Hypos

[nelly2605]

Since testing b/s more often and eating better over last 30 days,I've had a whopping 26 hypos.Thinking of knocking metformin on the head.Anyone else suffer lots of hypos?

[BlueSky]

Your BG must be very volatile. All those lows must have been offset by a lot of highs to produce that HBA1c. While metformin can be useful to reduce post-meal BG, the fact that it inhibits BG production by the liver makes it easier to slip into hypo's. So I would agree, try doing without metformin and see if this makes your BG more stable. But at the same time, I suggest you reduce carbs to the absolute minimum. Sounds like you have insulin resistance too. Reducing carbs (grains, sugars, potatoes, rice, pasta etc) and getting more exercise will help with this. :) I have some insulin resistance, which I became aware of as a strong dawn phenomenon effect. And a gym program has made an enormous difference.

[DeusXM]

But at the same time, I suggest you reduce carbs to the absolute minimum.

NO NO NO NO NO NO NO.

If you are having lots of hypos then reducing carbs is suicidal. I'm sorry BlueSky, I know you're mad passionate about low-carbing and somehow seem to think it's the answer to every problem but this is not the time. You are giving out very, very dangerous advice.

If you are having lots of hypos, you don't cut the carbs, you cut the insulin. End of story. But you need to know WHEN you need to reduce your insulin. So you need to start testing hourly again. You need to see exactly when you're having hypos. If they're regularly within 2 hours of your last bolus injection, you need to reduce your bolus you give at that time - you may need to rethink your carb ratios. If they're happening at random times in the day then you need to cut your basal intake. You will see instant results from reducing your bolus; reducing your basal (in increments of 4u) will take around 3 days to kick in.

Once you have established a specific reason for each hypo, THEN you can start thinking about altering your carb intake. But PLEASE, PLEASE do NOT cut down on your carbs now, because you'll just have even more hypos and you'll put so much strain on your liver that you could kill yourself.

[Emm]

Anyone else suffer lots of hypos?

Generally, no... but when I make diet changes like you have I have to recalculate my insulin needs, and that can lead to a few days or so of hypos / hyper readings. Personally I prefer the hypos (means I can munch on '****' without worrying, and I hate hate HATE the idea of running high and causing damage).

Do you use a carb-to-insulin ratio or are you on strict orders to have however-many units per meal? Have you adjusted for your diet changes?

Might be an idea to lose the metformin, but only if that's where the issue lies... if the met is helpful to you, then it might be easier to have a bit less of one of your insulins.

I definitely agree with BlueSky about the exercise - get all you can, any time you can, coz the difference it makes is worth it. Even just for the feel-good factor!

Em.

[dgrilli]

Boy Low Carbing and Hypos I would cut the insulin too.

Just wondering I'm pumping now and haven't had a Hypo that I know of for about 5 years. Last one I woke with the Fire Department over me them trying to feed me coca cola. Everyone in the office gathered around to stare at me.

Felt pretty bad that happened to me at work

[2high]

Personally I prefer the hypos (means I can munch on '****' without worrying, and I hate hate HATE the idea of running high and causing damage).


Em, you just want an excuse to eat chocolate!! Or cheesecake...

Neil, I agree with Deus about cutting the insulin and testing hourly, so that you can work out exactly when you are hypoing and why, whether it is in conjunction with your meal-time shots or more to do with your basal being too high. I'd be having a good chat to your endo and/or DE about it all, don't go playing around with the metformin etc before you do. And don't let your DE just brush you off this time! Hypos are serious, and not much fun to deal with.

Also, I know you're doing heaps better with the carbs and all that stuff, but do you have some sort of book to help you out with all the counting and the like?

Keep working hard Big Bro, you'll get there!

Kit.

[nelly2605]

Cheers guys!!!

I've decided to give the metformin a miss and see what happens.Still getting used to this carb-insulin ratio,making a few mistakes.Hopefully I'll get it bang on soon,lol.

Take care everyone

Neil

[BlueSky]

... I've had a whopping 26 hypos. ... Anyone else suffer lots of hypos?
__________________
Type 1 since October 1991
Last hba1c: 10.0()
Novorapid & Levemir

I think my comments were mis-understood. I was struck by the combination of a high HBA1c and lots of lows. It looked very familiar! And I related this to my own experience. Too many highs were being chased down with insulin and turning into hypos. The only way to break the cycle was to get rid of the highs by cutting carbs. The result was that major corrections were no longer required. So the hypos simply stopped happening.

So, yes, in answer to your question, I have suffered a lot of lows. After living with the problem for many years, I sorted it out with a technique is that is elegant in it's simplicity. Insulin was reduced in the process. But the main driver in preventing hypos was cutting carbs.

[2high]

I think my comments were mis-understood. I was struck by the combination of a high HBA1c and lots of lows. It looked very familiar!

I think Neil forgot to mention that his A1c of 10.0 was BEFORE he started monitoring properly... Lol, "little sister" being a tattle-tale here...

[DeusXM]

But the main driver in preventing hypos was cutting carbs.

No, the main driver in preventing hypos is matching your insulin requirements to your carb intake. Cutting carbs can make this perhaps easier. The reason I jumped on your advice was because you were advocating reducing carb intake to someone who was already having a lot of hypos and yet you made no mention whatsoever about reducing insulin intake. And then you even suggested more exercise - something that will certainly cause hypos if you're not adequately prepared.

Your advice will be useful once the initial problem is sorted out but would have made Neil's QOL much much worse at this stage.

[BlueSky]

No, the main driver in preventing hypos is matching your insulin requirements to your carb intake. .....

Deus,

If you re-read my post you will see that I was speaking for myself. I was not expressing an opinion, I was relating what had happened to me. Sorry if it upsets you. It seems that whatever I say gets you into some kind of rage. And I hope that your little rant made you feel better!

[Twister212]

Since testing b/s more often and eating better over last 30 days,I've had a whopping 26 hypos.Thinking of knocking metformin on the head.Anyone else suffer lots of hypos?
I suffered many highs and lows. Very brittle diabetes indeed. About six weeks ago I got a Dexcom continuous glucose monitor and it has resulted in a significant stabilization of blood sugars and hardly any hypos. Maybe one a week instead of one or two a day. The primary change is having a continual or at least frequent sense for which direction bgs are going. Here is a scenario: I test high, say 220 or 250, take insulin to lower bg. Now it may be the case that one hour later one drops to 150 or 125. However, every now and then, I drop to 60, don't ask me why. Well, this is exactly what the meter catches. In the hypo scenario, I can see that I am dropping fast when I pass, say 125 only 45 minutes later, and I know that I need glucose at that moment....thereby heading off the hypo incident. This happens to me all the time.

I still miss a few, and the meter isn't perfect yet. The sensors are good for approximately five or six days (although the company only validates them for three). The first day, they are not particularly accurate, but they are extremely accurate after that.

In any event it has significantly helped in stablizing my bgs and reduce hypos.

One last comment: If you have the discipline to pull it off, low carb diets work extremely well in reducing hypos for the reason BlueSky states above.

To state it differently, lower carbs means less insulin. Less insulin means smaller errors in dosing. DeusXM is right about matching insulin to carbs, but he misses the point...which is that large insulin doses mean large errors, which cause larger problems than small errors.

As an example, if one eats a bagel and covers it with 10 units of insulin but, for whatever reason...say exercise or the variable strength of the insulin...took 20% too much...well that extra 2 units will send you from your target of 125bg to perhaps 25bg.

However, if you eat a salad and cover it with 2 units of insulin...and similarly took 20% too much, then you've only taken 0.4 extra units. This will send you from your target of 125bg to perhaps 100bg.

My best diabetes management has been on low carb diets. That was about 10 years ago, since I never had the discipline to stick with it....

Hence the dexcom.

[Twister212]

Generally, no... but when I make diet changes like you have I have to recalculate my insulin needs, and that can lead to a few days or so of hypos / hyper readings. Personally I prefer the hypos (means I can munch on '****' without worrying, and I hate hate HATE the idea of running high and causing damage).

Do you use a carb-to-insulin ratio or are you on strict orders to have however-many units per meal? Have you adjusted for your diet changes?

Might be an idea to lose the metformin, but only if that's where the issue lies... if the met is helpful to you, then it might be easier to have a bit less of one of your insulins.

I definitely agree with BlueSky about the exercise - get all you can, any time you can, coz the difference it makes is worth it. Even just for the feel-good factor!

Em.
Disagree regarding enjoying hypos more than hypers...but I completely agree about enjoying the cure! Less so now, but I used to try to pick most enjoyable glucose source possible. You might as well get some kind of illicit pleasure out of this frickin disease.