded. We are seeing nos to one decimal point that are tinkered with (for good and fair purpose) trying to keep us informed so that we can stay safe. We must be our own adjudicators over how much we should react to displays, be alert to how accurate that last decimal point isn't (accurate) and how much we might be better to pause, see repeats and then respond in our own measured manner as appropriate.

Do consciously try to resist that binge eat response to hypos. Use your CGM alarms as ALERTS. Let the tech tell you that going low is likely - before it happens - then gentle snack response can and ought to keep you above the 4 mmol/L 'bottom' and 2.9 need never appear! Sometimes, just sometimes, a below 4 will happen. But we have the tech to prevent that almost all of the time. Good luck.

Thanks for all this!
I set alarms as warnings just yesterday. I set the low glucose alarm for 4.5 so I know to keep an eye on my BG and make sure it isn't trending downwards.
I actually set the high glucose alarm pretty high at 18.0 but this is because I check my BG very frequently (sensor makes it so easy/simple) so I'll usually see it going up too high before it gets that high, but also because 18 is around the measure where I begin to FEEL the hyper, usually just thirst and lethargy (high BG gives me the WORST lethargy, once it gets up in the 20s I usually have to just lie down and listen to music from exhaustion) and pins and needles in my feet and legs. I do have pretty bad diabetic neuropathy that presents as numbness in my feet and pain in my legs but when my BG is really high I get this specific tingly discomfort in them.

Which are the growth hormones again? I'm not very well versed in endocrinology. Is it related to the sex hormones? If so probably not as my estrogen is low due to low body fat and my testosterone is VERY low (just naturally, plus exacerbated by various meds).

I've ordered those glucose shots from amazon and in the meantime I got my mum to hold onto a bag of jelly babies for me (I'd eat them all immediately if not, even without a hypo lol) and told her if I have a hypo to give me 3, wait 15 minutes and I'll test again and to give me 3 more if it''s still low.

Hypos affect me in two different way and IDK why there's such a disparity between the two. I'll either get a "traditional" hypo with severe tremors, profuse sweating, tachycardia etc OR I'll get what I think of as a "highpo" where I feel physically completely normal (even at GB of 1.9 or less) but I get very happy and giddy? Like being stoned or drunk.

I've recently noticed small signs of an impending hypo to pick up on, too! Notably tachycardia. Whenever I feel my heart racing (like, fast enough that I can physically FEEL it beating) I know to immediately check my BG as it's always the first symptom, although by then it is often down to about 3.6.

 

[Proud to be erratic]

Thanks for all this!
I set alarms as warnings just yesterday. I set the low glucose alarm for 4.5 so I know to keep an eye on my BG and make sure it isn't trending downwards.

May I suggest that until you have thoroughly mastered this "trial and learning" problem, set your low alert at or very close to the upper limit of 5.6mmol/L. Give yourself the maximum warning time of a possible hypo coming along.

I actually set the high glucose alarm pretty high at 18.0 but this is because I check my BG very frequently (sensor makes it so easy/simple) so I'll usually see it going up too high before it gets that high, but also because 18 is around the measure where I begin to FEEL the hyper, usually just thirst and lethargy (high BG gives me the WORST lethargy, once it gets up in the 20s I usually have to just lie down and listen to music from exhaustion) and pins and needles in my feet and legs.

Now I think the high setting of 18 is a bit too much for anyone routinely. The strong guidance for me after surgery and subsequently during my DAFNE course was that 15 should be seen as an important upper threshold when ketones can start to be created, which can lead to a nasty and dangerous condition of Diabetic Ketoacidosis, frequently abbreviated to DKA. This can build up steadily,
and if someone does get full on DKA that can lead to unconsciousness and ultimately death if not treated.

Have you been prescribed ketone test strips? Has this ever been explained to you?

Brief periods above 15 are not good for any of us for other reasons of damage to nerve endings and accumulation within blood vessels. But brief periods that high are a concern for the long term whereas longer periods in hours or part days above 15 should be considered serious.

I do have pretty bad diabetic neuropathy that presents as numbness in my feet and pain in my legs but when my BG is really high I get this specific tingly discomfort in them.

I can't offer much help with this. I have neuropathy in my feet, which first started c. 20 yrs ago when skiing and then made much worse during my chemotherapy in mid 2020. I have no suggestions for relief or a cure; but I turned down a generous and kind offer from my daughter to buy me some form of foot warming and vibrating treatment apparatus - because I knew I would either not or only slightly feel the sensation and I would not be aware if any damage was being added to! So better for me to just live with the problem.

Which are the growth hormones again? I'm not very well versed in endocrinology. Is it related to the sex hormones? If so probably not as my estrogen is low due to low body fat and my testosterone is VERY low (just naturally, plus exacerbated by various meds).

Growth hormones come from the pituitary gland, which is somewhere near the back of one's brain (ie nowhere near the pancreas!). They progressively reduce output in middle age; you will still have output, I most likely haven't any left! Growth hormones can trigger the liver to add more glucose into our blood.

I've ordered those glucose shots from amazon and in the meantime I got my mum to hold onto a bag of jelly babies for me (I'd eat them all immediately if not, even without a hypo lol) and told her if I have a hypo to give me 3, wait 15 minutes and I'll test again and to give me 3 more if it''s still low.

Many of us can be at risk of "snacking" on JBs. Mine are in a variety of small containers, each of which hold just 3 JBs, reducing my likelihood of binging on JBs.

Hypos affect me in two different way and IDK why there's such a disparity between the two. I'll either get a "traditional" hypo with severe tremors, profuse sweating, tachycardia etc OR I'll get what I think of as a "highpo" where I feel physically completely normal (even at GB of 1.9 or less) but I get very happy and giddy? Like being stoned or drunk.

I've recently noticed small signs of an impending hypo to pick up on, too! Notably tachycardia. Whenever I feel my heart racing (like, fast enough that I can physically FEEL it beating) I know to immediately check my BG as it's always the first symptom, although by then it is often down to about 33.6.

This is just further reason to have your alert at 5.6 for the time being. You have the tech and I most gently suggest you ought to do your best to make full use of it.

I can't explain these 2 different ways you seem to be experiencing hypos, but I do know that a BG of 1.9 is seriously low and has the potential to make you unconscious, so is a state to be avoided!

I do understand that you've had several years of health difficulties, particularly your pancreatitis and now at 25 to be fully dependent on insulin must give you conflicting or contradictory messages. On the one hand you perhaps feel you've been managing health issues for ages and this is just another. On the other hand you perhaps feel you've been dealt a lousy hand and now got yet one more health issue. I can empathise with your circumstances. But I can only offer my non-medical opinion that yes, you defintely have been given yet another tough knock - but this knock has a solution.

Do continue to grapple with this BG management business and do keep asking questions. Let the tech alert you and fend off the unnecessary lows well before they become hypos. Treat the highs in a timely way, preferably before reaching even 13. 20s are not just really lousy to experience but just damaging to you. Use exercise and activity as much as you can to improve your natural insulin sensitivity and then the bolus insulin you are injecting should have a better chance of working for you. But highs ought to be treated before getting to the 20s. Not least because by then a substantially bigger correction is needed with the much increased chance of that big correction roller coastering you back to very low. Your swings between high and low are sometimes medically described as Glycaemic Variability and your long term goal is to greatly reduce that variability.

Have you, @Austin_98 been told anything about Time in Range (TIR)? Perhaps you are too new into all of this to have had the time or opportunity to get into knowing about TIR. The use of CGMs is sufficiently new that different protocols are being developed, Internationally, to make the best use of tech like CGMs for analysis of BG behaviour, where in previous decades the standard for BG assessment was from a vial of your blood sent to a laboratory to count haemoglobin cells and generate the HbA1c blood result.

Perhaps a more immediate question I should ask you is have you been told about the limitations of CGM, such as Libre 2?

Sorry, there is so much to learn about managing your D while you are still wrestling with getting some stability with your BG. It does take time, but you can get there. Has anyone mentioned books that you might find helpful? In his book "Think Like a Pancreas" the US author Gary Scheiner remarks that Diabetes is Complicated, Confusing and Contradictory. That has been my experience. But I have found that understanding some of what is going on has been a great help; I don't mean having an in-depth understanding of the minutiae of Endocrinology but knowing enough to partly explain to myself what I might have done better or more of or less of to get a different outcome tomorrow!

Good luck with all of this.

 

[PhoebeC]

This was very helpful, thanks!
I think I will separate out "doses" like that. Maybe have my mum keep them lol (I live with my parents and she's retired so we're almost always at least in the same house). I have trouble controlling myself regardless of blood-sugar. I'm pretty okay in the normal range, but once it's down to 3ish I wanna eat every carb in sight. If it's high (more than 13ish) I crave sugary carbs and if it's in the 20s or 30s I crave sugar constantly. My doctor said I experience "cravings based on actual need"* (about 15% of people have this where your body craves food/drinks that contain something it needs). You'd think it would be the opposite, but apparently if your sugars are very high (my devise goes up to 32 and up until a couple months ago my BG was always too high for it to read (where it just says "HI") your body isn't actually able to absorb/use any of it so your brain thinks your starving/need glucose immediately.
I think the overdoing it may be partly because I used to be bulimic (haven't binged and purged in 4 years though! 🙂) I still do overdo it if there's foods I love, especially sweet stuff (currently obsessed with cashew butter which is very low in carbs but I can eat the little 1200 cal tub in like 15 mins) but WITH carbs, usually either spread on bread or apple slices.
But like when my mum does the "big shop" online once a week, I pretty much eat everything sweet or "nice" the instant it arrives.
I just really hope it's related to my BG and not just because I'm greedy/gross :/

*eg twice I've gone through a period of strong milk cravings, drinking like 3 pints a day and both times when I had bloods done I was severely deficient in Vitamin D. Your body also needs calcium to absorb vit d, so the milk thing made a lot of sense.

Yeah I get the cravings above 15 I will feel so hungry and a little like a hypo actually, once I test I know it’s more likely I’m thirsty and it’s just this. Can’t always trust how you feel is what I have learnt, testing is so important for me for this reason