wife has type one diabetes.

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gary-in-kent

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Inka said:
Then perhaps it would be helpful for your wife to join this forum @gary-in-kent ? Does she have Type 1 or Type 2? There’s a wealth of knowledge here and personal experience - hundreds if not thousands of year
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My wife has type 1 and is also using Librelink. My wife is not good with computers, this is why I will be posting for her. I joined this form today, as this morning I was woken up by my wife as her blood level was about 2.0, she was sweating & in a trance and was not making sense when trying to communicate with her, I quickly got a glucose tablet and gave it to her then 15 mins later gave her a second tablet. she was in a bad way but soon recovered then slept for 2 hours, now she is fine. this has happened about 10 times over the past 5 years, I do have a Hypo kit pen for emergencies, I have used this once before when she was unresponsive and gave it to her while I was on the phone with 999.

We are both working closely with her healthcare team to adjust her insulin regimen or other aspects of her care to reduce the risk of these severe hypoglycemic episodes. The LibreLink system provides valuable data that her endocrinologist or diabetes team uses to make recommendations.
 
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Ok @gary-in-kent ,so she should set her Libre low alarm at 5.6. This should alert her before she drops too low and allow her to ward off hypos as much as possible. If her blood sugar was around 2, she should have had at least 3 glucose tablets straightaway. 1 is not enough. You don’t need to wait 15 mins between tablets. You give the glucose ‘dose’ and once you’ve treated the hypo with this, you wait 10-15 mins to retest blood sugar (unless she’s clearly dropping more). Your wife would have been told this at diagnosis and I presume you would have too or she would have told you. I simply don’t understand why you’d give someone suffering a severe hypo one glucose tablet. Perhaps this lack of knowledge is half the problem?

You might find the GlucoJuice shots helpful. Each one contains 15g carbs in a concentrated drink and they work fast.

What insulins is she taking?
 
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Inka said:
Ok @gary-in-kent ,so she should set her Libre low alarm at 5.6. This should alert her before she drops too low and allow her to ward off hypos as much as possible. If her blood sugar was around 2, she should have had at least 3 glucose tablets straightaway. 1 is not enough. You don’t need to wait 15 mins between tablets. You give the glucose ‘dose’ and once you’ve treated the hypo with this, you wait 10-15 mins to retest blood sugar (unless she’s clearly dropping more). Your wife would have been told this at diagnosis and I presume you would have too or she would have told you. I simply don’t understand why you’d give someone suffering a severe hypo one glucose tablet. Perhaps this lack of knowledge is half the problem?

You might find the GlucoJuice shots helpful. Each one contains 15g carbs in a concentrated drink and they work fast.

What insulins is she taking?
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Thank you for the advice. We've set the LibreLink low alarm at 4.7 on her phone. I appreciate the guidance on treating hypos; I'll ensure to give her more glucose tablets immediately if it happens again. We haven't tried GlucoJuice shots yet, but they sound beneficial, and we'll look into them. As for her insulin, she's on Novorapid and Toujeo
 
If she’s prone to hypos, setting it at 5.6 would be better. The Libre can be a bit behind actual blood sugar. If she gets an alert at 5.6, she can finger-prick. She might then actually find she’s 4 or below so can immediately top up with some glucose and longer-lasting carbs.

Toujeo is similar to Lantus. A once-daily basal doesn’t give as much flexibility as a twice daily basal like Levemir. On Levemir, she could lower her evening dose (if she’s prone to go low at night) and have as much or as little Levemir as she needs in her morning dose to cover her through the day. It’s quite common for the two Levemir doses to be different amounts, sometimes significantly so. Being able to adjust daytime and nighttime separately can help reduce hypos.
 
Inka said:
If she’s prone to hypos, setting it at 5.6 would be better. The Libre can be a bit behind actual blood sugar. If she gets an alert at 5.6, she can finger-prick. She might then actually find she’s 4 or below so can immediately top up with some glucose and longer-lasting carbs.

Toujeo is similar to Lantus. A once-daily basal doesn’t give as much flexibility as a twice daily basal like Levemir. On Levemir, she could lower her evening dose (if she’s prone to go low at night) and have as much or as little Levemir as she needs in her morning dose to cover her through the day. It’s quite common for the two Levemir doses to be different amounts, sometimes significantly so. Being able to adjust daytime and nighttime separately can help reduce hypos.
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This is a report derived from my wife's FreeStyle LibreLink data. I've noticed that she seems to be experiencing a significant number of hypo events. Based on the data provided: is this normal?


Date RangeAverage Glucose (mmol/L)Days of DataHypo Events
3 Sep - 16 Sep 20238.0100%18
20 Aug - 2 Sep 20238.5100%19
6 Aug - 19 Aug 20237.7100%20
23 Jul - 5 Aug 20237.4100%20
9 Jul - 22 Jul 20237.9100%15
25 Jun - 8 Jul 20238.3100%20
11 Jun - 24 Jun 20239.2100%16
28 May - 10 Jun 20239.2100%15
14 May - 27 May 20237.9100%22
30 Apr - 13 May 20238.8100%16
16 Apr - 29 Apr 20237.2100%31
2 Apr - 15 Apr 20238.9100%13
19 Mar - 1 Apr 20239.0100%13
5 Mar - 18 Mar 20238.5100%13
19 Feb - 4 Mar 20238.7100%17
5 Feb - 18 Feb 20238.0100%19
22 Jan - 4 Feb 20238.4100%14
8 Jan - 21 Jan 20238.2100%11
25 Dec 2022 - 7 Jan 20238.0100%10
11 Dec - 24 Dec 20228.2100%9
27 Nov - 10 Dec 20227.3100%14
13 Nov - 26 Nov 20228.4100%7
30 Oct - 12 Nov 20229.4100%10
16 Oct - 29 Oct 202210.5100%6
2 Oct - 15 Oct 20229.6100%4
18 Sep - 1 Oct 20229.1100%13
4 Sep - 17 Sep 20229.9100%12
21 Aug - 3 Sep 20228.7100%18
7 Aug - 20 Aug 20228.5100%12
24 Jul - 6 Aug 20227.9100%21
10 Jul - 23 Jul 20228.7100%4
26 Jun - 9 Jul 20229.2100%12
12 Jun - 25 Jun 20229.1100%9
29 May - 11 Jun 20229.9100%3
 
gary-in-kent said:
I've noticed that she seems to be experiencing a significant number of hypo events. Based on the data provided: is this normal?
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If these are all real hypos then this is a lot. Are they all checked with finger pricks or could they be compression lows?
The average numbers are on the high side which would suggest she is rollercoastering often which can be exhausting.
My suggestions are
- familiarise yourself with the limitations of CGMs (there is a thread which lists them)
- unless she is obviously hypo, double check all alerts with a finger prick
- raise the level at which Libre alerts from the 4s to the 5s and treat with a single dextrose when she gets an alert but not hypo
- do a basal test to check that here basal dose is not too high (there threads which explain this)
- identify patterns for the lows. For example, are they more likely to happen after eating or at night?
- consider requesting a more modern basal insulin such as Levemir or Tresiba.
- talk to her diabetes team and get their advice.

The forum members are brilliant and incredibly knowledgeable. The huge advantage is that someone will have been there and done that rather than the theory that you may have been researching (and have been quoting).
 
No, that doesn’t look normal @gary-in-kent That’s a lot of lows, if they’re all genuine and confirmed by fingerprick. There’s good advice from @helli above. One thing I’d add:- is she counting the carbs she eats and adjusting her Novorapid dose? Also, is she injecting her Novorapid far enough in advance of her meals (that helps stop high spikes)?
 
As both Inka and Helli have said, that's an awful lot of hypos - far more than is normal for most T1s. Good advice to see if she can switch to Levemir which is far more controllable. I attach the instructions for basal testing and would advise you do it. I found the book "Think like a Pancreas" by Gary Scheiner very informative and it helped me to understand how to successfully control BGs on MDI.
 

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As others have said the number of hypos your wife is having is very high. The strategies that have already been suggested are likely to help. It is important to work with her team to reduce the number of hypos. Let us know how it goes.
 
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