First hypo and Insulin

[Purls of Wisdom]

Had my first hypo, down to 3.5 .Took Glucose tabs. 10 mins on, it came up to 5.3. I had gone for a loooong walk, over 11,000 steps. I forgot to take mid morning snack with me. Returned home at lunch time. Hypo happened. As it was lunch time, I had no idea what to do with insulin. Called GP. Someone will be call me later. I could ve been dead by then. Diabetes Care Nurses unit operates on automated phone system. The local chemist was closed for an hour long lunch.

Can someone suggest what to do in an eventuality like this? Whether to take insulin or skip it? Who should I call in case I need an answer in an emergency?
Many thanks. X

 

[rebrascora]

Hi.

Sorry to hear you had your first hypo but sounds like you managed it well. I hope you had hypo treatment with you on your walk even if you didn't have a mid morning snack. If you didn't, this is an important lesson, especially if you walk on your own. Keeping yourself safe is your priority and hypos can happen at any time.

As regards taking your insulin for lunch, as soon as you are above 4 (recovering from your hypo) you can inject your lunchtime insulin and i would probably eat straight away rather than waiting. I might also reduce the dose of the lunchtime injection and maybe just give half or 3/4 of the dose depending upon if I had done a lot of exercise as your body will feel the effects of your walk for up to 48 hours after exercise and if you are doing daily exercise when you didn't before, then this will have an add on effect each day meaning that a reduction in basal insulin (Lantus I believe in your case) may be needed, so do continue to chase up your DSN for longer term advice but by all means, post here on the forum or ring the helpline number for Diabetes UK at the top of the page during office hours for advice.
Balancing insulin with food and exercise and other factors is a work in progress and you gradually learn what works for you. Mostly we all just muddle along making the odd mistake here and there and learning from them and gradually the mistakes get less frequent and we get a better understanding of how our particular body responds to things. Adjusting doses according to circumstances is a key part of that as you will find out but at this early stage I can understand your need for more precise guidance. All we can do is suggest what we would do in your situation.

 

[Kaylz]

This really is something you will need to discuss with whoever provides your care, as you are on set units it's difficult, most of us adjust our own insulin taking into account many factors (BG before eating, what exercise has/will be done etc) and most of us also count carbs and adjust for that

You dealt with it well

If you were calling the chemist to see what to do in regards to taking your insulin then they aren't qualified to help, they don't generally have folk trained in diabetes

What emergencies are you referring to when you say who should you call? xx

 

[Proud to be erratic]

I agree with @rebrascora and @Kaylz .

You did great and picked up a couple of useful lessons: never go anywhere without hypo response really handy; if unusually active, even only mildly unusually active, test more frequently. Activity helps your insulin do its stuff more efficiently.

Incidentally if you've got the warm weather we've had recently, then that can also improve your natural insulin sensitivity (ie reduce your natural insulin resistance). Which means any insulin on board goes 'further' so surplus glucose in your blood gets 'mopped up' leading to a risk of hypos.

 

[Purls of Wisdom]

This really is something you will need to discuss with whoever provides your care, as you are on set units it's difficult, most of us adjust our own insulin taking into account many factors (BG before eating, what exercise has/will be done etc) and most of us also count carbs and adjust for that

You dealt with it well

If you were calling the chemist to see what to do in regards to taking your insulin then they aren't qualified to help, they don't generally have folk trained in diabetes

What emergencies are you referring to when you say who should you call? xx

I thought I knew well what to do in case of hypo. Obviously not. It happened at lunch time. Did not know whether to take insulin or not hence the confusion.

 

[Rob Oldfield]

One other tip about hypos can be to note what warnings you get. I had a period where, when headed too low, I would fidget with my feet, tapping them repeatedly on the ground. If you can recognise those mannerisms they can be useful.

 

[Purls of Wisdom]

This really is something you will need to discuss with whoever provides your care, as you are on set units it's difficult, most of us adjust our own insulin taking into account many factors (BG before eating, what exercise has/will be done etc) and most of us also count carbs and adjust for that

You dealt with it well

If you were calling the chemist to see what to do in regards to taking your insulin then they aren't qualified to help, they don't generally have folk trained in diabetes

What emergencies are you referring to when you say who should you call? xx

That I definitely will do. Have not been for my first appointment. Have endless stream of questions. Emergencies mean when I am faced with something new and do not know what to do or who to turn? Hope it makes some sense. Thanks. X

 

[rebrascora]

One other tip about hypos can be to note what warnings you get. I had a period where, when headed too low, I would fidget with my feet, tapping them repeatedly on the ground. If you can recognise those mannerisms they can be useful.

Yes, I used to find my peripheral vision would start to go blurry as one of my first signs. Now when I am out walking I consciously check my peripheral vision every now and then as a sort of proactive check, maybe every couple of miles.
Tingling lips or tongue is a more obvious giveaway sign.

 

[helli]

I thought I knew well what to do in case of hypo. Obviously not. It happened at lunch time. Did not know whether to take insulin or not hence the confusion.

I have always been told when you have a hypo..
1. treat hypo
2. test and check that you have recovered (BG above 4.0)
3. make a mental note to understand why it occurred and what to do different next time. If I don't know, I make a written note to ask my DSN.
4. continue to dose and eat as usual.
5. keep a closer eye on levels for the next day as one hypo can follow another.

 

[Inka]

I thought I knew well what to do in case of hypo. Obviously not. It happened at lunch time. Did not know whether to take insulin or not hence the confusion.

You’re on fixed doses of Novorapid? I’d have either injected just before eating or even after the meal. I’d also have had a few extra carbs with my meal.

You still need the Novorapid to cover the food you’re about to eat, but you don’t want the Novorapid to start working too early so delay the injection and add extra carbs to your meal. That way you should be ok.

For exercise, you can ‘top up’ with glucose tablets if energetic and/or a small snack. That will give you extra glucose to offset the exercise.

 

[Lucyr]

Being faced with something new isn’t an emergency, it’s just everyday life. You can’t expect to ask someone for professional advice every time you meet a new situation, just use your own judgement. If it doesn’t work out, do something different next time.

 

[Purls of Wisdom]

I have always been told when you have a hypo..
1. treat hypo
2. test and check that you have recovered (BG above 4.0)
3. make a mental note to understand why it occurred and what to do different next time. If I don't know, I make a written note to ask my DSN.
4. continue to dose and eat as usual.
5. keep a closer eye on levels for the next day as one hypo can follow another.

Thank you for point 5. Pre dinner reading was high whereas bedtime reading is just above 5. Lantus taken. Hope it does not happen during night.

 

[Purls of Wisdom]

Being faced with something new isn’t an emergency, it’s just everyday life. You can’t expect to ask someone for professional advice every time you meet a new situation, just use your own judgement. If it doesn’t work out, do something different next time.

Being less than 4 weeks since diagnosis, I do not feel confident or equipped enough not to seek help.

 

[rayray119]

Being less than 4 weeks since diagnosis, I do not feel confident or equipped enough not to seek help.

Did they nor tell you how to treat a hypo when you started insulin if they didn't they should have. I was told while I was still in hospital. I was even given an flow chat on it.

 

[Purls of Wisdom]

Did they nor tell you how to treat a hypo when you started insulin if they didn't they should have. I was told while I was still in hospital. I was even given an flow chat on it.

I was well taught and prepared as to how to treat a hypo but knew nothing if I were to take insulin as usual or skip it since it was lunch time.

 

[Lucyr]

Being less than 4 weeks since diagnosis, I do not feel confident or equipped enough not to seek help.

Making decisions for yourself is something you’ll need to get used to as there just isn’t professional help available quickly enough to answer questions like “should I take insulin with the meal I’m about to eat next”. You just have to go with your best guess and learn from whatever happens for next time.

 

[leonS]

For help in this sort of case ring 111.

I would have just eaten the meal, and 15 mins or so later taken a reduced dose of insulin. Increasing the carbs will work just as well.

How much is a matter of try it and see. Just test ln an hour or so and have more if needed. After a few years you get to know better how much...

 

[Proud to be erratic]

I was well taught and prepared as to how to treat a hypo but knew nothing if I were to take insulin as usual or skip it since it was lunch time.

I can understand your dilemma.

The reply from @Lucyr at post #16 is very valid, but perhaps a little hard. You started this thread asking for advice, after the event and I think that was a good call by you. My first hypo was horrible and while I tried to work out 'why', my DSN later just told me they 'happen' , treat and move on; and I remember thinking 'but what's the answer to why....'. I hadn't found this forum at that time. My circumstances were rather different in those early days.

I hope you've now got a better feel for how to manage your next hypo, alas there will be a next!

Hypos are horrible, at first frightening, but manageable and less frightening once you realise they generally DON'T kill you. The incidence of that is extremely small, in practice. The short term problems that can arise are broadly two-fold:
repeated frequent hypos can lead to a loss of hypo awareness;
and over-responding with too many dextrose tabs or JBs etc, can start you onto the 'roller coaster' of low/ too high/ back to hypo.
In the longer term hypos can be damaging to you, which is also a good enough reason to avoid them!

I still don't have a specific answer to the nub of your original question. Yes, take insulin with your next meal (lunch in this case). But how much? You are still on fixed doses and not yet carb counting; and how much hypo response had you taken - ie what accumulation of carbs was now in your system? Rhetorical question, since you aren't carb counting. How big was your lunch going to be? Would your fixed dose normally match your normal lunch? More rhetorical questions. You need to ask your DSN.

After a hypo, after the initial treatment and initial recovery, I take some more lower GI carbs about 15+ mins later (eg a biscuit of 6-12 gms) to consolidate the recovery. However if it were my due lunch time, I'd eat that as planned. But how much bolus would depend entirely on: how deep had the hypo and response been; how big the lunch was going to be and hence how much my bolus would have been; then adjust by either reducing my bolus by a couple of units or having a supplement to my lunch. For me, if only finger pricking was available, this would be a trial and error lesson. Today, because I have Libre I can monitor simply and painlessly and adjust my lunch strategy accordingly; but that is no help to you just now!

Please don't be put off asking questions. How else do we learn?

 

[nonethewiser]

First one is very frightening, all one big learning curve how to treat & prevent them as much as possible.

Back in day had to have first hypo before leaving hospital as you were admitted for few days then when diagnosed, so felt sort of safe being there with help around.

 

[Purls of Wisdom]

First one is very frightening, all one big learning curve how to treat & prevent them as much as possible.

Back in day had to have first hypo before leaving hospital as you were admitted for few days then when diagnosed, so felt sort of safe being there with help around.

Oh no, you mean induced hypo?