Diabetes out of control in extreme heat

[Cornbunting]

Hi,

This is my first post so I hope this is the correct place. My husband, aged 68 has diabetes and uses insulin. He was first diagnosed aged 32, his whole family have it so it is inherited. I never know if this is Type 1 or Type 2.

He had been improving his levels, especially since he was provided with a Libre device that he wears on his arm.

However, in May and June we went to France for six weeks and had some hot weather 28 - 30 degrees. HIs sugar levels were all of the place. He would eat a meal with a decent amount or carbs and suddenly it would drop to 4 even before he had an insulin injection. Sometimes it was 20. He doesn't have a sweet tooth. He was getting alerts in the night that it was below 4 so had to eat something. We were eating the same meals as were were at home, OK drinking a little bit more but still had alcohol free nights. He doesn't drink a lot anyway. He reduced his insulin to try and avoid the low readings in the middle of the night but he still got quite a few near on Hypos. He would always check his blood glucose before going to bed and it would be OK but then ...

So his 3 monthly blood test at the GP was higher when we came back.

We are off to France again at the end of this month for six weeks. Can anyone give any advice on this as it is not good and he has a quite a few complications already with his diabetes, retinopathy, kidney disease etc. The temperatures in France are high again.

Also, what is the best thing to eat if you are are low? I don't want him to keep eating chocolate, biscuits or full sugar coke. I suggest a slice of bread and jam but hardly healthy.

Thanks very much.

 

[helli]

He was getting alerts in the night that it was below 4 so had to eat something.

I assume these alerts are from a CGM. Were they checked with a finger prick to to ensure they were not compression lows.

So his 3 monthly blood test at the GP was higher when we came back.

If he was suffering from real lows, his HBA1C would be lower not higher which suggests he may have been treating false lows or over treating the lows.
The recommendation for low alarms is
- check with a finger prick
- treat with 15g FAST ACTING carbs
- wait 15 minutes
- test again with a finger prick
- if recovered, eat 15g slow acting carbs
- if still hypo, treat with additional 15g fast acting carbs

Also, what is the best thing to eat if you are are low? I don't want him to keep eating chocolate, biscuits or full sugar coke. I suggest a slice of bread and jam but hardly healthy.

when our levels are low, the focus is getting fast acting carbs as soon as possible to raise levels.
This is something without fat (chocolate, biscuits, etc. contain fat). Full sugar coke, jelly babies, fruit juice, dextrose tablets are all fast acting carbs.
It is more unhealthy to have a low blood sugar than to eat any of these things.

 

[trophywench]

I've had hotter holidays in Greece when it's been literally scorchio when I've not needed ANY insulin with food and meals from getting up in a morning until AFTER dinner which we didn't eat till 8-ish at night when it had cooled down a bit. No alcohol either until the evening, ONE G&T on apartment shady balcony 6pm ish and a SMALL carafe of wine between us 2 with dinner.

In France - I can highly recommend the store-baked bakery doughnuts from the local Leclerc, Carrefour, Auchan etc which are not enormous but instead of jam, centres filled with stewed fresh fruit. In earlier summer the apricot ones are just The Best! but usually a choice of several different flavours anyway - apple, raspberry, plum, greengage - as long as you get there well before lunchtime to get the best choice of varieties.

Hot weather (or saunas, hot tubs etc) makes insulin work much mega faster and more efficiently than in normal sluggish UK temperatures.

I've been doing this for over 50 years now - and we all just have to play it by ear, or rather learn from what our BG meter is telling us. The Libre is frequently found to be at it's worst accuracy under 5 and above 8, so be guided by it at your peril! BUT - my BG meter still doesn't fib!

 

[Cornbunting]

He sometimes does finger prick tests but the Libre device is quite accurate. What are compression lows?

Maybe it was higher in the HBa1c test because he was getting readings of 20+ when he was away - he also gets those high readings when he is feeling unwell.

I will buy some dextrose tablets - thank you. Also, never thought of orange juice.

What would you classify as 15g slow acting carbs? A weetabix biscuit, or a small piece of bread (we eat granary bread), 15g is a very small amount. Real sleep disturbance doing all this of course so he feels really tired in the morning.

Is it unusual to have these abnormal readings during hot weather? Or is this normal for diabetics?

Thank you

 

[Cornbunting]

I've had hotter holidays in Greece when it's been literally scorchio when I've not needed ANY insulin with food and meals from getting up in a morning until AFTER dinner which we didn't eat till 8-ish at night when it had cooled down a bit. No alcohol either until the evening, ONE G&T on apartment shady balcony 6pm ish and a SMALL carafe of wine between us 2 with dinner.

In France - I can highly recommend the store-baked bakery doughnuts from the local Leclerc, Carrefour, Auchan etc which are not enormous but instead of jam, centres filled with stewed fresh fruit. In earlier summer the apricot ones are just The Best! but usually a choice of several different flavours anyway - apple, raspberry, plum, greengage - as long as you get there well before lunchtime to get the best choice of varieties.

Hot weather (or saunas, hot tubs etc) makes insulin work much mega faster and more efficiently than in normal sluggish UK temperatures.

I've been doing this for over 50 years now - and we all just have to play it by ear, or rather learn from what our BG meter is telling us. The Libre is frequently found to be at it's worst accuracy under 5 and above 8, so be guided by it at your peril! BUT - my BG meter still doesn't fib!

Thank you for your response. Just realised there is a reply button! He doesn't drink alcohol during the day. Luckily, as a diabetic he doesn't have a sweet tooth and doesn't like cake or sweet stuff. Those doughnuts sound delicious I will have a look next time I am in Leclerc (for myself). He does check his blood glucose before he eats - thing is if you don't have any insulin and eat say, a sandwich at lunchtime, won't your levels just go up and up without insulin to bring them down? I guess he can check the level after eating.

 

[Cornbunting]

I've had hotter holidays in Greece when it's been literally scorchio when I've not needed ANY insulin with food and meals from getting up in a morning until AFTER dinner which we didn't eat till 8-ish at night when it had cooled down a bit. No alcohol either until the evening, ONE G&T on apartment shady balcony 6pm ish and a SMALL carafe of wine between us 2 with dinner.

In France - I can highly recommend the store-baked bakery doughnuts from the local Leclerc, Carrefour, Auchan etc which are not enormous but instead of jam, centres filled with stewed fresh fruit. In earlier summer the apricot ones are just The Best! but usually a choice of several different flavours anyway - apple, raspberry, plum, greengage - as long as you get there well before lunchtime to get the best choice of varieties.

Hot weather (or saunas, hot tubs etc) makes insulin work much mega faster and more efficiently than in normal sluggish UK temperatures.

I've been doing this for over 50 years now - and we all just have to play it by ear, or rather learn from what our BG meter is telling us. The Libre is frequently found to be at it's worst accuracy under 5 and above 8, so be guided by it at your peril! BUT - my BG meter still doesn't fib!

Please see response above - I missed the reply button.

 

[helli]

What are compression lows?

When pressure is applied to a sensor, it will report false low readings. This is most likely to happen at night when we lie on our arm whilst asleep. This is one reason why it is advised to double check a low with a finger prick before treating (unless feeling definitely hypo).
Another reason for checking Libre (and other CGMs) is that they are designed to be most accurate at "normal" blood sugar levels (between about 4 and 8 mmol/l). Outside of this range, the Libre can exaggerate the readings. For example, you mention your husband sees readings in the 20s - these may be in the teens. However, it is still important to correct (after checking with a finger prick).
Libre (and other CGMs) are amazing pieces of kit. However, they have limitations and, sadly, it seems rare for DSNs to tell us about these and we have to learn from other users on forums like this.
If you do not understand these limitations, Libre will, at best, be frustrating and, at worse, be misleading, causing unnecessary over treatment of highs and lows.

Is it unusual to have these abnormal readings during hot weather? Or is this normal for diabetics?

Heat can affect our blood sugars and it is common to adjust our insulin dose to account for it. But, how it affects our levels is a very personal thing. Some people find heat very uncomfortable and the stress causes their levels to rise whereas others find they need less insulin to avoid hypos.

 

[trophywench]

Please see response above - I missed the reply button.

No you didn't! 🙂

No - when it's THAT hot, my BG absolutely didn't shoot up, BUT where we used to go in southern Crete (Plakias) it was say half a mile turning left walking along the front road (what would be the esplanade at a UK seaside town) which had local commerce on the inland side so we'd buy a ready made roll of choice at one shop and maybe a tiddly bit of fruit to have for lunch - and always a 2 litre bottle of Diet Sprite (lemonade) in the rucksack cos we both like that, to the beach we liked. Plus we'd have positively enormous doughnut which an old bloke came onto the beach to sell after lunch, between us before finally unpegging ourselves from under the beach brolly the last time that day and meandering back 'home', maybe via a supermarket just up one of the side streets if we needed anything. I agree it sounds unbelievable not needing ANY fast acting insulin ALL day, just my bedtime slower basal insulin, but that's the truth of it. And I found this out by experimenting on myself.

I'm only just over 5ft, small boned and not mega wide, about 68 kgs and everyone ids different anyway, but was just trying to let you know that differences in outside temperature can have an enormous effect on some people, sometimes. The French doughnuts do not usually have half a ton of sugar on the outside like British ones do, and the stewed fruit isn't mega sweet either - although not what you'd call either healthy or slimming !!! It still isn't humanly possible to eat one without licking your lips - and I might easily rather have an ice cream cone instead. Just depends normally on how much activity I might be doing that day as to whether I'd need insulin for that or not.

 

[Inka]

He sometimes does finger prick tests but the Libre device is quite accurate. What are compression lows?

Maybe it was higher in the HBa1c test because he was getting readings of 20+ when he was away - he also gets those high readings when he is feeling unwell.

I will buy some dextrose tablets - thank you. Also, never thought of orange juice.

What would you classify as 15g slow acting carbs? A weetabix biscuit, or a small piece of bread (we eat granary bread), 15g is a very small amount. Real sleep disturbance doing all this of course so he feels really tired in the morning.

Is it unusual to have these abnormal readings during hot weather? Or is this normal for diabetics?

Thank you

I use bread or plain digestive biscuits for slow carbs. A plain digestive is around 10g carbs so it’s easy to do the Maths and have one and a half biscuits or whatever he needs. Don’t ever substitute ‘healthy’ carbs for a hypo. It’s important to get fast-acting glucose into the body because in the worse case scenario, a person could lose consciousness, have a seizure, or worse. Dextrose glucose tablets are good, as are the small 150ml cans of real branded sugar Coke (Coca Cola) or some jelly babies.

Hot weather can play havoc with blood sugar. Usually people go low but it’s also possible to go high. On holiday, things like more activity, more alcohol and later nights can also affect things. The nighttime lows the Libre is alerting to do need checking with a fingerprick due to the compression lows mentioned above. They’re a real thing.

“He would eat a meal with a decent amount or carbs and suddenly it would drop to 4 even before he had an insulin injection“

Has he done a recent basal test @Cornbunting ? Perhaps his basal insulin needs reducing a bit in the heat? What insulins does he take? From what you’ve said, it’s not clear if he’s Type 1 or Type 2 on insulin or even MODY (a genetic type of diabetes). Type 1 is an auto-immune condition which means the body attacks and destroys the crucial insulin-producing cells in the pancreas. Type 2 isn’t. It’s often related to lifestyle and many Type 2s have insulin resistance.

 

[Cornbunting]

No you didn't! 🙂

No - when it's THAT hot, my BG absolutely didn't shoot up, BUT where we used to go in southern Crete (Plakias) it was say half a mile turning left walking along the front road (what would be the esplanade at a UK seaside town) which had local commerce on the inland side so we'd buy a ready made roll of choice at one shop and maybe a tiddly bit of fruit to have for lunch - and always a 2 litre bottle of Diet Sprite (lemonade) in the rucksack cos we both like that, to the beach we liked. Plus we'd have positively enormous doughnut which an old bloke came onto the beach to sell after lunch, between us before finally unpegging ourselves from under the beach brolly the last time that day and meandering back 'home', maybe via a supermarket just up one of the side streets if we needed anything. I agree it sounds unbelievable not needing ANY fast acting insulin ALL day, just my bedtime slower basal insulin, but that's the truth of it. And I found this out by experimenting on myself.

I'm only just over 5ft, small boned and not mega wide, about 68 kgs and everyone ids different anyway, but was just trying to let you know that differences in outside temperature can have an enormous effect on some people, sometimes. The French doughnuts do not usually have half a ton of sugar on the outside like British ones do, and the stewed fruit isn't mega sweet either - although not what you'd call either healthy or slimming !!! It still isn't humanly possible to eat one without licking your lips - and I might easily rather have an ice cream cone instead. Just depends normally on how much activity I might be doing that day as to whether I'd need insulin for that or not.

My husband is11.5 stone his weight never changes. Will try that then and monitor regularly. It's 33 degrees in Cahors today - hopefully it will cool down by the beginning of September.

 

[Cornbunting]

I use bread or plain digestive biscuits for slow carbs. A plain digestive is around 10g carbs so it’s easy to do the Maths and have one and a half biscuits or whatever he needs. Don’t ever substitute ‘healthy’ carbs for a hypo. It’s important to get fast-acting glucose into the body because in the worse case scenario, a person could lose consciousness, have a seizure, or worse. Dextrose glucose tablets are good, as are the small 150ml cans of real branded sugar Coke (Coca Cola) or some jelly babies.

Hot weather can play havoc with blood sugar. Usually people go low but it’s also possible to go high. On holiday, things like more activity, more alcohol and later nights can also affect things. The nighttime lows the Libre is alerting to do need checking with a fingerprick due to the compression lows mentioned above. They’re a real thing.

“He would eat a meal with a decent amount or carbs and suddenly it would drop to 4 even before he had an insulin injection“

Has he done a recent basal test @Cornbunting ? Perhaps his basal insulin needs reducing a bit in the heat? What insulins does he take? From what you’ve said, it’s not clear if he’s Type 1 or Type 2 on insulin or even MODY (a genetic type of diabetes). Type 1 is an auto-immune condition which means the body attacks and destroys the crucial insulin-producing cells in the pancreas. Type 2 isn’t. It’s often related to lifestyle and many Type 2s have insulin resistance.

We have the small cans of coke in the caravan fridge, rucksack and car for emergencies. I never heard of a basal test. He went to see the diabetic nurse at our surgery for his regular check up but she was new and wasn't up to date with his history. The former nurse was great. Hopefully next time we go she will have settled in. She told us to book in a new set of blood tests, not Hb1ac, the liver, kidneys etc, for when we get back in October.

 

[Cornbunting]

When pressure is applied to a sensor, it will report false low readings. This is most likely to happen at night when we lie on our arm whilst asleep. This is one reason why it is advised to double check a low with a finger prick before treating (unless feeling definitely hypo).
Another reason for checking Libre (and other CGMs) is that they are designed to be most accurate at "normal" blood sugar levels (between about 4 and 8 mmol/l). Outside of this range, the Libre can exaggerate the readings. For example, you mention your husband sees readings in the 20s - these may be in the teens. However, it is still important to correct (after checking with a finger prick).
Libre (and other CGMs) are amazing pieces of kit. However, they have limitations and, sadly, it seems rare for DSNs to tell us about these and we have to learn from other users on forums like this.
If you do not understand these limitations, Libre will, at best, be frustrating and, at worse, be misleading, causing unnecessary over treatment of highs and lows.


Heat can affect our blood sugars and it is common to adjust our insulin dose to account for it. But, how it affects our levels is a very personal thing. Some people find heat very uncomfortable and the stress causes their levels to rise whereas others find they need less insulin to avoid hypos.

Ah, thanks, not something I had realised - just lying on it during sleep. I'm afraid we have probably relied too heavily on the Libre. It recently had an update and we've noticed now it gives a reading without even holding it up to the sensor. Incredible. Will do fingertip tests more often if the reading is low or high.

I have to say I do feel weary - like a lot of men he doesn't seem to take great care with his health. He acts like a teenager in that regard. I feel I am always having to crack the whip!

 

[Inka]

We have the small cans of coke in the caravan fridge, rucksack and car for emergencies. I never heard of a basal test. He went to see the diabetic nurse at our surgery for his regular check up but she was new and wasn't up to date with his history. The former nurse was great. Hopefully next time we go she will have settled in. She told us to book in a new set of blood tests, not Hb1ac, the liver, kidneys etc, for when we get back in October.

Here’s a link explaining about basal testing @Cornbunting

https://www.mysugr.com/en/blog/basal-rate-testing/

Very simply, it’s fasting for periods of the day over a length of time to gather information about whether the basal insulin is doing what it should - ie keeping the blood sugar steady in the absence of food. If the basal insulin dose is wrong, it makes it hard to keep control.

 

[Merryterry]

Ah, thanks, not something I had realised - just lying on it during sleep. I'm afraid we have probably relied too heavily on the Libre. It recently had an update and we've noticed now it gives a reading without even holding it up to the sensor. Incredible. Will do fingertip tests more often if the reading is low or high.

I have to say I do feel weary - like a lot of men he doesn't seem to take great care with his health. He acts like a teenager in that regard. I feel I am always having to crack the whip!

I think the main thing (and it has been said before on this thread) is that insulin works better, faster and more efficuently in hot weather and you should adjust te dose downwards, (I finf by about 2 units).

 

[Cornbunting]

Here’s a link explaining about basal testing @Cornbunting

https://www.mysugr.com/en/blog/basal-rate-testing/

Very simply, it’s fasting for periods of the day over a length of time to gather information about whether the basal insulin is doing what it should - ie keeping the blood sugar steady in the absence of food. If the basal insulin dose is wrong, it makes it hard to keep control.

It is quite complicated but worth doing, I don't think it has ever been suggested at check-ups.

I wonder what the eligibility criteria is for an insulin pump? Perhaps only for Type 1 Diabetes.

 

[helli]

I think the main thing (and it has been said before on this thread) is that insulin works better, faster and more efficuently in hot weather and you should adjust te dose downwards, (I finf by about 2 units).

This is very dependent upon how the person reacts to the heat.
Some people find they need more insulin in the heat. I believe these depends how you feel about the heat. If you find heat uncomfortable, you are more likely to need more insulin.

 

[helli]

I wonder what the eligibility criteria is for an insulin pump? Perhaps only for Type 1 Diabetes.

The criteria for a pump (and CGM) in England is defined by NICE.
These guidelines are published on the Internet and can be found using Google.
But why do you think your husband would benefit from a pump? Does he need to take small insulin doses (as low as 0.05 units) or vary his basal throughout the day every 30 minutes?
Those of us with pumps have had to justify our needs to our diabetes team.

 

[rebrascora]

I think the other thing to know about insulin pumps is that they are not "plug and play" They need an awful lot of understanding and tweaking particularly in the early stages and knowing how and when you need to intervene if/when things go wrong. If your husband is as you say and doesn't bother too much with his diabetes or health or isn't keen to engage and learn and has to be badgered, then an insulin pump is probably not for him, regardless of whether he qualifies.