Very low readings and no awareness

[wendel]

Hi, I've been T2 since 2003 and struggling

I had a gastric bypass privately in 2011 to get rid of my insulin as I couldn't tolerate injecting daily and for 9 yrs I was insulin-free until this past year. I have been told by a consultant my pancreas is deteriorating and tests have shown this. but recently my sugars went as high over 31 and I was put back on insulin. These past two weeks I was given a libre to try by my nurse and it's recorded my sugar levels have gone down overnight to 2.6 the lowest I don't seem to get any signs anymore like I used to like shaking getting hot I get nothing at all. I'm getting worried that my pancreas is not producing any insulin now. and I'm worried this is going to turn into T1 anyone had this? I have been told that I cannot have a libre from my GP even though I was using it to carb count also as my ratio was 1 to 10 but I've not taken any nova rapid with meals as the readings have been too low.

any help or advise

 

[Kaylz]

Hi and welcome to the forum

Firstly, if you were diagnosed as a Type 2 and have managed without insulin for 9 years then it is highly unlikely you are a Type 1, a Type 1 wouldn't manage that, you would in fact just be an insulin dependant Type 2

Secondly have you confirmed these low Libre reading with a finger prick? They aren't 100% accurate and don'y work for everyone, also they are quite prone to show compression lows during the night if you've lain on it

I believe the only nation to prescribe the Libre to Type 2 insulin dependants is Scotland, I don't quite follow when you say you've been using it for carb counting though? The sensor only allows for scanning so could you clarify how you've been using it for carb counting?
xx

 

[wendel]

Hi and welcome to the forum

Firstly, if you were diagnosed as a Type 2 and have managed without insulin for 9 years then it is highly unlikely you are a Type 1, a Type 1 wouldn't manage that, you would in fact just be an insulin dependant Type 2

Secondly have you confirmed these low Libre reading with a finger prick? They aren't 100% accurate and don'y work for everyone, also they are quite prone to show compression lows during the night if you've lain on it

I believe the only nation to prescribe the Libre to Type 2 insulin dependants is Scotland, I don't quite follow when you say you've been using it for carb counting though? The sensor only allows for scanning so could you clarify how you've been using it for carb counting?
xx
[/QUOTE

Hi
when I was told to carb count my meals they said I had to do readings before my meals and after every meal and snacks so if I was having 40 g carbs I would have to take 4 units of nova rapid. 1 unit per 10g of carbs but where the readings are so low, I couldn't take 4 units. example: my readings said 3 my carbs intake was 25g for breakfast I would have to have taken 2 units but after I did my readings again after breakfast it had only gone up to 4.7 that's without taking nova rapid I hope this makes sense thank you for your reply

 

[wendel]

Hi and welcome to the forum

Firstly, if you were diagnosed as a Type 2 and have managed without insulin for 9 years then it is highly unlikely you are a Type 1, a Type 1 wouldn't manage that, you would in fact just be an insulin dependant Type 2

Secondly have you confirmed these low Libre reading with a finger prick? They aren't 100% accurate and don'y work for everyone, also they are quite prone to show compression lows during the night if you've lain on it

I believe the only nation to prescribe the Libre to Type 2 insulin dependants is Scotland, I don't quite follow when you say you've been using it for carb counting though? The sensor only allows for scanning so could you clarify how you've been using it for carb counting?
xx

Hi
when I was told to carb count my meals they said I had to do readings before my meals and after every meal and snacks, so if I was having 40 g carbs I would have to take 4 units of nova rapid. 1 unit per 10g of carbs but where the readings are so low, I couldn't take 4 units.

example: my readings said 3 my carbs intake was 25g for breakfast I would have to have taken 2 units but after I did my readings again after breakfast it had only gone up to 4.7 that's without taking nova rapid I hope this makes sense thank you for your reply

 

[SB2015]

Welcome to the forum @wendel

Sorry to hear about the difficulties that you have had in managing your diabetes.
As @Kaylz has said if you were T1 it is unlikely that you would have managed for so long with no insulin, especially as you are keeping low glucose levels T1 is an autoimmune disease where the insulin making cells in your pancreas are destroyed. Then the only way of getting the essential insulin is by injecting.

With T2 the pancreas is still making some insulin but it either doesn’t work well or is not enough for the amount of carbs being eaten. It is good to hear that you have been monitoring your levels and this should help you to make decision about changes to foods, portion sizes and levels of activity in order to keep them in range.

Testing before a meal and two hours after is good advice, as that will show whether your body is able to bring your levels back down to close what they were before the meal. Many T2s are not given any test kits and will be unlikely to get funding for a Libre.

Come back with any other questions that you have.

 

[Kaylz]

@wendel you don't NEED a libre to do this though, you can do that with any BG meter as long as you know your ratio which if your on insulin you should be prescribed with a BG meter

how long after breakfast did you test again? and what was it you had for breakfast?
xx

 

[leonS]

Not type 1, I do not agree. The clue is in what the consultant is reported to have said "ypur pancrease is failing [to produce enough insulin] and [a c-peptide] test proves this." I have assumed the words in []. This is type 1 and nothing will change that.

One criterion for the provision of Libre is a total lack of hypo awareness, but I would investigate the possibility of full CGM with alarms, rather than the flash monitoring probided by the Libre

 

[Kaylz]

@leonS if they were in fact Type 1 then they would have been reclassified as that if tests had shown that, which clearly they haven't been

 

[Alannah]

Hi Wendel Sorry to hear you are having a difficult time. As @Kaylz has said, you can monitor BG levels and carb count without a Libre (though, it is in my opinion much easier with one). Have you checked your libre readings against finger prick (bearing in mind libre will be 15-20 mins behind blood reading)? It sounds to me that you need to talk with the hospital team again, as it would I think, be up to them to prescribe libre, or a CGM which has alarms if your hypo awareness is significantly impaired. In any case, they'd be best placed to answer your concerns about insulin etc.

 

[Amity Island]

Hi, I've been T2 since 2003 and struggling

I had a gastric bypass privately in 2011 to get rid of my insulin as I couldn't tolerate injecting daily and for 9 yrs I was insulin-free until this past year. I have been told by a consultant my pancreas is deteriorating and tests have shown this. but recently my sugars went as high over 31 and I was put back on insulin. These past two weeks I was given a libre to try by my nurse and it's recorded my sugar levels have gone down overnight to 2.6 the lowest I don't seem to get any signs anymore like I used to like shaking getting hot I get nothing at all. I'm getting worried that my pancreas is not producing any insulin now. and I'm worried this is going to turn into T1 anyone had this? I have been told that I cannot have a libre from my GP even though I was using it to carb count also as my ratio was 1 to 10 but I've not taken any nova rapid with meals as the readings have been too low.

any help or advise

Hi Wendel,
Could I just ask, was it a "diagnosis" in 2003? Or was it "assumed" to be type 2?
From the members on this forum, it's not unusual to have been "diagnosed" (assumed, typically if over 40 years of age) with type 2 and then some time later after blood sugars get worse even after making all the necessary lifestyle and diet changes, had a c-peptide test done which then gave a true Type 1 Diagnosis.

 

[rebrascora]

I agree with @leonS The OP clearly states that the consultant says the pancreas is failing and tests have shown this.... it is logical to assume this test was a C-peptide test.
I am wondering if the OP may be LADA (Latent Autoimmune Diabetes in Adults) and the gastric bypass bought some time, by reducing the amount of food (including carbs) going through the system and therefore enabling the failing pancreas to cope better in the same way as oral meds sometimes do for LADA patients, who limp along for several years before needing insulin.
It would be interesting to know what your diet was like before the gastric bypass when you were using insulin? ie had you cut your carbs right down or were you eating normally or even over indulging (as many of us did pre diagnosis... so no judgement.... just trying to understand what is going on. Also, presumably you lost some weight after the gastric bypass... it would be helpful to know how much. That will have improved insulin sensitivity and again enabled the failing pancreas to limp along producing less insulin, because less was now needed...

I think you need to confirm with your consultant that a C-peptide test has been done and if this shows that your pancreas is no longer producing enough insulin then asking to be re catagorised as LADA or Type 1 so that you can perhaps continue with Libre, particularly if you have a phobia with needles (I am guessing this is/was the problem with injecting insulin) and you might even qualify for a pump.

As regards overnight lows I find that my Libre often shows me hypo when I am actually mid 4s and when you are asleep you are less likely to feel a mild hypo so it may be that it is just reading a bit lower than your actual BG reading....

For instance my Libre showed I was a steady low to mid 3s for over an hour this morning but finger prick showed I was 4.5 at the beginning and 5.8 at the end and no compression of the Libre, so I did not take a hypo treatment and felt fine. When I get to mid 5s my BG and Libre are usually pretty close, with my Libre usually just 0.2-0.3mmol lower on a steady reading, so I would not in itself assume you have lost hypo awareness just because the LIbre shows you low overnight and you don't wake up. I do think a reduction of basal insulin might be something to discuss with your nurse if you are getting regular overnight lows though.

 

[Ditto]

Hello and welcome to the forum.