My HbA1c is 46. I am type 2 diabetic.

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angeladalton

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Type 2
My HbA1c is 46. I have been type 2 diabetic for over 20 years. Recently I have had to decrease my insulin from 40 units to 30 units twice a day. I regularly monitor my blood sugar by finger pricks. Recently I am having low readings, below 4 with no symptoms. Has anybody had any issues like this before. It seems very odd. My diet or weight have not changed.
 
I use novomix 30. I ham still having hypos with no symptoms even with the insulin reduced. There doesn't seem to be a pattern to the hypos. I test between 2 to 4 times a day as suggested by my diabetic nurse who I see next Friday.
 
angeladalton said:
I use novomix 30. I ham still having hypos with no symptoms even with the insulin reduced. There doesn't seem to be a pattern to the hypos. I test between 2 to 4 times a day as suggested by my diabetic nurse who I see next Friday.
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Right, well if you haven’t increased the amount of times you’re testing, you could have been going low frequently over a period of time. This would blunt your hypo awareness and mean you don’t feel hypos or only feel them at a very low blood glucose level. This could potentially happen to anyone on insulin. It’s why it’s important to test enough and to treat even mild hypos so that you minimise the time you drop below target. If you keep your blood sugar slightly higher, eg try not to drop below 5 or similar, then over weeks and months you could get your symptoms back. This means actively managing your blood sugar and treating any drop below 5 with a small amount of carbs. You’ll have to test frequently else you’ll miss the drops.
 
Thank you for your reply and advice. I just wonder how long it will be before I can drive again. I have a car sat doing nothing.
 
angeladalton said:
I use novomix 30. I ham still having hypos with no symptoms even with the insulin reduced. There doesn't seem to be a pattern to the hypos. I test between 2 to 4 times a day as suggested by my diabetic nurse who I see next Friday.
Click to expand...

You could be missing lows or near lows with the infrequency of your directed testing advice from your nurse?

angeladalton said:
Thank you for your reply and advice. I just wonder how long it will be before I can drive again. I have a car sat doing nothing.
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You could get your licence back when you can regain your feel the hypo symptoms. And satisfy the DVLA.
Work on regaining awareness now. And my wild guess is a year?
 
angeladalton said:
Thank you for your reply and advice. I just wonder how long it will be before I can drive again. I have a car sat doing nothing.
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It will be months at least. Firstly, you need to improve your hypo awareness - this takes time. Then having done that you’ll have to maintain it and prove you’re ok. The DVLA might then ask for medical input or whatever, so, you can see that this could take a while.

When you see your nurse, have a list of questions to ask them:

1) Ask if other meds are causing your lows
2) Ask if you could be prescribed the Libre for a period of time to help you see the patterns of when you’re going low, and so that you can have the alarms alert you in good time when you’re dropping.
3) Ask if you’d be better on a basal/bolus regime with a basal/slow insulin and then fast insulin before your meals. This gives more flexibility and can improve control
4) Ask anything else you want.

Take pen and paper too so you can jot down the answers.
 
Good luck in regaining your hypo awareness @angeladalton

It can be a challenge, but many on the forum have successfully managed it, including me. I never completely lost awareness, but the level at which I was getting symptoms had become a bit erratic.

It took a concerted effort to reduce exposure to low level dips below 4, and I have found that I need to more or less constantly aim to treat in the low 5s now, because my symptoms begin to dull down if I have a week or two with lower BGs.
 
I am wondering if you might be having nocturnal hypos if you are on a mixed insulin and those nocturnal hypos are eroding your hypo awareness. Have you ever set an alarm and tested through the night? Say 2 or 3am?
Do you take less insulin in the evening than in the morning or are the doses the same?
Have you considered applying for the free Freestyle Libre 14 day trial as that might give you a greater insight into what your BG levels are doing. It is available to anyone with diabetes that hasn't get tried the system and has a suitable phone to activate and read the sensor. it reads you levels every minute day and night so can really help you adjust your diabetes management and keep yourself safer. If you need more info about that just ask us.
 
Interesting thought @rebrascora - I'm pretty sure it was long periods of below-4 that mangled my warning signs when I was on Lantus - sometimes hours at a time. 😱o_O😱
 
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