T2 diabetes and anxiety

Hello, have been a member for a while but haven’t posted in quite some time.

Please note, I am working with my PA-C and endo and am making an appt with a psychologist as soon as I can.

My story may be long, sorry for that.

A little history, have been T2D for over 20 years, diagnosed in my early 30’s, I’m now 51. I’ve been through most oral meds, Bydureon, Byetta, and have been on Lantus for about 7 years and recently added Januvia 100mg to the Lantus 30units taken in the morning. Most recent A1C in June was 7.

The main reason for my post is in the past year or so I’ve had 4 or 5 severe lows after dosing my Lantus. For example:
805pm - 160
854pm- 36

This scares the crap out of me. The most recent one was two weeks ago and again, large, fast drop in a short time frame.

My doctor recently switched me to Tresiba and have been taking 26 units in the morning along with the 100mg Januvia. I experience DP and have been running around 150-180 fasting, which I know is high. But I’m scared sh*tless when it comes times to dose Tresiba. Shaking and testing every 3-4 minutes until I’m convinced my sugar isn’t going to crash.

I don’t want to live this way. I need to rebuild trust but I’m at a loss how to do that. I also would like some answers about why my BS dropped so fast with Lantus. My PA-C and endo are both puzzled. I have thoughts about this but…sorry, it just sucks.

Sorry to end this so suddenly. I’m at work and starting to get teary.

Thanks for reading and an open to suggestions, thoughts, questions.
Be well.

I was on Lantus for basal and Humalog for bolus for years and fought with my endo for years that I was getting nightly scary lows due to Lantus and she said that did not make sense. When I finally got a CGM a few years ago, I proved this out to both myself and to her. I ditched the Lantus reducing how much I took every day over a couple of weeks until I stopped taking it and guess what? No more scary crazy nighttime lows. So for the past few years I have only been on the Humalog fast acting insulin and have been able to flatline my blood glucose 24/7. Hope this helps although YDMV

This does help, thank you.

As you well know, managing blood glucose is complicated. I only use insulin but I must factor in insulin dose timing and size. Food timing, amounts, and meal size also makes a difference. As does exercise, stress, and sleep quality.

Well, you get the idea. A hundred and one things including your diabetes pills all affect your blood glucose. Have you thought about using a continuous glucose monitor? If you don’t already use one, this is the missing piece for your peace of mind and safety. It can sound an alarm that will help you catch and counteract those scary hypos.

I lived with dosing insulin for 25 years without a CGM. With a bit of luck, I managed to survive through some crazy scary lows.

In addition to the safety benefits of a CGM, it is the single best teacher to help you learn how insulin, other meds, food, exercise and stress all affect your glucose levels. Your endo and PA can only make guesses after you give them the rough details of what happened after a scary low. The CGM will warn you in real time that you’re about to walk over a cliff.

After 37 years of using insulin, I think flying blind without a CGM is a poor choice and risky business. I apologize if my strong opinion may offend; I’ve crashed and burned too many times. If you use insulin, you will eventually go low. There’s no getting around that.

When I took a pump vacation a few years back, I used Tresiba as my basal insulin. I found that it provided a nice steady and peakless ride. Just keep in mind to allow 2-3 days between making any dose changes and judging whether it’s working or not.

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I don’t feel bad about these numbers.

We are in such a high risk time that running a little higher might be preferable than running on the low side (especially if you have seen some disruptive/concerning lows).

I’ve been running aggressive insulin dosages that put me on the low side and I have also had some severe lows during the pandemic. I don’t think that was practical. I now believe that I was being a little irresponsible, given the current state of the world.

I don’t want you to live in a state of fear. I agree with @Terry4 that you are well suited for a CGM, especially if you are taking insulin and especially if you are hypo-shy. There’s just nothing that could benefit you more - physically, emotionally, and intellectually.

This is what my sensor data looks like from Dexcom:

Hi, thank you for your reply. A lot of it hit home.

I do use a CGM, currently the Dex G6. Used the G5 a few years ago, stopped, got on the Libre, stopped, started again with the G6 at the beginning of 2020 and had so many problems I stopped, but now on it again, so far sensor number 1 is spot on. I’m learning to use it for trends and still do finger sticks, not nearly as many as I was without it.

Yes, the Tresiba does seem to provide a nicer ride, steady ups and downs.

I will keep in mind all the things you said, which is basically what my PA-C said. Diabetes is a complex disease. I guess having T2 diabetes for 20 or so years, I’m worried I’m getting sicker instead of healthier. Weird, I know.

Be well.
Michelle

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Thank you, I appreciate your support.

As I mentioned above, I am using the G6 again after having lots of issues with it earlier this year. So far, the first one I’ve worn has been spot on. I’ve been really paying attention to how foods/exercise affect my BS. If I eat something and go high, I get on the elliptical for 10-15 minutes. I enjoy watching it come down.

But, still dealing with the fear, although less. It will just take time.

Before I had cgm I was anxious to sleep alone. Business trips were terrible and I would wake up several times a night.
Now I have no anxiety. I get the predictive low warning on. I can head off all the lows
I know I’ll be woken up if there’s a problem.
It’s changed my life.

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I had issues early on w/ G6. I can’t say there aren’t issues that pop up.
I don’t think that we have gotten to the bottom of those ‘issues.’

Did you have ‘issues’ that lasted about 3 months and then went away?
That’s a thing. I blame a manufacturing fault that comes in shipments, given no other viable explanation.

Mine works pretty well most of the time. I get those blank times where it is figuring out calibration.
But if you manually calibrate at that time it usually comes right back.
Maybe I’m just lucky with it.

I hesitate to offer suggestions without direct questions but If I were a T2D, I’d certainly would want to know about this program. Many people with long-term T2D have been able to get off their diabetes medications, some including insulin.

I’m very much a do-it-yourself person and you could achieve the goals of Virta Health on your own but this program seems safer to me. Sorry if you’ve already considered and discarded this idea.

I am sorry you are having terrible lows, that is very frightening. Has the tresiba helped? I would get the cgm as others said, try to figure out what is going on and then if you can’t work it out on mdi and long acting, try a pump. You will have complete control over the basal that way. Things will not be perfect but for me is has been wonderful in treating sudden bad lows and also highs.

I get that. When I was single I used to put the receiver in a glass tumbler with glass stones so I wouldn’t miss the alert.

Now with COVID stress and restless nights and the compression lows from earlier this year I turn it off at night. I drink a LOT of water and get up a couple of times a night to pee. I use my meter to test at those times. It’s working out good.

I guess I’ll chime in on the CGM cheerleading team. I was surprised when my docs wanted me on a CGM even before they had me on insulin but I am so glad I went ahead and got one. I rarely get low’s, especially at night, but one night my alarm went off at 70 saying I’d be at 55 in ten minutes. Maybe you could set your low alarm a little higher, that way, you have time to react and treat. My sugars usually are high at night, so I don’t know why I had a low like that. Also, they loosen the guidelines for blood sugar control for seniors because of low blood sugars. Low’s are particularly dangerous for those of us in our “golden years.” A blood sugar of 36 is very dangerous. I hope that never happens to you again. I wouldn’t dream of going on any kind of insulin without a CGM, specifically because of nighttime lows. Good luck to you.

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The reason you were having those issues w Lantus is almost definitely specific to Lantus (and other biosimilar insulins) and how it works. When you inject Lantus, it crystallizes in your tissue due to pH differences in your body, and then those crystals dissolve slowly over about 20-24ish hours to work as insulin. That’s great when it works, but if you accidentally inject into a blood vessel, Lantus doesn’t crystallize properly and can instead all start working right away (or this may happen to some of the dose). Then instead of a gradual effect, you drop like a rock. Tresiba doesn’t work like this at all, which is probably why your doc switched you (neither does Levemir, but that tends to require 2x a day dosing). Do not worry about the same thing happening—it won’t. There is no way to use Tresiba that will result in a quick drop. That said, with Tresiba, you want to raise the dose very gradually, giving each adjustment 3-4 days to fully kick in, before raising again, because it is so long-lasting.

Also you may need a CGM, but you really may not, if the Lantus issue was the only time you had that kind of low. It will never hurt of course, and if you can get it great, but I don’t think from just what you’ve said alone you have reason to be anxious without it.

Good luck!

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Omg, thank you so much for this explanation. I had to stop what I was doing to reply. You have NO idea how satisfying this is to have an answer vs my PA-C saying it was an “anomaly”. I am about 60 lbs overweight and never thought I could inject directly into a blood vessel due to having belly fat. I did take out a syringe and a pen needle and compare the two. Yes, the pen needle is about half the length of the syringe.

Seriously, I’m in tears.

I am wearing a G6 and am having success with it after a failed attempt earlier this year. I watch it a lot and try not to freak out when I see a “downward” arrow. My first though is it’s the beginning of a crash. I have been running high intentionally due to the anxiety but will slowly increase my dose a little at a time. I so badly want to be in normal range again.

Thank you, you have no idea how much your reply has meant to me!!!

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I’m so glad!

I also think that there may be some individual differences in how well Lantus crystallizes and works depending on people’s specific biochemistry. Many people seem to find it to be very stable and effective, but some definitely do not. Luckily not the only choice!

Hmmm, wonder if it could have something to do with hormones? Went through menopause this year. Didn’t have any troubles until then.

What are the new guidelines?