Sudden Hypos

[newbs]

Recently I have been having sudden hypos and these are causing me to feel more unwell than I usually would. By 'sudden' I mean where my BG comes crashing down in a short space of time - this morning my levels went from 11.6 to 2.8 in less than an hour. I am not sure why this is happening but am guessing that the gastroparesis has something to do with it although I still know very little about it. It is very frustrating.

 

[Northerner]

I am sorry to hear this newbs From what others have said about their experiences with gastroparesis, sometimes the food doesn't digest quickly enough so you may be left with insulin circulating and no glucose to match it. I'm not sure what the solution is, perhaps others can give you some tips. Hope it doesn't happen too often.

 

[imtrying]

Hi Newbs,

Yes from what I've heard this is probably as your food is passing your stomach too quickly and therefore not being absorbed into your body....hence there's not enough food for the insulin you've injected.

Is this happening soon after you've eaten, or at other times too?

 

[AJLang]

This is just what I was telling my consultant about this morning and that I've learnt to guesstimate what to do. To be honest the specialists don't really have much advice. The way that I deal with it is that I wait until my BG has gone up to 10 - I then have two units of Humalog, wait to see if that has worked and if not give myself some more if I need it - which if it is the momrnig I do but if it is evening time I may not need the extra insulin until 2am, 3am, 4am - there is no set time.. If my BG is under 9 before I go to bed I don't have any humalog because the food is obviously not going to digest until later. I usually only have to do this for lunch and my evening meal. It's not ideal but I haven't been able to find a better solution - and my consultant thinks that I have one of the best HBAC1Cs that he has seen in someone with gastroparesis.

However it is not straightforward. I am worried that your tummy is full first thing in the morning - although that is probably from food still being in there from the night before. Fortunately for me a combination of domperidone and errythromycin means that my tummy is empty in the morning so I can usually carb count for that meal only (if I'm able to force myself to eat because I feel nauseous first thing/don't have an appetite). Lunch is more tricky and then, for me, the evening meal is the worse. I hope this post makes sense but if it doesn't please let me know

 

[AJLang]

Hi Newbs,

Yes from what I've heard this is probably as your food is passing your stomach too quickly and therefore not being absorbed into your body....hence there's not enough food for the insulin you've injected.

Is this happening soon after you've eaten, or at other times too?

In my experience it is the food passing through the stomach too slowly i.e. the food doesn't need insulin until it has passed from the stomach into the gut - i.e. gastroparesis causes problems because it is delayed gastric emptying

 

[AJLang]

From what others have said about their experiences with gastroparesis, sometimes the food doesn't digest quickly enough so you may be left with insulin circulating and no glucose to match it.QUOTE]

That's exactly the situation but the nature of gastroparesis means that it varies from hour-to-hour day-to-day. When the food does eventually leave the stomach then there isn't enough insulin circulating hence the need for additional bolus injections to cover this.

 

[newbs]

Is this happening soon after you've eaten, or at other times too?

At any time, no pattern to it.

 

[newbs]

This is just what I was telling my consultant about this morning and that I've learnt to guesstimate what to do. To be honest the specialists don't really have much advice. The way that I deal with it is that I wait until my BG has gone up to 10 - I then have two units of Humalog, wait to see if that has worked and if not give myself some more if I need it - which if it is the momrnig I do but if it is evening time I may not need the extra insulin until 2am, 3am, 4am - there is no set time.. If my BG is under 9 before I go to bed I don't have any humalog because the food is obviously not going to digest until later. I usually only have to do this for lunch and my evening meal. It's not ideal but I haven't been able to find a better solution - and my consultant thinks that I have one of the best HBAC1Cs that he has seen in someone with gastroparesis.

However it is not straightforward. I am worried that your tummy is full first thing in the morning - although that is probably from food still being in there from the night before. Fortunately for me a combination of domperidone and errythromycin means that my tummy is empty in the morning so I can usually carb count for that meal only (if I'm able to force myself to eat because I feel nauseous first thing/don't have an appetite). Lunch is more tricky and then, for me, the evening meal is the worse. I hope this post makes sense but if it doesn't please let me know

So do you literally just inject 2 units each time your BG reaches 9? Does this mean you have to do multiple injections every day?

I had a day of nausea on Friday and had to call work sick, something I hate doing but I don't deal with nausea very well! I did find the domperidone helped though. Trying to explain why I was off sick though was difficult and totally not understood. I am currently taking the domperidone when needed rather than regularly as after taking for over a week my throat and roof of mouth swelled up. Can't be sure if this was due to the domperidone but was told to stop taking 3 times per day and take only when required.

 

[AJLang]

Hi Newbs

Sorry to hear about your problems with Domperidone I take mine four times a day every day. I feel more nauseous than normal if I don't and realise that I've missed a dose. I don't have the two units of insulin until my BG has gone over 9. Yes I do have multiple injections - sometimes up to 9 Humalog injections a day - but they've become second nature - I'm used to them now but obviously will be really glad if I get a pump. Really understand about why you couldn't go to work because of nausea - I completely sympathise. Even with my medication my nausea was so bad the other week I could hardly move until I had additional anti-sickness tablets. But it is manageable and you can have a really, really good life with gastroparesis. I'm managing to be a senior lecturer (on a part-time basis) and study for an OU degree............and even have an interview in a few weeks to be an Associate Professor! What I'm trying to say is that although the gastroparesis can be horrible and scary to begin with over time it becomes manageable - you even get used to a certain amount of nausea. It will get easier to live with please have faith that it will

 

[AJLang]

Just to say that if it goes up to 15 plus (including 25 on particularly bad days) then I inject more units of humalog - but sometimes it can be three injections of humalog during the night/early morning. But it is manageable.

 

[AJLang]

There is a gastroparesis alternative to domperidone called metroclopramide - I don't have it because it makes me very sleepy but it does work for other people and does a similar job to domperidone. It can also be taken with domperidone.

 

[newbs]

Hi Newbs

Sorry to hear about your problems with Domperidone I take mine four times a day every day. I feel more nauseous than normal if I don't and realise that I've missed a dose. I don't have the two units of insulin until my BG has gone over 9. Yes I do have multiple injections - sometimes up to 9 Humalog injections a day - but they've become second nature - I'm used to them now but obviously will be really glad if I get a pump. Really understand about why you couldn't go to work because of nausea - I completely sympathise. Even with my medication my nausea was so bad the other week I could hardly move until I had additional anti-sickness tablets. But it is manageable and you can have a really, really good life with gastroparesis. I'm managing to be a senior lecturer (on a part-time basis) and study for an OU degree............and even have an interview in a few weeks to be an Associate Professor! What I'm trying to say is that although the gastroparesis can be horrible and scary to begin with over time it becomes manageable - you even get used to a certain amount of nausea. It will get easier to live with please have faith that it will

Well done on everything you're achieving/have achieved while suffering with this condition! Thank you too for all your positivity, it really does help to know that you are continuing with as normal a life as possible while having to do the things you do. I'm feeling quite nauseous again today so have taken the domperidone, have a lot to do today including work so trying to get on with it and hoping the tablet works soon. I am speaking to DSN later and hoping to see her before my appointment with the diabetes consultant on 18th April. It does feel scary, definitely, but I'll get there I'm sure. Thanks again Amanda. 🙂

 

[imtrying]

In my experience it is the food passing through the stomach too slowly i.e. the food doesn't need insulin until it has passed from the stomach into the gut - i.e. gastroparesis causes problems because it is delayed gastric emptying

oops, sorry! Glad you came along and corrected me 🙂 Just as well really! This info I read in relation to non-diabetic hypoglycemia, but thought the same would apply here. Learn something new every day! 🙂