Quick drop in blood sugars

[Emmakeets]

Hi
I've been lurking around the forum for a little while now and I wondered if anyone would be able to answer a question.

I have type 2 diabetes, am on basal insulin and a number of tablets. The insulin is a recent addition and they are currently changing it quite often to try and get it right.

The problem I am having is from when I leave work at 4 to when I have dinner around 7.30. Today I tested my sugars when I left and they were 15.3. I got home and was feeling unwell as I do every evening. I fell asleep and woke up feeling very sick and having a terrible headache. I tested my blood sugars again (this was just after 7pm) and they were 5.8.

This seems to be happening to me every evening. Is this dropping too fast? Is that why I am feeling unwell each evening?

Any help appreciated!!
Emma

 

[KookyCat]

Dropping rapidly can make you feel a bit mucky Emma (welcome to forum by the way 🙂) well it does for me. What insulin are you taking, and when? Are any of the tablets you take designed to lower blood sugar? That's one significant decrease!

 

[HOBIE]

I would feel unwell at 15 & miles better 5.8 . Welcome Emma & good luck 🙂

 

[Emmakeets]

I'm on 10 units of lantus which I take in the evenings. They started me on this to combat the high blood sugars I was getting first thing in the morning. I'm also on gliclazide (two in the morning, two in the evening), sitagliptin once a day and dapagiozin once a day.

I can't work out why they're dropping in the evenings so fast as I don't take any tablets in the afternoon and this is happening before I take any evening tablets or insulin!

HOBIE I don't think it's the low sugars that are making me feel ill, more how quickly they are dropping.

After I eat dinner I'm absolutely fine again!

 

[HOBIE]

Yes I think its the high blood sugar that's making you feel unwell. Feeling clogged up/slow/dehydrated. Have a look at food stuff that are slow release, like Porridge. Everyone's a little different. 🙂

 

[Confusingtheblues]

Hi
I've been lurking around the forum for a little while now and I wondered if anyone would be able to answer a question.

I have type 2 diabetes, am on basal insulin and a number of tablets. The insulin is a recent addition and they are currently changing it quite often to try and get it right.

The problem I am having is from when I leave work at 4 to when I have dinner around 7.30. Today I tested my sugars when I left and they were 15.3. I got home and was feeling unwell as I do every evening. I fell asleep and woke up feeling very sick and having a terrible headache. I tested my blood sugars again (this was just after 7pm) and they were 5.8.

This seems to be happening to me every evening. Is this dropping too fast? Is that why I am feeling unwell each evening?

Any help appreciated!!
Emma

I am a T2D so cannot advise on insulin use, but the symptoms sound a bit like what is called ;False Hypo' which can happen when bloods that have been high previous (i.e. an elevated fasting bgl) drop to around 5 or 6 following a successful change in meds or diet, and the body needs a while to adjust to the new levels. Its like the body is sensing imminent starvation, and has a panic attack.

At 5.8 it is probably not a hypo unless your meter is reading high, i say this becasue I use 2 meters, and I get true hypo's with one reading 3.8 and the other reading 6 or so. Both meters are within accuracy limits apparently. t depends on what meter you have, Some meters are calibrated for plasma blood, and will always read 12% higher than other meters calibrated for 'whole blood' This is a recent change, and not all meters have been changed. The NICE and DVLA figures they quote is for 'whole blood', and do not take the new meters into account. Check the literature that came with the meter, or contact the manufacturer.

 

[robert@fm]

What @Confusingtheblues said. To elaborate, a false hypo can ensue if (1) you are used to running high BGs so your body regards those as "standard" and standard BGs as "low", or (2) if you get a too-rapid drop in BG level (the latter can happen to just about any D sufferer). Sounds like both causes are at work in your case.

 

[Amberzak]

Hi. I always feel worse with a sudden change in sugars, but I also feel really unwell at a reading of 15.

 

[everydayupsanddowns]

Where did you read that DVLA regulations are based on whole blood calibration @Confusingtheblues? Almost all modern meters are Plasma calibrated as far as I know - I remember them switching over several years back.

 

[Confusingtheblues]

Accuchek and SD meters are plasma. Abbott are generally Whole Blood but i believe one of theirs is Plasma now. if you look at the DVLA guidelines for the last few years, then they follow the NICE levels and have not changed. The Plasma calibration started to come in around late 2011 and initially only covered meters that allowed alternate site testing. I have a NEO calibrated for Whole Blood, and a SD Codefree that is Plasma. The difference between them is fairly consistent with the SD reading 1.9 mmol higher in the low end range, but it can vary by a further mmol/L depending on the strip batches. Yesterday I had a minot hypo, my Neo read 3,8. but my SD showed 5.8 (5.9 on retest). DVLA says I am 'safe to drive' when above 5 mmol/L but there was no way I was fit to drive.

There is no ISO requirement for meters to be calibrated to either standard. Both of my meters meet their test solution requirement and so are deemed to be within specification. Having tracked my meters for 6 months now, it is not due to misreads. the difference is consistent, Other SD owners have reported theirs as reading high compared to a different meter that they use.
Not all new meters have changed to plasma, and anyway the guidelines still show the whole blood values.

 

[Robin]

I remember being confused at the time. I'd just learnt the figures, being newly diagnosed in 2007, and I remember my Accuchek changing. ( If I remember rightly, it was the strips that changed, not the meter. Maybe the meter I got was 'plasma ready') But the guideline figures that my DSN went by didn't seem to change, it was still 4-7. So I worked out if I used the new plasma figures on my meter, but carried on as if they were the old ones, my HbA1c ought to improve by 10%, which it did. ( Maybe that was coincidental and I was even more confused than I thought, but hey, something worked!)

 

[Confusingtheblues]

I remember being confused at the time. I'd just learnt the figures, being newly diagnosed in 2007, and I remember my Accuchek changing. ( If I remember rightly, it was the strips that changed, not the meter. Maybe the meter I got was 'plasma ready') But the guideline figures that my DSN went by didn't seem to change, it was still 4-7. So I worked out if I used the new plasma figures on my meter, but carried on as if they were the old ones, my HbA1c ought to improve by 10%, which it did. ( Maybe that was coincidental and I was even more confused than I thought, but hey, something worked!)

Hi Robin. Its ok so long as you are not a driver close to hypoland. Tonight I had a low bgl. My Neo read 4,4, but my SD read 7.3 I did not retest since I am running low on strips. That said, I was not in hypo, but could still fall into it when stressed by driving. Technically I was probably below DVLA minimum, but my SD says I would be ok to drive. I am also hypo aware, so I would detect early stage hypo. But if i was relying only on my SD, I could retest and see a reading above 5.5, but be on verge of losing it. This is scary.

 

[KookyCat]

Emma do you do any exercise when you leave work, by that I mean walking as well? Exercise could be making your blood sugar reduce quickly (mine can easily drop 4 points on a brisk walk) which is one thing to think about.

I notice that's a lot of medication you've got going on there and it still doesn't seem to be doing the trick, that 15 reading is pretty high, is that a normal level for you? How did you come to be diagnosed? I notice in your profile info you're quite young, did they consider if you might be type 1 at all? Sorry it's like 20 questions just trying to work out if there's an obvious answer 🙂. Lantus was very peaky for me (not at all flat and stable, and I mean not at all) but that's quite a small dose and should be burning out at that stage rather than revving up. Is it reducing your waking figure as intended? I'll stop now before I make it 30 questions 🙄

 

[@Fractis]

Hi Emma, I have noticed a similar effect, and it seems to boil down to a couple of different things in combination

• I seem to be running low on fuel by the time I leave the office, and if I don't snack my BG falls quite a bit
• As my afternoons are quite sedentary, I try and walk a bit as part of my commute (say half an hour or so) and this too can make my BG fall rapidly
  
• In cold weather (i.e. pretty much all the time) my finger prick tests come up quite a bit lower when I have been walking outside, leading to a few false hypos - it looks like this is down to reduced circulation in the extremities

The combination of the first two can leave me feeling pretty rough by the time I get home, even if I am not actually that low. It seems the process of falling rapidly is enough to make me feel grim, regardless of whether I end up very low or not.

I am gradually changing my schedule where I can, and over time things are smoothing out and I am generally managing to avoid the big falls. Sorry not to be able to suggest a silver bullet for this, but I am sure that as you get more practice with the medication and insulin you will be feel a bit better. In the meantime, feel free to have a good rant about it - you are more than entitled!

(Some have commented that I get very grumpy and belligerent when my BG is falling fast, but I don't believe that for a moment, I think I am ALWAYS enchanting company 😉)