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Very low hypo that came on very quickly

D

DancingStar

Active Member
Relationship to Diabetes
Type 3c
Why might this happen? If I know the cause I can try and stop it happening again:

Got up and checked BG - 7.6 on my Libra and it had remained fairly constant while I'd been asleep. This is a bit high for me, my waking BG is usually around 6.2. Injected 14units of Lantus - my usual dose. It was the last dose in the pen.

I don't have my breakfast until I've been up an hour or so, so I didn't inject any Novorapid - normally do that around 20 mins before I eat my breakfast.

About 40 minutes after the Lantus injection I was sitting on the sofa reading and I had the fastest, worst hypo I've ever had. It came on so quickly and it was so low it was unmeasurable on my Libra2. I couldn't sit up becauseI felt so weak and had slumped down to lie on the sofa. I was lucky i hadnt slipped onto the floor. Everything had gone so blurry and dark I could hardly see. Luckily my husband had just got up and he got me a carton of orange juice. I was so weak I couldn't hold the carton - he had to put the straw into my mouth.

It was so frightening and I don't know why it came on so quickly and with such intensity. Usually if I get a hypo it's because I've either misjudged the carb count etc and had a bit too much Novorapid, or I've done exercise and over exerted myself.

If I knew why it happened I could try and make sure it doesn't happen again, so any advice gratefully received.

Just to add, I've been unwell this week with some kind of mild viral illness - normally things like this makes my BC run slightly high, which I assumed was the reason why it was a bit higher than normal when I got up.
 
I’m sorry that has happened to you, it’s rare but isn’t unknown for Lantus to fail to crystallise properly under the skin, meaning it is absorbed too fast.. It might be worth looking at this thread, which is about Toujeo, another form of Glargine (like Lantus). sorry, I’ve managed to link to one of the posts, rather than the whole thread, but it will get you to the right thread anyway.
Busdriver60

Post in thread 'Severe hypo this morning'

rebrascora said:
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...
Click to expand...
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I knew it would be Lantus! Sorry to hear about your hypo @DancingStar Read the posts in that thread @Robin linked to and in the other thread I linked to in that thread above plus the blog from Diabettech. Having read those, if you’re sure it’s the Lantus, Yellow Card it.
 
Hopefully these links will take you to the right places:

Busdriver60

Thread 'Severe hypo this morning'

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...
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pondita

Thread 'Severe hypo after Lantus'

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...

www.diabettech.com

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 www.diabettech.com
 
Ive had a few episodes recently when my BS has shot down for no reason, I am on Lantus 22 units every morning
but the odd thing is its later on in the day when its happened so im not sure what happening.
 
Inka said:
Hopefully these links will take you to the right places:

Busdriver60

Thread 'Severe hypo this morning'

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...
  • Care
  • Love
  • Like

pondita

Thread 'Severe hypo after Lantus'

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...

www.diabettech.com

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 www.diabettech.com
Click to expand...
Thanks Inka and Robin for highlighting the possible Lantus links with Paul @Busdriver60
Both are Type 3Cs ( so lack of Glucagon) like myself but personally never had anything like this ever happen to me but is nice to be aware of.
My daily Lantus intake is only 6u so May be easier to deal with if a sudden drop but as you say all the basal insulins are designed to break down more slowly so they are longer acting but obviously on rare occasions they can break down much quicker and cause a clinical hypo
 
@Wendal The issue is the crystal method of glargine - ie that it’s reliant on the precipitation. That blog I linked to claimed this specific failure and thus severe hypo risk was known years ago. Levemir has a different method and so does Tresiba and so do the isophane insulins - none of these three insulin types are glargines like Lantus and none actin the same way* The isophanes are the original cloudy insulins, where you need to mix the insulin by twisting and turning. I don’t think any of those have the propensity to act like fast-acting, like glargine does. Of course, they may release a bit quicker or slower over the hours, but, to me, that’s very different from acting like a fast insulin, which must be so scary.

*Edited by me to add extra information to make it clear that the glargine insulins are only Lantus, Toujeo, etc and not any other basal insulin. See my comment to @Proud to be erratic below
 
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That sounds like such a frightening experience - I’m really glad your husband was there and able to help you so quickly. Severe hypos can be incredibly disorienting and leave you feeling quite shaken afterwards, especially when they seem to come out of nowhere.
You’re absolutely right to try and understand why it may have happened and as others have noted - Lantus could have a huge impact on that. Sometimes, especially at the very end of a pen, insulin delivery can be inconsistent. It’s possible a slightly higher dose was delivered unintentionally, or even that a small amount leaked and then absorbed rapidly, or (as Robin had mentioned) it could be due to different crystallisation.
I know being unwell can also play its role, even though illness can sometimes raise blood sugar, for some people (especially with certain viruses or fevers), it can actually make them more insulin sensitive too.
It's really positive that you’re reflecting on it and trying to piece it together. Be kind to yourself as you recover from the shock of it - that kind of experience can really shake your confidence, but you handled it so well.
Sending you warm wishes!
 
Many thanks to everyone who replied. I've read through the threads suggested and have a lot more insight into why it might have happened.

I'm going to report via Yellow Card. I have an appointment with hospital diabetic clinic on 12th May and will definitely mention it then, but I am wondering if I should talk to DSN before then to tell her what happened.

My husband usually goes to work very early, before I'm up and injecting my insulin. It was good fortune it happened at the weekend when he's here, otherwise I don't know what I'd have done because I wouldn't have been able to walk to where orange juice is kept. It's made me realise I need to have more emergency glucose around the house where I can grab it easily. I can usually tell if I'm going hypo and take avoiding action, but this happened scarily fast. I am also a bit cavalier about the alarm on my Libre - it often goes off in the night distubing us when I lie on it so I turn the sound down or the alarm off and forget to turn it on again. That's probably not such a good idea.
 
You could set your low alarm higher @DancingStar and put hypo stuff where you’d be able to get it. I find Lift Gluco Shots or cans of full sugar proper Coke work faster than orange juice. I also keep Dextro tablets everywhere so I don’t have to search if I’m dropping.

If you don’t feel happy with the Lantus, you could talk to your nurse and ask to change basals. It’s completely understandable if you choose to do that.
 
Inka said:
You could set your low alarm higher @DancingStar and put hypo stuff where you’d be able to get it. I find Lift Gluco Shots or cans of full sugar proper Coke work faster than orange juice. I also keep Dextro tablets everywhere so I don’t have to search if I’m dropping.

If you don’t feel happy with the Lantus, you could talk to your nurse and ask to change basals. It’s completely understandable if you choose to do that.
Click to expand...
I feel quite apprehensive about injecting Lantus this morning. I'm definitely going to get some Dextro tablets and keep them in various places around the house.
 
Inka said:
@Wendal The issue is the crystal method of glargine - ie that it’s reliant on the precipitation. That blog I linked to claimed this specific failure and thus severe hypo risk was known years ago. Levemir has a different method and so does Tresiba. The isophanes are the original cloudy insulins, where you need to mix the insulin by twisting and turning. I don’t think any of those have the propensity to act like fast-acting, like glargine does. Of course, they may release a bit quicker or slower over the hours, but, to me, that’s very different from acting like a fast insulin, which must be so scary.
Click to expand...
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 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.
DancingStar said:
I feel quite apprehensive about injecting Lantus this morning. I'm definitely going to get some Dextro tablets and keep them in various places around the house.
Click to expand...
@Dancing Star I can completely understand your apprehension about your Lantus this am. I've looked back at most of your posts since you joined the forum and you've had an unusual introduction to insulin dependency: Whipples, 3 yrs later then needing insulin. It is, I guess inevitably, why T3c is different! However being pretty rare as a type of diabetes diagnosis, the truly knowledgeable Specialists are equally rare and I still find HCPs that I encounter simply have a disappointingly poor understanding of T3c. If I were in your position I would now be clamouring to try a different basal, for at least 3 months.

I'm now pretty relaxed about my D management (I wasn't even 2 yrs ago). I've (very happily) found that my Dexcom G7 CGM gives me reliability and great accuracy, so I feel really confident about what it's telling me and it's alerts are far more comprehensive than Abbotts' Libre alarms; I get appropriate alerting well in advance of rapid changes. However I am still pretty diligent about keeping hypo treatment "mini-packs" with me at all times, everywhere. In different rooms; a packet of something in every jacket and coat pocket is my norm. Something handy even when just at the top end of the garden. I got caught out so many times in my first 12 months when I had no CGM, that I just won't be without an immediate hypo response treat - wherever I am.

I know my total pancreatectomy is different to your failing pancreas, @ Dancing Star. But it does mean that I know for certain I not only have no insulin being home grown; also no glucagon to tell my liver to open its glucose store when I'm going low; no somostatin to act as a balancing hormone between glucagon and insulin. And of course minimal digestive enzymes. I can (and frequently do) find I can drop from 6.5 to 4.5 in a couple of minutes with a double vertical arrow downwards to remind me I'm crashing! My G7 provides a very strident siren (my choice of sound) to tell me I'm only a few minutes from reaching 3.1mmol/L - which can not be turned off; I probably could allocate a mild sound to that alert, but wouldn't!

I wish you well for the future after your recent hypo incident.
 
@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.
 
Sorry to hear about your nasty hypo @DancingStar

Hope you aren’t too shaken up by it and that your levels have settled down again since. :care:
 
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