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Re: [IPk] Hypo control - insulin

Hi Pat and June,

June, I'm gonna return to something I suggested before: the old 'keep your 
sugars around 8 mmol/L for 3 weeks' thing.

I had rather blocked this from my memory because it was so unpleasant but I 
did experience something similar to your current situation a few months ago. 
I had two hypo incidents at work and two hypo incidents at home that all 
scared the beejeezus out of me. The work incidents went like this: high bg 
that wouldn't come down in the morning - a couple of boluses, a set change, 
then lunch, followed by a crashing hypo that went on for 2 hours and took 60 
g carbs to sort out in the afternoon. The home incidents went like this: 
fine bgs before dinner, balanced meal, fine bg before bed, bg below 3 at 1 
a.m. (profuse sweating, disorientation, shaking, panic, etc.). I became very 
worried about myself!!

After the fourth incident I phoned a friend who is a type 1 pumper and a 
Certified Diabetes Educator (American version of DSN, but, it seems, with 
more training than many UK DSNs). She said that I should do the 3-week 
sugars around 8 thing for a couple of reasons. The first is that I did not 
wake up until my glucose hit 2.5 mmol/L when I had the nighttime hypos. This 
meant that I was hypo unaware. The 3-week sugars around 8 thing is proven to 
help restore hypo awareness in many people.

The second reason why she wanted me to try the 3-week sugars around 8 thing 
was to help rebuild the glycogen stores in my liver. You may know that 
long-term type 1 affects the liver's ability to store glycogen. There's 
something that happens with regard to glycogen storage in the non-diabetic 
body that does not happen in the insulin-dependent diabetic body (not that 
anyone knows exactly what it is, as far as I know there's not a lot of 
information on it). My friend asked me to think back to the week before I 
had the first bad hypo experience. Did I have several lows with rebound 
highs? Did I wake up with high sugars in the mornings that might have meant 
my liver had dumped glycogen overnight? I couldn't remember but the point 
she was making was "one bad hypo begets another". If you have a bad hypo and 
your liver has to release glycogen to keep you functioning, that's glycogen 
that the liver may not be able to restore very easily. So your risk of a 
second bad hypo is quite high as there's not going to be enough glycogen 
available in the liver to pull you out of it AND your liver may not be able 
to secrete enough glucose to keep your bg stable to begin with, making you 
even more vulnerable. The next bad hypo you have could practically deplete 
the liver of glycogen, making your bg very unstable between meals and 
creating a scary cycle of hypos, hypos, and more hypos.

When my friend explained this to me, the pieces fit together. I hadn't seen 
the puzzle that way before because I was so worried and anxious. I did the 
3-week sugars around 8 thing to help restore my hypo awareness and to allow 
my liver to rebuild its glycogen stores and I have not had any bad hypos 
like that since. I too thought that perhaps my insulin was 'pooling' and 
being released later: more likely my liver was acting useless when it ought 
to have been making itself useful.

Type 1 13 years; MiniMed pumper 7.5 years; Animas pumper 2.5 years

----Original Message Follows----
From: Pat Reynolds <email @ redacted>
Reply-To: email @ redacted
To: email @ redacted
Subject: Re: [IPk] Hypo control
Date: Sun, 25 Jun 2006 11:35:19 +0100

Hi June,

While running down from 11 to 5 overnight isn't ideal, it is better than
hypos, temporarily.  While hypo asleep you won't have been resting, so
you won't have the energy to sort it out.

I hope Melissa can answer about the insulin - I can think of things that
will make a whole batch less effective, but not things that will
wholesale increase the strength.

My husband (?un) fortunately can do a whole lot of things without his
glasses, include drive.  I have just checked the shower (gosh, I need to
clean it) and behind the toilet, but not there...

Best wishes,


In message <001001c697d9$a45948d0$email @ redacted>, June Searle
<email @ redacted> writes
 >I had not actually thought about the bottle of insulin.  I changed to a
 >fresh one a few days ago.  One thing that strikes me is that I think this 
 >a new supply of insulin.  I collected it a few weeks ago and it is kept in
 >the bottom of the fridge.  I find it difficult to suspect that insulin
 >strength would be different for any particular supply of insulin.  An
 >interesting thought.
 >BTW, where does your husband usually take his glasses off?  I sometimes
 >leave mine in the bathroom.  What is he able to do without them? (Sorry, I
 >too ask the obvious questions!)

Pat Reynolds
email @ redacted
    "It might look a bit messy now,
                     but just you come back in 500 years time"
    (T. Pratchett)
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