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Weird situation with insulin and hypos

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This thread is now closed. Please contact Anna DUK, Ieva DUK or everydayupsanddowns if you would like it re-opened.
merrymunky

merrymunky

Well-Known Member
Relationship to Diabetes
Type 2
Hi all,

I’ve had a few occasions where I’ve used the novorapid before a meal and been spot on in my target range after tea (although today was slightly high at 8.2) then a few hours later I crash into a hypo.

Today was a particularly bad one that has taken a good 40 minutes to get under control. Felt a bit sick and tested and was 3.4. Had a good lucozade hit and a few sweets and 15 minutes later it had gone down further to 2.8. Some more glucose and ten minutes later it had gone down again to 2.3. Eventually it started to rise so I had a carby snack of a slice of bread with peanut butter and within the hour back up into the 5s again.

What I don’t understand is how I can be in target or even high on the insulin after tea then suddenly plummet so far down later on? I know novorapid continues to stay in the system for around 4 hours but I don’t get what is causing the huge crash after being in a good range after my meal. Surely the dosage has been appropriate to be in target after a meal. Any less and I would be too high.

It’s quite scary and tonight’s worried me as I just couldn’t get it under control for so long. Usually within the 15 minutes I feel better but tonight I definitely started to feel a lot worse (hot, very shaky etc) before it improved.

Potentially I only have a few more weeks of this as I won’t need insulin after baby arrives and I never had a hypo before insulin was introduced. Luckily the hypos don’t affect baby. She’s kicking about at the moment and seems unaffected but it does worry me when it keeps happening.

Has anyone else ever experienced similar?
 
I'd say its definitely too much insulin, the key isnt only being in range 2 hours later as that's sorted with a pre bolus timing change, it's being near where you were BG wise at least 4 hours after your last dose and your not as your coming down too much xx
 
My levels were stable all day though up to this point. I don’t understand books doses etc. I only use insulin in pregnancy and just work out what I need for the meals I eat. I usually nail it spot on but now and then I get these weird sudden crashes.

I test one hour after meals as per request from consultant in pregnancy I kept an eye on it all evening as I knew there was a chance it could come down quickly. I hour after eating it was high at 8.2. Two hours later it was 5.6. I had a snack to top up my levels before bed and by midnight I had crashed.

Surely if I hadn’t taken as much insulin I would have been way too high after tea though which is worse for baby than going hypo
 
Pre bolus is giving your insulin in advance of eating to stop the spike in BG, for instance I take 2.5-3 units for my breakfast, if I injected that and ate straight away then I'm pretty sure I'd be in the high teens post meal but by taking it 25 minutes previous to eating then I don't generally go above 8-9 and then around 4 hours later I'm near my pre meal levels but I'd still be there by the next meal even if I'd spiked to the high teens because the dose was correct but the timing wasn't, the dose is clearly too much if your crashing hours after taking it or the basal is too much, try a little less insulin if it's a regular occurrence but preferably with the same amount of carbs as then there's less variables, hypo's may not be harming the baby but they can harm you, pre bolus timing is also a very individual thing though and can vary on time of day, activity level, where you've injected it etc so you must be careful in regards to timing as well xx
 
Sorry you have had such a pesky hypo. Those stubborn ones are very scary.
As you say you usually nail this and I know where to come if I need info about carbs.

Two thoughts come to mind:

I am just wondering whether there is a lower fat content in the meals where you crash later. This can make a mismatch between the insulin action and the glucose release. High fat is usually the other way round and causes hypos after eating and then highs later when the glucose is released.
Lower fat than usual could have the opposite effect.

The other thought is just to check that you are ensuring that you are using different sights for each injection. If you use the same sights you can get a bit of a lump, that will then release its contents at unexpected times and cause a big hypo as there are no carbs to go with it.

I hope that you have a better day today.
 
It’s worth keeping track of what you’ve eaten when this happens. As SB says things like less fat can make a difference and different carbs will release and be used faster for you than others. My daughter can mostly eat pizza without problems but rice she’s likely to end up with a hypo later unless we’re careful. Everyone has their own food reactions. It sounds like you were crashing fast and caught it well with your symptoms but a fast drop will take a while to treat and correct. Unless you have a Libre or similar you can’t easily tell with a meter whether it’s a slow hypo or a plummet so it’s better not to over treat initially and then end up being really high afterwards so you did the right thing of treating testing and treating again. Just remember to drink with your hypo treatment as that helps your body absorb it faster.
 
Kaylz said:
Pre bolus is giving your insulin in advance of eating to stop the spike in BG, for instance I take 2.5-3 units for my breakfast, if I injected that and ate straight away then I'm pretty sure I'd be in the high teens post meal but by taking it 25 minutes previous to eating then I don't generally go above 8-9 and then around 4 hours later I'm near my pre meal levels but I'd still be there by the next meal even if I'd spiked to the high teens because the dose was correct but the timing wasn't, the dose is clearly too much if your crashing hours after taking it or the basal is too much, try a little less insulin if it's a regular occurrence but preferably with the same amount of carbs as then there's less variables, hypo's may not be harming the baby but they can harm you, pre bolus timing is also a very individual thing though and can vary on time of day, activity level, where you've injected it etc so you must be careful in regards to timing as well xx
Click to expand...

Ah ok. Yes I always make sure I take it a good few minutes before I eat. Consultant told me to give it 15 minutes so I always make sure I do that.
 
Have you thought about splitting your bolus?
With a pump I would just think oops if it happened two days in a row and then cut my basal back. So perhaps if it's not possible to change the basal have a look at the bolus delivery and or the the carb ratio you are using.
 
MM - absolutely honestly, I really would contact your hospital team if it happens again, cos suddenly low BGs in the 3rd trimester of pregnancy can be a sign of summat else that you do NOT want and we don't want for you, rather than the usual things.

As Sue said above - most T1s whose pregnancies I've seen documented, have had to split boluses during them sometimes, and had to test more and more and more during them. It's blooming hard work, especially when you aren't by then used to juggling things anyway, like T1s have to intuitively.
 
merrymunky said:
Hi all,

I’ve had a few occasions where I’ve used the novorapid before a meal and been spot on in my target range after tea (although today was slightly high at 8.2) then a few hours later I crash into a hypo.

Today was a particularly bad one that has taken a good 40 minutes to get under control. Felt a bit sick and tested and was 3.4. Had a good lucozade hit and a few sweets and 15 minutes later it had gone down further to 2.8. Some more glucose and ten minutes later it had gone down again to 2.3. Eventually it started to rise so I had a carby snack of a slice of bread with peanut butter and within the hour back up into the 5s again.

What I don’t understand is how I can be in target or even high on the insulin after tea then suddenly plummet so far down later on? I know novorapid continues to stay in the system for around 4 hours but I don’t get what is causing the huge crash after being in a good range after my meal. Surely the dosage has been appropriate to be in target after a meal. Any less and I would be too high.

It’s quite scary and tonight’s worried me as I just couldn’t get it under control for so long. Usually within the 15 minutes I feel better but tonight I definitely started to feel a lot worse (hot, very shaky etc) before it improved.

Potentially I only have a few more weeks of this as I won’t need insulin after baby arrives and I never had a hypo before insulin was introduced. Luckily the hypos don’t affect baby. She’s kicking about at the moment and seems unaffected but it does worry me when it keeps happening.

Has anyone else ever experienced similar?
Click to expand...

Hi Merry Munky,

As Kaylz said, sounds like there is a need to take a bit less insulin a bit earlier. It's not easy by the way. It's what diabetics try to master each and every day. For me, mornings and lunchtimes require an early bolus, up to 25mins before eating a meal. Stubborn hypo's seem to have no explanation, no matter how much glucose you take, it just won't pull up and often end up with a huge spike hours later.

I don't know about type 2's but for many type 1's the amount of mealtime insulin is usually based mainly on the amount of carbs in the meal. Have you been given a standard dose? assuming you must eat a certain amount of carbs?

The timing of your mealtime insulin also depends on the amount of fat in the meal, if there's a lot of fat then the insulin may be taken at the time of the meal, if there none or very little fat, but quick carbs, like boiled rice, bread, cereals, fruit juice etc. then that's when the meal time insulin needs to be taken earlier.

There is no specific advice, everyone has there own quirks and it's all a matter of testing and keeping records until you remember it all.

Good luck!
 
Amity - MM won't need insulin at all once she's given birth if she's normal! Mind you, how easily can you get nutritious low carb vegetarian food in maternity wards? Veggie, yes. BUT ….
 
One other thought @merrymunky , if I have a horrid hypo I tend to switch to fruit juice from my usual JBs as that Is absorbed more quickly. I have worked out how big a glass of the specific juice I need to get 15 g of carbs, so Neither of us need to think too much about it when it is needed.
 
You’ve had lots of great suggestions already @merrymunky - so just... (((hugs)))

I have found my diabetes has been through peculiar ‘seasons’ of the sort of thing you describe - sometimes generally for all meals... sometimes only in response to one particular type of carb, but definitely a change of ‘what usually happens’.

‘Usually...’ Ha!

It‘s often just a case of working out a new approach/strategy, then using it until things change again, and/or adding it to the ole playbook for when it comes around again!

But yes... if you are having nasty lows, and sudden changed to your diabetes behaviour, then getting checked by your DSN would be a very wise move - especially in your condition.
 
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trophywench said:
@merrymunky - I'd be 100% happier if you DID contact your team sooner rather than later frankly. Bad hypos in the latter stages can be a sign of something nasty, so I'd want you to get it checked even if you were a complete stranger.
Click to expand...
Yes having suffered with hypos during my pregnancy I was made aware of how important they where for my team.
Hypos in the late stages can be the sign of all sorts, don’t want to freak you out but please raise with your team as soon as you can
Take care x
 
trophywench said:
Amity - MM won't need insulin at all once she's given birth if she's normal! Mind you, how easily can you get nutritious low carb vegetarian food in maternity wards? Veggie, yes. BUT ….
Click to expand...
Luckily I am vegetarian! I am hoping to come off the insulin ASAP after birth as I had fantastic glucose control before pregnancy and indeed up to about 24 weeks. I’m just in that awkward tricky last stage where the pregnancy messes big time with levels.

It’s all been very much experimental my insulin users. Obviously I was given the 1 unit to 10g carbs ratio as a guideline but often found this didn’t work and I needed more anyway. I don’t have a set dose. It depends on what I’m eating and the need for more has increased for standard foods I didn’t need it for earlier on in pregnancy. Just trial and error sadly.
I will be glad to say goodbye to it soon enough
 
PhoebeC said:
Yes having suffered with hypos during my pregnancy I was made aware of how important they where for my team.
Hypos in the late stages can be the sign of all sorts, don’t want to freak you out but please raise with your team as soon as you can
Take care x
Click to expand...

They’ve always told me not to worry and that baby is unaffected by them.
 
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