Severe hypo whilst eating

[justtryingtohelp]

A family member of mine has had T1 diabetes for some years now. She has had a few severe hypos. She usually has good control but recently did not feel a hypo coming on and was eating at the time. She had a severe hypo and started chocking on the food. Luckily we were there to help her, the emergency services came quickly and treated her and she was fine.

Has this ever happened to anyone? Just concerned about this happening whilst eating when people were not around. She said she had tested 2 hours before eating and did not get any signs of being low but also when she's low she says she forgets to test before eating.

Another related question is how frequently do you test?

Any advice would be much appreciated.

 

[Pumper_Sue]

A family member of mine has had T1 diabetes for some years now. She has had a few severe hypos. She usually has good control but recently did not feel a hypo coming on and was eating at the time. She had a severe hypo and started chocking on the food. Luckily we were there to help her, the emergency services came quickly and treated her and she was fine.

Has this ever happened to anyone? Just concerned about this happening whilst eating when people were not around. She said she had tested 2 hours before eating and did not get any signs of being low but also when she's low she says she forgets to test before eating.

Another related question is how frequently do you test?

Any advice would be much appreciated.

Hi and welcome to the forum.
Do you know how many times your friend injects insulin? Is it twice a day or before meals and bed time?
If she is injecting before meals then she needs to test before she injects and adjust her insulin to match her blood sugars.
I hope she doesn't drive a car or hold a driving licence, as she will now lose her licence for no warning signs.
Sounds as if an urgent referal needs to be made for a consultant or a dsn to see her and sort things out.

 

[Northerner]

Hi, welcome to the forum 🙂 I've had a hypo whilst eating once due to taking my insulin too far in advance of eating. I compounded the problem by eating food that was low GI - slow release - so not digesting fast enough to bring my levels up. Fortunately, I was able to bring it back up by drinking some lucozade.

I test around 6-8 times a day: when I wake, before meals and before bed - occasionally an hour or two after eating to see the effect on my levels of the food I have eaten, also if I feel low or high, before exercising, sometimes after exercising! 🙂

Testing two hours before eating would not give much indication of what your levels are like immediately before eating. What insulin is she on? Does she inject before each meal?

 

[justtryingtohelp]

Hi Sue,

Thanks for the reply. Sometimes she injects before meals and sometimes just after but she also injects levemir twice a day I believe. She does not drive.

 

[Pumper_Sue]

Hi Sue,

Thanks for the reply. Sometimes she injects before meals and sometimes just after but she also injects levemir twice a day I believe. She does not drive.

Well the positive is she doesn't drive
Sounds as if she is very hit and miss with her control and testing.
My personal view is that she needs help from a professional face to face.
She does need to do a lot of testing to see what her blood sugars are doing though.

 

[everydayupsanddowns]

My minimum recommendation for your family member would be immediately before breakfast, lunch and eve meal, and again before bed. Plus as others have said, any time in between if she feels a bit odd.

Without those minimum 4x a day tests she can't judge doses properly, she could quite easily have been 'on the edge' or even a little under 4 before eating, and the insulin kicked in before the food had a chance to get digested.

 

[trophywench]

Well didn't the OP say that the lady said when she is hypo, she doesn't realise and also forgets to test? Which would indicate she didn't test, had her jab for the meal and wallop, which would always happen.

The usual advice to re-establish good hypo symptoms is to run your levels a bit higher for a month or two until you re-establish your symptoms.

Firstly are all her ratios right? - that's the amount of fast-acting insulin she injects to cover the carbohydrate in each of her meals - and secondly does she know how to do a basal test? see

http://www.diabetes-support.org.uk/info/?page_id=120

scroll down the page to find out how to test.

Ideally, I think she needs to ask her team at the hospital for help! Do they know how much she's struggling? Nobody should be left in this position without help being given - but if they don't know, we can't accuse em can we?

 

[justtryingtohelp]

Hi All,

Thank you so much for your responses. Trophywench, I don't know if she is aware of how to do a basal test so I will definitely send this link to her so thanks a lot.

For info, she did not inject anything before eating lunch which was when she had the hypo. I presume she was planning on doing it after but perhaps as she was low already she just forgot.

I have told her to go to see the doctor to tell them about the hypo so hopefully she will today. I have also suggested she tests more frequently, but she already does it when getting up and going to bed and before eating (unless she's low and forgets like this time) and a couple more times inbetween. She says she doesn't want to test more than that as her fingers become sore - does anyone else have that problem?

 

[Pumper_Sue]

Hi All,

Thank you so much for your responses. Trophywench, I don't know if she is aware of how to do a basal test so I will definitely send this link to her so thanks a lot.

For info, she did not inject anything before eating lunch which was when she had the hypo. I presume she was planning on doing it after but perhaps as she was low already she just forgot.

I have told her to go to see the doctor to tell them about the hypo so hopefully she will today. I have also suggested she tests more frequently, but she already does it when getting up and going to bed and before eating (unless she's low and forgets like this time) and a couple more times inbetween. She says she doesn't want to test more than that as her fingers become sore - does anyone else have that problem?

Hi,
sore fingers are caused by wrong adjustment of the finger poker or the wrong area of poking finger. Finger needs to be poked at the side not on the pad. She also has a total of 8 fingers to use. 🙂
You haven't actually said how old this lady is, so some of her problems could be related to age and not being compliant.
How long has she been diabetic for?
Her GP will know all about the hypo as the ambulance crew will send a letter or fax to say what has happened.

 

[justtryingtohelp]

Thanks Sue. She is 20 and has had diabetes for 5 years. When she was first diagnosed her control was bad in terms of going high frequently, which has caused her to suffer from neuropathy, but over the last year she has really sorted her control out and her BS is usually between 4-6.

 

[everydayupsanddowns]

For info, she did not inject anything before eating lunch which was when she had the hypo. I presume she was planning on doing it after but perhaps as she was low already she just forgot.

Unless she had been unusually active during the morning and hadn't done anything to compeansate for it, that hypo suggests waaaaay too much basal active at that time of day to me.

TrophyWench's link for testing/correcting basal (and also what basal insulin is actually supposed to be doing) will be very useful I would think.

 

[Pumper_Sue]

Thanks Sue. She is 20 and has had diabetes for 5 years. When she was first diagnosed her control was bad in terms of going high frequently, which has caused her to suffer from neuropathy, but over the last year she has really sorted her control out and her BS is usually between 4-6.

In all honesty, it sounds to me as if she is sailing very close to the wind ie running her blood sugars as low as she can as she is scared of the neuropathy.
That's if she has neuropathy. They say it takes a good seven years before any problems due to bad control.
She imho opinion needs help and or advice to get those numbers up a bit higher so she regains her awareness and can live a normal healthy life.
It's fine running a tight ship but the pay off is plenty of blood testing to make sure that ship doesn't sink 🙂
Many of us on here do have tight control but it involves a lot of testing and knowing what is going on.

As others have said first port of call is basal testing. 🙂

 

[justtryingtohelp]

Thanks that's good advice. She has been diagnosed with neuropathy. She was hospitalised with it last year and was in a great deal of pain in her feet/legs so is now on tablets for it. Its funny you say 7 years though Sue as the advise from her doctor was that you couldn't do any lasting damage with your BS being high for 5 years but it seems she was one of the unlucky ones.

 

[trophywench]

Re sore fingers - show her this !

http://loraldiabetes.blogspot.co.uk/2006/10/painless-pricks.html

(Hopefully Alan's title will make her laugh if nothing else!)

 

[Northerner]

Thanks that's good advice. She has been diagnosed with neuropathy. She was hospitalised with it last year and was in a great deal of pain in her feet/legs so is now on tablets for it. Its funny you say 7 years though Sue as the advise from her doctor was that you couldn't do any lasting damage with your BS being high for 5 years but it seems she was one of the unlucky ones.

I think a lot may depend on just how poorly-controlled you have been, I know of several young people with neuropathy and other complications in a relatively short space of time.

It is a bit of a tightrope trying to keep such tight control, and you do need to relax your targets a little if it is leading to lack of awareness and too many unexpected hypos.

 

[Lizzzie]

Hi.

That sounds like reasonable control for me, if anything on the low side. I've had times with readings like thus, usually when I've been making an effort to run fairly low d / t risks to unborn child etc.

However, if she's running that low she could do with testing a lot more, especially prior to meals because if you are running too low or too high, that is the time to correct it.

My bigger question though, perhaps sparked by something in your username, is why are you posting this not her? This is not meant to sound judgemental to either of you and may be to do with Internet access or faith in talkboards or similar, but while we on here will try to comment / help / educate as much as possible we are largely not professionals (im certainly not) and not necessarily seeing this situation in full context.

It might be that the best thing you can do is to support a visit to
her diabetic team as others have suggested before me.

 

[Lizzzie]

Just wanted to add, I should have put in above, whatever the reason you posted not your friend, I think it's great that you are posting here, looking to support her and find out more about diabetes. I didn't mean to project any negative vibes there, it just made me wonder about the bigger situation.