Unshakeable Hypos

[TheClockworkDodo]

I've been having a lot of these lately - you know the ones I mean, where you treat a hypo, test 15 minutes later and find you're still hypo, so you wait a bit and test again and you're still hypo so you have some more glucose or fruit juice or whatever and wait a bit and so on and by the time you get a reading over 4 it's an hour later and you could happily eat a whole packet of biscuits.

But yesterday evening I got a really bad one. I thought the grape juice I had at about half past ten had fixed it - by eleven my BGL was up to 4.0, so I had a hobnob, but then I tested again about half past eleven on the way to bed, expecting BGL to be 8ish and found that instead it was back down to 3ish, so had glucose gel ... tested again and decided to wait a bit ... tested again and had a spoonful of sugar ... tested again and had another wait ... tested again and had another glucose gel ... finally ended up having two ryvita at about one thirty am and not getting to bed until nearly two, by which time I had a really thumping hypo hangover.

Even for me, three hours is a very long hypo 😱

I know I normally have anything up to 17 hypos a week, but I am used to measuring them in minutes, not in hours!

Anyone have any ideas why this is happening? It's been noticeably worse since I've been on Tresiba, but because the Tresiba's been so much more predictable than the Lantus generally, I think this may just be co-incidence. Or it could be that I need a lot less basal and I never noticed that with Lantus just because it was so unpredictable (the problem with this theory is if I drop my basal half a unit I tend to end up having readings in the teens and having to put it up again).

Or could it be because I've lost so much hypo awareness that I'm hypo for ages before I realise I'm hypo? - would this mean a hypo would take longer to go away once treated?

Or is it just my weird metabolism changing how it reacts to insulin?! 🙄

 

[everydayupsanddowns]

Sorry to hear this Juliet - sounds a complete nightmare!

I would certainly start reducing my basal in that circumstance - probably by 10-20% at a time, and keep an eye on things. I am guessing with Tresiba you would need to allow a few days for the changes to settle each time?

 

[Robin]

Hi Juliet. I recently swapped from Lantus to Levemir, and I'm finding I need less of it. I think the lantus was so lumpy for me that I was getting a large proportion of it around the five hour mark, which meant I was actually running quite happily on a smaller dose the rest of the time. Maybe it would be worth trying a drop in your Tresiba?

 

[TheClockworkDodo]

Thanks for your replies 🙂

Well, I tried reducing my basal from 4.5 to 4 last night and this morning my fasting reading was 10.0 🙄
This is fairly typical for me - I'll have a couple of days when I struggle to get a reading above 4, reduce my insulin a tiny amount, and then have a couple of days when I struggle to get a reading under 8. And vice versa!

I don't seem to do the needing to wait to see changes, Mike, though yes, it is supposed to take a few days! I'll give it a few days though and see what happens ...

It may be the weather getting rapidly colder at the moment which means I'm needing less insulin overall, but I don't think that's the cause of the unshakeable hypos, as I've been getting those for some time now.

 

[TheClockworkDodo]

I've had a thought - do you think it's possible I still have pockets of Lantus trapped under my skin which are occasionally and randomly being released? I read somewhere on here that it's possible for insulin to linger under the skin for some time instead of being released when first injected, and that might explain the very long hypos.

 

[Radders]

Lantus used to do that to me. I'd be interested to know how long it can remain effective in that state since it would be quite warm!

 

[everydayupsanddowns]

I have wondered that Juliet. Especially where I have had correction boluses that seem to ‘disappear’. In theory I guess it could if trapped in scar tissue from injection site overuse (we’ve all had bleeders and our favourite spots I would guess).

Difficult to know for sure. Lantus does work by forming a depot of crystallised fluid of course (it is liquid at acid pH and forms crystals when the body equalises pH to neutral).

Of course, diabetes and insulin management is often more biology than maths - but sometimes the odd behaviours really do make you ask questions about how something can happen!

 

[TheClockworkDodo]

That's interesting, Mike - I didn't know how Lantus worked. I used to get blotches on my skin where I'd injected it, and had assumed this was something to do with the carrier fluid being so acidic.

Because of my ME and over-active immune system, it might be possible that if I do still have some Lantus deposits my body is actively attacking them (it seems to attack everything else!). I'm not sure how that would fit into the equation, but I'd agree about the biology and maths!