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Going Hypo
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dfreyer posted:
As usual I took my insulin injection, 10 Units of Lantus, then retired for the evening. The next thing I remember was an EMT trying to get me to open my eyes. He told my wife my Blood Sugar level was 10.

During this time I never felt so cold in my life, I curled up into a ball. The EMT team tried to warm me with just blankets but could not. When I arrived at the Emergency Room the doctors there told my wife (I was shivering in a tight ball and rolling in and out of consciousness) my body temp was 91.2.

I have had episodes where I have gone Hypo before, but not this severe. What I would like to know is first, why did this happen as I am quite careful with my insulin to make sure I take no more than what I am supposed to take. Second, why did my body temp fall when I was in a warm room and well covered. Lastly, what are both the short and long term effects on my body and how can I prevent this from reoccurring?

I have asked for an appointment with my Internist, however I would like to hear from this Community as well.

Thank you ahead of time for your help and insight.

David

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DavidHueben responded:
David:

I am not an insulin user. I have only had one hypoglycemic event in the last six years since diagnosis. It was when I was working a part-time job at a hardware store after my retirement.

It was a 103° day and I was helping to unload a hundred gas grills from a semi-trailer truck. The grills weighed about 200 pounds each.

I had skipped lunch in an effort to get the truck emptied as quickly as possible. I became weak, lightheaded, and dehydrated. But, I was not cold. My glucose level was 51. After some quick acting carbs and water, I was fine.

It is good you are getting with the doctor. Just out of curiosity, had you eaten properly (enough carbohydrates) before this incident?

Good luck getting to the bottom of this.

David
Watch what people are cynical about, and one can often discover what they lack. - General George Patton Jr
 
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cookiedog responded:
I have been a Type II since 1999. I was controlled by diet and exercise or diet, exercise and oral medicine only until last year.

During those ten years, I did not to my knowledge have a single Hypo episode.

In the past year, I have used long acting insulin. I have had 5-10 Hypo episodes. The lowest BS I am sure I had was 43. In each case, I realized I did not eat enough carb prior to exercising.

When I have gone hypo, I have gotten light headed, cold, confused, trembling and nauseated.
 
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mhall6252 responded:
I have been Type 2 for ten years and have never used insulin. I have never had a hypo incident of any kind. Very lucky me!
 
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nwsmom responded:
I have been Type II for 11 years, always on Metformin, but at one time a short stint on Januvia (all it did was make my wallet thinner). To my knowledge, I have never had a hypo incident. (My current A1c is 5.1.)
 
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arealgijoe responded:
Ouch..... with a blood sugar that low, it could ahve been much worse. My lowest was 25. I had shoveled from 3 or 4 steps befoer lunch and was TIRED. I sat down on the sofa and went OUT COLD. I came back slow, regained hearing first but could not process words well or form sentences. Soon my vision came back and more or less all was normal after the glucose IV. That was my worst case and only time I wnet over & out.

MORAL never shovel etc BEFORE a meal!

I have not had even a minor hypo Sx wise in a few years now. One huge advantage of having my MDI routine properly adjusted and good working knowledge of the insulins I am on. I do keep glucose tabs etc on hand at home, in the car and on my person, jsut in case.

The only time I was taken to ER COLD was after drinking a few sips of coke. I was low on Ox and my bS was HIGH.

Gomer
 
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teddybear200 responded:
Hi I was diagnosed with hyjpoglycemic many years ago, didn't even know I had it until one day driving home from work I was facing head lights. Scarey to say the least.

The man in the car stopped his car before we hit - apparently I passed out at the wheel. They thought I was drunk. The EMT was called they did a finger poke and I was 41. I did not get cold like you explained but I was very sick. I was lucky after that - even with the right foods my sugars barely went up to 80 at any given time.

I was in the "Hypo mode" for at least tens years before I became T2. I have never gone that low again.
One day I will soar on wings of an Eagle - Deb
 
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phototaker responded:
David, how very, very scary for you. I'm type II and have never gotten what happened to you. I have gone lower in my body temperature(very cold) and started shaking one day, and my blood pressure's bottom number was around 47, but my blood sugar was normal.I had to call the advice nurse. I now have bought a BP machine and take my blood pressure when I feel this way, only one other time. I'm not sure what caused it.

You're so lucky you live with someone, whom I assumed called the EMTS! I hope you find out soon why this happened. Please let us know. Good luck!

Gomer's suggestion of carrying glucose tablets, or keeping OJ or something on hand is good. In your situation, you went to bed, so that wouldn't have helped. I wonder if checking your blood sugar before you go to bed would help until you see the doctor.
 
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betaquartz responded:
The only family trait we have is with some sort of low in the BG. Most of my family gets very grouchy/irritable when they haven't eaten within the set time. This can be from being a grouch to hysteria with crying and screaming. Me I am just a bear to get along with. One of the reasons when in group situations where I don't control the meal times I take something with me, fruit, a low carb protein bar etc. I have never had the dizziness, disorientation, or cold clammy that often is associated with Hypoglycemic events.
 
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xring responded:
I've been hypoglycemic since childhood. I passed out in middle school after skipping breakfast & riding my bike 1 mile to school. I didn't know what the problem was at the time & neither did the doctor.

Since my diagnosis, I've had 4 lows - the lowest I've ever tested at was 57. I don't get cold - only a racing, pounding heart, severe shaking & sweating. I start to get those symptoms whenever I'm under 100. My doctor says not to treat when I'm over 70 to train my body to accept normal glucose, but that hasn't happened.
Politicians should serve two terms. One in office and one in prison
 
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laura2gemini2 responded:
The lowest I've gotten was around 27...and I was still awake, eating breakfast on campus. Whenever your body loses the fuel to keep everything going, it starts shutting down some non essential body parts, and I believe thats why you felt cold. Do you have triggers for your low sugars like feeling sweaty, hungy, dizzy, tingly (dopey doc and sneezy)? I know my sugar gets really low when I lose my sense of taste and my tongue starts getting tingly.

Lantus doesnt have a large peak, so Im not sure why your sugar would have gotten that low that quickly without you waking up. Did you just start another type of insulin that is quick acting like humalog or novolog? Did you do anything more strenuous before bed like working out? Or maybe did you eat less? All of those can contribute to low sugars.

As to long term affects I wouldnt worry but you should also talk to your doctor about all of this. I havent heard anything about long term affects of very low sugars, and for me the short term effects are feeling "weird" for a couple hours at least.
 
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auriga1 responded:
Very strange, indeed, that you would go that low with 10U of your basal insulin. So sorry that happened to you. Had to be very frightening.

I've been using two insulins since diagnosis and the first time it happened to me, it scared the wits out of me. I exercise to help keep my sugars in line along with diet and insulin. I still haven't figured out how to keep from going so low.

I must have miscalculated how many carbs I ate after dosing my insulin yesterday. The poor guy at the checkout counter at the drug store kept asking me if I was alright. I had purchased candy to take with me when I exercise and I had to have him open it so I could feel better. The shaking was so bad, I couldn't do it.

The one thing I don't get is cold when experiencing a low. Like xring, the sweats start, shaking and extremely warm. My face gets all red.

I have not been as low as ten, but I have hit 31. Not a good feeling at all because it happens all of a sudden and you can be anywhere at any time.

Glad you have an appointment with your internist. Hopefully, they can figure things out.
 
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Michael Dansinger, MD responded:
Wow, that is a pretty severe hypoglycemic episode. You are asking all the right questions, but you will not likely get satisfactory answers.

The fact is we often can't identify the cause of a hypoglycemic episode. Naturally you want to veryify that there was no inadvertant change in your insulin dose or other medications, as you have done. Then you want to try to review whether there was anything out of the ordinary regarding your food intake or exertion during the hours leading up to the episode, and then you want to consider whether you were somehow dehydrated or ill in any way. After that you want to have your doctor consider whether you have any new medical problems that could have caused this and would put you at risk for future episodes. We usually come up empty after considering all these explanations. You may (or may not) need a dose adjustment and your doctor will want to consider that as well.

Some patients do feel cold with severe hypoglycemia (and get sweats with moderate hypoglycemia). The tissues and organs start to get "low on fuel" when the glucose levels are so low. Think of a campfire that starts to go out and gets cold when there are no more logs to fuel the fire. It took a while for your tissues to reactivate and warm back up. Your doctor can consider whether there are underlying medical conditions such as thyroid or adrenal problems that need to be evaluated or ruled out.

A full recovery from such episodes is the rule, although prolonged hypoglycemia or severe hypoglycemia can cause death or severe brain injury. Mild loss of brain function, for example decreased sharpness or other subtle deficits would also be rare, but can result from the cumulative effect of many hypoglycemic episodes.

Keep us posted.

Michael Dansinger, MD
 
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beccasmurf responded:
That must have been very scary and it was a good thing you had someone with you!
I have been Type 1 for many years. Although I have never tried taking my temperature, when I have a blood sugar of less than 50, I tend to hang out in front of the heater with a blanket until it goes up. It is different with less sever low blood sugars. Then I just have the "thinking through cotton" feel and get very cranky.

As for why it happened, you are asking good questions, but it may come down to life. I have had lows from the normal stuff of over exercising or not eating enough. I have also had lows from being stressed or having my period or changing
schedules with daylight savings time. Many of my "worst" ones have been when I have moved. It is all just a balancing act and sometimes, something just tips the scales and our body reacts differently than we expect.
 
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dfreyer replied to DavidHueben's response:
Thanks David for the reply. Yes, I did eat a good supper (Beef Stew), capping off a daily calorie intake of about 1850.

To prevent such episodes from reoccuring I have changed my
injection time from "before retiring," "upon arising." This should give me enough time to recognize symptoms and break out the Glucose Tabs - should they be necessary. Also my doctor prescribed a "Glcose Gun" (GluCoGon) should I not be able to open my mouth during a Hypo Event. With this regimen, no reoccurences.

David


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