hypo aggressive behaviour

[bujanin]

For ten years my wife has very kindly helped me when I have nightime hypos and there are occasions when she has called an ambulance for me. She has always said that she is happy to help me. My daughter has grown knowing what a hypo is and has on four occasions - aged5/6 - called an ambulance when my wife has been away. Amazing kid who understands well what to do and how to see a hypo coming.

Now my marriage has broken down and as a logic for applying to take control of my daughters life my wife is claiming physical and psychological abuse due to me having been aggressive on occasions when having a hypo. Spitting and pushing her away when she has tried to give me dextrose. Apparently London Ambulance took details at the time. Can this be used as evidence of physical assault?

She also claims Psychological abuse to my daughter due to her having seen me having hypos. My daughter and I are alone for 25% of the month as my wife works overseas. She feels upset after a hypo episode although also pride at having helped me and she understands what is necessary. I would be considered as her primary carer.

Some background information - I am thirty years with type 1 and using a cgm. My hba1c most recently was 5.7 and I do work hard to keep my numbers low to try and stave off complications.

So I am asking if anybody can talk to this. I can behave quite aggresivley when having a hypo although I am not conscious of what is going on but can this be considered physical abuse? Does anybody else become physical when having hypo episodes?

I am really upset at the moment and trying to make sense of things. Thank you for reading.

 

[Inka]

I doubt it would count as physical abuse @bujanin Your wife could, however, claim it ‘wasn’t safe’ for you to look after your daughter. I also doubt that seeing you have a hypo counts as psychological abuse, otherwise that could be claimed about any parent with a medical issue.

How old is your daughter? What CGM do you have? What’s the Low alert set at? What insulins do you take? I think it would be of benefit to you to demonstrate you’re reducing the number of severe hypos you have. It does sound quite a lot of hypos if your daughter has called an ambulance four times. That’s what your wife will probably eventually claim - that you’re ‘not safe’ to care for a child. You can disprove this if you’re organised and focussed.

 

[bujanin]

I doubt it would count as physical abuse @bujanin Your wife could, however, claim it ‘wasn’t safe’ for you to look after your daughter. I also doubt that seeing you have a hypo counts as psychological abuse, otherwise that could be claimed about any parent with a medical issue.

How old is your daughter? What CGM do you have? What’s the Low alert set at? What insulins do you take? I think it would be of benefit to you to demonstrate you’re reducing the number of severe hypos you have. It does sound quite a lot of hypos if your daughter has called an ambulance four times. That’s what your wife will probably eventually claim - that you’re ‘not safe’ to care for a child. You can disprove this if you’re organised and focussed.

Thank you.
My daughter is seven now. I am using the DEXCOM G5 set at 4.5. When they happen I can see a reason for hypos after the event. Stupidly falling asleep with headphones in listening to a podcast and not hearing the alert. Having lowered the alert number during the day for whatever reason to 3.8 or similar and forgetting to reset. Not having calibrated the cgm for a day or two.
I use tresiba and humalog.
I have had an ambulance three times this year. The paramedic crews tell me that they see some diabetics on a weekly basis.

 

[Pumper_Sue]

Thank you.
My daughter is seven now. I am using the DEXCOM G5 set at 4.5. When they happen I can see a reason for hypos after the event. Stupidly falling asleep with headphones in listening to a podcast and not hearing the alert. Having lowered the alert number during the day for whatever reason to 3.8 or similar and forgetting to reset. Not having calibrated the cgm for a day or two.
I use tresiba and humalog.
I have had an ambulance three times this year. The paramedic crews tell me that they see some diabetics on a weekly basis.

You need to set your hypo alarm for 5 at the least. Not sure if you realise but the G6 you are using is not real time there is a 15min lag in the readings.
Having an A1c of 5.7 does not make complications less likely. The ideal is 6.5.
If you think about it logically you already have complications IE hypo unawareness which is very detrimental to your health and also your daughters.
If you are doing all the things you state in the above post I can fully understand why your wife isn't happy and very concerned for the safety of your daughter.
If you look at it logically what it boils down to is you can't look after yourself so how can you look after your daughter?

I'm not taking sides just looking at it from the outside if you see what I mean.

So you need to consider a plan of action which involves talking to your DSN and seeing what can be done to improve the hypo situation.
As you are not even doing the basics involved for using a CGM I would doubt there would be any chance what so ever to having a pump, so no point in suggesting that.
Good luck in sorting things out.

 

[Inka]

Thank you.
My daughter is seven now. I am using the DEXCOM G5 set at 4.5. When they happen I can see a reason for hypos after the event. Stupidly falling asleep with headphones in listening to a podcast and not hearing the alert. Having lowered the alert number during the day for whatever reason to 3.8 or similar and forgetting to reset. Not having calibrated the cgm for a day or two.
I use tresiba and humalog.
I have had an ambulance three times this year. The paramedic crews tell me that they see some diabetics on a weekly basis.

Ok, well there’s the first thing you can do - set your Low Alert a bit higher. You need to be alerted as it’s falling so you can take preventative action. I have the G7 and my alarm is set at 5 or higher, depending on what I’m doing. Sometimes I’ll set it at 6 if I’m exercising or have done a correction bolus. This is to allow me to control the fall and slow any drop. This makes hypos rare for me now. I don’t know what alarms you have on the G5 but the G7 has a Falling Fast alarm.

The trick is to spot falling sugars early. If you’re looking for a honest answer, three ambulances in a year is quite shocking. I’m sure you can work to improve this. To me, it sounds like a) your Low alert is too Low; and b) you’re running your sugars too low. You say your daughter can spot the signs of an impending hypo, but you should be able to too. I suspect your hypo awareness has been damaged over the years. The good news is you’ve got a good chance of getting it back.

Is there any particular time of day(or night) you’re prone to hypos?

If you can put a plan in place to reduce the number of hypos you’re having and their severity that should count in your favour. I’d aim to run sLightly higher for a while too, so you can get some hypo awareness back. You’ll also find it a mental relief to coast along a bit higher.

 

[everydayupsanddowns]

So you need to consider a plan of action which involves talking to your DSN and seeing what can be done to improve the hypo situation.
As you are not even doing the basics involved for using a CGM I would doubt there would be any chance what so ever to having a pump, so no point in suggesting that.

I would say that @bujanin should definitely be asking for a pump - in particular a hybrid closed loop that will automatically shut off insulin when levels are getting too low for comfort.

Insulin pumps in general have excellent outcome data for reducing hypoglycaemia, and sensor-augmented pumps doubly so.

It was my exposure to erratic hypos, and my fear of them, that secured me insulin pump therapy (though no ambulance call-outs in my case).

Dexcom’s lag is a pain when it comes to hypoglycaemia IMO. Added to the fact that it only updates data at 5 minute intervals - setting any lower than 5 on my G6 can mean that I am already below 4.0 by the time Dex tells me I’m in the 5s

I think you really do need to adjust your management strategy @bujanin - I spent many years ‘preferring to run on the low side’ feeling like this was ‘better’ diabetes management- but in actual fact I was far too exposed to low-level hypos, and it put a huge burden on my family.

There is no ‘protection’ in an A1c in the 5s when you are having severe hypoglycaemia because you hugely increase your risk of cardiac arrythmia / coma / siezure and even sudden death. You’d be far far better having an A1c in the low-mid 6s, with no severe hypos.

I used to need help from my family for overnight hypos every other month at one stage, but I’ve not had a single severe hypo for about 8 years.

Use the International Consensus for Time in Range as your target -

70% 4-10
less than 4% below 4.0 including less than 1% below 3.0
up to 26% above 10 is fine

You can read the full paper here: https://care.diabetesjournals.org/content/early/2019/06/07/dci19-0028

 

[Pumper_Sue]

I would say that @bujanin should definitely be asking for a pump - in particular a hybrid closed loop that will automatically shut off insulin when levels are getting too low for comfort.

My comment was based on the fact OP wasn't checking his CGM and or ignoring it, which would be fatal using a pump.

 

[Sally71]

I don’t think your wife should be able to claim psychological abuse for a medical condition that you had no choice over. However, that sounds like a LOT of hypos you’re having. In 11 years my daughter has never been so out of it that she was completely unaware of anything, and we’ve never had to call an ambulance. My mum has been type 1 for 56 years, has never used CGM or pumps or anything like that, and has also never had an ambulance called, I think in all that time there have only been 3 occasions when my dad had to assist her. The rest of the time she recognises that she’s dropping and just heads for the biscuit tin before it gets bad. Granted, her HbA1 is fairly shocking compared to yours, however I think you might be tending too far in the other direction. Perfect blood sugars are not possible for a type 1, that doesn’t mean it’s not worth making an effort but too many hypos are as bad for you as too many highs and you have to try to find the right balance. My daughter only achieved an HbA1c of 41 (5.9%) after we changed her pump software to closed loop, before that I thought it wasn’t possible to be that low without being hypo a lot. Even then we’ve had to keep adjusting things recently as she was still going low every day.

So I think it’s worth trying to find out why you are having so many lows. Set your CGM alarm higher for a start so that you have more time to deal with them (and don’t listen to music with headphones on if you are completely dependent on the alarm!). Running your blood sugars higher for a few weeks would help you to regain some hypo awareness (and in the long run wouldn’t hurt you), if you can feel it yourself if something is wrong it’s much better than relying on technology which can fail. Don’t get me wrong, CGMs are great and my daughter has had much better control since she’s had one, but you have to be aware of their limitations and relying on them completely instead of recognising what your body is telling you isn’t ideal. Then you need to speak to your doctor or DSN about adjusting your insulin doses so that you can avoid having so many hypos in the first place. Having a low HbA1c is great, but there’s a limit, if the only way you can achieve that is by being hypo half the time then it’s too low. My daughter’s was 50-53 for many years (6.7-7%), yes they say ideally it should be below 6.5 but we couldn’t get there without loads of hypos so the medics were happy because it was stable and about as low as we could get.

Please look after yourself. I think you’re trying too hard to achieve perfection and it isn’t working, learn to relax a little 🙂 A few hypos here and there are inevitable, but if you’re having them every day, and bad ones as often as you seem to, it’s too much. It must be impacting the rest of your life and it doesn‘t need to be like that. Good luck

 

[everydayupsanddowns]

My comment was based on the fact OP wasn't checking his CGM and or ignoring it, which would be fatal using a pump.

Insulin pumps do need careful attention for the best outcomes to be sure, but there are good emerging data around the effectiveness of hybrid loops to improve outcomes safely even where people are being less attentive to alarms etc 🙂

 

[bujanin]

Thank you for s[eaking so clearly. I should have been in this community years ago.

I have raised my low alert to 5.2.

 

[Pumper_Sue]

Thank you for s[eaking so clearly. I should have been in this community years ago.

I have raised my low alert to 5.2.

Fantastic, hopefully that will be a start to good things. 🙂
Have a look at your alarm options and see if you can find the noisiest/annoying one available so it grabs your attention, also have a look at your settings and check to see if you have the repeat alarm active as well. If not then perhaps set it for 15mins after the first hypo alarm. It will only alarm if you are still low.

I have my alarm set for 5 so when using the G6 I always had a couple of sweets just to make sure I didn't drop into hypo territory.

As you seem to be prone to night time hypos have you thought about Levemir as a basal insulin? This can be split into 2 doses which would allow you to reduce your evening dose and hopefully cut down your lows.

 

[SB2015]

Thank you for s[eaking so clearly. I should have been in this community years ago.

I have raised my low alert to 5.2.

Pleased that you have found us @bujanin

Raising your low alert is a good strategy to start with. It is important to get your hypo awareness back.

Like @everydayupsanddowns i used to work at having low levels in preference to higher ones as I was most worried about long term complications. I had a ‘good’ HbA1c but it hid many many mild hypos. However on here I learnt the importance of accepting fewer hypos relaxing music expectations to the international standard which @everydayupsanddowns has referred you to. Our sensors with warnings certainly make life a lot easier and I hope that the change to your alerts helps you to avoid the severe hypos.

You don’t mention whether you are a driver but you would not be allowed to drive with so many call outs and lack of hypo awareness.

If you let us know what insulin’s you use it will help us in our responses. There may be alternatives that would help you.

 

[Satan’s little helper]

Thank you.
My daughter is seven now. I am using the DEXCOM G5 set at 4.5. When they happen I can see a reason for hypos after the event. Stupidly falling asleep with headphones in listening to a podcast and not hearing the alert. Having lowered the alert number during the day for whatever reason to 3.8 or similar and forgetting to reset. Not having calibrated the cgm for a day or two.
I use tresiba and humalog.
I have had an ambulance three times this year. The paramedic crews tell me that they see some diabetics on a weekly basis.

Hello, I use ear buds on my device or phone I’m streaming from if in the event of a low (OK I use the Libre.)
The alarm overrides the music. It knocks it out if connected to a BT speaker system too. I’ve an app on my tablet set up as a “follower.” If I’m using that the alerts come through quick. Or if I just wish to check without grabbing my phone.

Good luck.

 

[Sarahp]

Hi I can’t comment on type 1 management but went through on receiving end of abuse, I was warned by my solicitor not to post my story or worries online as it can be used against me in court if ever needed to go that route. Really feel for you as diabetes messes with your behaviour and emotions but want you to be legally safe too especially as we know how diabetes can change us when in hypo and hyper moments. Best wishes Sarah

 

[rebrascora]

I think comparing notes with others in a similar situation in so important in these circumstances because you have no real bench mark and the paramedics telling you that they were called once a week to one diabetic has sort of normalized your situation in your own mind and perhaps made it seem not too bad, when most of us would be horrified if we needed assistance, even from a partner once a year, let alone medical assistance. I am so pleased you have come to the forum because it makes a huge difference getting the perspective of other facing the same challenges.

You clearly need to reassess your diabetes management but I think you also need support from your medical professionals and perhaps an intensive education course such as DAFNE. It would be worth asking about being put forward for such a course, or a refresher if you had one some time ago. There was a lady on my DAFNE course who had been Type 1 for 50 years and had been needing regular assistance both from family including her daughters and also paramedics far too frequently for a lot of years. She was on tiny doses of insulin but it turned out that her insulin injector which she had used for 40+ years and looked like a skeleton gun, was worn and not dispensing the correct number of units. She really trusted this device as it had kept her alive for all those years and this strong sense of trust and familiarity had made her reluctant to move on to modern pen injectors, but was in fact at risk of killing her! As a result of being on the DAFNE course, and the problems being identified, she was put forward for a pump and is now much, much better, so things can improve for you but you do need to change your mind set and take steps to improve your management, so I am really pleased to read you have increased your alarm level as a first step. I don't understand why anyone would have their alarm set below 4 or why the devices allow it to be set that low. Surely the main benefit of the system is to be forewarned so that you can take action to prevent a hypo, not that I always achieve that and perhaps your post will encourage me to set my alarm a bit higher than my current 4.2 although mostly that is enough time for me to respond as I follow a low carb way of eating so doses of insulin are small.

Anyway, I am really sorry to hear of your marriage breakdown and that your wife is using your hypos against you but I imagine they have put a huge strain on her over the years so in some respects I can understand her point and also that will be putting an emotional strain on your daughter as it has your wife, so it is important to acknowledge that. They have been your safety net and you have come to reply too heavily on them when you should not need to and in some respects you have deferred responsibility to them instead of actively managing your diabetes better. I understand why as your perspective has become skewed and in your mind you are managing it well but your team should have spotted the problem and been pushing you to address it. Perhaps you were not listening to their concerns properly.

I really, really hope that you can turn this around and show your wife that you are taking steps to remedy the problem for the sake of your daughter, if not yourself. Even without the aggression caused by a hypo, I can't imagine how scary it must have been wondering if she was going to have to intervene every day/night. I imagine it cost her a lot of worry and a lot of lost/poor sleep. Can you imagine how you would have felt if she (or your daughter) nearly died regularly and you had to be alert to the danger day and night and be responsible for preventing it. That is a huge mental and emotional responsibility.

I am not saying your wife is right to suggest this was deliberate physical or mental/emotional abuse but you have to also view it from her situation and the harrowing incidents she has had to deal with repeatedly. Personally I would be mortified if I had put that onto a partner or loved one, but I understand that you have just assumed it is the norm to have such hypos. In reality you are as much in control of stopping your levels going low as you are from stopping them going too high and sadly you have been getting the balance badly wrong up to now.

 

[bujanin]

Again thanks to everybody for taking the time to speak to me. I have taken a couple of clear points of which the biggest is that it is not normal to be having these night time hypos. I get caught up thinking that if I can stay at around 4.5 for eight hours of sleep that will underpin a twenty-four period of readings nicely.

I have also been really struck by sitting in the waiting room at St Marys Diabetes unit and watching so many people with leg and foot amputations. It was a real driver to stay low. Wheelchairs in and out. I have taken things to the extreme though I can see that now.

It hasn't helped me that the paramedics - who are priceless no doubt about that - have told me that the frequency of my hypos is not bad. I really assumed that all type 1s were having similar experiences. What a mess I got myself into.

 

[Inka]

I wouldn’t want to be 4.5 during the night. That only gives you a tiny cushion between normal and hypo. It’s a myth that everyone wakes up when they’re hypoglycaemic. Some people don’t wake up at all………ever.

The answer is a happy medium - not running overly high (because that increases your risk of complications) but not running too low (because that comes with the risks of severe hypos, which can cause seizures and worse).

More than that, running that bit higher should make you feel better physically and mentally too. I’d start with a basal test first because if you’re having so many severe hypos, you’re having too much insulin. If your basal is ok, then move on to your meal ratios.

 

[Nayshiftin]

From a non diabetic side as type 2 i cant comment .
Find out why your going hypo would be my aim to prevent .
It could be stress in the marriage.
Communication is the largest problem in marriages going wrong .
Anger sometimes comes out of fear. Both sides have fear here. Watching someone having a hypo refusing meds as they are unaware how obnoxious they are on the other foot is tough . Your daughter too may have observed too much . You might not be aware but subconsciously being out of control is scary.
It is tough but just because you have diabetes you are still a father , a husband an adult . You are responsible for your treatment.
A solicitor just wants a marriage to be annulled and if there is no other reason they really get into anything.
It would be kinder if you both agreed to separate amicably and a no reason divorce can be kinder.
Off course i am not in your marriage but your wife might be using this for you to get your act together.
Alcohol lowers blood is that in this equation?
Is there anything else medical going on ?
i have been rather full on l but all im trying to be honest.
I lost my first marriage because I really did not communicate. My second marriage has not been easy but its worth the fight. We all find saying sorry hard but need to express it . Even if your marriage is over planning how to care for yourself is necessary.
Be kind to yourself and take care to get all this manageable. You are worth getting better and with help hopefully the hypos are a thing of the past.

 

[Sally71]

Again thanks to everybody for taking the time to speak to me. I have taken a couple of clear points of which the biggest is that it is not normal to be having these night time hypos. I get caught up thinking that if I can stay at around 4.5 for eight hours of sleep that will underpin a twenty-four period of readings nicely.

I have also been really struck by sitting in the waiting room at St Marys Diabetes unit and watching so many people with leg and foot amputations. It was a real driver to stay low. Wheelchairs in and out. I have taken things to the extreme though I can see that now.

It hasn't helped me that the paramedics - who are priceless no doubt about that - have told me that the frequency of my hypos is not bad. I really assumed that all type 1s were having similar experiences. What a mess I got myself into.

Don’t beat yourself up about it, if nobody ever pointed out to you that you should be able to manage your diabetes better, how would you know? And I can understand the fear of complications. However, now that you do know you can do something about it, which hopefully will improve your life as well as relations with your family. Any questions, please do ask 🙂

 

[SB2015]

Again thanks to everybody for taking the time to speak to me. I have taken a couple of clear points of which the biggest is that it is not normal to be having these night time hypos. I get caught up thinking that if I can stay at around 4.5 for eight hours of sleep that will underpin a twenty-four period of readings nicely.

I have also been really struck by sitting in the waiting room at St Marys Diabetes unit and watching so many people with leg and foot amputations. It was a real driver to stay low. Wheelchairs in and out. I have taken things to the extreme though I can see that now.

It hasn't helped me that the paramedics - who are priceless no doubt about that - have told me that the frequency of my hypos is not bad. I really assumed that all type 1s were having similar experiences. What a mess I got myself into.

Just so pleased that you have found the forum, and can get a different perspective on your diabetes management.

The isolation, as T1 is not common, can leave us coming up with our own set of expectations, which may not be realistic. Now you are tapping into the experience of loads of us, so fire away with any questions that arise.