Diabetes and hypglacaemia

[mazea]

Is it possible to have diabetes and hypoglacemia? It doesn't seem how far I drop my basal insulin(know down to 2 units) my blood glucose which is stable 2 1/2 hours after a meal at about 6 seems to keep dropping between meals to a low level (hypos). I went to bed with a BGL of 9 and woke up with 4.9. I had hypo symptoms for the last 10 years, which were misdiagnosed as panic attacks.

[mazea]

These are my figures.

HABC1 of 15 when diagnosed with diabetes (doctors not sure if Type 1 or 2) on 9th May 2008. Negative for anitbodies.

Family history of diabetes: father Type 1 diagnosed with diabetes at 21 almost died, uncle diagnosed with Type 1. Both on insulin.


I measure my meals in lots of 15g. 15g carbohydrate is one unit below

8 June 2008
Novorapid: 4 units breakfast 4 units lunch, 4 units dinner and 5 units dinner
Lantus: 7 units once a day.
BGL 7.5 breakfast 5.8 lunch 10.4 dinner 3.2 hypo at supper
Food: 2 units carbs 7.00am, 9.30am, 12.30pm, 3.00 pm, 6.30pm, and 1 unit carbs at 9.00pm
BGL during day 3.5 - 13.2

13th July
Novorapid 101/2 units breakfast, 6/12 units lunch, 9 units dinner
Lantus 4 units once a day
BGL 6.3 breakfast, 7.1 morning tea, hypo 3.1 at 10.30, 7.4 lunch 8.2 afternoon tea, 4.4 dinner, 3.7 hypo at supper
Food 2 units carbs 7.00am, 12.00pm, 3.00pm, 6.30pm, 4 units carbs at hypo in morning, 5 units carbs at hypo at supper

23rd July
Novorapid 7/12 units breakfast, plan to take 4units lunch 4 dinner
Lantus 2 units once a day
BGL (9.0 BGL previous night at 9.30pm),4.9 breakfast at 7.14am 10.00am 4.4, 10.30am 2.6 hypo
Food: 2 units breakfast, no morning tea, 6 units carbs at hypo at 10.30

Any advice appreciated. I dropped my Lantus to 2 units and it seems like I can't go without morning tea still. My novorapid is a bit high at the moment too I suspect.

[Eddy]

Yes, it is possible. My GP once observed a patient who spiked well over 11.0 during an OGTT, then reactively dropped to 3.0 a few hours later. AFAIK, such is a more common phenomenon with insulin-resistant folks. (The deficient/depleted crowd just quits making the stuff, and hence lack the postprandial drop.)

FWIW: I suggest a fasting and/or post-challenge c-peptide test if trying to distinguish between insulin resistance and deficiency. You certainly have the risk factors in place for type 1...

Can you get several consecutive days of food/BG/insulin info? Preferably with varying amounts of food? I'm more than happy to play with the maths and see what numbers start popping out at me...

[mortis505]

What type of activity/work are you doing? Is it very physical? And what types of food are your meals?

[BlueSky]

Is it possible to have diabetes and hypoglacemia? It doesn't seem how far I drop my basal insulin(know down to 2 units) my blood glucose which is stable 2 1/2 hours after a meal at about 6 seems to keep dropping between meals to a low level (hypos). I went to bed with a BGL of 9 and woke up with 4.9. I had hypo symptoms for the last 10 years, which were misdiagnosed as panic attacks.
It sounds to me like you are honeymooning. You were diagnosed recently. After insulin treatments starts, the insulin production improves. Blood sugar numbers come down , and the requirement for injected insulin is reduced. It is temporary, though. The honeymoon could last months, or it could be years. Eventually your insulin requirement will increase again as you you become increasingly dependent on the stuff you inject. In the meantime, expect to see a lot of changes in the amount of insulin you need to inject to keep you blood sugar in the target range. :o

[SuzySushi]

Several thoughts here. I'm not sure of your BG levels because we use a different measure system in the USA, but....

1) You probably need to eat more than three meals a day. Many people with diabetes follow a six small-meals schedule: breakfast, morning snack, lunch (your dinner), afternoon snack, dinner (your supper), evening snack. Snacks are usually 15 to 30 grams carbs.

2) Fast-acting insulin begins acting about 30 minutes after you take it, and typically peaks in 2 hours, but it doesn't wear off until 4 to 5 hours after you take it. Again, the way to solve this would be to have a small snack between meals. You may need a larger snack if you exercise.

3) As others have said, you might still be in the "honeymoon" stage where your insulin needs have gone down from those of your initial diagnosis.

Best to check with your doctor or certified diabetes educator about all of the above.

[Funnygrl]

4.9 is a great fasting number- not really hypoglycemia. One of the issues coming to play here may be that you've been high for awhile before dx and while figuring out insulin doses, and now the lower end of normal feels like hypoglycemia to you.

[mazea]

[/quote] It sounds to me like you are honeymooning. You were diagnosed recently. After insulin treatments starts, the insulin production improves. Blood sugar numbers come down , and the requirement for injected insulin is reduced [/quote]

I suspect you may be right Blue Sky. I feel like my insulin levels are rapidly going down in the past few days, from 8 to 2 lantus in a week. My novorapid is astill bout the same as a few months ago, I'm exercising 20 minutes a day due to a foot injury- other than that no physical activity. I really appreciate your input and everyone elses. Thanks everyone.

2 1/2 hours after my meal last night my blood glucose was 7.3 and immediately I went to bed thinking I was pretty safe. At 11.00pm my blood glucose was 2.5 (Hypo) and I had 4 units of carbs. Then at 5.00 in the morning, I woke feeling ill and I got up to test my blood glucose had again gone down again to 3.4 (Hypo) so I had another 4 units of carbs before going back to sleep again.

I'm thinking I should stop my lantus althogether as I'm down to 2 now and the next step is stopping my Lantus. My doctor said not to go to low on the Lantus, but I keep having hypos. Has anyone else stopped their lantus in a honeymoon period?

It's like my body wants to have hypos or something and I'm averaging 3 hypos a day in the last week.I had a scary one last week where my meter said LOW. It gave me a chance to eats lots of jellybeans really quickly but I didn't like it AT ALL. I felt really felt like my brain wasn't working and about to pass out.

[BlueSky]

... I'm thinking I should stop my lantus althogether as I'm down to 2 now and the next step is stopping my Lantus. ....
That sounds like a good idea. It is not unusual for this to happen during the honeymoon period.

[Scratch]

What about MODY? MODYs won't have antibodies, MODYs will sometimes not need basal insulin but need bolus insulin because a genetic problem impairs good insulin response to meals.

See the Wikipedia link for more basic info -- Maturity onset diabetes of the young - Wikipedia, the free encyclopedia (http://en.wikipedia.org/wiki/Maturity_onset_diabetes_of_the_young)

[BlueSky]

What about MODY? MODYs won't have antibodies, MODYs will sometimes not need basal insulin but need bolus insulin because a genetic problem impairs good insulin response to meals....
It is unlikely that someone with T2 or MODY would have an HBA1c of 15% at onset. It sounds to me like T1 that has not been picked up by the antibody test.

[Eddy]

I'm thinking I should stop my lantus althogether as I'm down to 2 now and the next step is stopping my Lantus. My doctor said not to go to low on the Lantus, but I keep having hypos. Has anyone else stopped their lantus in a honeymoon period?


I never honeymooned, but you shouldn't be dropping like that during the night. That is indeed indicative of too much insulin in your system. I cast a "me too" vote for what BlueSky and Scratch have said.


It's like my body wants to have hypos or something and I'm averaging 3 hypos a day in the last week.


Ughh. My condolences.


I had a scary one last week where my meter said LOW. It gave me a chance to eats lots of jellybeans really quickly but I didn't like it AT ALL.


Everyone is different, but my poison of choice is flat (regular!) soda. It works faster than anything else I've found.


I felt really felt like my brain wasn't working and about to pass out.


Your assessment is highly accurate. I'm glad that you were okay, and hope that you don't have to go through that again. Seriously consider having an emergency glucagon kit for someone to inject you, should you ever pass out.

I've read that eggs help "recharge" the adrenal glands. Interestingly, I tend to crave eggs after hypos. Consequently, I try to eat eggs after too { many | bad of } hypos.

[Eddy]

2) Fast-acting insulin begins acting about 30 minutes after you take it, and typically peaks in 2 hours, but it doesn't wear off until 4 to 5 hours after you take it. Again, the way to solve this would be to have a small snack between meals. You may need a larger snack if you exercise.


Everyone is different. With standard SQ administration, rapids start acting in 5-10 minutes for me. Novolog finishes in 1h:15m, Humalog in 1h:30m, and human R in 2h:00m.

I'm an extreme case, judging from what I've seen around here. However, I'd hesitate to bet on much rapid still hanging around after four or five hours -- even for a normal person. (Nota bene: I'd be equally hesitant to dismiss the possibility.)

Hmmmm. Maybe we need an "aspart/glulisine/lispro total activity time" poll. I'd love to see a histogram.

[Eddy]

http://www.diabetesforums.com/forum/type-1-diabetes/30388-rapid-activity-time-type.html

[mazea]

Thanks for the responses. I think that the novorapid time is interesting. Is there a particular way you can test your novorapid repsonse time?

I checked my ketones and blood glucose yesterday at 11.00pm and the ketones were .02 and my blood glucose level was 10.2. I checked my blood glucose level at 1.15 and it was 6.6. I woke up this morning at 8.00 am and I was having a hypo. My blood glucose level was 3.5.

I tried to reduce my novorapid yesterday and ended up getting a few high readings like 11, so I think that reducing my novorapid won't help. It looks like the lantus might have to go, but I am reluctant stop taking it. When I reduce my lantus below 4 units, I have an embarrassing problem during all the days I have been on 2 units of lantus. The problem is I have bad gas all the time and all day. The farting makes me unable to go anywhere where there are people. Why would this happen? I put my lantus up to 3 last night just so I can stop farting. In all seriousness though this is a real problem.

[BlueSky]

... I checked my ketones and blood glucose yesterday at 11.00pm and the ketones were .02 and my blood glucose level was 10.2. I checked my blood glucose level at 1.15 and it was 6.6. I woke up this morning at 8.00 am and I was having a hypo. My blood glucose level was 3.5. .....
That is a big drop from 11pm to 8am. It could be partly because of the Lantus. But I suspect that your high BG at 11pm had a lot to do with it. When blood glucose is high, the beta cells produce as much insulin as they can. And this causes your blood glucose drop a few hours later. Use your Novorapid to get your blood glucose into the target range (5-7) before going to bed and see if you still have such a big drop over night. Set your alarm clock to wake you at 1am so you can test again.
..... When I reduce my lantus below 4 units, I have an embarrassing problem during all the days I have been on 2 units of lantus. The problem is I have bad gas all the time and all day. The farting makes me unable to go anywhere where there are people. Why would this happen? I put my lantus up to 3 last night just so I can stop farting. .....
It sounds like you had some gastro problems there. I doubt that the Lantus caused it. Try stopping the Lantus again and see what happens. :)

[mazea]

I wish it were the case I had a bug of the stomach. I was fine a year ago and didn't have gas at all. Then I got the gas and it got worse and worse until I ended up in hospital and was diagnosed with diabetes. Then in hospital I started on 10 lantus and the gas went away totally. Now that I started reducing my lantus, the gas is coming back.

Although since I went up to 3 units of lantus last night, the gas has gone away again.

My readings were all over the place today, despite my efforts to keep them under control. Is this a start of a honeymoon?

Novorapid
5units for breakfast,
2units at 9.00am (as my reading was too high)
4 1/2 units for lunch

Food
2 units for breakfast,
2 units for lunch,
2 units at 1.30,
4 units at 3.00pm.
I estimate I have to to eat 70g carbohydrates between meals to ensure I don't have a hypo.

BGL breakfast: 3.6
BGL 9.00am 13.1
BGL 11.00 8.6
BGL lunch 2.4
BGL 1.00pm 4.3,
BGL 3.00pm 5.8,
BGL 4.00pm 2.3