Newbie Type 2 Hypo Question

[TerryP]

Hi – Just a little background. I was diagnosed in September of last year (finger pricks at 35 mmol/L and HbA1c at 119). I’m male and just coming up to 60 years old. My treatment is Gliclazide @ 80mg Twice Daily and I feel so much better, it’s like chalk and cheese. Anyway, the reason for going straight onto Gliclazide is because my Pancreas is compromised so that’s the route the diabetes team thought I should take which I’m ok with. So, this is the bit I don’t understand. As someone on Gliclazide my target figures have been elevated to between 5 & 8 however does that mean that a Hypo for me starts at 4.6 instead of 3.6? The reason I ask is that I need to know when I should start thinking about my rescue pack and I’m never sure that if I am at 4.6 if that is classed as a Hypo?

Thanks for taking time to read this.

 

[Kaylz]

I'm not sure why your targets have been raised because of the medication your on, even those of us on insulin still use the range of 4-7

A hypo is anything below 4 but some f us would have a small carby snack at 4.6 but not treat it the way we would a hypo so we'd probably have a biscuit or something or even just 1 glucose tab etc xx

 

[Elenka_HM]

Welcome to the forum! I am on insulin, not Gliclazide, but they also gave me a target range starting at 5. However, they told me an hypo is under 4 and that's when I am supposed to treat with the jelly babies, glucose tablets or similar. I suppose it could be the same for you. You can always check with your team for peace of mind.

I'd also consider @Kaylz idea of eating something with carbs if you are between 4 and 5, so you can prevent your level to go lower. If it's not hypo you don't need the fast acting sugars.

 

[Leadinglights]

It may depend on the specific issue you have with your pancreas but others with compromised pancreas generally say gliclazide is not necessarily the best medication, but hopefully someone more familiar with those issues will be along to comment.
Some people are termed Type 3c so if you look for those posts you may find some helpful information.

 

[helli]

Just because you are below your target does not mean you are hypo.
For example, I calculate my insulin to aim for a target blood sugar of 6mmol/l but I am not hypo until my levels reduc to 4mmol/l.
My Libre target is 4.5 to 9.5. I react when I reach 4.5 in order to avoid a hypo below 4.0. I treat a hypo below 4.0.
The difference between reacting and treating is how many carbs and type of carbs. Below 4 I need fast acting carbs, above i take slower acting carbs.
(I also suspend my basal below 4.5 but that is only relevant if you are treating your diabetes with an insulin pump.)

 

[Elenka_HM]

My Libre target is 4.5 to 9.5. I react when I reach 4.5 in order to avoid a hypo below 4.0. I treat a hypo below 4.0.

That's a great way to explain it.

I guess some of us are given a higher target when we start this meds, just so we have more room for the reacting part. That might be the case for the original poster. At the begining I was worried when I was just under 5 (4'9) , then my nurse explained they just gave me this target because they didn't want me to go too low as a newly diagnosed.

 

[everydayupsanddowns]

Welcome to the forum @TerryP

It does sound as though they just wanted you to have a it more wiggle room at the lower end, and not to push your BGs too near the edge.

While 4.0 is usually given as the definition of a hypo I have heard some clinicians describing that as an ‘alert value’. The point around which your body should start firing warning signs. It’s only a tiny bit lower (3.5ish or just below) where impairment of brain function begins.

You may also find that the onset of hypo warning symptoms can begin when still above 4.0 - especially if your levels are dropping rapidly.

 

[TerryP]

Thanks for all your advice, I feel I have a better understanding of when I need to act or react. The only other issue I have is that I am finger pricking twice a day, before breakfast and before the evening meal. My morning results seem to be stable, but my evening ones are inconsistent. Sometime high, sometime low sometimes ok. The problem is that I am looking a back in history at a certain point in time. So, for example if my number in the evening is high, well that’s too late, I would have thought that I would want to catch it before it got too high, but that would involve pricking my finger many times a day (which I don’t want to do). Do people do them regularly during the day.



BTW this forum is really good as I can ask questions that I would normally keep to myself.

 

[Kaylz]

If you don't want to prick multiple times a day, do you have a smartphone? If so which one? Freestyle Libre are doing a 2 week free trial of their Libre 2 sensor which monitors levels and gives a reading when it is scanned

Most of us went through phases of when testing foods to test before and then again 2 hours later to see what sort of reaction we had and altered things based on results but what would your plan be if you did catch your higher reading earlier? For those of us on insulin we can inject some more insulin but with you not having that what would you do when you saw the higher reading?

Do you drive? If so then I'd say testing more than twice a day would be a wise thing to do seen as your on a hypo causing medication and there are rules on levels before driving, also if you do have a hypo you'll have to prick more than twice that day

I'm Type 1 but I finger prick at least 5 times a day and used to be much more xx

 

[TerryP]

If you don't want to prick multiple times a day, do you have a smartphone? If so which one? Freestyle Libre are doing a 2 week free trial of their Libre 2 sensor which monitors levels and gives a reading when it is scanned

Most of us went through phases of when testing foods to test before and then again 2 hours later to see what sort of reaction we had and altered things based on results but what would your plan be if you did catch your higher reading earlier? For those of us on insulin we can inject some more insulin but with you not having that what would you do when you saw the higher reading?

Do you drive? If so then I'd say testing more than twice a day would be a wise thing to do seen as your on a hypo causing medication and there are rules on levels before driving, also if you do have a hypo you'll have to prick more than twice that day

I'm Type 1 but I finger prick at least 5 times a day and used to be much more xx

Hi - yes I do finger prick before I drive (and then every 2 hours) but to be honest over the last 2 year driving has been very limited so not really that much of an impact. I did look at the Libre 2 sensor (to see if it was available on the NHS) but it seems that even though I take tablets to control my diabetes I am not able to get it (does this match others understanding). At the moment the only thing I do is think to myself ' I wonder what I ate/did that caused that spike)

 

[Kaylz]

Hi - yes I do finger prick before I drive (and then every 2 hours) but to be honest over the last 2 year driving has been very limited so not really that much of an impact. I did look at the Libre 2 sensor (to see if it was available on the NHS) but it seems that even though I take tablets to control my diabetes I am not able to get it (does this match others understanding). At the moment the only thing I do is think to myself ' I wonder what I ate/did that caused that spike)

At the moment it is only available on prescription to Type 1's and not all of those are prescribed it either and there is a list of criteria to meet and Scotland do prescribe to Type 2's that are insulin dependant using MDI (multiple daily injections) but as I say you could have a 2 week free trial (1 sensor) by requesting a sensor here - https://sample.freestyle.abbott/gb-en/freestylelibre.html xx

 

[TerryP]

At the moment it is only available on prescription to Type 1's and not all of those are prescribed it either and there is a list of criteria to meet and Scotland do prescribe to Type 2's that are insulin dependant using MDI (multiple daily injections) but as I say you could have a 2 week free trial (1 sensor) by requesting a sensor here - https://sample.freestyle.abbott/gb-en/freestylelibre.html xx

Thanks for the info. I have an Samsung phone so would hope that would be ok. I just re-read your response to me "but what would your plan be if you did catch your higher reading earlier?"....that is a fantastic question and one I need to spend some time pondering on. 🙂

 

[Kaylz]

Thanks for the info. I have an Samsung phone so would hope that would be ok. I just re-read your response to me "but what would your plan be if you did catch your higher reading earlier?"....that is a fantastic question and one I need to spend some time pondering on. 🙂

No problem, I currently use the Samsung A7 with my sensors and it works perfectly fine (must start using my Samsung A22 5G that's been lying here unopened for months lol)

I'm glad you feel comfortable here to ask the questions you want answers to 🙂 xx

 

[grovesy]

I use a Galaxy A40, it scans the Libre no problem for me!

 

[TerryP]

I'm really torn with getting the sample Libre 2 sensor as I may well find that I get on really well with it, but then can't afford the £96+ per month and would be disappointed

 

[helli]

I'm really torn with getting the sample Libre 2 sensor as I may well find that I get on really well with it, but then can't afford the £96+ per month and would be disappointed

My advice would be to use it for 2 weeks to learn what affects your blood sugars so you can adapt your lifestyle and test less often going forward.
If you are taking insulin which can result in hypos, there is a good reason to have it al the time. But if you are managing your diabetes through lifestyle/diet changes, 2 weeks should give you a good insight into what changes to make. Maybe you could get an additional sensor once a quarter to check a few things out.

 

[TerryP]

Hi all, another little question. I know that you should wash your finger/hand in warm soapy water before a finger prick to stop potential contamination, however what can you use if you don’t have access to water and soap, for example if you need to do a finger prick when you are in your car on a journey. Do alcohol wipes do the job or does that contaminate the reading?

 

[helli]

Hi all, another little question. I know that you should wash your finger/hand in warm soapy water before a finger prick to stop potential contamination, however what can you use if you don’t have access to water and soap, for example if you need to do a finger prick when you are in your car on a journey. Do alcohol wipes do the job or does that contaminate the reading?

Alcohol wipes can affect the reading. I believe paramedics use saline solution.

 

[Leadinglights]

Hi all, another little question. I know that you should wash your finger/hand in warm soapy water before a finger prick to stop potential contamination, however what can you use if you don’t have access to water and soap, for example if you need to do a finger prick when you are in your car on a journey. Do alcohol wipes do the job or does that contaminate the reading?

Do you keep a bottle of water in your car and tissues as you could use that or just wipe away the first drop of blood and use the next one.
I think you can buy water wipes, meant for babies really.

 

[trophywench]

If you haven't been doing anything mucky with that hand since you last washed it - just prick, wipe the first drop of blood away and use the next drop to test.

Because I worked in an office unless I'd been filing ie rifling through old paperwork I'd not bother washing either hand until I next happened to use the loo. Nothing gangrenous yet ......