Need help

[JDJ]

Hey my name is Sean ive had type 1 for about 2 years now. I take Novomix 30 in the morning and at night before breakfast and evening meal. Usually i take about 50-60 units but recently ive been getting daily hypo's. These hypo's seem alot diffrent than ones ive gotten in the past... i completely lose the plot i need to be helped by parents etc and i cant feel them comming. Afterwards i have a hard time remembering exactly what has happened. During the hypo's i have a hard time thinking/reading i cant even construct a sentance.. its like im drunk or even worse stoned or something. On top of this whenever i test my blood sugar levels they are ALWAYS within target... this is very weird for me as usually in the past ive struggled to always controle my diabetes and when ive been within target its always been at the high end now im like 4.1-5.2. To make it even weirder im testing my sugar levels after meals before meals etc and more often than not im BELOW target .. im running sugar levels from 2.3-3.4

An example of tonight i had a hypo before my evening meal and had a sugar level of 2.1 .. .. had something to eat and a can of coke took my second insulin dose of 50 units ... tested my sugar levels a while after and it was 3.1 had another can of coke and ive just tested my sugar levels again and they were 2.3. Even with these low sugar levels i find it hard to really feel the hypos and they seem totally diffrent than in the past. Usually i could always feel them early and do something about them and when i wa sin a hypo state i was usually just a bit shaky and felt like i could eat everything in my fridge but now the hypo's are way worse. I mean whats up.. am i shooting too much insulin.. is my pancreas making 'some' insulin of its own? and as a result i get the constant low sugar levels or target levels? I mean its gotten to a stage now where when my sugar levels are between 9-11 i find that a shockj and find it very high...

all help appreciated :) ATM im on holiday and so cant visit my doctor or clinic so its pretty vital i get some advice so i know what to do ...

cheers!

[JDJ]

the only thing that has been diffrent to me in the last few weeks is that ive been going to the gym and doing alot of excercise...

can a person with diabetes go to the gym?

[JediSkipdogg]

Well, the reason you are having hypos is because you are on a mixed insulin. The problem with mixed insulins is that you have two required insulins and you can't give more or less of one over the other.

So when you give 50 units at say dinner you are giving both a short acting and a long acting insulin. The short acting is covering your dinner meal. That is a very key part, making sure you cover that meal. However, the second insulin is a long acting insulin, and it covers the 12 hours after the meal. You have to get that amount right or else you will experience a hypo before your next meal, which it appears you are.

So what do you do? You have a few solutions...
1) Give less insulin. However, you have to make sure you aren't eating more for that meal that you give the insulin or else you won't have enough short acting to cover it. But that will help to make sure you don't go low before your next meal.
2) Get off a mixed insulin ASAP. For almost everyone I know, you can't achieve great control on a mixed insulin. Basically you have to feed the insulin and not let the insulin cover the food.

A person with diabetes can go to the gym. However, you have to make sure you eat to cover the exercise you are doing at the gym. Sounds kinda counteractive. But it's true. Another option would be if you weren't on a mixed insulin you could give less insulin at dinner and right after you eat go work out. Or give less of the long acting insulin which will cause your BG to rise slightly, but the working out will bring it down.

I hope I didn't lose you too much.

[MJM]

Sean,
when you exercise your blood sugars will drop. As another contributor mentioned you should take something to eat before the exercise starts. The symptoms of hypos are varied and one of them is that you act like you are drunk. When you are at that stage you are very near unconsciousness. The reason you are not aware of your hypos is that you have, as a result of a lot of hypos, become hypo unaware. This can be overcome with good control. I'm not familiar with the insulin you are on but it seems to me that you are certainly taking too much. You need to get this sorted quickly. I would suggest that you reduce insulin levels somewhat and if you then get highs you can increase gradually until you come within target range. I think your target range should be over 5. Exercise also has to be taken into account. Do you do the same exercise everyday and do you eat before exercise. Have a good hols and hope everthing works out well for you.

[Cyborg]

You may need to speak with your doctor about reducing your insulin or moving to a more traditional form of treatment such as MDI.

[Stuboy]

What does MDI stand for?

[corwin]

What does MDI stand for?
Multiple Daily Injections.

[JDJ]

Thanx for the help guys, ive wanted to go on the MDI for a while now but my doctors felt i needed to controle my diabetes more with the mixed insulin. Maby after i tell them about the hypo's etc they will let me change over.

cheers

[corwin]

Thanx for the help guys, ive wanted to go on the MDI for a while now but my doctors felt i needed to controle my diabetes more with the mixed insulin.

Is it me or is it like saying: "Only if you can keep good control we'll give you something that will help you keep good control"?

[JediSkipdogg]

Some doctors just make me shake my head and wonder. So they won't give you an insulin that gives good control until you figure out how to get good control with an insulin that can't give good control. That's like telling a building they will only get to build the second building of the world trade center if they figure out how to build the first building in under 6 onths. A nearly impossible task.

[mark-TN]

Well it is a two edge sword. MDI, if done correctly, can improve control dramatically. If done incorrectly it can most definitely worsened control and pose more problems than it will solve. Going on MDI requires a certain amount of commitment. One, you need to commit to learning how to count carbs, next you need to commit to learning your ratios- which will take a good bit of experimentation to fine tune, next you need to commit to taking 4 or more injections a day, and most importantly you need to commit to testing BGs several times a day. If your doctor does not feel that you have the ability or desire to do at least these things at the bare minimum he most likely will not approve putting you on MDI. I believe you should go on MDI as it will provide the best chance at control- but if you really want it, be prepared to show your doctor that you are ready for it as otherwise he may not approve it. Your doctor sounds very conservative; but in some cases that is exactly what is prudent.

Mark