Author Topic: Mystery hypo  (Read 465 times)

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Offline Quantum Learning

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Mystery hypo
« on: 22 November 2017, 08:30:44 PM »
I wasn't going to post this as I thought 'oh it's just one of those things' but the more I think about the less I can work out what happened.

It was a week ago, I woke at 6.7 so didn't correct, had my usual zero carb brekkie, don't remember if I ate any lunch but would only have been some cream cheese if I had. Next tested b4 dinner at 8.6  so injected 20 units to cover correction & meal. 5 hrs later later before bed I was 6.7 so only injected my 80 units of Toujeo as I do every night. Woke 5 hrs later @ 4.38am feeling sick, sweating & shaking, tested & was 3.7. Had a fine old time with my (normally) forbidden beloved Haribo jelly babies, waited till I was 7.6 & went back to bed.

As it was a good 10 hrs since I injected the NovoRapid & I definitely didn't inject 80 units of that instead of the Toujeo I have to say I have no idea what caused it. As a type 2 who is producing very little of my own insulin (it seems) it's not impossible my pancreas decided to help me out but why would it if my levels weren't high anyway?
Type 2 dx Nov 2012 with fasting BG 14%/129.5
HbA1c Jan 2013 79/9.3%
April 2013 50/6.7%
July 2013 39/5.7%
Oct 2013 39/5.7% Chol 5.9
July 2014 45/6.3% Chol 5.5
Aug 2015 61/7.7% Chol 5.9
May 2016 84/9.7% Chol 6.9
Oct 2016 53/7%  Chol 6.3
Dec 2016 41/5.9% Chol 6.0
June 2017 51/6.8% Chol 6.1
Oct 2017 52/6.9%
Jan 2018 51/6.8% Chol 5.9
Metformin SR 2000mg, Doxazosin 4mg, Lansoprazole 30mg, Fexofenadine 180mg Co-Codamol 30/500g when needed. Amitriptyline 20mg
Toujeo/NovoRapid, Allergic to Levemir

Offline sedge

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Re: Mystery hypo
« Reply #1 on: 22 November 2017, 10:34:59 PM »
How do you know that your pancreas - having had a nice rest - didn't help out?

Answer - you don't know and neither does anyone else!  Stuff happens - especially when D doesn't render your Beta cells dead as a dodo.
Jenny

T1 DX 1972, pumping Novorapid 24/05/11

HbA1c - 7/07 8.7, 1/08 7.8, 9/08 8.4, 3/09 7.3, 7/09 7.2, 12/09 7.3, 11/10 8.1, 2/11 8.6, 9/11 6.5 2/12 6.4  5/12 50/6.7  11/12 52/6.9  01/13 46/6.4  06/16 46/6.4  12/16 45/6.4

Offline Pattidevans

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Re: Mystery hypo
« Reply #2 on: 22 November 2017, 11:48:27 PM »
Well, basal needs change from time to time you know.  A week ago I reduced my overnight basals by quite a bit because I was going low. 3 nights ago all changed and I am now waking at 7 ish.  No real reason I can detect.

So Q, try testing in the night by setting an alarm at maybe 2 am and 5 am.  You may need to reduce your overnight basal.  Weather has changed too and that has an affect.  Most people need less insulin in hot weather and more in cold.  I am the direct opposite!
Patti


Type 1.  Mis-diagnosed T2 May 2003, finally had CPeptide test 15/7/11 and proper diagnosis 1/9/11.  Now pumping Apidra with Roche Spirit Combo pump. Hba1c 6.1 Sept 2017.  45 (6.3) April 2018.


© 2015 Patti Evans

Offline nytquill17

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Re: Mystery hypo
« Reply #3 on: 23 November 2017, 12:28:16 AM »
Absorption of insulin under the skin is a biological process too. I'm not as familiar with Toujeo, but for most long-acting basals, the reason they are long-acting like that is because the insulin molecule is "wrapped" in other stuff that controls how quickly it's absorbed. So when the "wrapping" for whatever reason doesn't work as intended (say you accidentally inject some or all of your dose into a small blood vessel under the skin, or certain chemical reactions don't happen as anticipated) then the speed of absorption and action of the basal insulin can actually be altered.

I know Lantus was famous for doing this for some people - not everyone though! But because the main way Lantus' absorption was slowed was by altering its pH slightly (hence also why Lantus stings for some people) so that it would interact with the pH of your body, crystallize, and then those crystals would slowly break back down and dissolve. If for whatever reason your body pH didn't react as expected and that crystallization didn't play out, you ended up with a pool of medium-acting insulin under the skin instead.

But probably the most common is hitting a vessel; if your injection site bleeds a lot or bruises, you may experience some effects on absorption. There's not much you can do to prevent it (hitting those small blood vessels is just one of those things that happens sometimes, we've all done it) or really to try and fix it once it happens, you just have to make a mental note that it happened and keep an eye out for weirdness!
T1 DX 1995
Omnipod since 06/04/18 (Novorapid)
 
  ~-~-~-~
"If you can't ride, can you fall?"
"I suppose anyone can fall," said Shasta.
"I mean can you fall and get up again without crying, and mount again and fall again and yet not be afraid of falling?"
"I - I'll try," said Shasta.
  ~C.S. Lewis, The Horse and His Boy
  ~-~-~-~
"There is no answer; seek it lovingly."

Offline Pattidevans

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Re: Mystery hypo
« Reply #4 on: 23 November 2017, 07:58:49 AM »
Oh yes, absorption issues.  Sedge has had them and her DSN told her that pockets of insulin can lie under the skin for up to 13 years then suddenly release.  I remembered that when I went to the physiotherapist for a hip problem.  She was massaging my bum (where I used to inject basal) and commented how lumpy it was.  I told her to go steady as it could be insulin deposits.  It was, I was hypo almost immediately I left and on and off all evening.
Patti


Type 1.  Mis-diagnosed T2 May 2003, finally had CPeptide test 15/7/11 and proper diagnosis 1/9/11.  Now pumping Apidra with Roche Spirit Combo pump. Hba1c 6.1 Sept 2017.  45 (6.3) April 2018.


© 2015 Patti Evans

Offline Quantum Learning

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Re: Mystery hypo
« Reply #5 on: 23 November 2017, 12:51:13 PM »
Well I usually need more when it's cold although a couple of times in the summer when other stuff was going on I thought maybe I should increase the basal but I'm reluctant to inject more than 80 units, it takes a long time to inject it slowly which I do to help with the stinging and indeed absorption.
I will try the basal testing but have a tooth abscess at the mo so am expecting AB's later today when I see the dentist. That'll change everything I'm sure  :P
Type 2 dx Nov 2012 with fasting BG 14%/129.5
HbA1c Jan 2013 79/9.3%
April 2013 50/6.7%
July 2013 39/5.7%
Oct 2013 39/5.7% Chol 5.9
July 2014 45/6.3% Chol 5.5
Aug 2015 61/7.7% Chol 5.9
May 2016 84/9.7% Chol 6.9
Oct 2016 53/7%  Chol 6.3
Dec 2016 41/5.9% Chol 6.0
June 2017 51/6.8% Chol 6.1
Oct 2017 52/6.9%
Jan 2018 51/6.8% Chol 5.9
Metformin SR 2000mg, Doxazosin 4mg, Lansoprazole 30mg, Fexofenadine 180mg Co-Codamol 30/500g when needed. Amitriptyline 20mg
Toujeo/NovoRapid, Allergic to Levemir

Offline himtoo

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Re: Mystery hypo
« Reply #6 on: 23 November 2017, 12:57:31 PM »
a slightly different angle  -- we know that meters have a +/- of 10-15% -- so I would suggest that you could have been as high as 4.2
and that as a person myself -- I always try to look on the positive so..................

it is great you woke to feeling like you did at that level and you tested , ate the sweets and went back to bed -- job done !!
T1 Dia Aug 1972 -pumping omnipod since 29/09/15  Losartan 100mg , simvastatin 40mg,Furosemide 40mg, Omeprazole 80mg , Doxazosin 8mg
Hba1c - 06/2013 6.1 02/2014 43(6.1) 07/14 42(6.0) 08/14 40( 5.8 ) 12/14 39 (5.7) 08/15 41 ( 5.9) 10/15 44 ( 6.2 ) 03/16 49 (6.6)
cholesterol --nov 2011 4.3 june 2012 4.4 June 2013 4.1 Feb 2014 4.1 dec 14 4.5 oct 15 4.4
Dafne grad. necrobiosis lipoidica on legs
laser treatment on both eyes 2002 and 2012, injections left eye 3 , wearing Noctura mask since oct 2014

Offline Quantum Learning

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Re: Mystery hypo
« Reply #7 on: 23 November 2017, 01:15:20 PM »
Yes, unfortunately my meter can be pretty crap, one day last week, fasting was 11.4 which I didn't believe so I tested again & it said 8.3. Now these differences make a huge difference to the amount of correction I would do, 14 units for the 11.4 & only 8 units for the 8.3, I didn't know what to do so ended up playing safe & did 6 units (it was the morning after the hypo so didn't want another one).

As I've said before, myself and others have complained to the DSN at the surgery (she's lovely & very helpful/knowledgeable) but the GP's there won't prescribe strips for any other meter, she has tried  :(
Type 2 dx Nov 2012 with fasting BG 14%/129.5
HbA1c Jan 2013 79/9.3%
April 2013 50/6.7%
July 2013 39/5.7%
Oct 2013 39/5.7% Chol 5.9
July 2014 45/6.3% Chol 5.5
Aug 2015 61/7.7% Chol 5.9
May 2016 84/9.7% Chol 6.9
Oct 2016 53/7%  Chol 6.3
Dec 2016 41/5.9% Chol 6.0
June 2017 51/6.8% Chol 6.1
Oct 2017 52/6.9%
Jan 2018 51/6.8% Chol 5.9
Metformin SR 2000mg, Doxazosin 4mg, Lansoprazole 30mg, Fexofenadine 180mg Co-Codamol 30/500g when needed. Amitriptyline 20mg
Toujeo/NovoRapid, Allergic to Levemir

Offline Alan

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Re: Mystery hypo
« Reply #8 on: 24 November 2017, 09:44:54 PM »
Oh yes, absorption issues.  Sedge has had them and her DSN told her that pockets of insulin can lie under the skin for up to 13 years then suddenly release.  I remembered that when I went to the physiotherapist for a hip problem.  She was massaging my bum (where I used to inject basal) and commented how lumpy it was.  I told her to go steady as it could be insulin deposits.  It was, I was hypo almost immediately I left and on and off all evening.

I learn something new every day. I have never seen that mentioned before on any forum. Do you know if there are any research papers or official guidelines on the subject?
Cheers, Alan, T2, Australia.
--
Everything in Moderation - Except Laughter.
There is nothing I could eat I like more than my eyes.
Type 2 Diabetes - A Personal Journey (latest: Slow Cooked Beef Brisket)
Born Under a Wandering Star (Surviving Long-haul Flights in Cattle Class)

Offline sedge

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Re: Mystery hypo
« Reply #9 on: 24 November 2017, 11:48:32 PM »
Yup Alan - it even used to happen with the older animal insulins, same as you could build up an immunity to them so way back then they'd swap you from porcine to bovine or vice-versa.  It happened to me but they'd invented 'Human' ones by then so I went straight onto that from porcine - my consultant explained it to me at that time (mid 90s) but by the early noughties I'd lost hypo symptoms and had accidents at the wheel - could so easily been so much more than just wrecking a couple of cars. 

It is a thing they have NEVER shouted from the rooftops and doesn't happen to very many people - but it can happen and still does!
Jenny

T1 DX 1972, pumping Novorapid 24/05/11

HbA1c - 7/07 8.7, 1/08 7.8, 9/08 8.4, 3/09 7.3, 7/09 7.2, 12/09 7.3, 11/10 8.1, 2/11 8.6, 9/11 6.5 2/12 6.4  5/12 50/6.7  11/12 52/6.9  01/13 46/6.4  06/16 46/6.4  12/16 45/6.4

Offline Pattidevans

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Re: Mystery hypo
« Reply #10 on: 25 November 2017, 09:20:01 AM »
I certainly had a lumpy buttock and the combination of massage and sonar most definitely set off hypos.  I did expect it cos of what had happened to Sedge.  Do you remember Sedge, you were hypo in the D clinic and ate all their biscuits etc... that was when the nurse had told you about pockets of insulin IIRC.
Patti


Type 1.  Mis-diagnosed T2 May 2003, finally had CPeptide test 15/7/11 and proper diagnosis 1/9/11.  Now pumping Apidra with Roche Spirit Combo pump. Hba1c 6.1 Sept 2017.  45 (6.3) April 2018.


© 2015 Patti Evans

Offline himtoo

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Re: Mystery hypo
« Reply #11 on: 25 November 2017, 10:10:34 AM »
wow sedge -- that brings back the memories -- the old porcine insulin  -- I can remember when I was switched onto human
 -- I was very reluctant

I am sure I was told they were loads faster so never to prebolus ( which has turned out not to be true )

I regularly pre-bolused on MDI and continue to on my pump with no negative issues ( just positive getting better post meal spikes )
T1 Dia Aug 1972 -pumping omnipod since 29/09/15  Losartan 100mg , simvastatin 40mg,Furosemide 40mg, Omeprazole 80mg , Doxazosin 8mg
Hba1c - 06/2013 6.1 02/2014 43(6.1) 07/14 42(6.0) 08/14 40( 5.8 ) 12/14 39 (5.7) 08/15 41 ( 5.9) 10/15 44 ( 6.2 ) 03/16 49 (6.6)
cholesterol --nov 2011 4.3 june 2012 4.4 June 2013 4.1 Feb 2014 4.1 dec 14 4.5 oct 15 4.4
Dafne grad. necrobiosis lipoidica on legs
laser treatment on both eyes 2002 and 2012, injections left eye 3 , wearing Noctura mask since oct 2014

Offline sedge

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Re: Mystery hypo
« Reply #12 on: 25 November 2017, 12:49:31 PM »
I had to change - I might just as well have injected saline solution as the dear ole Welcome Foundation Ultralente (80u/ml) which was the only weapon in my armoury ever since 1972, for what use it was to me!  (Well - it still must have done a bit for me since I didn't fairly instantly go into DKA - but I didn't know any of 'all that jazz' at the time LOL - just nowhere near enough, though)
Jenny

T1 DX 1972, pumping Novorapid 24/05/11

HbA1c - 7/07 8.7, 1/08 7.8, 9/08 8.4, 3/09 7.3, 7/09 7.2, 12/09 7.3, 11/10 8.1, 2/11 8.6, 9/11 6.5 2/12 6.4  5/12 50/6.7  11/12 52/6.9  01/13 46/6.4  06/16 46/6.4  12/16 45/6.4