Hypo's

[Starfire]

I am type 2 on 32 units of Humulin M3 mid-day plus evening 22 units

I can get the onset of a Hypo at 13 and the doctors don't believe me - but my Hypos are related to the rate of drop - not my sugar level.

I can be as low as 3 and very hungry but stable with no Hypo onset.

But when levels drop 5 or 6 per hour I am on the way to a Hypo.

Anyone the same?

 

[Copepod]

I think you mean that you get feelings of hypo at the levels and in the situations you mention. Whether or not you feel hypo, dropping below 4 mmol/l is hypoglycaemia, and if you don't detect it, that means you are lacking hypo awareness. That has implications for driving, operating machinery, looking after children, for example.

So, make sure you do identify and treat any episodes of hypoglycaemia, particularly if you are taking any medication known to cause hypoglycaemia eg glicazide, insulin, but not metformin - although people do experience hypoglycaemia on metformin, diet only etc, or even if they don't have diabetes at all, but participate in endurance sports.

 

[Starfire]

For me feelings of a Hypo are always followed by a Hypo - it is definitely rate of drop and apparently random - I cant correlate it to anything. I can be stable for weeks with constant diet/activity and for no apparent reason trip.


more than twenty years diabetic type 2 - plus brother 63 years diabetic type 1 ( 1949) and two nephews type 1

 

[trophywench]

Well although I feel hypo at 'normal' levels by which I mean I only usually feel em around 4.0 or below - when they are plummeting as opposed to dropping gradually, the feelings are exaggerated and I think many people find that. So I can feel very hypo and test and I might only be like 4.1 - but if I don't treat it pdq as a proper hypo it only gets worse and of course you are onto a bit of a loser then cos you have to drink enough Lucozade to refloat the Mary Rose to get your BG up - but then of course it subsequently carries on rising.

Far better to treat it at the higher level, but just be a bit cautious. Just 10 to 15g carb and don't go berserk. Enough to nip it in the bud. No half a packet of biscuits to follow!

But 99 times out of 100, my hypos are explainable. I wouldn't be happy if I couldn't identify why I got them.

Are you certain you haven't eaten less carbs than usual/eaten at a different time/done the ironing or vaccuuming/had warmer weather at those times? And are you on any oral diabetes medications such as Gliclazide?

 

[Starfire]

Yes very similar and if I dont catch it early it is very difficult to control and will take several days to return to stable BG.

But if caught early a sandwich will stablise it.

Lucozade, Glucose, Fructose nor Lactose does not work for me as well as Sucrose. (another arguement with Doctors ) but a sandwich will.

I will detect a Hypo onset as high as 13 - rare but definate and with no change to diet or activity.

Also have taking as much 90 units of Insulin on occasion when sugar uncontrolable with no effect other than severe cramp in legcalf.

Eating is related more than sugar level.

 

[Northerner]

I am type 2 on 32 units of Humulin M3 mid-day plus evening 22 units

I can get the onset of a Hypo at 13 and the doctors don't believe me - but my Hypos are related to the rate of drop - not my sugar level.

I can be as low as 3 and very hungry but stable with no Hypo onset.

But when levels drop 5 or 6 per hour I am on the way to a Hypo.

Anyone the same?

Hi Starfire, welcome to the forum 🙂 It's certainly true for me that a rapid drop in levels will produce more pronounced hypo symptoms - a non-diabetic person would get a much smoother fall by balancing glucagon and insulin output from their lovely working pancreases, plus of course they would never reach a point where they could drop 5 mmo/l or more - their levels would simply never get high enough for that to happen.

However, I would be concerned if you are experiencing hypo symptoms at 13 since that would imply your levels were even higher before you detected the symptoms. Also, for levels to rise so high and then plummet would suggest that whatever you ate had a very big impact on your blood glucose levels and possibly a timing issue with your insulin/food i.e. a big rise from food where your insulin was unable to match it, followed by a big peak in your insulin when there is no food digesting to cover it. You may be better suited to using a slow-acting insulin fr your background requirements and more tailored doses of fast-acting insulin to cover your food (known as a basal/bolus or MDI regime).

 

[trophywench]

Just had another thought actually. What if your 'hypo symptons' at 13 are actually hyper symptoms?

 

[Starfire]

Just had another thought actually. What if your 'hypo symptons' at 13 are actually hyper symptoms?

Thought of that but different - with a Hypo I get the shakes if I drop to 4 or 5
but I can be 3 and very hungry but no shakes nor Hypo and a sandwich will pull up BG no problem - if I get a Hypo at 5 I will have big problem stabilising BG and it will take days.
If a Hypo, eight Glucose tabs wont work quickly - take hours and I will have problems, better to eat something but will over-eat.

The Hypos seem to occur when my BG drops too fast, not my actual BG level.

 

[DeusXM]

No, I think the point trophywench is making is that hyper symptoms and hypo symptoms can be extremely similar. Some people, when they have high blood sugar, get the sweats, the shakes and the hunger. The principle is similar - the body doesn't have enough energy getting into it, so it stimulates you to eat. The difference is obviously that with a hyper, the energy is there but just can't get into the muscles as there isn't enough insulin.

To be honest, the best approach looks to be to minimise the swings in your BG - that means cutting back significantly on the foods that cause BG swings (ie carbs, and reducing your insulin intake accordingly. Unfortunately, the insulin regime you're on will make this impossible so you may need to consider changing to a different regime first.

 

[Starfire]

I confirm the condition and BG low - and it is a Hypo onset - rapid BG fall and if I don't catch it I will start to Hypo - my point is that it's not BG level which triggers a Hypo, but the fall rate - when my BG falls fast, I get a Hypo.

 

[Northerner]

I confirm the condition and BG low - and it is a Hypo onset - rapid BG fall and if I don't catch it I will start to Hypo - my point is that it's not BG level which triggers a Hypo, but the fall rate - when my BG falls fast, I get a Hypo.

I understand what you are saying, but technically a hypo is only when your blood sugar levels fall below 4.0 mmol/l (or below 3.3 mmol/l for a non-diabetic person). It's perfectly possible to become hypoglycaemic with a very slow fall which may produce only very mild symptoms, if any.

 

[Pumper_Sue]

I am type 2 on 32 units of Humulin M3 mid-day plus evening 22 units

I can get the onset of a Hypo at 13 and the doctors don't believe me - but my Hypos are related to the rate of drop - not my sugar level.

I can be as low as 3 and very hungry but stable with no Hypo onset.

But when levels drop 5 or 6 per hour I am on the way to a Hypo.

Anyone the same?

The reason for your rapid drop wouldn't have anything to do with the timing of your insulin would it?
Most people on mixed insulin take it morning and evening not how you are taking it.

 

[Starfire]

The reason for your rapid drop wouldn't have anything to do with the timing of your insulin would it?
Most people on mixed insulin take it morning and evening not how you are taking it.

Hi Sue,
Nop - I am stable for weeks and without any change to my regime I will suddenly get a Hypo onset - I am not new to diabetes with more than sixty years family experience.

Northener - I am aware of the technical terms but to me a Hypo is a condition of how I feel and regardless of level an onset can occur and my feeling changes and the condition which I call a Hypo starts.

 

[Josco]

I have had symptoms of hypos even when my BG was not low. It is very uncomfortable and the only way I found to deal with it was to take just one small mouthful of Lucozade. That would settle the feelings. I did not ever ask my diabetes team about it though so this is just my own experience. Many symptoms of low and high blood sugars are the same and one of my former colleagues had a problem telling whether he was hypo or not because he experienced similar symptoms when his BG was over 12 or so. He just had to keep testing. Be reassured that if your BG is 13 then it should be ok to ignore the symptoms if you can and just monitor your levels.

 

[Starfire]

Be reassured that if your BG is 13 then it should be ok to ignore the symptoms if you can and just monitor your levels.

hmm! Hi Josco - Although it isn't very often I dare not ignore it when it starts for it will surely go to a full blown Hypo and can be at levels I should not get a Hypo but I still get the shakes at 5-4, a sandwich works best to stop it. It is very uncomfortable and a little scary.

 

[everydayupsanddowns]

I've been reading this thread with interest, and wondering what to make of it.

I'm less sure of the situation because as a T2 you will most likely have production of a decent amount of your own insulin - though it would seem not quite enough in general terms as you have been put onto Humulin M3 (a mixed insulin with, on average, 30 minute onset, 3.5hr peak and 5hr tail).

Here's where I've come to: I don't think the hypo symptoms are your problem.

I have to agree with others that at 13 you are not hypo, symptoms or no, what I think you need to concentrate on is the rapid drops in BG that trigger your symptoms at such high levels.

If you are testing when you feel symptoms at 13, and know they are triggered by a rapid drop the chances are you have been significantly higher immediately previously *and* as you say your drop is sufficient that you dare not ignore symptoms at that level because you know you will drop below 4 'soon after'. This suggests a drop from maybe 18 to below 4 in just a few hours and is just not right at all.

I wonder if there might be a little 'reactive' hypoglycemia going on. Overenthusiastic 'extra' phase 2 insulin being pushed out by your pancreas in response to significant post-meal spikes which then overlaps with your M3 casuing your BGs to crash over a very short timescale.

Do you do much testing before and 1-2 hours after meals? That might give you some good clues.

I also note that you your confusion that you can be 'stable for weeks' and that you don't change your diet/levels of activity but all of a sudden things don't work differently. I don't think you are alone in that at all. Of the things which affect our BG levels we can only directly control a few factors. Many other internal processes (ebb and flow of various hormones) and external factors (temperature etc) can massively affect your BG levels. If it was just a case of finding the 'right' doses and carb counting the meals accurately life would be so much easier, but unfortunately there is no 'right' with diabetes, only 'right for now'. And when things change and 'usual' doses etc stop working as expected we just have to chase the goalposts. Sometimes round in circles.

I really hope you manage to make some progress with your puzzle.

 

[Starfire]

Hi Mike - I do know what hypoglycemia is - I had studied biochemistry to first year medical and understand ATP energy conversion of sugars and metabolic pathways even if a bit rusty. I agree it is not hypoglycemia in a medical sense but the symptoms are the same as a hypo and without a name I use Hypo (albeit incorrectly) to describe the experience.

I am tending to agree with the Aussie surgeon who is getting an 80% cure of type 2 when he by-passes the duodenum (extreme obese correction) - he thinks the duodenum is producing an anti-insulin hormone not yet identified and type 2 is diet related.

In discussion with my brother who has had type 1 since 1949 he agrees with me on the randomness of the condition and the difficulty to correlate it. Also he comments on the increase in incidence from when he was a child - diabetes was almost unheard off and the low incidence was probably diet related as at that time after the war ration books and restricted diet were in operation.

He suffered an insect bite before getting blood-poisoning and developed type 1 immediately after.
I also have two nephews ( brothers sons ) with type 1 both also suffer a 'virus' immediately before developing the disease. There is a inheritance aspect tending to a pronounced likelihood of catching it with a virus trigger.

 

[everydayupsanddowns]

So to what do you attribute your rapid drops in BG?

Do you have a strategy to try to reduce their number and/or severity?

 

[Starfire]

They occur infrequently and suddenly for no apparent reason Mike and I am at a loss to explain but they do occur.

They have no name to describe them so I use the term 'Hypo' to explain them as the symptoms are the same (They are not hypoglycemia)

A sandwich provides the best solution as glusose takes too long and I can go deeper even after taking eight tabs - just keep on sinking, also sucrose works better than glucose or fructose - not tried lactose.

It is most important to catch them early because if deep I have great problems to stabilise BG after and it takes days. Will over-eat as I will be ravinous, the hunger which develops very quickly, is intense.

 

[everydayupsanddowns]

Does anything here sound familiar: http://en.wikipedia.org/wiki/Reactive_hypoglycemia

I does specify 'non diabetics', but reactive hypoglycemia does seem to crop up among discussions between T2s too.