Hypo Awareness

Had diabetes for 32 years. New to Dafne but have been counting carbs. for about 6 years. Is there anyone that's has had hypo awareness. I haven't worked for about 8 months because of this and have been trying all of this time to get it back. Does anyone have any advice. I have just about had enough of diabetes

Hypo unawareness usually develops from having too many hypos. I attended an excellent presentation by Professor Stephanie Amiel recently on fighting hypos:

https://youtu.be/jV1ta51w5J4

https://www.diabetesvic.org.au/See-all-news-detail?content_id=a1R9000000JPHzjEAH

I found it very helpful and I'd highly recommend viewing it.

My understanding of regaining hypo awareness is to avoid having hypos for a period of time. This can be achieved by raising your target BG levels for a period of about 6 weeks, so rather than aiming to keep BGs between 4.5-8, you would look at keeping them between 6.5 -10. The risk of diabetic complications over such a short period of time is extremely low, and usually some hypo awareness will return by the end of the 6 weeks.

An alternative (if you can afford it) is to wear a continuous glucose monitor (CGM). I wear a Dexcom G4 which alerts me when my BGLs drop below a set BGL reading that I have specified as being low for me. Prior to wearing the CGM, I was confident that I had excellent hypo awareness, but once I was wearing it, I discovered that I was having multiple hypos, especially during the night, that I had no idea about. My hypo awareness is now much better as I have avoided having as many hypos as previously. The Abbot Freestyle Libre is a popular choice on this forum and is certainly cheaper than the Dexcom. However, unlike the Dexcom it does not alert you when you are hyper or hypo, so is not as useful for avoiding hypos (although it can be excellent for detecting patterns).

Hope that helps.

Warwick said:
Hypo unawareness usually develops from having too many hypos. I attended an excellent presentation by Professor Stephanie Amiel recently on fighting hypos:

https://youtu.be/jV1ta51w5J4

https://www.diabetesvic.org.au/See-all-news-detail?content_id=a1R9000000JPHzjEAH

I found it very helpful and I'd highly recommend viewing it.

My understanding of regaining hypo awareness is to avoid having hypos for a period of time. This can be achieved by raising your target BG levels for a period of about 6 weeks, so rather than aiming to keep BGs between 4.5-8, you would look at keeping them between 6.5 -10. The risk of diabetic complications over such a short period of time is extremely low, and usually some hypo awareness will return by the end of the 6 weeks.

An alternative (if you can afford it) is to wear a continuous glucose monitor (CGM). I wear a Dexcom G4 which alerts me when my BGLs drop below a set BGL reading that I have specified as being low for me. Prior to wearing the CGM, I was confident that I had excellent hypo awareness, but once I was wearing it, I discovered that I was having multiple hypos, especially during the night, that I had no idea about. My hypo awareness is now much better as I have avoided having as many hypos as previously. The Abbot Freestyle Libre is a popular choice on this forum and is certainly cheaper than the Dexcom. However, unlike the Dexcom it does not alert you when you are hyper or hypo, so is not as useful for avoiding hypos (although it can be excellent for detecting patterns).

Hope that helps.

I can see why you are feeling frustrated. There seems to be large swings from hight to low and back again with not a lot of readings in the desired range.

Can I ask why the number of basal injections vary so much from day to day? i.e Sunday 1 basal injection, Monday 4, Tuesday 2, Wednesday 4, Thursday 6, Friday 3, Saturday 5 and Sunday 4.

When I look at others' diaries, usually they inject basal insulin only once or twice per day, and it tends to largely be the same amount each day at the same time(s). If this isn't just a diary input error, then it would explain why your BGLs are so unpredictable.

One of the DAFNE principles is to only make small changes (10%) to basal insulin doses and then wait a couple of days to see how BGLS respond.

Also, not particularly important, but a CP is 10g of carb. I suspect that you are entering grams of carbs instead of CPs. So for example on Monday, your 126 CPs would equal 1.26 kg of carbohydrate which would be a fairly significant achievement Just in terms of making the diary more readable for others, if it is in fact 126 grams of carb, then divide by 10 and round to the nearest CP so it becomes 13 CPs. Or if it is more helpful for you to leave it in grams, then leave it that way and we'll figure it out.

Thanks,
Warwick.

Thanks Warick. Yes that's right about the carbs. and portions just the way I write it and my memory is bad so the nurse said she can put up with it. I asked my ex wife about my severe hypo years ago and it was probably more than 6 years ago. I was only seeing a endo. for about 6 mths after that. The start of this year or late last year I have just seeing one again. They are thinking in all that time 6yrs. or more that I have probably lost my hypo awareness. That is probably right. I haven't worked for 12 months because I can't get a medical clearance. I'm working hard on getting it write but some days I have had enough a lot of ups and downs. I don't no weather I'm Auther or Martha some days any way enough of my problems it's a beautiful sunny day😎 Thanks Warick. I'm bloody hopeless with computers and writing as you have noticed and that why basal entry's are wrong. Am and Pm it should be of 8 units levemir.
Thanks Richard

No problem Richard. I just wanted to be sure rather than assume something that wasn't actually correct.

You keep a very detailed diary, so well done on that.

Is the above fairly typical for you with mainly high values or was that week different from usual?

Do you feel hypos occasionally or do you have no symptoms at all?

Would you be able to post your diary for this week? I think that your basal (or at least your night time basal) is correct.

Your blood sugars rise significantly between early morning and when you take breakfast about 10 am. There are two possibilities that I can think of to account for this:

1) You are suffering from Dawn Phenomenon which most T1Ds do suffer from. You will notice that most of your overnight (1 am readings) are pretty good, but during the night they rise and then keep on rising from 7ish in the morning until you have breakfast around 10.

2) Your basal insulin runs out overnight. This could well be a possibility as you are injecting very early evening, and then waiting until mid-morning to inject again so there is about a 16 hour interval between your evening dose and your morning one, and then only about 8 hours between morning and evening dose. Can I suggest that you change the timing of the basal insulin doses so they are almost exactly 12 hours apart? That would then allow me to see if it is the basal insulin running out, or the Dawn Phenomenon that is the issue.

What QA and basal insulin are you on? If you are on Lantus which generally lasts 18-24 hours, then it probably isn't the second possibility above, but if you are on something like Levemir which has a shorter action time, then it could well be.

Thanks,
Warwick.