# unexplained hypos



## sunjean (Oct 5, 2013)

Hi, Just joined this site as a wife of a type1 for 38 years and thank you for your welcome messages. Hubby has been using a pump for 3 years now. Knows it inside out and could probably pass a degree course in pump using!! The problem we have are unexplained hypos which are at times severe. After each one we try to work out why it happened but sometimes just can't. These are usually the severe ones which require me to force glucose down him in order to bring him back to normality and as other carers will know can be very difficult when the diabetic refuses to cooperate and open his mouth!!
The last one was this week when he was so confused he did not know who I was and was imagining hundreds of people " panicking and trying to feed him sugar and they had to stop." The only way I could get him back to normal was to tell him that he could make them stop by eating these special tablets in my hand (dextrosol ) which thankfully he did. This was the worst one I have ever seen and was quite scary. 
As usual when it was over we looked at what could have gone wrong but prior to his tea his blood sugar levels were fine at 6.5 and he pumped in the right amount of insulin for the carb value of his food so why a couple of hours later he should have such a bad hypo is unexplainable.
He is now wearing a sensor alongside the pump to see if we can get a pattern over the next week. 

Two things I'd like to ask. Does anyone have any tips/advice to make it easier to get glucose down my hubby at these times that they have tried. Also does anyone know if the blood glucose sensors are available on the NHS yet as they cost us ?50 a time and only last for a week. I always feel much happier when he is wearing one but the cost is just too much to use one all the time.

Sorry to have gone on a bit but thank you to anyone who has read this and I feel much better for getting it off my chest!!  I sometimes feel quite isolated as a wife of a diabetic as the emphasis is usually on the patient and not on the person looking out for him.


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## novorapidboi26 (Oct 5, 2013)

Hi, sorry to hear your hubby is having these severe hypos..........what kind of level is he at on these occasions......?

Do you now how much insulin he takes at meals and the basal over the whole day.......I expect he is on very little....

In all my 15 years diabetic I have never had a hypo that I couldn't treat myself however my wee brother had a few bad ones and sugary liquid was the best thing at that time, otherwise glucagon was injected.........has he one of these injections for emergencies.....

don't know much about cgm availability either but fingers crossed it reveals the answer......

welcome to the forum.....


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## Pumper_Sue (Oct 5, 2013)

Hello and welcome to the forum. 
Has your hubby done any basal testing lately? If not well worth doing.
My basals a pain and shift every couple of weeks 
I find the quickest form of glucose is using liquid glucose found in the cake making aisle in the supermarket.

Sensors ask someone how to reset them as many people get 2 or 3 weeks out of one sensor. 
It's very rare to get them on the NHS, but it can be done.

These hypos do they come up once you have the glucose in him, or does it take a lot of glucose to get any movement in blood sugars?
If the above then ask to be tested for Addison's disease.

Other ideas are as it was within a couple of hours of eating, is his carb ratio correct and or did he do the wrong type of bolus for the food he ate. IE did he have a high fat meal so insulin hit home before the carbs did?
Another option, is his tummy emptying properly IE has he nerve damage from his long term diabetes?


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## Lauras87 (Oct 5, 2013)

Hi & welcome.

Sorry to hear about your husbands hypos. 
Have you tried liquid glucose to treat him when he's too far gone?

Has he recently checked his basal? Just wondering if this maybe part of the problem


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## Northerner (Oct 5, 2013)

I'm just wondering, if he has been diagnosed for a long time, whether his sites are compromised in some way e.g. by scarring or lipohypotrophy? This can lead to erratic absorption of the insulin.


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## Redkite (Oct 5, 2013)

Hello sunjean,

There are a few possibilities:

- his carb counting was correct but is the carb ratio correct for that time of day? (for example, if he is getting these hypos always after tea, his tea time carb ratio would need adjusting);

- the type of food may have needed a dual wave or extended bolus (some foods, e.g. pasta are slower to digest, and the insulin reaches the bloodstream before the glucose from the food);

 - had he been doing any energetic exercise before eating?  (we always find less insulin is needed for a meal after exercising).

Another thought that springs to mind if he is having mysterious severe hypos (and none of the above things apply) is coeliac disease.  Your husband should be checked annually for coeliac antibodies (one of the checks done at his annual blood tests), as this is another autoimmune condition that people with type 1 have a higher risk for.  Perhaps he could check his last annual review results and see if this was done, and if not he should request a test for this.

I can't offer any advice on helping him take his glucose tablets, as my son is 12 and so far has always been cooperative.  What I would say is that we find liquids to be easier than tablets when he is in the 2's or lowest 3's - mini cans of coke are ideal.  Some people find it easier to suck through a straw than to chew hard dextrose tablets.


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## Redkite (Oct 5, 2013)

P.S. sensors are fab, and I wish we had them full time too!  Funding on the NHS is extremely difficult - my son's consultant is trying to make a case for exceptional needs funding due to his kidney problems, but since the change to CCGs there is a wall of silence on funding sensors.


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## trophywench (Oct 5, 2013)

That's the first I've ever heard about coeliac antibodies causing severe hypos.  Why is that?

I've never ever been checked, never ever heard that I was supposed to and never displayed any symptoms of gluten intolerance of any kind, so it's never occurred that I ought to be..

More info please Redkite.  Is it in Pumping Insulin or TLAP ?


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## Hanmillmum (Oct 5, 2013)

trophywench said:


> That's the first I've ever heard about coeliac antibodies causing severe hypos.  Why is that?
> 
> I've never ever been checked, never ever heard that I was supposed to and never displayed any symptoms of gluten intolerance of any kind, so it's never occurred that I ought to be..
> 
> More info please Redkite.  Is it in Pumping Insulin or TLAP ?



Coeliac testing should be part of your annual tests as far as I know as it is another autoimmune disease. My little one has just been dx with coeliacs from the blood test showing antibodies, she didn't have any symptoms other than the occasional tummy ache and constipation. Was quite a shock tbh. Didn't suffer with any severe hypo's though either as a result but I suppose if gluten destroys the villi then absorption of foods becomes a big problem over time.


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## Redkite (Oct 5, 2013)

trophywench said:


> That's the first I've ever heard about coeliac antibodies causing severe hypos.  Why is that?
> 
> I've never ever been checked, never ever heard that I was supposed to and never displayed any symptoms of gluten intolerance of any kind, so it's never occurred that I ought to be..
> 
> More info please Redkite.  Is it in Pumping Insulin or TLAP ?


I am no expert on coeliac, this is just stuff I've picked up from other forums!  Screening for coeliac antibodies is definitely supposed to be part of the annual tests for people with type 1, as is screening for thyroid antibodies.  People with undiagnosed coeliac can have all sorts of problems with food absorption, leading to hypos (not necessarily severe) among other things.


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## Pumper_Sue (Oct 5, 2013)

I was always told the blood test was unreliable as gave a lot of false negatives  I'm only screened if I ask for the test though.
Perhaps it's different for children?


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## Northerner (Oct 5, 2013)

Redkite said:


> I am no expert on coeliac, this is just stuff I've picked up from other forums!  Screening for coeliac antibodies is definitely supposed to be part of the annual tests for people with type 1, as is screening for thyroid antibodies.  People with undiagnosed coeliac can have all sorts of problems with food absorption, leading to hypos (not necessarily severe) among other things.



I wonder if I'm being tested for it? I only found out the other day that I am being tested for thyroid - my consultant was looking at my notes and said they were very comprehensive with my tests, so possibly other things as well!


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## Redkite (Oct 5, 2013)

Pumper_Sue said:


> I was always told the blood test was unreliable as gave a lot of false negatives  I'm only screened if I ask for the test though.
> Perhaps it's different for children?


From what I can gather, if you test positive for coeliac antibodies, you would not receive a diagnosis of coeliac without first having the results confirmed with a biopsy.  But I did think it was part of the standard annual tests, as coeliac can develop at any age, similarly to type 1.


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## trophywench (Oct 6, 2013)

Well it isn't part of DUK's 15 essentials LOL and I can assure you I know exactly what tests I have because ever since 1972 I have always had the forms that go off to the lab with the blood, well prior to having the blood taken.

You have to take them with you when you see the vampire, as the GP surgery vampire does not have access to where the hospital blood tests are requested, since they are standard pre-printed Diabetes Clinic forms and they have a pile of then and just stick a label on one to identify the patient, though the surgery can access the results afterwards.

It's never been mentioned to me at all in over 41 years.


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## HOBIE (Oct 6, 2013)

Glucogel is the stuff for YOU & hubby. You can get it on perscription & comes in box of 3.  They are in small tooth paste tubes. You snap the end off & squirt it in gob.  When you are in that type of Hypo you are fighting for your LIFE & your head is in a different place  I am quite strong & i know my wife has had a rought time in the past.   Hope this helps


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## Redkite (Oct 6, 2013)

trophywench said:


> Well it isn't part of DUK's 15 essentials LOL and I can assure you I know exactly what tests I have because ever since 1972 I have always had the forms that go off to the lab with the blood, well prior to having the blood taken.
> 
> You have to take them with you when you see the vampire, as the GP surgery vampire does not have access to where the hospital blood tests are requested, since they are standard pre-printed Diabetes Clinic forms and they have a pile of then and just stick a label on one to identify the patient, though the surgery can access the results afterwards.
> 
> It's never been mentioned to me at all in over 41 years.


Hmm, the plot thickens! . Maybe it's just children who are screened then, but that seems odd when all folks with type 1 are at greater risk of coeliac.  And Hashimoto's thyroiditis - do adults get screened for that?


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## trophywench (Oct 6, 2013)

Yup, our TSH gets checked at least once a year.


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## Pumper_Sue (Oct 7, 2013)

HOBIE said:


> Glucogel is the stuff for YOU & hubby. You can get it on perscription & comes in box of 3.  They are in small tooth paste tubes. You snap the end off & squirt it in gob.  When you are in that type of Hypo you are fighting for your LIFE & your head is in a different place  I am quite strong & i know my wife has had a rought time in the past.   Hope this helps



My GP and many others refuse to issue glucogel. (Costs about ?11 for 3 tubes)
There's a better tasting alternative to be had in the supermarket.....
It's called liquid glucose comes in 140gm tubes so plenty of hypo treatments for ?1.04.
Also icing sugar in tubes is very good, people in the USA tend to use this as a very quick fix. Just think of all the different colours you can choose from.


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## everydayupsanddowns (Oct 7, 2013)

I'm never quite sure which tests are checking what. eg FBC (full blood count) - should prob look that up to see what it means!


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## Aoife (Oct 7, 2013)

everydayupsanddowns said:


> I'm never quite sure which tests are checking what. eg FBC (full blood count) - should prob look that up to see what it means!



Full blood count is testing you haemaglobin, white blood cells (can show infections, problems with immune system) and platelet count


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## fencesitter (Oct 7, 2013)

William def gets an annual check for coeliac as part of the routine


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## bev (Oct 8, 2013)

http://www.diabetes.org.uk/Guide-to-diabetes/complications/Related-conditions/

Hi all,

Like Redkite - I thought everyone was screened - but it seems maybe its just children - although the link does say that adults should also be checked.Unexplained hypo's are one of the signs just after eating - a few children on the CWD list have had these symptoms and ended up with a diagnosis after having a biopsy. It surprises me that it isnt offered in general screenig for all Type 1's given that there is a well-known link/risk.Bev


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## Pumper_Sue (Oct 8, 2013)

Hi Bev,
it could be that an adult would mention any symptoms to their GP or consultant, thus no point in testing unless symptoms showing.


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## everydayupsanddowns (Oct 8, 2013)

Aoife said:


> Full blood count is testing you haemaglobin, white blood cells (can show infections, problems with immune system) and platelet count



Thank you!


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## bev (Oct 8, 2013)

Pumper_Sue said:


> Hi Bev,
> it could be that an adult would mention any symptoms to their GP or consultant, thus no point in testing unless symptoms showing.



Hi Sue,

Yes your probably right - but a lot of people with this condition dont have any symptoms at all. I forget who told me now but someone said that they often find this when doing an autopsy - lots of damage to the intestines which would have had a huge impact on that persons health - often resulting in osteoporosis and worse. It is also important to remember that symptoms like IBS and gastroperiasis (sp?) can often be undiagnosed coeliac. Sometimes feeling bloated can be a sign too - but most people would put that down to feeling full after a meal - so its quite confusing and most people wouldnt have a clue they have any symptoms as such. Certainly as there is a link with Type 1 I would have thought that screening all adults too would be a necessity. Many people say they havent felt so full of energy once they change to GF foods and feel they have their life back. Unfortunately a lot of GP's hand out heartburn remedies as the symptoms can be similar to that - so it masks the condition and it goes undiagnosed for years.Bev


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## trophywench (Oct 8, 2013)

Oh Lawks a mercy!  - I'm just the sort of person who reads the symptoms and thinks they have the disease!

Does coeliac give you the wind? - as in Trumpet Voluntary?  without the follow through, LOL


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## Hanmillmum (Oct 8, 2013)

trophywench said:


> Oh Lawks a mercy!  - I'm just the sort of person who reads the symptoms and thinks they have the disease!
> 
> Does coeliac give you the wind? - as in Trumpet Voluntary?  without the follow through, LOL



Lol - it does, but so do many other things too. 

Coeliac UK recommend 3 yearly coeliac bloods for T1 adults though no official guidelines in place. They report 2-10% T1 are later dx with coeliacs too. There does not appear to be any T1 adults on this forum with coeliacs too. There is no apparent correlation with T2.


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