Frequent hypos

[Cpfc09]

Hi there,
My daughter was diagnosed with type one diabetes 2 weeks ago and now is constantly having hypos we have reduced her lantus to 3 units and put her carb to insulin ratio up,her nurse said to do so, we are currently checking her BG every hour as she drops so quickly. Apparently she is in what's called the honeymoon period, has anyone else had this and is there anything else we can do for her, she had a hypo this morning and required 2 treatments before it came up.

Thanks for reading.

 

[Thebearcametoo]

Hi, how old is your daughter and what are her regular glucose levels. Does she show hypo awareness? What levels are her hypos and what is your treatment? I would put the insulin ratio back down until she settles.

It’s not uncommon to have phases where there’s a lot of hypos and especially in the early days there’s a lot of guesswork that goes into the ratios until you have enough data to work from. It feels more comfortable as a parent to run the glucose levels to the higher end of target or just above it if you’re unsure about anything or everyone’s getting stressed with the hypos.

A hypo of 3.5-3.9 will be a lot quicker (usually) to recover from than one lower but everybody differs and it can depend on how rapid the downward trend of the glucose was at that point. We always give water with glucose/dextrose tablets or we use lucazade sport. Having water with tablets helps the sugars get into the blood stream faster. It can take a couple of goes to get a stubborn hypo back up. You’ll get used to what works for your daughter in different scenarios. It can make a big difference to wait 15 minutes instead of 10 to give enough time for levels to rise but to begin with 10 can feel like you have more control (it can lead to you over treating though which can then mean you get into a rollercoaster of highs and lows).
You will find a sweet spot in how many carbs work well for her at meals and you’ll get to know which carbs tend to result in hypos (often because of a mismatch of insulin and glucose absorbing). For my 9 year old we tend to have around 60 carbs per meal (less than that and she often gets hungry sooner) but some meals will be a lot more. We try to give her some fat and protein with any carbs and to mix fast and slower release but kids are sometimes stubborn about what they want so she often eats carb heavy meals with little else. We’ve learnt over time (it’s almost a year since diagnosis) what the effects of her usual food combinations will be and may over count under count carbs a little to help balance it.

It will get easier

 

[Cpfc09]

Hi thank you for your message she is 7 and her levels are usually at around 8, when she went into hospital they were 35 and her ketones were around 5. She cant tell when she is in a hypo so it's a shock when it shows hypo on the monitor for treatment we have glucose tabs, glucose liquid and gels plus jelly babies as our nurse said they can be great for a hypo. Her last hypo she was at 3 after 1st treatment it went to 3.3 then after 2nd treatment went to 4.3.

 

[Thebearcametoo]

Lack of hypo awareness makes it hard. My daughter has mostly had some hypo awareness but it does come and go. You will learn by looking at her that she’s not right (sometimes hypos and hyper can look the same) and that can prompt you to test. Which insulins is she on? Novorapid tends to peak about an hour after injecting so sometimes it can help to give the insulin and then wait for a period before eating so the insulin works at the same speed as the food but it can be trial and error to sort that. For now I would put the carb to insulin ratio back down and just make sure she’s not having too many fast acting carbs with her meals. Keep your nurse involved. We called the out of hours numbers lots in the first few weeks and it takes a lot of the guesswork out of it as they can easily give you different things to try or suggest changes to doses.

 

[Cpfc09]

Hi she is on novarapid and lantus although the nurse is changing her lantus because she says it stings when going in the skin, we did ring the out of hours number last night and he was very good with us we have changed her ratio to 1 unit of insulin per 25g of carb, as she was on 1 unit per 18g before.

 

[trophywench]

I'm with her with the Lantus stinging - orrible stuff. Oww!

I'm sorry NHS but sounds to me like Lantus is too 'aggressive' (in its action, not the stinging here) for your daughter and the sooner she can be changed over to something else, the better. I'll be interested to see what they change her to.

(For the benefit of some of the other 'old hands' on the forum, I honestly wonder if something like Insulatard which is a lot slower to 'ramp up' and 'get going' would be helpful here?)

 

[Thebearcametoo]

My daughter didn’t like Lantus either and is now on tresiba instead.

 

[everydayupsanddowns]

Hi there,
My daughter was diagnosed with type one diabetes 2 weeks ago and now is constantly having hypos we have reduced her lantus to 3 units and put her carb to insulin ratio up,her nurse said to do so, we are currently checking her BG every hour as she drops so quickly. Apparently she is in what's called the honeymoon period, has anyone else had this and is there anything else we can do for her, she had a hypo this morning and required 2 treatments before it came up.

Thanks for reading.

sorry to hear about your daughter’s diagnosis, and her current phase of hypos

I find hypos often come in waves, and once you’ve had one in a day you can be mire likely to have another. Even if they are quite low-level ones and not very dramatic.

Hope the suggested basal and ratio tweaks work better.