Fast acting Basal insulin?

[Vicsetter]

Yesterday I tested at 5 : 7.6. Injected 1.2 units Victoza and then 60 units Levemir, both injections produced a spot of blood. Felt sleepy so lay down watching Emmerdale. Wake up 1 hour later feeling groggy, got the wife to get my meter and : 2.4 😱 lowest hypo ever. Bread and marmalade and 20minutes still 3. Spoonfull of marmalade and another 20 minutes 6.4. Went to bed early without supper. Woke up this morning : 7.3 so back to normal.

Question: anyone else experienced this effect, I can only assume it was the levemir injected into a vein that did it as this is my normal pattern of life.

 

[Redkite]

Assuming this has been your routine dose and timing for the past few days, what was different about yesterday? Had you been very energetic in the hours beforehand perhaps? I think it's pretty hard to accidentally inject into a vein (droplets of blood can come from tiny capillaries in the subcutaneous fat), but you could have injected into muscle, where the insulin would be more quickly absorbed.

Just querying your choice of hypo remedy - we always use fast acting carbs to treat a hypo, ie. as close to 100% glucose as possible - dextrose tablets, lucozade, full-sugar coke, etc. Bread and marmalade are more slowly absorbed and will therefore take longer to bring your levels back up. If this is what normally works for you with mild hypos, perhaps consider using a faster acting sugar for really low hypos 🙂

 

[Northerner]

Yes, it's happened to me a couple of times with lantus, which I would inject about an hour before bed and long after any bolus insulin should have expired so could only blame the lantus - most perplexing!

 

[Vicsetter]

Assuming this has been your routine dose and timing for the past few days, what was different about yesterday? Had you been very energetic in the hours beforehand perhaps? I think it's pretty hard to accidentally inject into a vein (droplets of blood can come from tiny capillaries in the subcutaneous fat), but you could have injected into muscle, where the insulin would be more quickly absorbed.

Just querying your choice of hypo remedy - we always use fast acting carbs to treat a hypo, ie. as close to 100% glucose as possible - dextrose tablets, lucozade, full-sugar coke, etc. Bread and marmalade are more slowly absorbed and will therefore take longer to bring your levels back up. If this is what normally works for you with mild hypos, perhaps consider using a faster acting sugar for really low hypos 🙂

If you look at my timings it took 40 minutes to get back to normal, quite fast enough. Marmalade is nigh on 100% sugar in a dissolved form so gets absorbed quickly, the bread (and peanut butter) may slow it down a tad but will stop a large spike.

 

[Redkite]

If you look at my timings it took 40 minutes to get back to normal, quite fast enough. Marmalade is nigh on 100% sugar in a dissolved form so gets absorbed quickly, the bread (and peanut butter) may slow it down a tad but will stop a large spike.

I realise I'm speaking from a type 1 child perspective, but 40 minutes to come up from a hypo is unacceptably long - 15 minutes is our norm. A 2.4 feels dreadful so a quick recovery is preferable 🙂. He gets a rapid rise back to the normal range (4-8 is his target), but no spike beyond that as he doesn't overdo the total carb amount. So for him, it's a question of a relatively small amount of fast acting carbs, as opposed to a larger amount of slower acting ones. I thought marmalade had a GI round about 50%. But each to his own 😉

 

[Vicsetter]

Assuming this has been your routine dose and timing for the past few days, what was different about yesterday? Had you been very energetic in the hours beforehand perhaps? I think it's pretty hard to accidentally inject into a vein (droplets of blood can come from tiny capillaries in the subcutaneous fat), but you could have injected into muscle, where the insulin would be more quickly absorbed.

Just querying your choice of hypo remedy - we always use fast acting carbs to treat a hypo, ie. as close to 100% glucose as possible - dextrose tablets, lucozade, full-sugar coke, etc. Bread and marmalade are more slowly absorbed and will therefore take longer to bring your levels back up. If this is what normally works for you with mild hypos, perhaps consider using a faster acting sugar for really low hypos 🙂

Coke isn't good for hypos only 33g carb per bottle, lucozade is a bit better at 65g per 380ml bottle but I wasn't in any kind of mood to drink that much. I have sooo many hypos my dextrose tablets are 5 years beyond the best before date🙄. I make the marmalade myself but it is probably about 70% sugar and is very easy to leave in the mouth so it gets into the body quickly, no waiting for it to go down to the stomach, a teaspoon is probably about 10 gram carbs. It took 30 minutes to get to 6.4 and so a lot quicker than that to get to 5. The requirements for driving force you to wait 30 minutes after hypo treatment. I don't know but I would suspect that a 120kg 65 year old T2 reacts somewhat differently (timescale wise) to a T1 child. It must be pretty scary for a child to have a hypo, but at my age I would rather have a hypo than a heart attack (as I know from experience).

 

[Vicsetter]

No blood and no repeat of yesterday, even though i was 5.5 before my injections tonight (driving brings it down).

 

[Northerner]

No blood and no repeat of yesterday, even though i was 5.5 before my injections tonight (driving brings it down).

Good to hear 🙂

 

[bev]

Hi Vicsetter,

I think like everything else diabetes - what works for one might not work for another.😉

Coke is the very best treatment for Alex (15) and the small cans are perfect as they dont overtreat a hypo. We were told at clinic and by Gary Shneider - the reason fizzy drinks work so much quicker/better for a hypo is that the bubbles help to get it round the system quicker. Type 1's wouldnt usually have a slow release treatment for a hypo (like bread) as it just doesnt work as quick. A hypo should take no longer than 15 minutes to bring back to normal range - hence the '15 minute rule' that teams talk about. We were also told that jelly babies arent as quick due to the gelatine which slows down absorption so gave up on them and we did find the coke works extremely quickly. Its also easier to carry around than a large bottle of lucozade. Alex doesnt like glucotabs so coke is best for him.

I wouldnt have thought your insulin would work that fast to cause a hypo though. Perhaps you were already on the way down for some reason and this is just a coincidence? Even the 'fast acting' insulins dont work that fast hence the reason most Type 1's bolus 25 minutes or so before food to give the insulin time to start working. Perhaps you could see if there is a pattern or watch out for any exercise that is unusual for you that might have caused it.🙂Bev

 

[Northerner]

...I wouldnt have thought your insulin would work that fast to cause a hypo though. Perhaps you were already on the way down for some reason and this is just a coincidence? Even the 'fast acting' insulins dont work that fast hence the reason most Type 1's bolus 25 minutes or so before food to give the insulin time to start working. Perhaps you could see if there is a pattern or watch out for any exercise that is unusual for you that might have caused it.🙂Bev

However, as happened to me on lantus, you can't rule anything out in this game! I don't like drinks to treat hypos, I have a need to actually chew something, hence jelly babies for me.

 

[Cleo]

I think like everything else diabetes - what works for one might not work for another.😉

Completely agree - I tried coke a few times and I just CAN'T drink the stuff when I am hypo - the bubbles just burn the back of my throat (maybe I'm a wuss?!) and when you're feeling hypo you want something that gets you out of that awful black hole with the least amount of hassle and as quickly as possible.

Interesting Bev that you said that they didnt advise the use of jelly babies - I went on a dafne course last March and we were told to use them. There's so much lack of consistency in diabetes education isn't there?! Three to four jelly babies work a treat for me, but I also have a backup stash of dextrose tabs and small cartons of juice.....all stored away in my "hypo treatment cupboard"....aahh such an exciting life being a T! 😉

 

[bev]

Completely agree - I tried coke a few times and I just CAN'T drink the stuff when I am hypo - the bubbles just burn the back of my throat (maybe I'm a wuss?!) and when you're feeling hypo you want something that gets you out of that awful black hole with the least amount of hassle and as quickly as possible.

Interesting Bev that you said that they didnt advise the use of jelly babies - I went on a dafne course last March and we were told to use them. There's so much lack of consistency in diabetes education isn't there?! Three to four jelly babies work a treat for me, but I also have a backup stash of dextrose tabs and small cartons of juice.....all stored away in my "hypo treatment cupboard"....aahh such an exciting life being a T! 😉

Hi Cleo,

Completely agree with you.🙂If you dont like coke then clearly not a good idea for you! Alex doesnt like glucotabs - he thinks they taste like chalk! It does seem like we dont have consistancy between different teams/organisations doesnt it - that is where confusion creeps in which isnt helpful when you are the person having to deal with the condition is it. Sometimes I do wonder whether anyone actually knows all there is to know about Type 1 - probably not - and some of it is guesswork and some is down to individual body make-up/weather/temperature/formation of the clouds...its a dark art sometimes isnt it.🙂Bev

 

[Vicsetter]

Hi Vicsetter,

I think like everything else diabetes - what works for one might not work for another.😉

Coke is the very best treatment for Alex (15) and the small cans are perfect as they dont overtreat a hypo. We were told at clinic and by Gary Shneider - the reason fizzy drinks work so much quicker/better for a hypo is that the bubbles help to get it round the system quicker. Type 1's wouldnt usually have a slow release treatment for a hypo (like bread) as it just doesnt work as quick. A hypo should take no longer than 15 minutes to bring back to normal range - hence the '15 minute rule' that teams talk about. We were also told that jelly babies arent as quick due to the gelatine which slows down absorption so gave up on them and we did find the coke works extremely quickly. Its also easier to carry around than a large bottle of lucozade. Alex doesnt like glucotabs so coke is best for him.

I wouldnt have thought your insulin would work that fast to cause a hypo though. Perhaps you were already on the way down for some reason and this is just a coincidence? Even the 'fast acting' insulins dont work that fast hence the reason most Type 1's bolus 25 minutes or so before food to give the insulin time to start working. Perhaps you could see if there is a pattern or watch out for any exercise that is unusual for you that might have caused it.🙂Bev

I have found that the Victoza gives quite a good drop in BG shortly after injecting. No normally levemir just boosts the morning injection and levels me off. I regularly inject Levemir at levels below 6 with no noticeable drop in blood sugar.
Although I had 1 piece of bread, I did have 2 teaspoons of marmalade afterwards. Interestingly when I tested at 30 mins it was 6.4 (I could easily have been above 4 at the 20 min mark), when I went to bed it was still 6.4 (no food since) had a digestive in bed and in the morning was 7.3. T2s have strange mechanisms, and I don't think a lot of research has been done on the combination of Victoza and Levemir.

 

[Vicsetter]

Interesting I found this published by Diabetes UK:

Immediately treat with a short-acting carbohydrate such as:
a glass of Lucozade or non-diet drink
three or more glucose tablets
five sweets, eg jelly babies
a glass of fruit juice

The exact quantity will vary from person to person.
If your hypo is more severe and you cannot treat it yourself, someone else can help you by:
applying GlucoGel (or treacle, jam or honey) on the inside of your cheeks and gently massaging the outside of your cheeks.

If you are unconscious, Glucagon can be injected if the person you are with has been trained to use it. Otherwise the people you are with should call an ambulance immediately.

That should please those of us that use jelly babies

 

[bev]

Interesting I found this published by Diabetes UK:



That should please those of us that use jelly babies

Hi Vicsetter,

Like I said - what works for one wont necessarily work for another.

I stopped reading much of what DUK pushes a while ago - they are certainly not up to date with the latest research and fruit juice contains fructrose which is a lot slower than glucose so shouldnt be used as a hypo treatment - certainly not a low hypo. It might be allright if you are hovering around 4 and just need a top-up but it isnt quick enough. Gary Scheiner (think like a pancreas) is also not a fan of jelly babies due to the gelatine. But each to his own.🙂Bev

p.s. Glucogel doesnt work for Alex and our teams now dont advocate it either.