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
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...
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
>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!)
email @ redacted
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