How dangerous is a hypo?

[Tefler]

My other half has type 1 diabetes and injects 4 times a day. Usually, there's a warning when the blood sugar drops, but over the last couple of years, on 3 occasions, it's happened at night with no warning. The first time there was no choice but to call an ambulance - he passed out and was unconscious. The more recent couple of times, though, have seen him having something like a fit, his arms and legs twitching and him not responding to anything I said. His eyes were open, but vacant and not really focussing. I couldn't get sugar into him without risking him choking (and me losing a digit or two). On each occasion, I called an ambulance - but both times he had stopped the twitching and was speaking almost rationally by the time the paramedics arrived, probably within 15 to 20 minutes.
My question is: am I being too impatient? He's embarrassed when the paramedics come because we appear to be wasting their time. Now he's asked me to say I won't call them in the future. I need to know if not calling them could be dangerous. Any thoughts?
I'd also like to know what causes the fits and why he comes round afterwards, if anybody can answer those questions, too.

 

[Inka]

Better safe than sorry is my opinion. I don’t think you did anything wrong. A hypo seizure is frightening. There’s no way you could know that he was going to improve or not. Hypos can be extremely dangerous.

Has he any idea what’s causing these? What insulins does he use? When does he inject? Does he have a bedtime snack?

 

[Thebearcametoo]

Do you know how to test his glucose levels? Knowing what number his glucose levels are can help you to decide on treatment and to see if any glucose you have got into him means his levels are going in the right direction. Do you have glucogen in the house and do you know how to administer it? You basically need a workable emergency plan that you are happy to do to keep him alive.

If he’s not able to swallow your options for getting glucose into him include running glucogel on the inside of his cheek or using Glucogen.

 

[Robin]

My other half has type 1 diabetes and injects 4 times a day. Usually, there's a warning when the blood sugar drops, but over the last couple of years, on 3 occasions, it's happened at night with no warning. The first time there was no choice but to call an ambulance - he passed out and was unconscious. The more recent couple of times, though, have seen him having something like a fit, his arms and legs twitching and him not responding to anything I said. His eyes were open, but vacant and not really focussing. I couldn't get sugar into him without risking him choking (and me losing a digit or two). On each occasion, I called an ambulance - but both times he had stopped the twitching and was speaking almost rationally by the time the paramedics arrived, probably within 15 to 20 minutes.
My question is: am I being too impatient? He's embarrassed when the paramedics come because we appear to be wasting their time. Now he's asked me to say I won't call them in the future. I need to know if not calling them could be dangerous. Any thoughts?
I'd also like to know what causes the fits and why he comes round afterwards, if anybody can answer those questions, too.

Hello, Tefler, and welcome to the forum. The short answer is, he is twitching and fitting because his brain is being starved of glucose. At the moment, his body responds, by releasing adrenaline, which in turn causes the liver to release some emergency glucose to feed his brain, which is why he seems to be recovering by the time the ambulance arrives. One day, if he continues to have really low hypos, his liver won’t respond, and he really will need that ambulance. So dig your toes in and don’t agree not to call one, unless you have put a system of management in, which probably involves training you how to admimister a glucagon injection. (they aren’t a case of pointing and stabbing, stuff has to be mixed, and drawn up into a syringe, so not something you ever want to be faced with doing in the middle of the night if you haven’t practised it first)

 

[SB2015]

Welcome to the forum @Tefler

In addition to the above advice about dealing with night time hypos, it will be important to find what is causing them. There are lots of possibilities that need to be worked through and it counts like your partner could do with the some help from a Diabetes Specialist Nurse (DSN). Is he under the hospital clinic or managed through his GP. If so it would be worth asking for a referral to the hospital.

 

[Tefler]

Wow! Those answers came quickly. Thank you! Is glucogen the pen thing? I've never been sure how one goes about getting such a thing, but it sounds useful.

 

[Robin]

Wow! Those answers came quickly. Thank you! Is glucogen the pen thing? I've never been sure how one goes about getting such a thing, but it sounds useful.

Yes that’s the one, I think it would normally be prescribed in a hospital clinic setting, not many GP nurses would be trained to prescribe it, I don't think. (mine certainly wouldn’t!)

 

[Bruce Stephens]

I've never been sure how one goes about getting such a thing, but it sounds useful.

It's something you get with a prescription. You can also get glucogel (which can help if the patient's semiconscious).

 

[Amity Island]

My other half has type 1 diabetes and injects 4 times a day. Usually, there's a warning when the blood sugar drops, but over the last couple of years, on 3 occasions, it's happened at night with no warning. The first time there was no choice but to call an ambulance - he passed out and was unconscious. The more recent couple of times, though, have seen him having something like a fit, his arms and legs twitching and him not responding to anything I said. His eyes were open, but vacant and not really focussing. I couldn't get sugar into him without risking him choking (and me losing a digit or two). On each occasion, I called an ambulance - but both times he had stopped the twitching and was speaking almost rationally by the time the paramedics arrived, probably within 15 to 20 minutes.
My question is: am I being too impatient? He's embarrassed when the paramedics come because we appear to be wasting their time. Now he's asked me to say I won't call them in the future. I need to know if not calling them could be dangerous. Any thoughts?
I'd also like to know what causes the fits and why he comes round afterwards, if anybody can answer those questions, too.

Hi,

Here is a video of how to administer the glucagen "pen" (syringe).

Also, there is a the Freestyle Libre glucose monitor which would be very helpful, it gives a continuous graph of blood sugars from a sensor worn on the arm when it is swiped. Video also below. You can check to see what blood sugars are and the direction they are going before going to sleep, it would also allow someone else to check blood sugars during the night without waking the person wearing the sensor. They are available on prescription as an alternative to finger pricking, or they can also be bought online direct form Abbott.

Also, there is a freestyle libre "2" supposed to be coming out in England any time now. This would set off an alarm when blood sugars go below 4mmol (or whichever value you set it to) which would help avoid dangerous night time hypos which would be peace of mind.

 

[Bloden]

Wow! Those answers came quickly. Thank you! Is glucogen the pen thing? I've never been sure how one goes about getting such a thing, but it sounds useful.

Hiya @Tefler. Er, the pen thing is his insulin, I should think. My glucagon kit is bright orange and contains a syringe with a covered needle, etc. - definitely no pen in there. You don’t want to be giving him insulin when he’s hypo, obviously!

 

[rebrascora]

Hi Tefler

This situation must be really frightening for you and it is important your other half understands that he is also putting you at risk as you could easily get injured trying to help him when he is fitting like that as well as a tremendous source of stress.

He needs to be taking action to manage his diabetes better and that involves getting help and education from his diabetes clinic. I don't know if he drives but these incidents would probably cause him to lose his driving licence even though he was not driving at the time and didn't need the ambulance when it arrived and would invalidate his insurance, so he needs to take action.
There are education courses like DAFNE and tech gadgets like the Freestyle Libre or even insulin pumps as well as possibly an emergency Glucagon kit, but as others have said, his Diabetic Specialist Nurse or the diabetic clinic need to be contacted to get help. Do not agree to not calling an ambulance. It is dangerous and life threatening. If he is sufficiently embarrassed then it is up to him to get help to prevent it happening again, not for you to promise not to get the help which could save his life.

 

[Deleted member 27171]

Hi @Tefler welcome to the forum, though sorry its these worrying experiences that have led you here.

Absolutely call an ambulance if you are concerned. Every time. No paramedic is going to consider you a time waster if your partner is so low he is fitting and not waking up.
I can understand your partner asking you to delay if hes actually begun to recover by the time they arrived the last time, but honestly feel its a bit of an unfair ask. The fact that he has come round on his own in the past is not a guarantee he will do next time, so best not to take any chances. I don’t want to appear alarmist, but its better calling an ambulance than to regret not calling one.
As has already been mentioned, he should be able to get a Glucogen injection kit on prescription - if he has one and you don’t know how to use it, the video posted above will help. He can also get glucogel, that you can rub in his gums/cheek if unable to drink anything.
The most helpful solution long term is for him to talk to his diabetes team about how to prevent his, either through changes to his insulin doses or tech to support him in avoiding overnight hypos - are they aware of the issue and it being something which is recurring?

 

[trophywench]

Enough severe hypos (and these are severe!) and he'll cause himself brain damage, which can be permanent. I remember another lady such as yourself several years ago with a T1 husband and a similar story and they had a young daughter. He did cause himself brain damage and she divorced him in the finish because the man she loved didn't live there any more, he was utterly unreasonable and he had scared both the girls too many times.

For goodness sake - urge him to confide in someone medically expert in diabetes who can help!

It was my understanding that the GP gets a report of any ambulance calls to any of their patients - or at least they used to, when I was a lot younger and having frequent hypos,

 

[atoll]

ask your gp to prescribe a glucogon injection kit they used to be given out all the time but cuts have curbed the supply every diabetic on insulin should have one in the top of the fridge for emergency use by a partner

 

[KARNAK]

Hello @Tefler welcome to the forum.

His type 1(T1D) is for life, death is forever, hospital DSN needs to be contacted asap.

 

[everydayupsanddowns]

Welcome to the forum @Tefler

Absolutely agree that...

- YES you should call an ambulance
- You need a glucagon injection kit in the house

and really importantly
- His diabetes management, particularly around hypos really needs an urgent overhaul.

Does he drive? Because if these hypos where he doesn’t catch them in time and needs help from someone else start happening during waking hours he will lose his licence.

The overnight ones are really serious, and significantly impact on you - so they need to be fixed. And I speak as someone who (to my shame) put my wife through years of grief with overnight hypos, which I just didn’t recognise were as bad and as frequent as they were - because my brain was on the fritz at the time so I wasn’t really ‘there’ which made ignoring them easy for me, but not for her.

I would suspect he may be having quite a few ‘low level’ ones during the day too. Simply put... the more you have, the less you feel them, and the worse and potentially more catastrophic they become before you spot them.

It‘s a nasty cycle - but it can be broken. And hypo awareness can be improved and restored at higher levels - to some extent.

He may need to switch background insulins, or switch to a pump with integrated CGM. There are also courses and training that are proven to help.

Good luck with it!