Newly diagnosed and couldn't get blood sugars to go up

[SB2015]

Hi @Ann wainwright I was diagnosed at the age of 53, so like you a late starter with all this. Your panic is very understandable and it does sound like you are experiencing false hypos, as your body has become used to having higher glucose levels so now you are finding that normal levels feel very low and scary.

The sensors give us a lot more information but can also feed our panic. Do you know how to set your low alert. If you set this at 5 it will give you time to turn your levels round before getting into hypo zone (less than 4). If you feel weird just check with a finger prick and try to avoid treating with jelly babies/juice etc until you are below 5. This will help you to re-educate your body to get used to normal levels, but your panic is completely understandable.

Like @Inka I still weigh stuff when I am at home so that I know how many carbs I am eating, rather than guess. I can then match my insulin to the carbs I eat. It maybe that at this stage you are on fixed doses of insulin in which case you will need to eat the same amount of carbs at each meal. It is a lot to take in at the start but this will get easier. It does sound like you had some active insulin working, and when you found that your levels would not rise, as you had eaten less carbs but injected the same amount of insulin for breakfast. It is well worth talking to your team about how to make adjustments to your insulin.

As you are in the early stages after diagnosis, you may well still have some beta cells that, having had a bit of help by your injecting insulin now, Decide that they will do a bit of work again, and not always when you want them to and without any warning. The joys of the ‘honeymoon period’ .

Keep asking questions. No one minds on here and nothing is considered silly. We have all been there and there is a wealth of experience to tap into. Just ask.

 

[Amity Island]

Hi Inka - I took my lantus 6 units at 8.30am and then at 9.30am took 2 units of novorapid with a bowl of all bran with milk and a cup of tea and my blood sugars shortly went up to 12 (less than usual since I had taken a smaller bowl of cereal). but by 10.30 they had started to gradually drop but noticed by 11am they were going down quite fast (arrow pointing down on Libre 2). When it got to 6 I took 2 jelly babies but nothing happened, I then took 3 more jelly babies, it came up to 6.5 after 5 minutes but then started going down again - i eventually took 14 jelly babies and a carton of juice but it didnt dramatically go up - just to 7.2 ( I also checked this on the blood glucose monitored which was similar). I went to A&E as I was so scared and they gave me a sandwich and I brought it back up. My worry is - Why did the fast sugar not make my blood sugar go up rapidly? Im scared I may have a hypo now and the jelly babies not work. thanks for listening

Hi,
In this instance, soon after diagnosis, if I was experiencing hypos, my first line of action would be to check basal / background blood sugar levels. E.g I'd skip breakfast and the insulin with the meal. This way, one can focus solely on what is happening to blood sugars without the food and insulin for the food. If blood sugars are steady, then this would likely confirm the issue is with the meal time insulin. If blood sugars are dropping even when no eating/bolus, then the basal will need adjusting the next day.

When you know the basal insulin is holding steady, then it's time to look at mealtime insulin doses.

Btw. Doses for mealtime insulin can be different across the day. E.g one may need more insulin for exactly the same meal eaten at breakfast to the same meal eaten at lunch or dinner. It's all trial and error in the beginning.

 

[Tdm]

A little trick to 'see into the future' with your readings.
You libre/cgm is always a bit behind your blood glucose.
So if you want to 'look ahead' 5- 10 min you can do a blood strip test to see what is going to happen. Sometimes that can be reassuring.

Alo, libre can be a drama queen and overexagerate when levels are rapidly changing, so you should be blood strip testing anyway before treating your hypo

Also, if you are feeling to are going lower than you should, have rapid acting carbs....gucose tablets, full sugar fizzy drink, apple juice etc
Whole fruit, eg bananas, will take longer and are more useful to take after you have dealt with a hypo, to stabalise things.

 

[Woodywoodpecker]

Hi Thebearcametoo - this is good advice as I can now feel when my blood sugars are dropping and I go into a panic, even if the downward arrow on libre is on the reading of 8 I will panic that its going to plummet. I have started to eat half a banana to see how that goes.

Hi Ann I was like you very anxious when saw arrow heading down, I was off and on the Libre every few minutes, till nurse at hospital told me it lags behind and can take a while to go back up just finger prick. I was also diagnosed at 58 in April my birthday won’t forget that one in a hurry, it does get easier. I’m not a 100% with lows, but a lot better than I was. I take lift glucose chews they seem to work for me, but everyone is different

 

[SimonP]

Hi Simon - thanks for the advice - what is IoB? When my libra is on 6 with the arrow pointing downwards I do start to feel unwell but not sure if this psychological also.

IoB = Insulin on Board.

You can feel large rates of change of blood sugar, though also knowing how quickly it's dropping sometimes makes you feel worse about the whole situation!

 

[helli]

You libre/cgm is always a bit behind your blood glucose.
So if you want to 'look ahead' 5- 10 min you can do a blood strip test to see what is going to happen

This is not my understanding for the Libre.
As you mention, changes in BG are reflected in interstitial fluid (which is what CGMs read) after about 15 minutes.
The algorithm that Libre uses to “predict” the current value takes this into consideration by extrapolating the current trend of your BG graph. If the trend continues, this is pretty close. However, if the trend changes direction (e.g. when recovering from a hypo), Libre will take some time to realise you have recovered. This also explains some highs or lows that “disappear” from your graph when the algorithm catches up with the change in direction.

 

[Tdm]

Yes, but the libre gets it wrong. It does try to predict ahead, but has no idea if you have turned a corner, as the interstitial fluid is behind.
The blood strip test, however, will be quicker to see of your hypo treatments have worked as thse affects turn up sooner in the blood than the interstial fluid

 

[helli]

Yes, but the libre gets it wrong. It does try to predict ahead, but has no idea if you have turned a corner, as the interstitial fluid is behind.
The blood strip test, however, will be quicker to see of your hypo treatments have worked as thse affects turn up sooner in the blood than the interstial fluid

I think we are agreeing with each other.

 

[PhoebeC]

@Ann wainwright the risk from harm with hypos is more than often if the person has "severe" hypos, so they are unable to help themselves or loose consciousness. I don't know how often this is, I have had 2 of these "severe" in nearly 20 years so for me it is not a huge risk. My DSN said it is not "common" but couldn't give numbers or data.

Or if having a hypo when doing something else exercise or driving, then injury due to this is a risk, again it is not a huge number of people with diabetes.

There are side effects if you have too many too often, but the odd hypo although they are awful and should be avoided will not harm you too much, and are unlikely to kill you unless they are "severe". I know they feel awful. And they should be avoided, but try not to panic, not at 5, or above, its a good level.

Follow the hypo advice, wait the actual time it says, don't rush yourself out of them https://www.diabetes.org.uk/about-diabetes/complications/hypos#treatment
It does feel like a long 15-20 minutes but if you have stop and had treatment do wait it out, as much as you can.

I am sure someone on here will know where to find the data. The other person on the DAFNE course I have been on was very worried about hypos, and me talking about my 2 bad ones (only when I was pregnant) and that now at most they are annoying and don't stop me doing anything (they do slow me down) has helped his outlook on them.

Take care

 

[rebrascora]

I think the fear of hypos can be much more debilitating than hypos themselves. I certainly found that and once I experienced a few and gained confidence in managing them, the fear subsided a lot and that enabled me to sleep so much better and get on with my life during the day. I average about 1 hypo a day according to Libre anyway although it exaggerates somewhat. Most are so mild that I just feel a bit hot or I can sense my peripheral vision is a bit blurry or I have a sensation a bit like a tummy flip like when you go down in a lift and I can just eat a jelly baby or two and continue what I was doing. Every now and then I have a full hypo where I feel confused and heart racing and really shaky or my vision goes black for a few seconds each time I blink etc. I haven't had a really bad one requiring assistance in the nearly 6 years I have been diagnosed. I am particularly prone to nocturnal hypos but I am so laid back about them now that I can wake up calculate how many jelly babies I need, pop them in my mouth and be back to sleep in a matter of 2 minutes and sleep really soundly straight after. During the first few months of diagnosis I used to wake up every 2-3 hours and finger prick (I didn't have Libre then) because I was so anxious that I would have one in my sleep and not wake up. Then when I started to reintroduce exercise I started having regular nocturnal hypos (again before Libre) and I learned that my body would wake me and I could deal with it fine and since then I have slept really well even when I do hypo and wake up and treat it and go straight back to sleep, I wake up in the morning well rested.

Interestingly, if my levels are above 8 during the night I toss and turn and feel hot and uncomfortable and often have stressful dreams, so I really hate being too high during the night, whereas being a bit low is actually far preferable for me for quality of sleep and in fact in some respects it is natural for the body to want to be low during the depths of your sleep as that is when non diabetic people can drop below 4.

 

[dannybgoode]

Interestingly, if my levels are above 8 during the night I toss and turn and feel hot and uncomfortable and often have stressful dreams

This is interesting. I've noticed my sleep much improved since starting on the insulin.

I think high blood sugar will affect sleep as you're pretty 'wired'.

At the moment I still feel tired during the a lot as I adjust to running on normal levels but I'm sure that will improve 🙂

 

[PattiEvans]

For what it's worth I 'm looking at my 22nd anniversary of diagnosis in the new year (diagnosed age 57) and I have never had a hypo that required third party assistance. You will get used to running at a normal level (people who do not have diabetes are running at around 5.0 to 5.5 nearly all the time), it's only now that you've been running high for so long that you feel low at that level. Do try to stick it out and take all the advice about 15g carb and wait 15 minutes then fingerprick that you've been given in this thread. Meantime lots of hugs - it's a hard road to begin with, but you will be taking it all in your stride in no time at all. I recommend you get a copy of "Think Like a Pancreas" by Gary Scheiner. It's quite readable and it helped me understand the fundamentals of insulin use which was invaluable at the time.

 

[helli]

Wow! My diabetes consultant looked at me as if I I was from another planet when I explained how I toss and turn if my BG is above 8. Somehow, nice to know I am not alone with waking if my BG rises and then my mind is too active to get back to sleep.

 

[PhoebeC]

I sleep like a log but feel like death when I wake if I sleep with high levels. My main symptom is sleepy / tiredness. Interesting how we are all different.
And the Hyper dreams are a thing for me.

 

[Ann wainwright]

I think the fear of hypos can be much more debilitating than hypos themselves. I certainly found that and once I experienced a few and gained confidence in managing them, the fear subsided a lot and that enabled me to sleep so much better and get on with my life during the day. I average about 1 hypo a day according to Libre anyway although it exaggerates somewhat. Most are so mild that I just feel a bit hot or I can sense my peripheral vision is a bit blurry or I have a sensation a bit like a tummy flip like when you go down in a lift and I can just eat a jelly baby or two and continue what I was doing. Every now and then I have a full hypo where I feel confused and heart racing and really shaky or my vision goes black for a few seconds each time I blink etc. I haven't had a really bad one requiring assistance in the nearly 6 years I have been diagnosed. I am particularly prone to nocturnal hypos but I am so laid back about them now that I can wake up calculate how many jelly babies I need, pop them in my mouth and be back to sleep in a matter of 2 minutes and sleep really soundly straight after. During the first few months of diagnosis I used to wake up every 2-3 hours and finger prick (I didn't have Libre then) because I was so anxious that I would have one in my sleep and not wake up. Then when I started to reintroduce exercise I started having regular nocturnal hypos (again before Libre) and I learned that my body would wake me and I could deal with it fine and since then I have slept really well even when I do hypo and wake up and treat it and go straight back to sleep, I wake up in the morning well rested.

Interestingly, if my levels are above 8 during the night I toss and turn and feel hot and uncomfortable and often have stressful dreams, so I really hate being too high during the night, whereas being a bit low is actually far preferable for me for quality of sleep and in fact in some respects it is natural for the body to want to be low during the depths of your sleep as that is when non diabetic people can drop below 4.

thanks for the feedback. I have started to now also get panic attacks which has been awful . Can I ask - re lows - I can feel my stomach go as you say and then the libre will record number 6 but with the arrow pointing downwards and this is when I grab for the glucose. Is the arrow pointing down on the libre 2 significant in the speed of the hypo ? thanks

 

[Ann wainwright]

Hi Ann I was like you very anxious when saw arrow heading down, I was off and on the Libre every few minutes, till nurse at hospital told me it lags behind and can take a while to go back up just finger prick. I was also diagnosed at 58 in April my birthday won’t forget that one in a hurry, it does get easier. I’m not a 100% with lows, but a lot better than I was. I take lift glucose chews they seem to work for me, but everyone is different

Hi - I am feeling incredibly anxious tonight as I had the arrow pointing down in the night last night and about 3 hours ago. I took the lift tablets x 4 and a banana and the blood sugar started to come up but I continued to feel extremely faint and nauseas and think i may have been experiencing a panic attack. It is now 3 hours since this happened and I am still shaking and feel nauseous and so fearful. Are they now getting better for you? Did you have severe anxiety/panic and if so how did you handle it? If you had a libre reading of 6 with arrow going downwards and have that sinking feeling in your stomach is this when you would take the glucose chews? thanks for any info

 

[Ann wainwright]

For what it's worth I 'm looking at my 22nd anniversary of diagnosis in the new year (diagnosed age 57) and I have never had a hypo that required third party assistance. You will get used to running at a normal level (people who do not have diabetes are running at around 5.0 to 5.5 nearly all the time), it's only now that you've been running high for so long that you feel low at that level. Do try to stick it out and take all the advice about 15g carb and wait 15 minutes then fingerprick that you've been given in this thread. Meantime lots of hugs - it's a hard road to begin with, but you will be taking it all in your stride in no time at all. I recommend you get a copy of "Think Like a Pancreas" by Gary Scheiner. It's quite readable and it helped me understand the fundamentals of insulin use which was invaluable at the time.

Hi Patti - thank you so much, I just need to hear that it will get better and I won't have the terrible panic and fear which is unbearable. I will also order this book now and have a read. How long did it take you to feel confident and not worried Pattie?

 

[Woodywoodpecker]

Hi - I am feeling incredibly anxious tonight as I had the arrow pointing down in the night last night and about 3 hours ago. I took the lift tablets x 4 and a banana and the blood sugar started to come up but I continued to feel extremely faint and nauseas and think i may have been experiencing a panic attack. It is now 3 hours since this happened and I am still shaking and feel nauseous and so fearful. Are they now getting better for you? Did you have severe anxiety/panic and if so how did you handle it? If you had a libre reading of 6 with arrow going downwards and have that sinking feeling in your stomach is this when you would take the glucose chews? thanks for any info

Hi Anne don’t think I have been as anxious as you. I do suffer with anxiety and I would panic when arrow was going down, but never took anything till alarm went off 3 lift for me. The one time I really panicked was after having a Chinese, took too much insulin had small can off juice went up then down, then had chocolate and 5 lift my hubby told me to calm down, I ended up at 16 through my panic. My libre is set at 4.8 when goes off I just have the lift, at night 4.4, the night ones have never bothered me just treat and turn over. My anxiety was mostly at work and out and about, my diabetic nurse told me if going a bit low have a snack when going out. It’s only natural what you are feeling but please calm down, if alarm goes off take your lift and try waiting, as looking at libre will make u feel worse. Please believe me it does get better, and it’s really early days for you. I’m 8 months in now and bit more confident, not keen on the lows but getting better. My diabetic nurse told me I was overthinking everything, so mibi that’s what you are doing as well.

 

[Leadinglights]

A panic attack can be helped by breathing slowly and regularly into a paper bag, seems an odd thing to do but dies work for some people.

 

[rebrascora]

thanks for the feedback. I have started to now also get panic attacks which has been awful . Can I ask - re lows - I can feel my stomach go as you say and then the libre will record number 6 but with the arrow pointing downwards and this is when I grab for the glucose. Is the arrow pointing down on the libre 2 significant in the speed of the hypo ? thanks

The arrow gives you the direction of travel and the rate at which it is travelling. I think there are actual figures for the rate of change for each arrow and even an horizontal arrow can mean there is still some slight change going on but it is slow.
It is really important to understand that levels go up and down in everyone so seeing upward arrows and downward arrows throughout the day is fairly normal. The upward arrows mean that more glucose is releasing into your blood stream than there is insulin to deal with it and the downward arrows mean the insulin is winning and bringing your levels down. If you have got your bolus insulin dose correct, it will bring you back down into range and not go too far, but occasionally it happens that we don't get that dose quite right for a number of reasons and we go too low. If your levels go up really fast they will usually also come down quite fast and this is down to not quite timing the insulin optimally. So the carbs are digested and release their glucose before the insulin is absorbed into the blood stream to deal with them and then when levels have gone quite high the insulin then starts hitting the blood stream to deal with them and that is when they then start to drop. As you get better at managing your diabetes, you can learn to carefully adjust the timing of the insulin so that it gets a head start and hits the blood stream as the food is releasing it's glucose and then you don't get those big rises and falls because the insulin and glucose balance each other out. The other thing is that when levels go really high your own body will try to produce some insulin to bring those levels back down, so then you can have too much insulin, because you have what you injected plus any your body managed to make.

How long in advance of eating do you inject your insulin? This is called prebolus timing.
The optimum timing varies from person to person and meal to meal and depends on which insulin you use. I think they usually suggest injecting NovoRapid 20mins before a meal, but sometimes you may need longer than this and sometimes shorter. If you can get the timing better, your levels will not go so high so fast and therefore will not drop so fast afterwards, which is what is making you panic, but even with a vertical downward arrow on 5.0mmols you should have time for your Glucose tablets to turn it around before you become hypo. As I said in one of my posts above, I occasionally see a 4.3 with a vertical downward arrow and 2 well chewed jelly babies (10g carbs total) will deal with it for me and whilst Libre will show my levels continuing to drop for half an hour afterwards because of the algorithm, a finger prick 15 mins later will show my levels are above 4 and the Libre graph will show that I didn't actually go into the red at all.

I know people say that Libre lags behind blood so people might see a 4.3 with a vertical downward arrow and think they must already be hypo if Libre reads behind blood, but Libre is extrapolating a fast downward trend which is likely already bottoming out anyway if your insulin dose is somewhere near correct, so that vertical downward arrow may be wrong and your blood glucose could already be leveling out at 6 or 4.3 in my case, when you see that downward arrow. If you eat lots of glucose at that stage, you will just push it back up and your body will not get used to levels being in the 6s, so you will feel that sinking feeling every time you come down to 6.

A top tip for treating hypos or fast dropping levels is to chew well and/or swill whatever your chosen hypo treatment is, around in your mouth rather than swallow it quickly. The cells inside your mouth will absorb it quicker than in your stomach and they are nearer to your brain, so that glucose they absorb can get to your brain quicker from your mouth, so take time to chew and enjoy your hypo treatment. At 6 with a vertical arrow I would not personally do anything except keep an eye on it but if you are really worried about it, have a couple of glucose tablets which is about 7-8g carbs and wait 15 mins and test with a finger prick. If your result is higher than 6.0 then your hypo treatment is working and you don't need to do anything more except ignore Libre if it says you are still dropping. Libre is a wonderful bit of kit but it can be a real drama queen in these situations and unfortunately feeds people's anxiety and panic. Remember people managed without any means of testing for many, many years before we even got finger prick devices let alone Libre. You have a surprisingly amount of time to treat a hypo and a lot of the bad feeling is panic rather than the low BG. When you panic the body releases adrenaline and that makes you feel even worse and a lot of the feelings associated with hypos are actually caused by adrenaline rather than low BG, so if you can become more confident of treating hypos, you tend not to get that horrid adrenaline rush which can last far longer than the hypo itself. The only way I found to manage hypos well was to experience them and get good at managing them. It is like facing your fears, once you know you can manage it, it isn't nearly so frightening.

As regards you getting a downward arrow during the night, that was most likely because you lay on the sensor, causing a compression low. Basal insulin should not be causing arrows to be anything other than horizontal. If you wake up with the low alarm going off, make a note of which side you were lying on when you woke and was it the Libre arm. If it was and your graph shows a sudden dip or a downward arrow, then it was almost certainly a compression low. It will take about 30-45mins from releasing the pressure to show your true level, so again finger prick testing should reassure you.

I find box breathing helps with panic attacks. I don't generally get them with hypos but do with other, probably much less scary stuff, like having to go to a party!