Checking in ideas wanted for home alone

hi ya'll

i'm a single guy living alone, i'm now taking insulin(Lantus) for the first time so lows are now becoming an issue. i've been low the last two mornings. and i am on to working this out...

but what i am looking for is ideas for connecting with someone or friends or something or them checking in on me to make sure i haven't gone into a diabetic coma.

is this an issue for any of you? do you have something set up?? was thinking of maybe something on my computer or iPhone...

(i don't have a neighbor to come knock on my door)

thanks,
~m

I understand the anxiety about lows, because I started out my insulin career with one scary low (caused by a misunderstanding by both me and my doctor) and was scared of insulin for awhile afterwards.

Your idea is good, but I don't know how practical it is. Lows can happen anytime, though our highest concern is usually at night when our blood sugar can drop dangerously low without us being awake to recognize the danger. But you could end up in the "danger zone" at 3AM or 7AM or whenever, and even if you have someone willing to contact you if you don't e-mail or text message them by say 8AM, it could be too late.

But I don't intend to scare you more with that statement. I also live alone. When you have a partner you have back-up to tell you what they see, or wake you up if you are sweating or seem agitated, but living alone it isn't real practical. But that doesn't mean there aren't things you can do to protect yourself. After the scare I mentioned above I thought up some things I could do; some of which I did and have discontinued, some of which I never bothered with as I got more comfortable with my insulin management, some of which I still do.

Most important is for you to test, test, test, especially when you are in the process of changing insulin doses. Have your protocol established for what lows you want to treat (I treat under 60, some people under 70). Have your treatment of choice close by to wherever you are, bed, living room, work, car, etc. When I had the scary low I lived in Guatemala with a winding concrete staircase. If I hadn't had glucose tablets upstairs next to my bed, I wouldn't have made it. Find out how many glucose tablets you need to treat. (They are a lot more reliable than food items, and you won't be tempted to overtreat and then go high). For me I take 2 glucose tabs in my 50s, 3 if I'm lower. I'm an average sized woman. If you're a large guy you may need more. I don't retreat after 15 minutes, but wait closer to 1/2 hour to retest and treat if necessary. The only time I treat higher than 60 is before bed when I like to be at least in the 80s. If you use fast acting insulin (it doesn't sound like you do yet), try to not have fast acting insulin on board when you go to bed. Long acting insulin hits you much more gradually and so is less dangerous.

I strongly recommend you read the book Using Insulin by John Walsh. Those of us on insulin manage our doses 24/7 and we find we don't wait for a doctor to tweak doses. If you are low for 3 days in a row when you get up (I assume you're taking the Lantus at night) try reducing it by a unit or a couple units. Then stay with the lower dose for another three days before you consider more changes. If you are uncomfortable at this point changing your own doses, call your doctor and ask him if you can bring the dose down a bit as you are having lows. Eventually by slow trial and error you will find the right Lantus dose to have you where you'd like to be. If not, some of us have found we need to split our Lantus dose in two so you might talk to your doctor about that. Others have found that Lantus was too hard to dose accurately so we switched to Levemir which seems to have a smoother action for many of us (in two doses).

Trial and error, trial and error! But testing is the key. As you become aware of what your particular low symptoms are you will recognize lows and can treat before it gets dangerously low. Until you feel confident you can keep your bedtime number higher, say over 100. Many Type 2's are told you only need test once a day. This is ridiculous for anyone, but especially for someone on insulin. Testing will keep you safe, especially until you both stabilize your insulin doses and get more familiarity and confidence. If you don't get prescribed enough test strips, implore your doctor to over-ride insurance regs and give you more - if you can afford it you can buy them over the counter or even on e-bay.

As someone who lives alone these are the things I'd recommend for now. Down the road you might want to talk with your doctor about putting you on a basal/bolus regimen if you are having highs 2 hours after meals. If you try and reduce mealtime highs with just basal insulin you risk going low at other times.

Oh and on the list of things I thought about but didn't do was getting a CGM. CGM's are good for letting you know which way your blood sugar is trending. So, if fore instance you are 80 at bedtime and going up -cool, but 80 and going sharply down might mean you need to do something. CGM's are another reassuring device, though probably overkill for someone just on Lantus. Why did I never get one? I learned enough to reassure myself about lows and I decided I obsess enough about my blood sugar and it would just drive me nuts. But if your'e interested, plenty of people on here use them.

Finally - and this I did do. Down the road, when you have been on a basal/bolus regimen awhile you might consider a pump. It is a lot easier to regulate your basal levels when you can increase or decrease them by the tiniest amounts and have different levels for times of day as needed. It isn't easy, though to get a pump as a type 2.

Do get the Walsh book and don't hesitate to ask more questions as you go along. Lots of knowledgeable people here.

I also live alone, and have also had some scary lows especially pre-pump. My house alarm system has a remote, like a car remote. I keep it next to the bed at night next to my dexcom. Probably overkill, but it makes me and my family/friends a lot more comfortable.

Hi jrtpup, what a good idea! I would never have thought of it. I'm impressed.

Most of the scary seizure and not-waking-up-in-the-morning types of lows that you hear about are from Type 1s, and I think as a Type 2 on basal insulin alone you are probably at much lower risk of those types of severe lows than a long-term diabetic (who may have lost most of their symptoms of lows) on a basal and bolus insulin.

However, these are some of the things I've done:

* I don't go to bed below 100 mg/dl. If I'm below that level I'll have a SMALL snack to bring me up a bit (small being like 4-8g of carbs). If I'd done a lot of exercise during the day I'd eat a larger snack when I was on Lantus, although now that I'm on a pump I just decrease the basal rate overnight. If I have "insulin on board" from a bolus I will wait until it's gone before going to bed.

* I keep Skittles and a juice box in my nightstand next to my bed. I have never been unable to make it to the kitchen as an adult—although during the day I've had lows where, if I hadn't had something on my person, I'm sure I would have passed out, and I had numerous severe lows as a kid/teenager where I could not help myself—so I keep stuff there just in case. I also keep the "low stuff" in my kitchen in the same place at all times, so that I never have to go searching for food when I'm low and half asleep.

* Family and friends "check in" with my unofficially on MSN Messenger and Facebook. If I don't log in or post by about mid-morning, they will give me a call. This isn't really a system I set up officially, I've just told them about what to watch for in case of serious lows—including me not waking up in the morning—and they started doing this on their own.

* If I have any reason to think I might drop low overnight (i.e., exercise or drinking alcohol the night before), I don't hesitate to set my alarm for the middle of the night to test (I will even set it twice—for 2:00 AM and 4:00 AM, for example—if I'm really worried).

* I don't have one currently, and it may not be relevant for you on basal insulin alone and living alone, but in the past I've had a glucagon kit which I've taught family and friends to use. I don't carry one with me and it's not something you can typically use on yourself, but if going travelling or camping or living with someone who can use it, it's a good idea to have one.

I don’t live alone but I sleep alone several nights a week. I am extremely lucky that I have always woken up if my blood sugar went low. I’m right off the kitchen so it’s not far to go to get food. In 25 years I have never had a problem. I wake up at the first little flutter of my heart. Rapid heartbeat is usually the first noticeable symptoms. I’m very lucky in that respect.

Setting an alarm to wake up in the middle of the night works well especially when you are working on changing your insulin timing/amounts. I have been diabetic "forever" and I pretty much do a finger stick in the middle of the night as I am use to waking up at least once during the night so I just do a quick test.
And then keeping your fast acting sugar/glucose tabs/etc by the bed is important as it's better to treat first and then find the glucometer than the other way around if you think you are low.

Trudy, if you already have a house alarm it's just a one-time cost for the remote. Much easier than those monthly fee 'I've fallen and I can't get up' systems LOL

Are you taking Lantus in one or two (split) doses? Do you take Lantus in the evening? It takes some fine tuning to get basal doses figured out, so don't get frustrated.

Though pharm literature states Lantus last 24 hours, it doesn't for most people. It also peaks, which results in lows. Many do better on split doses for these reasons, despite doctors arguing this isn't needed. Doctors get their drug info from pharm reps selling their product. I had persistent lows on Lantus. I lowered doses, split doses, took it at different times. The result was still the same--lows.

Best basal move for me was switching to Levemir. Smoother, more stable & level than Lantus. An added plus is that Levemir doesn't sting & doesn't lose potency at 28 days like Lantus.

Sorry, this doesn't answer your question. But, wanted to suggest ways to minimize lows.

Well, I guess I will pipe in and be harsh about this. Lows are a risk with insulin. And it is good to have a healthy fear and respect for lows. But don't approach severe lows as a foregone conclusion, they are a results of a chain of events which I have some significant control over. I refuse to go through life depending on others to keep me well and healthy. I need to do that yourself. So my first, second and third defenses against severe lows are in my hands.

I never want someone to have to come to my rescue. It just isn't part of my strategy for managing lows. It it ever happens, it will mean an utter failure of all my efforts.

Solid advise from all on this issue. Couldn't say it any better myself. Just one suggestion. Since you are alone, go to Medic Alert and get an ID bracelet with your info. They got all kinds of "stuff" you can wear 24/7. $35 bucks a yr, and worth it.

Have you ever thought of Life Alert? You put it around neck and push button. Do you have a close neighbor you can depend on to check in on you or phone you./ It is hard being alone.