Hypos and eating

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Hellybell80

Hellybell80

Well-Known Member
Relationship to Diabetes
Type 2
Evening all,
I have a question regarding hypos.
I developed type 2 a couple of years ago. Pretty much straight onto insulin as meds didn't touch my very high sugars. Monitor unable to read as was so high.
1st Hba1c 76 I think it was
Last year it went up to 97. Wasn't looking after myself. Not taking injections or eating much. For a few months before tests.
Early this year I got it down to 52. Which I was pleased about.
But I get alot more hypos now mainly evenings and through the night. Not all the time. But a few times a week.
If I reduce my lantus it dosnt control my sugars very well. I take nova with meals. But I don't eat very much at all.
Now I can't get a flash device as I'm type 2. But a few times my husband has had to treat me at night for hypos. He's noticed as I was thrashing and sweating profusely. Gels or jelly babies at the ready .
Because I work outside alot in the soil finger prices are a bit of an issue as there's not always running water to wash hands.
I can't afford to provide any devices for myself.
Whats the chances of getting it on prescription? Has any type 2 been able to get one?
 
Have you done basal testing to get your Lantus dose right, then you can adjust your mealtime doses to stop the hypos? Do you carb count to adjust the novorapid dose?

Whether you can get libre on prescription depends where you live.
 
My lantus seems to be ok. In general it keeps my base line steady throughout the 24hours.
I was supposed to go on a course but I'm still waiting to help with adjustments. I take around 18 units of nova with a meal. But if I don't eat much or its not many carbs I adjust it down.
It's not all the time. And alot of the time my sugars are between 5 and 7.5.
I make sure I go to bed on at least 7 as the nurse suggested.
 
Hellybell80 said:
My lantus seems to be ok. In general it keeps my base line steady throughout the 24hours.
I was supposed to go on a course but I'm still waiting to help with adjustments. I take around 18 units of nova with a meal. But if I don't eat much or its not many carbs I adjust it down.
It's not all the time. And alot of the time my sugars are between 5 and 7.5.
I make sure I go to bed on at least 7 as the nurse suggested.
Click to expand...
If you’re going hypo in the middle of the night then either you’re taking too much Lantus, and you need to basal test again, or you’re taking too much novorapid too late. Hypos are caused by taking more insulin than you need, so if you’re having them overnight a few times a week you’re taking too much insulin.
 
Not always the case. Several things can cause hypos. In general my sugars are good. I have sugar levels that dip or go up through the night. Finding out from testing through the night. I get a blood sugar rise about 4-5am. Which is not uncommon.
Also depending on how much physical exercise I get through the day. Hormones too can play a part.
My question was about libra or other monitoring devices for type 2s.
 
Early this year I got it down to 52. Which I was pleased about.
But I get alot more hypos now mainly evenings and through the night. Not all the time. But a few times a week.

You might find a twice daily basal more flexible @Hellybell80 You could then reduce your nighttime dose when you’ve been exercising or for hormones or when needed, and you could keep your daytime dose the same. It gives much more flexibility and allows you to keep safe at night while maintaining control during the day.

There’s an online course called BERTIE that might help. It’s aimed at Type 1s but as you’re on insulin, you’d probably find the information useful too. Here’s a link:

https://www.bertieonline.org.uk/

As for the Libre, I think it depends where you live. However, if you can show how you’ve tried to solve the issues you’re having (eg by changing basal, doing a course, etc) then I’d think that improve your chances.
 
Hellybell80 said:
Not always the case. Several things can cause hypos.
Click to expand...
Like what? If you mean things like increased exercise or reduced food can cause hypos then no, it’s having too much insulin for those events that causes the hypo.
 
@Hellybell80 sorry to read about your issues.
It sounds as if you are on fixedish doses where you just “adjust it down” sometimes. This soight adjustment may not be enough but it is hard to tell without any trends to review.
It may be useful to keep a record of your BG (including when you hypo), you carbs, your insulin and your activities. This may enable you to spot some of those trends such as being more likely to hypo after a more active day.
Before transitioning to a pump, I took the same insulins as you. I found I needed to reduce my Lantus by 20% after exercise to avoid overnight hypos.

Libre is great for spitting BG trends but not why - you still need to take note of insulin doses and exercise which you can do on the LibreLink app, But Libre alone will not reduce hypos. This is why i think a course such as the Bertie only @Inka suggested may help.

To help with your case for a Libre, you could apply for the free trial to try it out yourself and get some data to share with your DSN. The trial is available from their website.
 
@helli yea I used the free trial when I was first diagnosed. It really helped me see trends. I do use an app for recording my BS. The libre was more for an alarm system if it drops etc. And to see trends more. Unfortunately I already had nerve damage in my fingers before my diagnosis of Diabetes. Which was caused from a different issue. So 5-8 Tests a day on my fingers does give me a few irritating problems.
Because my days arnt fixed with what my plans are I never really know what tomorrow will bring exercise wise. I could be sat on my bum all day or working physically hard.
So using a libre or anything that's easier to track would make my life easier.
It's not uncommon for me to be sick after eating as well. Or only eat one meal a day. (Obviously I don't take my nova if I don't eat)
Which can again be annoying with insulin amounts.
But I'll have a look at Bertie.
 
Hellybell80 said:
@helli yea I used the free trial when I was first diagnosed. It really helped me see trends. I do use an app for recording my BS. The libre was more for an alarm system if it drops etc. And to see trends more. Unfortunately I already had nerve damage in my fingers before my diagnosis of Diabetes. Which was caused from a different issue. So 5-8 Tests a day on my fingers does give me a few irritating problems.
Because my days arnt fixed with what my plans are I never really know what tomorrow will bring exercise wise. I could be sat on my bum all day or working physically hard.
So using a libre or anything that's easier to track would make my life easier.
It's not uncommon for me to be sick after eating as well. Or only eat one meal a day. (Obviously I don't take my nova if I don't eat)
Which can again be annoying with insulin amounts.
But I'll have a look at Bertie.
Click to expand...
Hi @Hellybell80 It sounds like you are juggling many variables.
It would be well worth you documenting what is happening and also what strategies you have tried to solve the problems that you have identified. this may help your case for getting a Libre sensor.

With regard to other strategies, I found a switch to Levemir and splitting the dose was very helpful to me. I was then able to adjust my doses for day and night separately if I had been very active during the day. I scaled the reduction according to my level of activity.

Where I ate just before exercise I was able to use reductions in Bolus insulin to give me some spare glucose available for higher levels of activity.

All of this is indeed a juggling act, and one we did day by day.
 
Hellybell80 said:
I developed type 2 a couple of years ago. Pretty much straight onto insulin as meds didn't touch my very high sugars. Monitor unable to read as was so high.
Click to expand...
Are you sure you are T2? Who diagnosed you and how? Did you ask for tests to ensure it wasn't T1? I ask because your presentation sounds like mine at diagnosis (BGs too high for meter to read and straight onto insulin as meds made no difference and didn't bring BGs down). I was diagnosed T2 over the phone in a conversation between the local hospital DSN who had never met me and the GPs nurse who had. The diagnosis was based solely on my age at the time. It took some time, but I eventually insisted and got the tests which proved I was T1. At which point all kinds of doors opened and I was eligible for all the things you are being denied.
 
I wondered that initially @Pattidevans but the 18 units bolus insulin sounded ‘high’ to me (obviously not high, hence the inverted commas as people should take what they need, but high for Type 1?)
 
Hello @Hellybell80 , Here is some rough info on who’s entitled to a prescribed Libre. Which could help your case?

Getting a free CGM, flash glucose monitor (Freestyle Libre) or insulin pump on the NHS – who should qualify?

If you live in England, Wales, or Scotland, see the latest guidelines on whether you — or someone you’re supporting— should be eligible for a flash glucose monitor (Freestyle Libre), continuous glucose monitor (CGM) or insulin pump to help manage diabetes. If you live in Northern Ireland, you...
www.diabetes.org.uk www.diabetes.org.uk

If you are only under your GP and DN At a your surgery for the diabetes? I would recommend referral to an endocrinologist. Due to the nature of your job. (You could put forward the unhygenic nature?) The endo might recommend the libre put on your repeat list to your GP?

Good luck!
 
I feel your pain @Hellybell80

I am another that can have very solid BG levels on the whole, and what would be classed as ‘good control’ by many HCPs, but perhaps 2-3 random times a month my diabetes decides to change the rules just for one night and I can have a whopper of a hypo. But then the following night everything switches back.

Intensely frustrating when I was on MDI (and being ‘told off’ for them by the hospital clinic), but 90% of the time my doses were doing exactly what I wanted - so it wasn’t really possible for me to adjust basal to meet the ‘no insulin needed tonight’ level without mangling my levels for 90% of nights :(

I really hope you can make some progress with accessing sensors even if your classification remains unchanged - as they seem particularly relevant in your circumstances.
 
Inka said:
I wondered that initially @Pattidevans but the 18 units bolus insulin sounded ‘high’ to me (obviously not high, hence the inverted commas as people should take what they need, but high for Type 1?)
Click to expand...
I see what you mean, but I have come across T1s with similar doses. Sometimes it's caused by IR as well as lack of endogenous insulin, known as "double diabetes". I put on almost 20 kilos after diagnosis, due to following the dietitians advice to eat carbs for 60% of my meals and I was taking quite large doses then. Fortunately I managed to lose the weight and of course pumping does reduce needs. Considering the OP is having so many hypos perhaps the high doses are what's causing them? NR can hang around for ages in some people - sometimes over 5 hours.

I think it's worth @Hellybell80 asking for the tests anyway.
 
Oh, yes, I agree it would be worth asking for the tests. Even if they rule out Type 1, it’s still useful information. I’ve just looked back at @Hellybell80 ’s earlier posts and having the tests was mentioned then but I don’t know if they happened.
 
Pattidevans said:
Are you sure you are T2? Who diagnosed you and how? Did you ask for tests to ensure it wasn't T1? I ask because your presentation sounds like mine at diagnosis (BGs too high for meter to read and straight onto insulin as meds made no difference and didn't bring BGs down). I was diagnosed T2 over the phone in a conversation between the local hospital DSN who had never met me and the GPs nurse who had. The diagnosis was based solely on my age at the time. It took some time, but I eventually insisted and got the tests which proved I was T1. At which point all kinds of doors opened and I was eligible for all the things you are being denied.
Click to expand...
Mine was diagnosed because I tested my sugars myself. I wasn't feeling right. Alot of my family have diabetes so knew to check. I used to just check my urine once a month. Never had any issues at all then 2 weeks after my neg urine tests I was just feeling really ill. So I tested again. Very high in urine. So I made an appointment with nurse. It was over 20 at the time on a fast. Then obviously had the proper blood test. Hba1c was I think 72. But always argued it had come on quick. But because of my age over 40 that it was type 2. Put on glitz and it didn't change my sugars at all. Started to get higher on them. So within a couple of weeks I was started on insulin. Funnily enough when I went through a bad patch and didn't take my insulin for a couple of months it went up to 97. So in my head. Before any treatment when I was first diagnosed was actually lower then several months after diagnosis. So it actually got naturally worse.
But the Dr won't refer me as adamant I'm a t2. Which is fine. Even though he now admits that I had a Hba1c 1 year before diagnosis that my levels were fine (I was tested). I did ask for the GAD test but I have to be in hospital at the time and they won't do it.
 
everydayupsanddowns said:
I feel your pain @Hellybell80

I am another that can have very solid BG levels on the whole, and what would be classed as ‘good control’ by many HCPs, but perhaps 2-3 random times a month my diabetes decides to change the rules just for one night and I can have a whopper of a hypo. But then the following night everything switches back.

Intensely frustrating when I was on MDI (and being ‘told off’ for them by the hospital clinic), but 90% of the time my doses were doing exactly what I wanted - so it wasn’t really possible for me to adjust basal to meet the ‘no insulin needed tonight’ level without mangling my levels for 90% of nights :(

I really hope you can make some progress with accessing sensors even if your classification remains unchanged - as they seem particularly relevant in your circumstances.
Click to expand...
That's exactly how I feel. Thank you. I thought it was just me with this issue. I actually don't feel like I'm a failure now. I don't want to mess too much with my lantus if its good 90% of the time.
 
Satan’s little helper said:
Hello @Hellybell80 , Here is some rough info on who’s entitled to a prescribed Libre. Which could help your case?

Getting a free CGM, flash glucose monitor (Freestyle Libre) or insulin pump on the NHS – who should qualify?

If you live in England, Wales, or Scotland, see the latest guidelines on whether you — or someone you’re supporting— should be eligible for a flash glucose monitor (Freestyle Libre), continuous glucose monitor (CGM) or insulin pump to help manage diabetes. If you live in Northern Ireland, you...
www.diabetes.org.uk www.diabetes.org.uk

If you are only under your GP and DN At a your surgery for the diabetes? I would recommend referral to an endocrinologist. Due to the nature of your job. (You could put forward the unhygenic nature?) The endo might recommend the libre put on your repeat list to your GP?

Good luck!
Click to expand...
Thank you. He wouldn't refer me before. But I'll try again
 
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