low blood glucose / hypoglycaemia

[AnnSebastian]

Hello. I’m Ann a new member. (T2 on insulin) I’m on a crusade to improve my diet and health by significantly reducing carbs and continuing my tumeric supplements. I had a bg reading of 4.6 - 2hrs after evening meal yesterday - a little too low I think. I fixed it with a sandwich and cocoa. It wont happen again.

My question is - I’ve never had a ‘hypo’ but my diabetes nurse makes a big deal of the possibility. Has anyone on this forum experienced it? How low does blood glucose need to get before hypoglycaemia is a real possibility?

 

[Bruce Stephens]

Has anyone on this forum experienced it? How low does blood glucose need to get before hypoglycaemia is a real possibility?

I imagine everybody on insulin will experience it. You're likely to feel it at around 3.5 (so a bit below 4.0). The advice is to act when we go below 4.0, and (for people on intensive insulin therapy, so mostly Type 1) there's a guideline to spend less than 5% of the time below 4.0 (when that can be measured). (There's a strong element of "roughly" in all this since our home testing gadgets aren't all that accurate, though they're good enough.)

Normally we'll feel when we're going low, but the more we stay lowish the more likely we are to lose that awareness. That can be dangerous (hence the DVLA requirements, for one thing). So it's most definitely worth taking care and trying to avoid going low.

 

[AnnSebastian]

Thanks for replying.
Thats the lowest reading I‘ve ever had after eating.
I’m in the process of changing my habits for the better right now so expecting a few hiccups. Better it happened at the start while I‘m paying 100% attention. I’ll have to check my bg more often for a while and maybe start to take a little less insulin.

 

[Type1London]

Hi @AnnSebastian, welcome to the forum firstly! I think there will be a lot of us on here rather familiar with hypos so you're not alone 🙂

You may start to feel shaky, hot, sweaty if you're low (.9) but if you have been used to higher blood sugar readings for a while you may feel like this even when you're not low, it's just your body adjusting to your new lower blood sugar levels. It sounds like you're on the right lines if your BGs are coming down which is a great start!

 

[Ljc]

Hypo’s are horrid, horrid things.
Here is some info on hypo’s
Treating hypo’s
It doesn’t say so in the above link, but you need to test and treat every 15 minutes until you are above 4.0.
It’s very easy to over treat a hypo , esp if you have the hypo hunger , this is where your feeding from the fridge and cupboards,
I set the timer on my meter fir 15 minutes to remind me to retest , as it’s easy to forget things when hypo even when you think you’re coping well.
Personally unless my BG goes very low or it’s one that just won’t go away , I don’t tend to have a snack as recommended afterwards as it would shoot my BG levels up far too high, but you may find you need to.

Causes

 

[Kaylz]

Personally I wouldn't have had a sandwich and a cocoa for a 4.6, a gluco tab possibly but a sandwich and cocoa would be far too much carbs, I believe your on a twice daily insulin regime, I'd talk to your team before reducing carbs unless you know what your doing regarding insulin dose changes and carb reduction, chances are your current doses are based around your current diet and carb consumption so drastically reducing the carbs could cause many more low readings however if you know what your doing then it shouldn't be too much of a problem xx

 

[AnnSebastian]

Thanks for the replies to my post.
I don’t really have a ‘team’. Just one nurse and 3 monthly appointments. She left last month and with the COVID crisis I’m more or less on my own. I’m pretty resourceful and well-informed though, my problem is more sticking to the script than knowing what it is. I’ve managed to reduce my daily insulin needs from 40 to 30 units over a couple of months. Now I’m going to try harder. My original question was ‘should I be so worried if my morning ‘fasting Blood Glucose’ levels aren’t quite low enough (recently 6-7.5) if my total average level remains under my target of 8.5?

 

[trophywench]

I have to tell you Ann, because you are on mixed insulin I wouldn't know now the best way of doing what, Fair enough either on MDI or a pump, I could suggest something useful, but not with Insulatard. It does what it does when it does it - and if you don't comply with it, then it's you that suffers.

Most of us would rather control our diabetes rather than have it control us, and more modern insulins have enabled us to do so. How long ago did you go onto insulin and had you been on tablets before that, just recap the history if you would please.

 

[AnnSebastian]

I have to tell you Ann, because you are on mixed insulin I wouldn't know now the best way of doing what, Fair enough either on MDI or a pump, I could suggest something useful, but not with Insulatard. It does what it does when it does it - and if you don't comply with it, then it's you that suffers.

Most of us would rather control our diabetes rather than have it control us, and more modern insulins have enabled us to do so. How long ago did you go onto insulin and had you been on tablets before that, just recap the history if you would please.

I know I’m replying to a really old post here - but - I’ll summarise as a draft to put in my bio.
Started getting extreme attacks of ‘heat sensitivity’ about 20 years ago. My doctor gave me an A1C test and when I called for results the receptionist said I was fine. (Hmmm) Fast forward quite a few years. It got worse and worse and I felt awful so I asked for another test. GP contacted me ‘shock horror’ told me to see him asap. A1C was well over 100? Put me on metformin and innolet straight away.
I’ve been dealing with it ever since - occasional appointments with diabetes nurse. But COVID has messed everything up. I saw the advert for a free trial of the Libre sensor and have been using it for about 3 months. It’s been life changing - when it works - but I’ve had 3 of them that seem to have been duds and it’s hard work contacting their customer services.

Nobody has suggested trying a different brand of insulin - but then I haven’t been called for an appointment for ages.

 

[Inka]

I’m confused @AnnSebastian Are you just on isophane insulin or are you taking a mixed insulin? It’s not so much the brand of insulin, but the type. Many people find a basal/bolus regime better even though it’s extra injections.

 

[Kaylz]

it’s hard work contacting their customer services.

in what way? I've called them 18 times in under a year and all calls have been under 9 minutes long from first recorded message to finishing the survey at the end xx

 

[trophywench]

But you've had all the annual checks we're supposed to have every year ? - so what's your latest HbA1c test result and when was it?

 

[grovesy]

in what way? I've called them 18 times in under a year and all calls have been under 9 minutes long from first recorded message to finishing the survey at the end xx

I always phone , get through quicker than to my GP surgery.

 

[silentsquirrel]

What is the name of the insulin you take? Innolet seems to be a device for administering insulin, rather than a pen, and from a quick google seems to be available for different insulins.

 

[Lucyr]

in what way? I've called them 18 times in under a year and all calls have been under 9 minutes long from first recorded message to finishing the survey at the end xx

And you don’t even have to call. Just use the online faulty libre sensor reporting form and they’ll either post out a replacement or give you a call if they need more info.

 

[Kaylz]

And you don’t even have to call. Just use the online faulty libre sensor reporting form and they’ll either post out a replacement or give you a call if they need more info.

Easier for me to call, gets dealt with quicker and I've had issues with Freestyle's site for months on the laptop

 

[AnnSebastian]

I’m confused @AnnSebastian Are you just on isophane insulin or are you taking a mixed insulin? It’s not so much the brand of insulin, but the type. Many people find a basal/bolus regime better even though it’s extra injections.

I’m getting confused with all the crossed posts here. I signed up quite a while ago but didn’t log on again until recently. So I’ve mixed up old posts with new. My fault. I’m feeling a little fragile at the moment so maybe I’ll log off for a while.

If it matters - I’m using innolet (image below) 500mg metformin twice daily. I also use Tumeric with black pepper and Cinnamon to supplement them.

.

 

[rebrascora]

InnoLet I believe is the device itself used to dial up and deliver the insulin and Insulatard is the insulin it uses. So you are using Insulatard insulin.

 

[Bruce Stephens]

So you are using Insulatard insulin.

Which is an older (and presumably cheaper) long acting insulin. (It's what I was on before Levemir.)

 

[AnnSebastian]

But you've had all the annual checks we're supposed to have every year ? - so what's your latest HbA1c test result and when was it?

Actually. I’m not sure. My diabetes nurse retired a while ago and then coronavirus kicked in. I had one meeting with another nurse after that but I haven’t been followed up - or tried to make an appointment since. I’ve stayed at home for the duration and preferred not to go to public places. They don’t tell me anything I can’t find online anyway. I know what I need to do, it’s more a matter of making myself actually do it, but if I needed help I wouldn’t hesitate to ask.

Interesting comments about different types of insulin though. I might make an appointment to check that out.

I live in Clapham, South London, and I’m sure services vary widely across postcodes.