Low sugar attacks with no alerts

[ramze12]

Hi,
I am new to this forum and I really think it is a great site. My sister who has been diagnosed with type-1 Diabetes for 27 years is starting to going into low level attacks lately. This is not abnormal because we have seen this happen sporadically from time to time over this period but the problem is that she does not feel these attacks coming anymore.

Over the past week, she has blacked out with low levels (2) two times. She has made arrangements to see her specialist at Jefferson (PA) but they cannot get her in for 2 weeks.

Let me tell you a bit about her and what her regiment has been for quite some time. She takes 3 shots a day, one at 8am, one at 5pm and then a third at 9pm. I am not sure of the amount of each shot. It seems that every other day, she wakes up with her sugar level being around 40. Last night, around 10pm, her level was 90 and she was afraid to fall asleep at this level for fear that it would drop in her sleep and she would not wake up. She at a candy bar and drank a soda to bring her level at 11pm to 145. When she woke up this morning at 7am, the level was 37.

In speaking with the doctor today, he mentioned the obvious that she should try to cut back on her insulin levels each dose and monitor it this week. One thing I was not aware of that he mentioned in passing was that he thought that her kidneys may not be functioning properly, causing the insulin to stay in her body longer thus dropping the sugar levels down to dangerous levels.

Sorry for the above rambling, but here is my questions.

1. Does anyone have these types of attacks and not feel them anymore? What was the result or findings and how have you been since? She used to always be able to feel these coming in the past.
2. Does anyone have experience with kidney related problems that they can enlighten me of.

My sister is only 35 years old and she has lived with this since she was 7 years old. Any experience with the above two questions would be greatly appreciated if you could pass them along. The unknown is the hardest thing to try and deal with.

Many thanks in advance.

[rzrbks]

Part of the problem depends on what her Basal insulin is and what time she injects it.

The 1st thing I try when hit with early morning lows is the have a before - bed snack of something that will take longer for the body to process: cheese and crackers, meat(ham, pastrami etc.) and crackers or maybe a peanut butter and jelly sandwich.

Next thing is to check my readings throughout the day and make sure those are hitting the target range--if they're low, all other things being equal, then I can dial back the amount of basal insulin.

Another thing I check is the Bolus amounts, if I'm hitting real lows 3-4 hours after a meal, then I know that I'm over-bolusing and ease back on my bolus ratio.


Hope any of this might help.

[mark-TN]

ramze-

Welcome to the boards. I am so sorry your sister is having such a go of it. I'm unclear about the correlation between problems with kidney trouble and the absorption of insulin, so I am no help there.

Your sister is experiencing what is called Hypo-unawareness. This happens when you have several lows in a short amount of time. When the body detects a low sugar it releases hormones to try to counteract it. This causes nervousness, sweating, and just a strange feeling that diabetics recognize as a low sugar. It takes time for these hormone stores to get built back up. If your sister is having 1 or more low sugar attacks per day there is just not enough time to build back these reserves so when you go low you do not detect these strange feeling and the physical symptoms are just not there. The important thing is for her to get to the doctor a concentrate on preventing lows in the first place. What type of insulin is she on? Most diabetics on multiple daily injections normally take 4 shots or more per day (1 or 2 shots of the long acting basal insulin and a shot at eat meal of short or rapid acting bolus insulin). She may need to take a serious look changing her regiment. Is she going to a endocrinologist or just a general practitioner? She most likely should get in to see a CDE (certified diabetes educator) as well if she is currently not seeing one.

I hope this helps, and I wish you the best. You certainly are a caring sibling to make an effort like this to help out your sister. With that kind of support she should be able to get things headed in the right direction and eventually straightened out.

Mark

[HeatherP]

I agree w/ Mark and Rzr. She should have a serious talk w/ her doctor about changing not just her doses but which insulin she takes. There's a relatively new insulin called Lantus that many of us are on. It provides a background level of insulin without peaks, and we inject Humalog (or a similar short-acting insulin) before each meal. I was having terrible lows the last year I was taking NPH. Since switching to Lantus my blood sugar levels are much better than ever before. The CDE angle is also a very important suggestion. This person can work out a meal plan that your sister can live with and help determine her individual sensitivity to insulin and activities and teach her how to plan and make changes when necessary. She'll be much better off for having the visit.

You might also suggest she check us out. She'll find plenty of information, advice and support for what she's going through.

Best wishes,
HeatherP

[archimeech]

NPH was really screwing me up too. My wife had to help me out a couple of times in the middle of the night. I didn't even know I was dropping until I'd wake up to her force feeding me a gallon of OJ. I would try the Lantus or go on a pump. I use the pump therapy, and while it's not for everyone, it works much better for me.

[TAutry]

Hi ramze,

Sorry to learn of your sister's difficulties. The others have offered some very good advice. I agree with rzrbks regarding your sisters choice of snack. She should consider more complex carbohydrates that are absorbed much more slowly like a bowl of oatmeal or a whole wheat waffle with peanut butter and a few blueberries on it. The latter is a recipe I just learned which makes a dandy 'breakfast taco' or snack.

Of course it goes without saying that frequent monitoring is a must and a visit to the doctor ASAP.

I wish her good luck. Keep us posted.

Travis

[MarkMunday]

Ramze12,

I would agree with what has been said by the others. Reduce the frequency of the lows and the hypo-awareness will return. The challenge is to figure out what is causing the lows and fix the problem.

Overnight lows are probably being caused by peak action of the 9pm shot. And having a snack before bed doesn't seem to help. So either the amount of this shot needs to be reduced. Or, better still, switch to basal/bolus regimen with basal insulin that doesn't peak - ie Lantus.

I find the kidney question a bit confusing ...

.... he mentioned in passing was that he thought that her kidneys may not be functioning properly, causing the insulin to stay in her body longer thus dropping the sugar levels down to dangerous levels.

Kidney problems are a long-term complication of diabetes. But I have never heard of low blood sugar being caused by them. Insulin is injected under the skin and is absorbed directly into the bloodstream. The kidneys aren't involved in this process. So it is unlikely that the kidneys could have anything to do with the lows.

Cheers,

Mark