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Re: [IPk] Hypo control - insulin

Hi Pat, Melissa and others

Thank you all for your help over the past week.

Melissa, I had kept in my mind what you said today and previously about 
maintaining a level of 8 but had not managed to get the bgs higher at 
bedtime until the day before yesterday when I really took on board that it 
was the bolus and not the basals which was to blame for the trouble.  I have 
now managed to get through 2 nights although I did wake up sweating in the 
middle of the night and tested but my bg was not low.  I will continue this 

What you said about glycogen had also been going through my uneducated 
brain.  Even before this three weeks I had been having more hypos than made 
me happy and have recently seen my GP requesting tests on my liver.  These 
have come back OK.

I knew I had read something like you have just said in the past but could 
not fully understand it.  Thanks for explaining again.  This really sounds 
like the reason for the problem and sounds hopeful for the future.  I will 
take your message with me tomorrow so I can explain what I am thinking.  I 
am also making a list of all the ideas which have been considered over the 
past week.

Hopefully I shall soon be able to go to bed again with a reasonable bg and 
actually sleep more deeply. I am finding it all exhausting which can't be 
helping.  It's a good job I am retired.  Thanks again to everyone who has 
contributed ideas and comments.

----- Original Message ----- 
From: "Melissa P. Ford" <email @ redacted>
To: <email @ redacted>
Sent: Sunday, June 25, 2006 5:02 PM
Subject: 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.
> Melissa
> Type 1 13 years; MiniMed pumper 7.5 years; Animas pumper 2.5 years
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