My worst hypo yet

Type 1 and LADA New to Type 1 Diabetes
1

I woke up at 2 in the morning soaking with sweat, when I tried to sit up the whole room started spinning. It was hard to see because I had bright white spots in my vision. My first thought was that I had wet the bed and had a bad dream, then I realized it was low glucose. I took 4 glucose tablets, lucky I had them on my nightstand. It took 30 minutes before I could get up then I tested. I was 65, that was 30 minutes after the glucose tabs. Now that I can think about it, I had tested 105 when I took my bedtime lantus and had a snack, about 10 carbs. The only thing I can think of is I must have made a mistake with my insulin. I'm still in the honeymoon stage and I've read it can cause variations but I don't think it could be this big.

I had sweated so much I had to take a shower and change all my clothes because they were so wet with sweat. It's 3 AM so I decided to nap on the couch and change my bed sheets later. I just tested again, I was 88 so I should be ok.

2

Definitely scary but it sounds like you handled it perfectly, Madison! As for the "why" it's hard to say and sometimes I try and not worry about the why too much. Is there any possibility you could have taken fast acting insulin instead of Lantus?

3

I mixed up my insulin once. I was lucky my wife woke up and found I was wet with sweat, when she couldn't wake me up she called 911. I take Novolog and Levemir, the pens are exactly alike except for the color bands. After that I check them real close.

4

Huh. Me too and around the same (local) time of between 1:30 to 2:30 AM.

In my case I noticed my pump's CGM alarm was sirening and I had enough wits to look at it and start eating. I didn't realize how low I had gone at first but I just kept on eating as I started to get enough sense back to realize how bad this reaction was.

I was also soaked through with sweat. It's been a while since I've had a low that was this bad. I wasn't so much knocked out as not thinking straight. It seemed to take a long time to get some semblance of sense back.

(Though since I've got the CGM I've notice I'll wake up covered in sweat some mornings without having had a hypo. Strange, but hopefully that is going away now that I'm avoiding the early morning hypos most times.)

You seem to have handled it much better than I did. I ended up bouncing back into the low 300s later that AM. Oh, well. Been there before, will probably be there again.

In my case it looks like I did a correction bolus around 10PM & apparently didn't lower the bolus enough to offset for the 1/2 hour or so of dog walking I had done earlier in the day. Ooops.

Are you only taking Lantus? I wouldn't be so quick to assume that you got your dosage wrong unless you are really, really new to injections. Often it is other changes to our routine which catch up with us. Often we can't pin it down precisely. I think of these as "WTF? BGs".

I also wouldn't expect Lantus alone to drop you that low that quickly. Strange.

-iJohn
T1 LADA ~1978; 1st pump: Minimed 507 (~1997); currently: Paradigm 723 (2013) + CGM (2014)

5

Mixing up short-acting with long-acting insulin is a common yet serious mistake. I was hauled off to the emergency room when I did that on MDI. If I were you I would build in some systemic safeguards against that happening. Perhaps storing your long acting in a completely different location than your short-acting may help.



You survived, you’re wiser. Live and learn. Good luck.

6

Nice catch!! The first time I had a hairy hypo I was home alone and decided I wanted ice cream to treat it with. The ice cream was frozen solid so I figured I'd zap it in the microwave. Oh wait, despite starting to fry, I know that microwaves heat inside out so (****DANGERDANGERDANGER****) I figured "I know, I'll use the broiler..." then the phone rang and, while yakking with my buddy, I relized I lit the box on fire which, of course, melted the ice cream. I hate sweaty sheets as I had them all the time 1986 or so until I started pumping in 2008...Again, great save with the glucose tabs and taking care of yourself in that situation.

7

i too wouldn't for sure say it was wrong insulin...maybe just too much. do you ever wake up and check your blood sugars in the middle of the night you could have been much lower before you woke up. do you have a CGM. It may be you're dropping too low in the middle of the night and need to lower your basal dose(s), especially if you're still honeymooning. I see white spots too when i'm low, that's my first sign, typically. Make sure you're a bit higher before bed and basal test overnight, waking every 2 hours to check or see if you can get a CGM. It sounds like you were really low. good luck!

8

Good job!

Consider keeping something far more substantial at your bedside re: sugarwise. You don't want something you have to find, locate, or ever count. A bottle of soda comes to mind. Same in the fridge, one for the car too.

Your ability to act, much less focus is disappearing fast, the ability to locate stuff is shrinking even quicker. Bottles are easy to keep, store, and find in the dark....

IMHO

9

You handled yourself like a pro. It may be that now that your system is settling down your insulin requirements will decrease even if you don't have a full-fledged honeymoon. If you didn't make a mistake your basal is set too high and unless you know for sure that you erred, you might consider cutting back on your Lantus tonight to be safe.

10

I told the nurse and Teruo, my T1 boyfriend, about my hypo. Teruo thinks I mixed up my pens and injected Humalog instead of Lantus. Since the hypo came about 3 hours after I injected, if it was too much lantus it wouldn't have started enough to cause that bad hypo. I told him that right after I took the glucose tabs I went back to sleep for a while. He thinks I was almost past the point of no return and I am lucky I woke up. He wonders what woke me up. I said it wasn't my time to die so I woke up, I really believe that. I tried to call the doctor at the hospital but he is on trip and won't be back until Saturday and I didn't want to talk to someone that didn't know my case.

I was setting the alarm and getting up every 2 hours to test but since I was doing ok I stopped doing it 2 days before the hypo. I'll sure start doing it again even though I don't get enough sleep doing it. It's hard to go right back to sleep after testing.

I would love to get a CGM, my Mom is still looking for a clinic to manage my treatment. The clinic would have to get the CGM and train me how to use it.

I got my lab test results from last Saturday, I'll post them when I feel better, I tired from being up most of the night. The only ones that were out of range was my glucose, high and my BUN test.

11

I think you did fine. Lantus acting normally won't cause sudden lows, it doesn't start working for 1-2 hours and won't reach a peak for 6 hours. But I said "normally." Lantus must be injected into the subcutaneous fat layer and you must not inject it into muscle or veins. So the proper technique is to choose an area of your body with a good layer of fat (usually your abdomen) and pinch up to inject. This is the technique that you should have been taught, but maybe not. If you misinjected Lantus, it is possible that it can cause a sudden low. There are numerous posts about injection technique, I started one here.

In the meantime, if you are on a single Lantus injection a day you may actually find it safer and less stressful to simply take it in the morning. That way any problems you have can be handled while you are awake.

12

Been there, done that. You have my understanding. As my endo has said "it's more of an art, than a science." Best of luck.

13

That's a good idea, Brian. I was just thinking about you, Madison, while I was reading on the forum. I was just wondering what you are up to.

I've mixed up the pens before. For some reason, I took short acting instead of long acting, so it was a giant mistake - 35 u Humalog. I thought I was going to die and just started chugging juice. Maybe my blood sugar was low or maybe I just wasn't paying attention. Good thinking, Teuro! He might be right, but you don't know for sure.

Be sure that you double check what your delivering - say the name and the dose out loud to yourself. Keep the Lantus in a special place, that's different than the short acting. You could store the Lantus in a ziplock bag in the vegetable drawer. Then, store the Humalog somewhere different, like on a shelf.

I have 'forgotten' to deliver a couple short acting, meal shots, lately. Its because I have been collecting detailed records on my blood sugar. I'm writing a mini report, doing calculations in my head, and checking my blood sugar on 3 different devices. I am simply not paying good enough attention. If I'm distracted when I'm delivering insulin, like if someone is talking to me, then it helps me to quietly say, "Lantus, 35 units" out loud to myself, deliver the shot, and then circle it on the paper where I'm recording it.

14

For a while, in college, I kept a 2-L bottle of soda, on the floor, next to my bed. Worst case scenario, I figured I could always roll off the bed, onto the floor and get it. Once, the dexterity in my hands went, so I couldn't open the bottle. I could barley see or move, but I was able to crawl to a pair on scissors that I found on the floor and puncture a hole in the 2 Liter. I poured more of it on the floor, than in my mouth, but in a pinch, it worked. If you use a bottle of soda, keep a pair of scissors nearby, just in case. Soda bottles are good because even if you loose vision during the episode, you can feel for them. Big bottles are easier to find than small ones, which can rolling around under the bed.

15

I think if you injected short-acting insulin instead of Lantus, you would wake up high the next morning? The short-acting will wear off in a few hours, and you'll be without any long-acting insulin. Can others here comment on this?
Sometimes, diabetes just bites you in the rear end. Sounds like you did everything right to treat it.

16

When I was using pens, I kept them in different rooms of the house. My Lantus pen was in the bedroom since I took a shot before going to sleep and my Humolog pen was in the dining room since I used it before eating. It's easy to get distracted - especially right before bed when you're tired.

Brian made a good suggestion about taking a morning Lantus shot. Your overnight coverage might not be the best but it is certainly safer.
17

That's a good point. She is still honeymooning, and I think she takes a very small Lantus dose. Could we say, for sure, that she would wake up high? I know I would, but maybe she wouldn't if she is still producing insulin. Did you wake up high, Madison? Did you wake up high, before, when you left your Lantus at school? Its interesting...

18

Madison,

I debated whether or not to post again as I may come across as annoying ... or worse. If so, I apologize in advance. That's not my intent. I'm just trying to provoke potentially useful pondering.

It's really hard to comment meaningfully without more specifics about your current treatment. In your original post you mentioned "bedtime lantus" and "honeymoon stage". But in your next post your wondered if you had "injected Humalog instead of Lantus". So ... are you using MDI (Multiple Daily Injections)? Do you know what your Insulin Sensitivity and Insulin-to-Carb Ratio are?

When were you diagnosed & (if you're comfortable saying) how old were you? I'm mostly just curious, but these small details also sometimes help to better understand the person you're conversing with. It also helps to avoid wasting time talking about things which you are probably already very familiar.

About "getting up every 2 hours to test". I tend to think you probably don't need to continue to do this so long as you are getting consistent results & the sleep time hypos have not repeated. But it's hard to speculate without knowing more about your treatment and how your body reacts to insulin.

About CGM: If you are interested in learning more about CGM, there are already a number of discussions you could follow on TuDiabetes and/or other sites. Some people have recently asked for more information about CGM in general and you might find those discussions particularly interesting.

If so, just ask and I or someone else could point you towards them.

About your T1 boyfriend, Teruo. I'm sure he's a wonderful person, an exceptional & valued partner and that I'm completely wrong to ask, have you every heard of "Male Answer Syndrome"? (Perhaps they call it something else in Japan?)

Finally, about "it wasn't my time to die so I woke up". Yeah, sure, but ... an otherwise healthy, well nourished diabetic with a properly functioning liver is not as likely to die from an accidental insulin overdose as is often assumed.

You will probably never hear this from anyone in the medical profession since they want to do all they can to discourage someone from having a hypo. And certainly it is possible to die from an insulin overdose. It's just not as likely in most situations as is commonly believed.

But of course, regardless, you always want to detect & prevent or recover from them as quickly as you can. Even if they don't kill you, the really bad ones can leave you feeling like death might have been better. ;-) And the hypos tend to throw off your body's equilibrium. One example of this is often referred to as the Somogyi effect.

-iJohn
T1 LADA ~1978; 1st pump: Minimed 507 (~1997); currently: Paradigm 723 (2013) + CGM (2014)

20

Thank you for your considerate & detailed reply, Madison. It suddenly hit me what I find so attractive about you. You paragraphize when you write. ;-) No "wall of text". Bless you! I truly believe the world needs more people like you!

So, "this" is all relatively new for you then. It sounds as though you may be a LADA (Latent Autoimmune Diabetic Adult), but probably your doctor(s) would disagree because you're not technically an adult. Whatever.

It's a hell of thing to have thrown at you when you're a teenager and already have so many other parts of life you're trying to sort out for yourself. But, as Buckaroo Banzai was fond of saying, "No matter where you go, there you are." (It's kind of an (obscure ?) 80s thing. If you're curious Google him/it.)

For lack of anything better to say just at this particular moment, I'll drag out a book recommendation. This is a fairly "classic" intro book. I'm not sure if it would be useful to you or not, but it's still worth suggesting.

Think Like a Pancreas by Gary Scheiner

Do you have access to an online English language library? I know you can check this book out as an ebook from the NY Public Library and hopefully others. If you still have a library card/account for a US library you could try looking it up there. I think it makes more sense to borrow it from a library so you can decide if you actually like a book before you buy it.

I now take 4 units of humalog before each meal and try to eat 60g carbs each meal. This is a fixed dose and I haven't been told to change it, which will hopefully happen when I get under permanent care by another doctor or clinic.

Typically an MDI patient would "figure out" what their Carb Ratio and Insulin Sensitivity Factor are and use those to help them decide how to adjust their insulin dose. My guess is that no one has discussed this with you yet because of your supposed "honeymoon" status. That is, I think they're not sure if your body will react consistently to insulin & food at this point so why throw it at you?

Still, I also do not see how mandating a fixed dosage & carb quota is any better. So ... I'll try to at least sketch out the concepts and you can investigate further if you want to.

The basic idea is to use really simple arithmetic to guess how much insulin you're going to need. The most surprising thing is perhaps that it can actually sorta kinda work.

The Carb Ratio is just the ratio of carbohydrate to insulin (C:I) that "works" for you. If your doctor says take 4 units for 60g then he's implicitly saying "Why not try a Carb Ratio of 15 (60 g / 4 units) and see how that works for you?"

You use the Carb Ratio like this. Suppose you decide you only want to eat 40g of carb, not 60g? Well, the guess for your insulin is to divide the carbs in the meal by the carb ratio. In this case, 40/15 is ~2.66 or 2.6 units of insulin. (To be conservative, maybe round it down to 2 1/2 units?)

The idea in a nutshell is that if you eat 15 grams of carb, it'll take 1 unit of insulin to compensate for it. (Finding out what your carb ratio is at which times of the day can be sort of the "Holy Grail" of T1 diabetes. ;-)

The Insulin Sensitivity Factor is used to determine how much insulin to give yourself to correct a high BG (Blood Glucose) value. This probably was never mentioned because your BGs all appear to be well within the "normal" aka "acceptable" range. So, at this point you really don't need to worry about giving yourself insulin to "correct" for a high BG test result.

I don’t seem to be able to detect hypos until I’m very low. I have been 65 a few times and felt normal. It makes me wonder just how low I was when I woke up with that bad hypo. I was too shaky to test until 30 minutes after I took the glucose tabs, and then I was 65.

Hypos differ. Different people on insulin will experience hypos differently. The same person will also experience a hypo differently at different points in their life. As time passes how you react to low BG may also change.

One of the hardest things for me to keep remembering is that all diabetics are different. Sure, we share a lot of common experiences. But the only one who truly knows what your diabetes is like and how to work with it is yourself. It's like your clothes. You're the only one who knows what it feels like when you wear them.

I have tested my BG and gotten results back in the 30s ... which I then treated without any danger of blacking out. I have also been fairly oblivious as I described in my first post to your thread. There have also been times I was wandering around so low I was completely oblivious to what was happening around me.

For now probably the best suggestion is to just test your BG whenever you feel "funny". Hopefully that will mean that you waste some test strips because it turns out you're just fine. But better to test and have a better idea where you stand than to experience the frustration of a hypo.

Also, until you have a better feel for how it affects you, test more frequently when you are exercising. In this case I am not referring just to being at the gym or jogging. Any type of physical activity may affect your BG. For example, walking around or cleaning/vaccuming. These may or may not affect you. You just have to try it and see what happens.

The other tricky part about exercise is that it can hit you hardest some time after it happened. When I walk dogs for our local shelter I may go somewhat low while I'm doing it. But I also have to remember to cut back on my insulin for when I'm sleeping that night because I'm likely to get a hypo then as a result of the exercise 12 hours (or more) earlier.

OK, enough for now. I'm going to go watch some bad TV. ;-)

-iJohn
T1 LADA ~1978; 1st pump: Minimed 507 (~1997); currently: Paradigm 723 (2013) + CGM (2014)