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newly diagnosed T1, having frequent hypos

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This thread is now closed. Please contact Anna DUK, Ieva DUK or everydayupsanddowns if you would like it re-opened.
daniel warren

daniel warren

Member
Relationship to Diabetes
Type 1
hi guys iv recently been diagnosed type one after being admitted into hospital dka. since iv been discharged from hospital i thought i was getting the hang of things i understand carb counting and i test regularly, i try to test every two hours to keep my sugars tight and for the first week i was seeming to ok maybe had one low, but this week iv had quite a few hypos i had two yesterday and it worrying my that im doing something wrong, i use a accu-chek aviva expert machine to check my sugars and input my carb in take and it works out how much to inject for but i think i may be injecting to much of my novarapid and its causing my sugars to drop to low but then i have injected upto 1 unit less than my machine tells me and have had a few highs because of it, for breakfast i had some cereal and a piece of toast and worked out the carbs to be 41 inputted that into my machine and it told me to inject 4 units so i did and at about half 10 i felt shaky so checked my sugars and they were at 3.7 and its starting to get me down is there anything i can be doing to keep my sugars more stable
 
daniel warren said:
hi guys iv recently been diagnosed type one after being admitted into hospital dka. since iv been discharged from hospital i thought i was getting the hang of things i understand carb counting and i test regularly, i try to test every two hours to keep my sugars tight and for the first week i was seeming to ok maybe had one low, but this week iv had quite a few hypos i had two yesterday and it worrying my that im doing something wrong, i use a accu-chek aviva expert machine to check my sugars and input my carb in take and it works out how much to inject for but i think i may be injecting to much of my novarapid and its causing my sugars to drop to low but then i have injected upto 1 unit less than my machine tells me and have had a few highs because of it, for breakfast i had some cereal and a piece of toast and worked out the carbs to be 41 inputted that into my machine and it told me to inject 4 units so i did and at about half 10 i felt shaky so checked my sugars and they were at 3.7 and its starting to get me down is there anything i can be doing to keep my sugars more stable
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Hi Daniel, sorry to hear you are having teething troubles getting your insulin doses sorted out. As you are relatively recently diagnosed it's more than likely that your insulin will need adjusting, and this may apply as much to your basal (slow-acting) insulin as your mealtime insulin. What can happen after diagnosis, particularly when you are seriously affected like you were with DKA, is that your pancreas can recover some function once it is being 'supported' by the insulin you are now injecting. This can make it difficult to predict things (it's often called a 'honeymoon period') because your pancreas may be erratically producing some insulin. Unfortunately, this period can last from a few weeks to months or longer, but hopefully things will settle for you soon 🙂

The reason I mention the basal insulin is because this possible 'revival' in your pancreas can mean you also need reduction in this 'background' insulin. Basal insulin is designed to cover the glucose output from your liver - small amounts of glucose are trickled out 24/7 so that your body has energy available to keep your heart, brain, lungs, digestive system etc. working when you do not have a source of glucose available from the meals you eat. If the basal dose is too high then it can interfere with your calculations for your mealtime insulin (bolus) doses) - too much basal can mean you effectively have too much insulin for the food you eat, and this can lead to unpredictable lows :(

In the weeks after I was diagnosed I found myself reducing my basal doses quite often, in line with the advice I got from my DSN - have you been reducing yours? Have you tried doing a 'basal test'? This is where you try to check that your basal dose is correct by testing during periods of several hours at a time without eating carbs - if the dose is set correctly then your levels should stay steady. It's explained in more detail here:

https://forum.diabetes.org.uk/boards/threads/basal-testing-made-easy.19060/

Ignore the references to pumping, the principle is the same for injections.

Without ensuring your basal dose is correct and just keeping you steady and 'covering' the activity of your liver, it can be very difficult to get your mealtime doses correct. Also, I would also not rely too heavily on the advice of your meter for dose suggestions - it will have been programmed with ratios of carbs:insulin and these can change. Again, in the weeks after I was diagnosed my TDD (Total Daily Dose) of both basal and bolus insulins dropped from around 65 units to 45 units! Speak to your DSN about basal testing and possibly changing ratios 🙂

Good luck - you will get there, keep testing and use your experiences and readings to inform your insulin calculations 🙂
 
Northerner said:
Hi Daniel, sorry to hear you are having teething troubles getting your insulin doses sorted out. As you are relatively recently diagnosed it's more than likely that your insulin will need adjusting, and this may apply as much to your basal (slow-acting) insulin as your mealtime insulin. What can happen after diagnosis, particularly when you are seriously affected like you were with DKA, is that your pancreas can recover some function once it is being 'supported' by the insulin you are now injecting. This can make it difficult to predict things (it's often called a 'honeymoon period') because your pancreas may be erratically producing some insulin. Unfortunately, this period can last from a few weeks to months or longer, but hopefully things will settle for you soon 🙂

The reason I mention the basal insulin is because this possible 'revival' in your pancreas can mean you also need reduction in this 'background' insulin. Basal insulin is designed to cover the glucose output from your liver - small amounts of glucose are trickled out 24/7 so that your body has energy available to keep your heart, brain, lungs, digestive system etc. working when you do not have a source of glucose available from the meals you eat. If the basal dose is too high then it can interfere with your calculations for your mealtime insulin (bolus) doses) - too much basal can mean you effectively have too much insulin for the food you eat, and this can lead to unpredictable lows :(

In the weeks after I was diagnosed I found myself reducing my basal doses quite often, in line with the advice I got from my DSN - have you been reducing yours? Have you tried doing a 'basal test'? This is where you try to check that your basal dose is correct by testing during periods of several hours at a time without eating carbs - if the dose is set correctly then your levels should stay steady. It's explained in more detail here:

https://forum.diabetes.org.uk/boards/threads/basal-testing-made-easy.19060/

Ignore the references to pumping, the principle is the same for injections.

Without ensuring your basal dose is correct and just keeping you steady and 'covering' the activity of your liver, it can be very difficult to get your mealtime doses correct. Also, I would also not rely too heavily on the advice of your meter for dose suggestions - it will have been programmed with ratios of carbs:insulin and these can change. Again, in the weeks after I was diagnosed my TDD (Total Daily Dose) of both basal and bolus insulins dropped from around 65 units to 45 units! Speak to your DSN about basal testing and possibly changing ratios 🙂

Good luck - you will get there, keep testing and use your experiences and readings to inform your insulin calculations 🙂
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Hi northerner, thank you for the reply its been a big help, iv only adjusted my basal insulin once from 18 to 16 because i found my sugars were dropping quiet alot during the night and my dsn advised me to try it but iv found the last week im having a lot of lows even when i adjust my rapid insulin by upto 1 unit, i just put it down to being a bit more active than anticipated but i think it may be by basal may be to high, ill speak to my dsn team about doing a basal test.

thank you so much,
 
Welcome Daniel.

Northerner has covered it all, so I won’t bother to repeat it all. I will mention an excellent book that you might want to get. Type1 Diabetes in Children, adolescents and young adults by Ragnar Hanas. Ignore the age references. I was diagnosed at 53 and still found, and continue to find it, useful.

The start of treatment is quite muddling whilst your pancreas decides to play sometimes, but it does eventually settle. Keep in touch with your Diabetes team and they will gradually help you to get things sorted.

Lots of people on here and all happy to help, so ask any questions you have. Nothing is a silly question. Just ask.
 
Well extra activity will ALWAYS reduce our BG Daniel. Even 'daft' things can and do, you don't have to go to the gym for it to happen. One of my mates always went hypo (she doesn't now cos she's learned how to prevent it) when she did the ironing - married to an office worker and two strapping teenage boys at school - all those shirts! LOL

The bolus (ie mealtime) insulin dose is very often started out at 1u to 10g of carb but it could be anything in real life - 1u to 30g carb or 1u to 4g. We are all different and it's only a starting point! Also it won't necessarily be the same for every time of day or indeed for everything we might eat!

It's no good faffing about adjusting insulin without much idea of what's causing it - and you haven't! So get that basal testing done.
 
Welcome to the forum Daniel. You shouldn't be struggling with hypos and adjusting insulin doses on your own. Do you have a phone number for a diabetes specialist nurse?
 
Copepod said:
Welcome to the forum Daniel. You shouldn't be struggling with hypos and adjusting insulin doses on your own. Do you have a phone number for a diabetes specialist nurse?
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hi copepod, yeah i do have a number for them i just havent had the chance to call due to work and there unavailable on weekends im going to call them first thing monday morning and have a chat with them and get there advice

thank you 🙂
 
Welcome Daniel 🙂. All sorts of things can effect my bg. Worry ,work, Stress & its not just physical stuff. Good luck 🙂
 
Glad you're planning to talk to your DSN, Daniel - hopefully they should be able to give you specific advice rather than the more general advice we can give here. You've already been given some good general advice about adjusting, so I won't add to it, I'll just say that sometimes the dose of basal they put you on originally, which is a "best guess", can be a long way out - my basal was reduced from 16 units to 6 units after I had hypos every night during my first week as a diabetic!
 
thank you for all the advice guys, its been really helpful and given me a bit of a boost, iv been getting myself worked up about this the past few days and worrying its going to be a constant battle, i dont seem to be having highs just yoyoing between normal range bg and lows, im going to call my dsn monday morning and speak to them 🙂
 
daniel warren said:
i dont seem to be having highs just yoyoing between normal range bg and lows
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That's a pretty good indication that your doses are on the high side now Daniel - let us know how things go 🙂 There will always be some ups and downs and some 'unexplaineds' but you do gradually get a handle on it the majority of the time - it's just a case of being well-prepared so you can tackle it when things don't quite work out. I found I learned an awful lot in my first 6 months that made things easier in the long run. I'm still learning, but these days I get very few unexpected readings 🙂
 
Hope you get good suggestions from your DSN. As the others have said some basal testing may help provide the answers.
 
They (DSNs) get paid to help people just like you mate! And NEW diabetics ensure their continued employment of course! LOL

They get a good many boring old diabetics like me too of course, so it's nice for them to get someone they need to TEACH, isn't it?

Never judgemental DSNs. They still ask me eg What did you try doing to resolve (whatever it was), Jen? I tried this - and as you can see from my BG monitor results - it was an utter disaster! Big grins all round. Yes - I can see it probably wasn't the best plan! ...... perhaps if you tried (something else) instead?

When you ring, also get that Nurse's (well if you like em I mean) email address so if you need them in between being able to phone - you can still reach em! And I also have to say to you that 'little probs and glitches' for any diabetic using insulin esp T1s are NOT 'little' at all actually. Just get em sorted ASAP so they stay 'little'.
 
Hey guys, quick update I’ve spoken to my dsn and she has altered my quick acting insulin to 1 unit for 15g and that seemed to do the trick yesterday did have a hypo this morning so called and spoke to my team again and they’ve asked me to adjust my solos acting from 14 units to 12 so I’m going to see how I get on with that

Thanks again guys
 
You'll soon get used to making such decisions for yourself Daniel. Treating your own diabetes ain't a job anyone else will - or can! - do for you - you are issued with the tools - now learn how to do the job yourself !
 
Glad your team were able to advise, Daniel - hope the reductions work for you - if not, do keep getting back to the DSN. You will, as Jenny says, learn to make these adjustments for yourself after a while, but it does take a while to gain the knowledge and confidence to do it.
 
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