Regular hypos on insulin and metformin

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Sheppeyescapee

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I became diabetic last year as a consequence of pancreatitis and have been taking insulin since. I have also been seeing the lipids clinic as my cholesterol and triglycerides were high and tested positive for high levels of LipoproteinA. The lipid clinic recommended that I go on metformin as well as insulin as the diabetic clinic said I may have some mixed type of diabetes insulin insufficiency and insulin resistance. My GP doesnt know how to deal with me as I'm not a straight forward type 1/2. Since getting up to the maximum dosage of metformin I have been having a lot more hypos. In the last 2 weeks I've had 5 hypos and the latest took the most amount of sugar to correct so far (25 jelly babies).
 
Hi.

That sounds like a really bad hypo and must have been pretty scary. I'm sure I would be panicking if I had to take more than 6 JBs for one let alone 25!! What did your levels go up to afterwards? Which insulin(s) are you using and when do you inject it? If you are going hypo frequently, then the obvious conclusion would be that your insulin dose(s) is/are too high. Are there particular times of day when you go hypo or is it totally random? What are your levels like when you are not hypo? If you are on a mixed insulin, have they given you a guide as to roughly how many carbs to aim for at each meal. Are you aware that exercise and alcohol can both drop your levels some considerable time afterwards so need to be undertaken in moderation.

GPs usually have very little understanding of diabetes and insulin use and it needs to be carefully tailored to the individual. Ideally you would want to be referred to the diabetes clinic at the hospital where the staff will have a much more in depth knowledge.. ie they are specialists, even the nurses. As a Type 3c you should be treated as a Type 1 and have access to technology and education courses the same as Type 1s and if you are currently on a mixed insulin, then push for a more modern and flexible basal/bolus insulin regime involving 2 different types of insulin, one for background to deal with the glucose trickled out by the liver and the other to cover meals. It means more injections but they enable much better control of your BG levels and a much more varied lifestyle and food choices.
 
If you’ve started metformin to improve your insulin resistance then you will need to reduce your insulin doses as the effect of the metformin builds up. Are you confident in doing that yourself, or do you have someone you can get in touch with for support doing that?
 
I agree with both the above - it sounds like your insulin needs reducing, and possibly quite significantly if you’re having such big hypos.

What insulins do you take and when? Are you counting carbs? And when exactly did you have the hypo - ie the circumstance not the time, eg just before lunch or whatever?
 
Sorry to hear about your nasty hypos @Sheppeyescapee

Those relentless ones that need repeated treatments can be quite frightening.

Hope you manage to get your doses adjusted to avoid anything similar happening in the near future.

Depending on which insulin(s) you are on, carb counting could be a really helpful strategy (even if your dose(s) are remaining consistent.

There’s a quick overview of the technique here:

The nuts and bolts of carb counting

When you live with type 1 diabetes, carb counting is a great way of managing your blood sugar or glucose levels. It can give you more freedom and flexibility in what you eat when you're preparing meals at home, grabbing food on the go or eating out. Carb counting does take some time and effort...
www.diabetes.org.uk www.diabetes.org.uk
 
Sheppeyescapee said:
I became diabetic last year as a consequence of pancreatitis and have been taking insulin since. I have also been seeing the lipids clinic as my cholesterol and triglycerides were high and tested positive for high levels of LipoproteinA. The lipid clinic recommended that I go on metformin as well as insulin as the diabetic clinic said I may have some mixed type of diabetes insulin insufficiency and insulin resistance. My GP doesnt know how to deal with me as I'm not a straight forward type 1/2. Since getting up to the maximum dosage of metformin I have been having a lot more hypos. In the last 2 weeks I've had 5 hypos and the latest took the most amount of sugar to correct so far (25 jelly babies).
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Sounds fun not :(
You don't say when you are going hypo? If it's within an hour or so of your meal bolus then I would perhaps look at the amount of Creon you are taking, ie., are you taking enough to digest the food you are eating. Also as others have said look at your insulin doses as well because it could just be a very simple reduction in either basal or bolus insulin depending on time of hypos.
 
Hey folks sorry for the delayed response I didn't sleep until 4:30am. My type 3c diagnosis isn't "official" the diabetes clinic gave me some vague mixed type diagnosis which has left my GP basically treating me for both type 1 and type 2 at the same time, they don't even believe type 3c is a thing 🙄 I don't currently take creon because of this. I have longstanding problems with digestion, I had gastroparesis which was in remission prior to becoming diabetic due to my Ehlers-Danlos Syndrome, but my digestion started playing up again since the pancreatitis.

I take humulin I twice a day at breakfast and dinner, 15 units. I'm on slow-release metformin. Pre-metformin that amount comfortably kept my blood sugars in the 5-7 range, with the occasional hypo if I forgot correct for extra activity. I don't drink alcohol very often, like once a year. The hypos happen usually between 4-6 hours after dinner in the evening. Last night was probably the worst one I've had so far. I had a later dinner last night because I lost track of time doing stuff so the hypo hit me later in the evening than usual.
 
Can they not test you to see if you need Creon? If I’m remembering correctly from what I’ve read here, there are tests, I think.

You inject one dose of your Humulin i at dinner - and hypo 4-6 hours later. That’s exactly at the peak of the action of the Humulin. I think you need to discuss reducing your dose for the evening at minimum.
 
It does sound like your meds, and insulin doses in particular need reviewing.

As others have mentioned, Metformin doesn’t reduce blood glucose levels directly, but rather works to increase sensitivity to isulin, and to reduce glucose output from the liver, which can combine to make your insulin doses more potent than they would have been.
 
Sheppeyescapee said:
don't currently take creon because of this. I have longstanding problems with digestion, I had gastroparesis which was in remission prior to becoming diabetic due to my Ehlers-Danlos Syndrome, but my digestion started playing up again since the pancreatitis.
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Can you not contact your gastro/pancreatic team? Perhaps ring the sectary and ask for an apt. A GP can not prescribe Creon it has to come from a consultant.
Hopefully things will be sorted out sooner rather than later for you.
 
I'm not currently under a gastro and I haven't seen the pancreatic team at all since my pancreatitis, I was supposed to be but I think I got lost somewhere along the way as I haven't heard a peep from them in the last 14 months since I was admitted.
 
Sheppeyescapee said:
I'm not currently under a gastro and I haven't seen the pancreatic team at all since my pancreatitis, I was supposed to be but I think I got lost somewhere along the way as I haven't heard a peep from them in the last 14 months since I was admitted.
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In that case ask to speak to your GP and ask/insist he writes to the team so you can have an apt. If there's an online form to contact your surgery with then perhaps do it that way if you feel happier that way.
 
Thank you for all the advice, I contacted the DSN at the diabetes clinic at the hospital and they returned my call pretty quickly today and we have a plan for decreasing my insulin dosage 🙂 Need to wake up early tomorrow to call the doctors to get a phone consultation with my GP to chase up the pancreatic team and refer back to gastro team.
 
Sheppeyescapee said:
Thank you for all the advice, I contacted the DSN at the diabetes clinic at the hospital and they returned my call pretty quickly today and we have a plan for decreasing my insulin dosage 🙂 Need to wake up early tomorrow to call the doctors to get a phone consultation with my GP to chase up the pancreatic team and refer back to gastro team.
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Really pleased things are going in the right direction.
 
I hope the decreased insulin dosage helps with the hypos and that you can get referred back to the pancreatic & gastro teams - clearly you need to be seeing specialists rather than a GP.

I agree with @rebrascora - if I were you I would also ask your DSN why you are on mixed insulin and not on a basal-bolus regime (aka multiple daily injections or MDI) as the latter is much more flexible and would enable you to eat what you want when you want rather than having to stick to a set amount of carbs every meal, and would also enable you to adjust your own insulin doses whenever anything else changes (eg if you are doing more exercise and therefore having more hypos, or if you're stressed and your blood sugar goes up). I should have thought this flexibility would be much more suitable for someone with gastropareisis and Ehlers-Danlos Syndrome: if the DSN doesn't know you have these or doesn't know how they effect you, do tell her, as specialist medical professionals are often a bit lacking in awareness of different specialisms and the fact that some patients might have two or more conditons at the same time.

Sheppeyescapee said:
I take humulin I twice a day at breakfast and dinner, 15 units. I'm on slow-release metformin. Pre-metformin that amount comfortably kept my blood sugars in the 5-7 range, with the occasional hypo if I forgot correct for extra activity.
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I also can't understand why you are on Metformin at all, if the insulin was already keeping your blood sugar in the 5-7 range - surely instead of decreasing your insulin they should be decreasing or stopping the Metformin? Type 3cs are normally treated the same as type 1, ie with insulin, not with Metformin. I understand they thought you had some insulin resistance, but you're not on a huge amount of insulin and if that amount was keeping your blood sugar in range I can't see why they think you need Metformin. I'd definitely be querying this with the DSN if I were you.
 
You could ring the diabetes clinic helpline and explain that you are having really persistent late evening/bedtime hypos. If you don't have a number for the helpline, the hospital switchboard should be able to put your through to it, but do ask for the number. It is often just an answering machine where you leave your name and date of birth and a brief description of the problem and then a DSN will ring you back, usually the next day but sometimes takes 2-3 days, especially if it is a weekend. Really hope you get some help with this as it is a very worrying situation.
 
Doh, sorry, I didn't realise that - I was thrown by the reference to injecting twice a day, as basal-bolus would obviously normally be four or five injections a day. In that case, I'm wondering why on earth the OP has been told to only inect insulin twice a day?!
 
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