Not sure why this hypo has happened - any suggestions?

[soupdragon]

Hi All

Have just had my first hypo at work this morning. I've recently returned to work after an op but don't think the change to routine is responsible as there have been no other problems this week.
I didn't eat breakfast before leaving for work this morning so only injected 11 units of Levemir (usual amount at the moment). Waking level was fairly normal for me.
Got to work and blood glucose started falling really quickly. It was low after one can of coke (mini one) so had to have another to get over 4. Another needed and a snack to keep it fairly stable for the rest of the morning (but was still falling slowly). Have just had lunch with no insulin. Glucose levels are now starting to rise a bit.
I have double checked that I took the right insulin - definitely no Novorapid this morning.
It would be great to hear any suggestions as to why this might have happened as I'm quite confused!

 

[Pumper_Sue]

If that's the first time you have skipped a meal and the result is hypo land then it means your basal is to much.

Perhaps try the same tomorrow making sure you have loads of hypo treatment and if the same result then you need to lower your basal. Hope that helps.

 

[helli]

I think you are newly diagnosed, @soupdragon
If that is the case, your pancreas may be still have the odd enthusiastic spurt of trying to do its own thing and produces insulin in addition to that you have injected. This can be a pest, especially as it is never predictable.

AS @Pumper_Sue says, it would be a good idea to try to repeat the scenario again and see if you get the same results. As there are so many things which can affect our levels, we do, sometimes, just experience inexplicable highs and lows. But it is always good to attempt to work out what is happening to avoid it in the future.

 

[mikeyB]

@helli, I think that the op @soupdragon refers to was a pancreatectomy, so I reckon the hypo was certainly caused by the missed meal and excess basal - like a few of us of who have zero pancreatic functions for other reasons, we don’t get enthusiastic spurts of insulin, we have to inject it all in addition to taking by mouth the missing pancreatic digestive enzymes.

@Pumper_Sue’s idea is spot on, I reckon.

The other day when I went to Liverpool I hadn’t eaten anything. I’d lowered my morning basal, but even then I still had a late afternoon dip in BG, but I had a pack of Dextro tabs to fix that. I’d missed any breakfast or brunch because with the Creon I would have needed the loo exactly at the time of my EMG test. It’s like clockwork. I do exactly the same thing for going to the football, so I don’t miss any of the supreme skills of Blackburn Rovers, even though the disabled loss at the ground are first class.

 

[soupdragon]

Thanks for your responses @Pumper_Sue, @helli and @mikeyB.
A bit more info - I've been diagnosed over two and a half years now and the recent op was an adhesiolysis. I do have a little bit of pancreas left, which possibly might be trying to be "helpful" at times.
I often miss breakfast (or have it late) and the Levemir is my usual morning dose (I need less at night) and often on work days I need some Novorapid to prevent a glucose rise in the morning if I'm not eating (or extra if I am).
I've never experienced such a sudden drop in blood glucose without exercising, which is why it was a surprise. The Levemir seemed to act as fast as Novorapid this morning, which has never happened before. I have double checked the pens and cartridges so I know I didn"t take any Novorapid, just the Levemir.
It may just be one of those things but I'd obviously rather avoid it happening again if possible.
I'll keep an eye on things over the next few days.
One positive is that it gave me the opportunity to discuss diabetes with the class I had just met (thought they deserved an explanation about why I was having to drink coke during their lesson!).

 

[helli]

My only other thought is alcohol.
If you had a drink the night before, your liver may be helpfully holding back with the glucose dump until it has sorted out the poisonous alcohol, Livers aren't very good at multi-tasking and can take up to 24 hours sorting out the booze.

Just thought I would throw it out there as an idea.

 

[soupdragon]

Thanks for that idea @helli.
I've been warned not to drink since the pancreatitis. Rarely drank before that actually - glass of fizz on Christmas and birthday was about my limit.
I'll bear it in mind if they ever let me drink again!

 

[Pumper_Sue]

Would there be a possibility of hitting a blood vessel by any chance thus a rapid uptake of your Levemir?

 

[soupdragon]

Would there be a possibility of hitting a blood vessel by any chance thus a rapid uptake of your Levemir?

I think you might be right @Pumper_Sue .
Things seemed back to normal later in the day (apart from needing slightly more Novorapid for meals later on).
Thinking back, something similar happened about a year ago when I injected Lantus into a vein. I thought at that time that was what had happened because there was a lot of bleeding. I was able to check my levels and eat extra carbs when the blood glucose dropped. No bleeding this time, though but the effect was the same.

 

[soupdragon]

Would there be a possibility of hitting a blood vessel by any chance thus a rapid uptake of your Levemir?

Thanks for the suggestion!