Hi all

[Nolster]

Newbie to the site.
I've been type 2 for over 15 years
Last year , I was put on humilin 1...one daily injection. Started off at 2units. Now on 36.
I'm also on dulaglutide , have been for about 4 years. Recently been upped to 3mg instead of 1.5.
On one metformin tab per day (slow release)
I find it very difficult to find information for when I'm sick for example. As although I'm on insulin , I'm not type 1 so I don't have all the basal, background insulin etc. Or whatever they're called. Please excuse my ignorance.
So over the weekend , I've been ill with diarrhoea on and off. Had phine consult today with gp, got a dample bottle to give her sample as may be food poisoning. Typical today tho, I haven't needed the loo. I do get hypos, or at least, I feel them come on normally when I'm about 6.5.
I've tried to eat carbs on n off all weekend. Even today. Yet cant seem to get my sugars to go above 6.5.
Had a bap/roll , cup of tea with sugar n 2 digestive biscuits before bed last night and woke up with a 5.5 reading. Anyone recommend what to eat, especially before bed ?
My appetite wasn't great over the weekend as tlu can imagine, but been truing to keep the sugars up as I said above. Any info appreciated xx

 

[PattiEvans]

Hi there @Nolster.

I do get hypos, or at least, I feel them come on normally when I'm about 6.5.

It is normally accepted that hypos are under 4. However, if you have been used to having high BGs you can start to feel low at much higher levels than that. This is known as a "false" hypo. Why would you want to have BGs over 6.5?

Had a bap/roll , cup of tea with sugar n 2 digestive biscuits before bed last night and woke up with a 5.5 reading. Anyone recommend what to eat, especially before bed ?

Humulin I is an intermediate acting insulin normally taken twice a day. Is that how you take it? I would suggest that rather than trying to up your carbs it may be wiser to reduce your Humulin overnight injections. Either that or it could be that the hugely carby snack before bed sent you high and your own insulin production together with the Humulin pushed you down to 5.5. Incidentally I would be more than happy to wake on 5.5 but that's another story.

Apart from that you are on a right old mix of diabetic medication and it could be any combination of the oral drugs (or even just metformin) causing the diarrhoea. I would seriously suggest you ask your GP to refer you to a diabetic clinic at the hospital to get your meds sorted out.

 

[Nolster]

Hi there @Nolster.

It is normally accepted that hypos are under 4. However, if you have been used to having high BGs you can start to feel low at much higher levels than that. This is known as a "false" hypo. Why would you want to have BGs over 6.5?

Humulin I is an intermediate acting insulin normally taken twice a day. Is that how you take it? I would suggest that rather than trying to up your carbs it may be wiser to reduce your Humulin overnight injections. Either that or it could be that the hugely carby snack before bed sent you high and your own insulin production together with the Humulin pushed you down to 5.5. Incidentally I would be more than happy to wake on 5.5 but that's another story.

Apart from that you are on a right old mix of diabetic medication and it could be any combination of the oral drugs (or even just metformin) causing the diarrhoea. I would seriously suggest you ask your GP to refer you to a diabetic clinic at the hospital to get your meds sorted out.

The thing is. Yes my 'normal' bloods are about 7/8/9 even. So as soon as I get to 6.5, I feel shaky ,headache, weak.
I was at a wedding on Friday n told gp this, I was ill during the night with stomach that night , rhen on Saturday n again on Sunday. Explained my 'poor yuck sorry. To my gp. She thinks food poisoning.. wants a sample.
I do occasionally have tummy episodes n can tell the difference between my normal problems and this.
5.5 for me in morning is to low compared to what I'm used to.
Normally after I eat, my sugars go to 7s 8s 9s. This hasn't been happening the last few days.
I only take humilin in the morning.
Thanks.

 

[everydayupsanddowns]

Welcome to the forum @Nolster

Sorry to hear about your upset tum, must have been pretty grim for you.

Have you had a conversation with your GP about the BG range she would like you to be aiming for?

It seems like you’ve had some increases in meds fairly recently, including upping the dose of dulaglutide and introducing insulin - presumably with the intention of reducing your HbA1c, but this will most likely involve a reduction in BG levels.

Those 5.5s and 6.5s which are triggering hypo symptoms are not dangerous in themselves, but your internal glucose ‘thermostat’ needs a little time to reset, so that the warning signs only kick-off in the low 4s.

Adding extra carbs overnight just seems to be fighting the meds, and stopping them make the BG reductions they may be intended to produce? But you’d need to check with your GP really, as I’m just guessing.

 

[SB2015]

Welcome to the forum @Nolster
Sorry to hear of the difficulties that you are having.

The insulin that you are using along with the other medications can make it difficult to work out what to change. Many T2s who start to use insulin find it a lot easier to manage if they switch to the two separate insulins (basal/Bolus regime that you mentioned) . You might find it very helpful to get a referral to the specialist Diabetes team who will be more familiar with managing the balance between the meds and insulin, and can work with you to find what best suits you.

 

[Nolster]

Welcome to the forum @Nolster

Sorry to hear about your upset tum, must have been pretty grim for you.

Have you had a conversation with your GP about the BG range she would like you to be aiming for?

It seems like you’ve had some increases in meds fairly recently, including upping the dose of dulaglutide and introducing insulin - presumably with the intention of reducing your HbA1c, but this will most likely involve a reduction in BG levels.

Those 5.5s and 6.5s which are triggering hypo symptoms are not dangerous in themselves, but your internal glucose ‘thermostat’ needs a little time to reset, so that the warning signs only kick-off in the low 4s.

Adding extra carbs overnight just seems to be fighting the meds, and stopping them make the BG reductions they may be intended to produce? But you’d need to check with your GP really, as I’m just guessing.

Thanks Mike

I started on the humilin in January 2020... the dulaglutide has been upped for the past few months, with no immediate effects really. Blood sugars still haven't improved massively.

Ah I know what you mean re my own glucose thermostat. Good way of putting it.
Ever since I started on insulin, my very first 'low' was 3.4 ..I recognised this at the time. Ever since then, I feel those false hypos as you say, round about 6.5

I added the extra carbs because of the upset tummy seemed to be lowering my bg, which I'm not used to and feel a bit scared when they get to those figures. Especially at bedtime , as because I'm not type 1, I'm pretty ignorant when it comes to knowing a load of information re lows, even tho I read things on the Internet n what not.
Basically a sick day rule, but for type 2 on ONE daily dose of, insulin it's difficult to find the correct info

 

[Nolster]

Welcome to the forum @Nolster

Sorry to hear about your upset tum, must have been pretty grim for you.

Have you had a conversation with your GP about the BG range she would like you to be aiming for?

It seems like you’ve had some increases in meds fairly recently, including upping the dose of dulaglutide and introducing insulin - presumably with the intention of reducing your HbA1c, but this will most likely involve a reduction in BG levels.

Those 5.5s and 6.5s which are triggering hypo symptoms are not dangerous in themselves, but your internal glucose ‘thermostat’ needs a little time to reset, so that the warning signs only kick-off in the low 4s.

Adding extra carbs overnight just seems to be fighting the meds, and stopping them make the BG reductions they may be intended to produce? But you’d need to check with your GP really, as I’m just guessing.

Thanks Mike

I started on the humilin in January 2020... the dulaglutide has been upped for the past few months, with no immediate effects really. Blood sugars still haven't improved massively.

Ah I know what you mean re my own glucose thermostat. Good way of putting it.
Ever since I started on insulin, my very first 'low' was 3.4 ..I recognised this at the time. Ever since then, I feel those false hypos as you say, round about 6.5

I added the extra carbs because of the upset tummy seemed to be lowering my bg, which I'm not used to and feel a bit scared when they get to those figures. Especially at bedtime , as because I'm not type 1, I'm pretty ignorant when it comes to knowing a load of information re lows, even tho I read things on the Internet n what not.
Basically a sick day rule, but for type 2 on ONE daily dose of, insulin it's difficult to find the correct info

Gp

Welcome to the forum @Nolster
Sorry to hear of the difficulties that you are having.

The insulin that you are using along with the other medications can make it difficult to work out what to change. Many T2s who start to use insulin find it a lot easier to manage if they switch to the two separate insulins (basal/Bolus regime that you mentioned) . You might find it very helpful to get a referral to the specialist Diabetes team who will be more familiar with managing the balance between the meds and insulin, and can work with you to find what best suits you.

Thank you foe reply.

My diabetes is managed by the community diabetes team.
It's them who put me on the humilin 1...January 2020.
She also few months back , raised the dulaglutide dose after a phone consultation. I was happy to up the dose

I just find it difficult to find 'answers' on the Web, (especially if you're sick) regards a type 2 on ONE daily insulin injection.
Thanks

 

[PattiEvans]

Hi @Nolster

It's unusual for any illness to reduce blood sugar. The most expected result of illness is to raise blood sugar, because a body under stress produces Cortisol, a natural steroid. Steroids raise BGs. Sick day rules normally suggest increasing insulin, which is clearly not appropriate in your case. So it's hard to say what you should do under the circumstances, but certainly I would suggest a conversation with the community diabetes team.

 

[helli]

It's unusual for any illness to reduce blood sugar.

It is not that unusual for illness to cause low blood sugars especially if it is a digestive problem - you may not fully digesting the carbs when suffering from vomiting and diarrhoea so have too much insulin on board. I know from experience this is possible with basal/bolus regime and see no reason why not with fixed mixed dose.

In my case, I at a bag of chips and bolused for it just before setting out on a Channel crossing in a force 8 gale on a small yacht. I am sure I need expand no further describing the consequences.

 

[PattiEvans]

It is not that unusual for illness to cause low blood sugars especially if it is a digestive problem - you may not fully digesting the carbs when suffering from vomiting and diarrhoea so have too much insulin on board. I know from experience this is possible with basal/bolus regime and see no reason why not with fixed mixed dose.

In my case, I at a bag of chips and bolused for it just before setting out on a Channel crossing in a force 8 gale on a small yacht. I am sure I need expand no further describing the consequences.

@helli No, I understand that vomiting up carbs which you have eaten and bolussed for would be likely to cause low BGs. When I contracted an infection that caused diarrhoea it caused raised BGs but as we always say, everyone is different. Incidentally the OP isn't on mixed insulin, just background Humulin I an intermediate acting insulin.