Severe hypo this morning

[Busdriver60]

Sorry to hear about your experience Paul and it must have been very disconcerting but am sure you have gained from the experience.
You have the edge over me in that I have never had a clinical hypo.I know some may consider “ engineering one” in safe circumstances in order to learn how to deal with it but personally am happy just to avoid the experience.

Yes, It was very scary indeed, as this was the first ever time this happened. I thought I was going to collapse.

 

[Busdriver60]

As I understand it, the isophanes have a physical ingredient that slows the absorption. That’s why they’re cloudy and why you have to roll and twist them - to ensure they’re well-mixed. The genetically engineered basals have various processes that slow absorption, like glargine’s crystal formation, but if that fails then the glargine becomes a fast insulin basically. I’m no scientist, but to me, the physical slowing of the isophanes is more predictable than relying on a process that might not happen (the glargine crystal precipitation).

It would be good if a rival insulin company produced their own detemir insulin after the Levemir patent expires.

Yes, I could maybe suggest it to my care nurse? what are your thoughts? is it worth it?

 

[Busdriver60]

Sorry to hear about your experience Paul and it must have been very disconcerting but am sure you have gained from the experience.
You have the edge over me in that I have never had a clinical hypo.I know some may consider “ engineering one” in safe circumstances in order to learn how to deal with it but personally am happy just to avoid the experience.

Thank you Wendal, I guess its all about learning from the experience, although it was unpleasant.

 

[Busdriver60]

Whilst this Phenomenon is known with glargine insulins it is rare and I have not heard of anyone having frequent recurrences.
That said, I understand it can knock your confidence so it is certainly worthwhile highlighting this to your DSN (who should know about it) and discussing whether it is better to change to one of the modern (but more expensive) long acting insulins like Tresiba.

I used Lantus (another glargine) for 12 years without any issues.

Thank you helli, Thats very useful to know. Initially, I started using Lantus, but only temporarily, just 2 weeks, as my care said Toujeo would be more suitable for me. So, I just went along with it and have been using Toujeo ever since. This is the first problem I've had with it.

 

[everydayupsanddowns]

Sorry to hear about your nasty hypo @Busdriver60

Hope you aren't too shaken up by it

 

[Busdriver60]

Glad that you are feeling a lot better @Busdriver60 .
Severe hypos are very scary and do sometimes come out of the blue whatever we have done. It does sound like this could have been your insulin and I am glad that you have changed it.
Well done to both you and your OH for managing this one so well.

I also find that I can go sky high after a hypo. It is really hard to wait 15 minutes for levels to come before retreating the hypo and I find that I am so hungry.

Thank you SB2015, yes could well be right. My DSN was very surprised when I told her what happened, so she told me she will investigate what went wrong. Hopefully she will find out soon and let me know soon. I don't want this to happen again to me or anyone else.

 

[Busdriver60]

Sorry to hear about your nasty hypo @Busdriver60

Hope you aren't too shaken up by it

it came as a complete shock, and I thought I was going to collapse, I was sweating and things looked all blurred. It was frightening. Feeling OK now 🙂

 

[everydayupsanddowns]

Yeah those nasty ones always shook me up for a few days. Thankfully it’s been a while.

Hope you a get to the bottom of what happened and take precautions to help prevent it happening again, Especially with your DVLA application going on - it would be a nightmare to get a second ‘strike’ at this point 😱

 

[Inka]

We can’t give dose advice @Busdriver60 That would be a decision for you and your nurse. If you want to try a different basal insulin, you could ask to do so for a trial period eg 3 months, and then decide which you prefer.

 

[Busdriver60]

Yes, if you don't use fast acting meal time insulin, which was what I first assumed had caused this, then I would be concerned about continuing to use Lantus or any other Glargine insulin, especially if you are looking to go back to bus driving, as there is no real way of predicting if this might happen again. It may be that there is something about your body chemistry which could have a tendency to this effect with Lantus and when there are other non Glargine insulin options, then it might be worth exploring them.

Did you not have your phone with you to get the Libre low alarm yourself before you got that low. What is your low alarm set at or have you turned the alarms off?

I personally find jelly babies are great but they work best if you chew them a lot and hold them in your mouth because then the glucose absorbs through your mouth which is closer to your brain, rather than your stomach where it can sometimes end up sitting on top of a meal you have eaten and be slowed or "diluted" by that meal. They are also pretty easy to carry and at about 5g carbs each, easy to portion up into 10g (2JBs) or 15g (3JBs) portions so you don't loose track of how many you have eaten. I put 2 in an empty test strip pot or 5 in an old "Lift" tube and that goes in all my bags and coat pockets. I leave Lift tablets in the car as the car can melt JBs in the summer.

I used Lantus initially for the first 2 weeks after my diagnosis as they did not have Toujeo pen in their stock but put Toujeo on my prescription. I have been using it ever since and still using it. I did not have issues with this pen until yesterday morning. I am now using the new Toujeo pen. My DSN was very surprised when I told her what happened. She is currently investigating, and she had taken my pen to be investigated. She will let me know their finding and the next step. With the Libre alarm, it was set at 5, but now I have adjusted it to 5.6, just be sure and with the volume turned up.

 

[Busdriver60]

Yeah those nasty ones always shook me up for a few days. Thankfully it’s been a while.

Hope you a get to the bottom of what happened and take precautions to help prevent it happening again, Especially with your DVLA application going on - it would be a nightmare to get a second ‘strike’ at this point 😱

Yes indeed, my DSN was very surprised when I told her, and is now investigating, she thinks it could be a problem with my previous Toujou pen. It could've been a blockage possibly.

 

[everydayupsanddowns]

Yes indeed, my DSN as very surprised when I told her, and is now investigating, she thinks it could be a problem with my previous Toujou pen. It could've been a blockage possibly.

Great to hear she is looking into it. I’d hope if you had an equipment failure, the DVLAers would take that into account.

 

[Busdriver60]

We can’t give dose advice @Busdriver60 That would be a decision for you and your nurse. If you want to try a different basal insulin, you could ask to do so for a trial period eg 3 months, and then decide which you prefer.

Yes, I will go along with her suggestion from 12 to 10, but if that doesnt work, then I will increase back up to 12.

 

[Busdriver60]

Great to hear she is looking into it. I’d hope if you had an equipment failure, the DVLAers would take that into account.

I hope so. But at least I now know what a hypo is and have experienced it, so I know what action to take next time.

 

[rebrascora]

I used Lantus initially for the first 2 weeks after my diagnosis as they did not have Toujeo pen in their stock but put Toujeo on my prescription. I have been using it ever since and still using it. I did not have issues with this pen until yesterday morning. I am now using the new Toujeo pen. My DSN was very surprised when I told her what happened. She is currently investigating, and she had taken my pen to be investigated. She will let me know their finding and the next step. With the Libre alarm, it was set at 5, but now I have adjusted it to 5.6, just be sure and with the volume turned up.

Just to clarify, Lantus and Toujeo are both insulin Glargine but the Toujeo you are now using is triple strength compared to Lantus.
I think it is more likely that it was the action of the insulin Glargine than a fault with the pen. Do you remember where in particular you injected it. Could you have hit some scar tissue or an area where there is very little fat or a blood vessel?
I know they are very scary and I am pleased that you are now able to view it as a learning experience because until you have experienced a hypo, it is hard to know how you would manage it and the experience really reinforces how very important it is to be vigilant and prepared especially with keeping your hypo treatments close to hand at all times. So pleased it happened at home and your good lady was there to support you through it.

 

[Busdriver60]

Just to clarify, Lantus and Toujeo are both insulin Glargine but the Toujeo you are now using is triple strength compared to Lantus.
I think it is more likely that it was the action of the insulin Glargine than a fault with the pen. Do you remember where in particular you injected it. Could you have hit some scar tissue or an area where there is very little fat or a blood vessel?
I know they are very scary and I am pleased that you are now able to view it as a learning experience because until you have experienced a hypo, it is hard to know how you would manage it and the experience really reinforces how very important it is to be vigilant and prepared especially with keeping your hypo treatments close to hand at all times. So pleased it happened at home and your good lady was there to support you through it.

Thank you Rebrascora. I'm so grateful to you and the other members of the forum.
I will be on my guard from now on.

 

[Proud to be erratic]

Firstly Happy Birthday Paul. No doubt @GracefulAng has found something to make your day special.

Yes, I will go along with her suggestion from 12 to 10, but if that doesnt work, then I will increase back up to 12.

I fully understand @Inka's position regarding members not being allowed to give dosing advice. However I do think making any change on the basis of a single event (the first in almost a full year) is dubious. I suspect she also didn't look back at recent daily graphs, which show you are running highish (above the green band of being in range) a lot more frequently than is desirable. What is good, and perhaps influenced her decision, is that there is a lot of evidence that each time you do end up very high your body is gently recovering you from those highs, without you making any specific effort.

Whatever you decide to do, in respect of her dosing advice, I can only encourage you to start the process of being more diligent about carb awareness and specific carb monitoring and recording carb details in your MySugar app. I believe with that greater awareness of carb content, you will naturally start thinking about making lower carb choices, when there are natural alternatives. Yesterday's lunch together was an ideal opportunity to show you that the ciabatta option was 69 gms carbs, according to the packaging; whereas your toasted sandwich choice was only 39 gms carbs. We were unlucky in the cafe having nothing that was even more healthy or lower carb; sorry about that - I choose the venue! From MySugar reports you will develop a sense of how carb heavy any one meal was, and how carb heavy the day/week/ month has been. Then you should be able to more routinely acquire that sense of carbs being eaten and hopefully see trends of recovery from highs in relation to both activity and basal insulin dosing.

You could also consider asking your Nurse whether you might benefit from moving to Tresiba instead of your Toujeo. I find it a very stable insulin and dependable which, as far as my life goes, is very beneficial for me.

 

[Proud to be erratic]

Paul, in case you haven't seen @Inka's post #8 in a different thread:

https://forum.diabetes.org.uk/boards/members/43336/

and my comment a bit later:
I realise this is @DancingStar's thread; and I see that @ Wendal has quite deliberately tagged Paul, @Busdriver60, who had a very similar incident like this only a few days ago.

Paul (@Busdriver60) if you haven't already seen the very clear comment by @Inka (thank you) then it is well worth you making yourself familiar with this detail, before you go to Frimley Hospital for that endocrinology appointment, very recently requested by DVLA. There is a definite nagging worry in my mind that your recent hypo could bring at the very least hesitation by the Frimley Consultant in straightaway supporting your restoration of your licence. I believe you would be best advised to ask your care nurse to move you to a different basal, that isn't an isophane such as Lantus. I also think that you would find Tresiba a very suitable basal for your circumstances. I would be happy, Paul, to spell out at another time, why I think this.

[Apologies, @DancingStar, for cutting into your thread. I only have an android phone and this does not allow me to have 2 threads open at the same time, so copying from one thread to another is cumbersome for me. I will copy all of this across to Paul's recent post.]

Paul, I think your explanation and response to a Frimley Consultant could be:

"Horrible as it was, you've learnt from your very low hypo in early April. You now know what a deep hypo feels like and your sharing with your wife's phone was very fortunate.
You have immediately taken steps to prevent a recurrence: increased the volume on your phone; set the low alarm to its highest possible setting of 5.6 mmol/L; you are doing all you can to make sure that you always have hypo response treatments, even more close by than before.
From your viewpoint this hypo was the first time anything like this has happened in the 12 months since you started on insulin. You have searched your memory and can find no obvious possible explanation - unless it was a failure by your Lantus to release slowly on that one occasion and are in discussion with your care nurse to move to a different type of insulin, such as Tresiba. [This last point will depend on what you decide to do and how quickly it happens]. [A change of basal demonstrates this is important to you to prevent a recurrence, even once every 12 months is still unwanted and inappropriate for you and your licence]

 

[Inka]

@Proud to be erratic Great comment but, to be clear, Lantus is NOT an isophane insulin. It is a genetically engineered glargine insulin and it is the glargine that the problem is with.

The isophane insulins do NOT use the dodgy (to me) crystal precipitation that Lantus/glargine does.

Anyone wanting to get away from glargine basals has the choice of Levemir (but that’s being discontinued in 2026), Humulin i , Hypurin Isophane or Tresiba. Levemir, Humulin i and Hypurin Isophane have the advantage of being twice daily basal insulins, meaning that you can separately adjust the morning and evening doses if, for example, you need less basal at night.

As a note, when I take a pump break, I use an isophane insulin twice daily because I need a lot less basal at night than during the day. The isophane gives me flexibility and is the closest I can get to my pump basal (Levemir would do similar).

TLDR: isophane insulins are NOT glargine insulins. They’ve been around for years and are not anything to do with Lantus hypos.They are a separate and different kind of basal insulin. So-called Lantus hypos only come from glargine insulins eg Lantus, Toujeo, etc.

 

[Proud to be erratic]

Thank you @Inka for tidying up the confusion I was potentially causing