Severe hypo this morning

[Busdriver60]

Hi Everyone!

This morning, I had my first severe hypo, which took me by surprise; it came as a complete shock. I thought this could only happen in warmer weather, but this was at 7.30am in the kitchen! I had taken my insulin first thing in the morning after reading my finger-pricking BG, which was 7.9mmol. Not too long after, I was about to make my breakfast when I didn't feel myself; I was sweating, and things looked hazy. I thought I was about to collapse when my wife rushed in after she noticed my Libre app on her phone, and she had to immediately do my finger-prick BG. My BG was 2.5mmol. She had to treat me straight away with sugary treats, wait 15 minutes for the next finger-pricking BG and so on, until it read 6.0mmol. Soon, my BG reading went to the other extreme, where the high reading was off the scale!! Later in the afternoon, I attended my appointment at the urgent care centre, where the doctor checked me over, and I was ok. Even now, nearly 1 year after getting the condition, I still find it exceedingly difficult to control. Lesson learnt...

Every day, I learn as much as I can about my condition and have made mistakes from what I have learned. But this morning, I experienced my first-ever severe hypo. I found it frightening. The fact that it happened was maybe a good thing, as I now know what a severe hypo is and know how to deal with it.

 

[Inka]

Bad hypos can be frightening @Busdriver60 I hope you’re feeling much better now. You say the hypo happened shortly after you had your insulin - are you just taking Toujeo? Toujeo is glargine insulin like Lantus. I mention that because there’s a type of hypo known as a Lantus hypo, when the crystals don’t form correctly so the insulin is released quickly rather than slowly. I’m wondering if Toujeo can do the same.

 

[Ieva DUK]

That sounds like such a scary experience, and I’m really glad your wife was there to help you through it. It’s great that you’re taking the time to learn from each experience, even the difficult ones, and turning it into something you can manage better moving forward. It’s completely normal to feel overwhelmed and frightened when something like this happens, especially when it’s unexpected. The fact that you were able to get your BG back on track so quickly, with the support of your wife and the doctor, is a huge positive.

Hypos can definitely throw folk off guard, but every time it teaches something new about how your body reacts to different factors. It’s really encouraging to hear you’re continuing to learn and adjust as you go.

Stay kind to yourself and keep leaning into those lessons. Your approach to learning from each moment is really inspiring for others. And, always trust your body and instincts - you’re doing your best and adapting as needed, it's just the first year and you've done so much already!

Sending you lots of positive energy and wishing you smoother days ahead!

 

[Busdriver60]

Bad hypos can be frightening @Busdriver60 I hope you’re feeling much better now. You say the hypo happened shortly after you had your insulin - are you just taking Toujeo? Toujeo is glargine insulin like Lantus. I mention that because there’s a type of hypo known as a Lantus hypo, when the crystals don’t form correctly so the insulin is released quickly rather than slowly. I’m wondering if Toujeo can do the same.

Yes, it is Toujeo Solostar insulin. I don't understand why my BG went down very quickly, despite the fact that my insulin is a slow-releasing one. My diabetes nurse was as surprised as I was. She suggested getting a new one from the fridge and getting rid of the old one. BTW, thanks, I feel much better now after being checked over by the hospital doctor.

 

[Busdriver60]

That sounds like such a scary experience, and I’m really glad your wife was there to help you through it. It’s great that you’re taking the time to learn from each experience, even the difficult ones, and turning it into something you can manage better moving forward. It’s completely normal to feel overwhelmed and frightened when something like this happens, especially when it’s unexpected. The fact that you were able to get your BG back on track so quickly, with the support of your wife and the doctor, is a huge positive.

Hypos can definitely throw folk off guard, but every time it teaches something new about how your body reacts to different factors. It’s really encouraging to hear you’re continuing to learn and adjust as you go.

Stay kind to yourself and keep leaning into those lessons. Your approach to learning from each moment is really inspiring for others. And, always trust your body and instincts - you’re doing your best and adapting as needed, it's just the first year and you've done so much already!

Sending you lots of positive energy and wishing you smoother days ahead!

Thank you, leva DUK
It's always good to learn from people like you. I'm so glad I joined the forum!

 

[Inka]

Yes, it is Toujeo Solostar insulin. I don't understand why my BG went down very quickly, despite the fact that my insulin is a slow-releasing one. My diabetes nurse was as surprised as I was. She suggested getting a new one from the fridge and getting rid of the old one. BTW, thanks, I feel much better now after being checked over by the hospital doctor.

With the glargine hypos, it’s because very occasionally the insulin doesn’t form a depot of crystals. These crystals allow the glargine to release slowly over 24hrs. If the crystals don’t form, then the insulin releases quickly all at once and can cause a hypo @Busdriver60

 

[Inka]

I’m not saying it is a glargine hypo, but it’s possible. The nurse should know about them. Here’s a recentish thread with some information:

Thread 'Severe hypo after Lantus'

Apr 29, 2021

Hi all. I had a severe hypo after injecting my Lantus last night. The first time that happened to me since my LADA diagnosis 5 months ago, and at the risk of sounding dramatic, I’m feeling this morning like I literally had a brush with death. I take 8 units of Lantus at about 10 pm daily, and did so last night. I had planned to do a basal test last night, so hadn’t eaten anything since dinner at 5 pm. Just read and watched TV in the evening. BS was steady in the 7’s by 10 pm. I took my Lantus in my buttocks, alternating the site like I normally do. Injection site dry after removing...

• pondita
• glucagen hypo lantus severe hypo type 1
• Replies: 24
• Forum: General Message Board

 

[Busdriver60]

With the glargine hypos, it’s because very occasionally the insulin doesn’t form a depot of crystals. These crystals allow the glargine to release slowly over 24hrs. If the crystals don’t form, then the insulin releases quickly all at once and can cause a hypo @Busdriver60

Thank you for the information😉

 

[Thebearcametoo]

Bad hypos are scary. One thing to know is to ‘stop the drop’ and once you’re not going down be more cautious about having more fast carbs so you don’t end up with a hyper afterwards. With my kid as long as he’s not going down still we try to allow more time before adding more carbs or only add a smaller amount of carbs as it can take a while for the sugar to finish the upwards bump.

 

[SB2015]

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.

 

[Busdriver60]

Bad hypos can be frightening @Busdriver60 I hope you’re feeling much better now. You say the hypo happened shortly after you had your insulin - are you just taking Toujeo? Toujeo is glargine insulin like Lantus. I mention that because there’s a type of hypo known as a Lantus hypo, when the crystals don’t form correctly so the insulin is released quickly rather than slowly. I’m wondering if Toujeo can do the same.

Yes indeed, now I know what it's like, so next I would be prepared. Next time I could be alone and that would scare me.

 

[Inka]

Yes indeed, now I know what it's like, so next I would be prepared. Next time I could be alone and that would scare me.

I like the Lift GlucoShots for scary hypos @Busdriver60 They unscrew simply (no worry about the can pull snapping off on a 150ml can of Coke) and can be drunk quickly. They work very quickly too, being a liquid. It can be reassuring to have some in rooms you’d be in upstairs and downstairs.

If you think it could be a glargine hypo, you could also considering changing insulins. Sadly, Levemir is being discontinued else I’d suggest that, but there are things like Hypurin Isophane or Humulin i (isophane) or Tresiba.

 

[rebrascora]

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.

 

[helli]

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.

 

[Inka]

Indeed, it is rare @helli but not super-rare. It seems to be to do with body composition in the area in which it’s injected. This blog explains better than I can. The author had the Lantus hypos happen twice, as they detail. There’s also some interesting information about glargine compared to other basal insulins:

Lantus: Lethal or Lifesaver? #DOC #gbdoc | Diabettech - Diabetes and Technology

SummaryFollowing issues I experienced with Lantus (Insulin Glargine) in November 2014, I spent some time researching it, looking at absorption and pharmacokinetics and other users' experiences. I reached the conclusion that Glargine has the potential to be lethal and that due to its...

www.diabettech.com

When I was first diagnosed, there seemed to be a lot more basal insulins to choose from. Even though I have a pump, I do take pump breaks and I think it’s very sad that the choice of basal insulins has reduced. In that blog, the author praises Levemir and talks of the improvement in their blood sugar control - and yet now the option to use that basal will be disappearing.

 

[rebrascora]

Really interesting to read that @Inka and particularly as it suggests NPH insulins like Hypurin/Isophane can have even more unpredictable results than Glargine, which is relevant to me as those were the ones I was intending to move to when Levemir is discontinued..... unless a company starts producing a generic Determir now that the patent has expired.... which would be by far my preference, as I love my Levemir.

 

[Inka]

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.

 

[trophywench]

There is no way on earth I would voluntarily agree to use glargine again for the reason that yes I destroyed all the fat cells on my outer thighs whilst using it and never realised until I'd donned a pair of leggings (lovely and expensive thermal short legged M&S ones for short arses like moi!) that I used to wear under my motorbike leathers one morning and caught sight of myself in the wardrobe mirrors before donning my leathers and suddenly noticed the two huge hollows - that was over 20 years ago now and this Feb I thought to myself, must have recovered by now surely so just thought I'd just try a cannula there. JHC!!!!! to quote Holden Caulfield (Catcher in the Rye) Had to rip the thing out pdq - no way Pedro could I possibly stand that pain! Plus - the thing that happened to me and others with Lantus was it crystalising brilliantly but then not dispersing until suddenly - at an entirely random time one day dispersing and sending me VERY hypo for hours on end despite eating and drinking half a ton of carbohydrate washed down with a gallon of old fashioned full glucose Lucozade.

Bloody awful.

 

[Wendal]

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.

 

[Busdriver60]

Bad hypos can be frightening @Busdriver60 I hope you’re feeling much better now. You say the hypo happened shortly after you had your insulin - are you just taking Toujeo? Toujeo is glargine insulin like Lantus. I mention that because there’s a type of hypo known as a Lantus hypo, when the crystals don’t form correctly so the insulin is released quickly rather than slowly. I’m wondering if Toujeo can do the same.

Yes, my care nurse was very surprised, when I saw her at my local hospital this morning. I told her exactly what happened and what action was taken to deal with it. She thinks, it could be my Toujeo pen, some sort of blockage maybe, but she did say she will investigate. he also suggested I should lower my insulin dosage from 12 to 10. Is she right? What do you think?