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Worried about husbands low blood sugars
by gaylemh, Mar 29, 2006 12:00AM
Hi,
My husband, 53 was recently diagnosed with diabetes. Pills were tried but didn't work, so now he is on Novolog. (20 units before breakfast and 20 units before dinner). (Is this a high dose?) He has had a number of low readings, sometimes as low as 35. Normally he can feel it coming on and has juice or soda and he's fine. The problem is a couple of times it hit so fast that as he is getting something to drink he passes out. I am new too all this and it's very scary when it happens. My question is, is there long term physical or mental damage when the sugars go low too often. Also if no one is there to help, would the person die? (This is my biggest fear, I realize I can't be with him 24/7, so when I'm not there I'm always worried, and have become a very anxious person.)
Also is it nomal for someone to fight your trying to help them when their sugar is low? He argues with me and its hard to get him to drink something?
Any help or info would be appreciated.
Gail
My husband, 53 was recently diagnosed with diabetes. Pills were tried but didn't work, so now he is on Novolog. (20 units before breakfast and 20 units before dinner). (Is this a high dose?) He has had a number of low readings, sometimes as low as 35. Normally he can feel it coming on and has juice or soda and he's fine. The problem is a couple of times it hit so fast that as he is getting something to drink he passes out. I am new too all this and it's very scary when it happens. My question is, is there long term physical or mental damage when the sugars go low too often. Also if no one is there to help, would the person die? (This is my biggest fear, I realize I can't be with him 24/7, so when I'm not there I'm always worried, and have become a very anxious person.)
Also is it nomal for someone to fight your trying to help them when their sugar is low? He argues with me and its hard to get him to drink something?
Any help or info would be appreciated.
Gail
Doctor's Answer
by JDRF-Team-sgg, Mar 30, 2006 12:00AM
Yes, with the fast-acting insulins such as Novolog and Humalog, blood sugar levels can drop very quickly if the match between the carbohydrates that the person eats and the insulin dose are not perfect. Also, I find that since foods with higher fat content digest at a slower rate than foods that have little or no fat, sometimes the insulin action peaks before the carbohydrates have been digested (as in the case of french fries, for instance), and I can drop low before the food completely digests even if the match of insulin to the amount of carbohydrates is correct. So the balancing act is a difficult one.
As for why your husband becomes less than cooperative when you tell him to drink some juice, this is common. I believe that when our brains are not functioning well, we cannot think clearly enough to understand that we are in trouble, and tend to refuse all sugary foods or drink because we know that normally we cannot have these foods. So the instinct is to refuse. He is NOT in control of his brain functions at those times, so you must realize this and don't let any anger or argument bother you. This happens because his brain is not working well, and he cannot help it. So tell yourself that this is not his real personality, and ignore it. You may have to try various techniques to get him to cooperate. In my case, my husband has found that raising his voice a little and sort of barking an order at me works best.... I get angry, but I comply with his wishes and later on understand that he did this to sort of "shock" me into action (i.e., drinking the juice). In the case of another couple I know, the husband sort of gently cajoles, and does this over and over until his wife cooperates. He tells me that he has found that she is likely to not drink juice when he tells her to, but that she WILL test her glucose levels when he asks her to. Once she sees a low number on the glucometer, she will then let him bring her a glass of juice. So you might want to try asking him to test his glucose levels when low rather than just asking him to drink juice. He may be more agreeable, for if he is right, he can prove it by doing the test, and the test can remove any doubt about whether he is OK or not.
Let me suggest that you ALWAYS keep a Glucagon Kit in your medicine cabinet. If you don't know what this is, it is a substance that stimulates the liver to release emergency sugars that will raise the blood sugar levels temporarily if a person passes out. After injecting glucagon, the person will come to and then can drink juice or eat something solid. If he gets so contrary that he absolutely refuses to cooperate and then passes out, you can inject this substance and bring him back without having to call an ambulance. So ask your doctor for a kit and always keep one handy. It can take the fear away to know you can help him if he passes out.
The dosage you mention may be normal or may be high, for each person has his own body chemistry and needs a dosage specifically set up for his or her own needs. I would hope that his doctor has not just told him to take 20 units before each meal, but has explained how the person must calculate his insulin needs based on the number of carbohydrates that he intends to eat. Most doctors work with the indivicual to establish a mathematical formula that we use before we eat to figure out exactly how much insulin we need for each meal. This way, we can be sure that the dosage is pretty accurate for that particular meal, and we can alter the dose for variations in food. If he has been given a standard dose and no education about how to count carbohydrates or alter the dose of insulin, I suggest that you ask his doctor to refer you to a diabetes educator to learn these things.
Some of your other questions are about long-term brain damage or about danger of death. Some studies that I have read about tend to indicate that there can be some damage to short-term memory if a person has many lows that are not fixed quickly and that get severe. From what I have read on the subject, the most important thing is to fix the low as quickly as possible, so the body is not low long enough for the brain to send out signals of danger or for brain cells to be damaged. It is suggested that instead of eating a snack when low, we always go for the quickest possible digestion of carbs via juice or sports drink (which supposedly is even quicker than juice at fixing the problem). As for danger of death, yes, people have been known to pass out from low glucose levels (usually at night while asleep) and die, but this is very rare. The person has hours before being in any danger of loss of life if unconscious.
If sugars are going low often, then it is indeed possible that his dose of insulin is too high, and he may need to work with his doctor to lower it. I wish you both the very best.
As for why your husband becomes less than cooperative when you tell him to drink some juice, this is common. I believe that when our brains are not functioning well, we cannot think clearly enough to understand that we are in trouble, and tend to refuse all sugary foods or drink because we know that normally we cannot have these foods. So the instinct is to refuse. He is NOT in control of his brain functions at those times, so you must realize this and don't let any anger or argument bother you. This happens because his brain is not working well, and he cannot help it. So tell yourself that this is not his real personality, and ignore it. You may have to try various techniques to get him to cooperate. In my case, my husband has found that raising his voice a little and sort of barking an order at me works best.... I get angry, but I comply with his wishes and later on understand that he did this to sort of "shock" me into action (i.e., drinking the juice). In the case of another couple I know, the husband sort of gently cajoles, and does this over and over until his wife cooperates. He tells me that he has found that she is likely to not drink juice when he tells her to, but that she WILL test her glucose levels when he asks her to. Once she sees a low number on the glucometer, she will then let him bring her a glass of juice. So you might want to try asking him to test his glucose levels when low rather than just asking him to drink juice. He may be more agreeable, for if he is right, he can prove it by doing the test, and the test can remove any doubt about whether he is OK or not.
Let me suggest that you ALWAYS keep a Glucagon Kit in your medicine cabinet. If you don't know what this is, it is a substance that stimulates the liver to release emergency sugars that will raise the blood sugar levels temporarily if a person passes out. After injecting glucagon, the person will come to and then can drink juice or eat something solid. If he gets so contrary that he absolutely refuses to cooperate and then passes out, you can inject this substance and bring him back without having to call an ambulance. So ask your doctor for a kit and always keep one handy. It can take the fear away to know you can help him if he passes out.
The dosage you mention may be normal or may be high, for each person has his own body chemistry and needs a dosage specifically set up for his or her own needs. I would hope that his doctor has not just told him to take 20 units before each meal, but has explained how the person must calculate his insulin needs based on the number of carbohydrates that he intends to eat. Most doctors work with the indivicual to establish a mathematical formula that we use before we eat to figure out exactly how much insulin we need for each meal. This way, we can be sure that the dosage is pretty accurate for that particular meal, and we can alter the dose for variations in food. If he has been given a standard dose and no education about how to count carbohydrates or alter the dose of insulin, I suggest that you ask his doctor to refer you to a diabetes educator to learn these things.
Some of your other questions are about long-term brain damage or about danger of death. Some studies that I have read about tend to indicate that there can be some damage to short-term memory if a person has many lows that are not fixed quickly and that get severe. From what I have read on the subject, the most important thing is to fix the low as quickly as possible, so the body is not low long enough for the brain to send out signals of danger or for brain cells to be damaged. It is suggested that instead of eating a snack when low, we always go for the quickest possible digestion of carbs via juice or sports drink (which supposedly is even quicker than juice at fixing the problem). As for danger of death, yes, people have been known to pass out from low glucose levels (usually at night while asleep) and die, but this is very rare. The person has hours before being in any danger of loss of life if unconscious.
If sugars are going low often, then it is indeed possible that his dose of insulin is too high, and he may need to work with his doctor to lower it. I wish you both the very best.
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In answer to your question, it is very unlikely that a low blood sugar would lead to death. With hypos, the danger is falling or having an accident that causes injury. So I wouldn't get too worried. But, having said that, hypos should be avoided by managing the combination of food, insulin and exercise. And it doesn't sound like you have been given the tools to do this.
It is quite normal for a diabetic to fight with someone trying to help. So don't take it personally and be firm if you have to get him to take a sweet drink. An aggressive reaction is typical.
Cheers,
Mark
He is pretty good as far as taking his sugars and drinking something if he can catch it before it goes too low.
He fights with me when he has reached the point of where he cannot do it himself. I think part of it is he is very angry about having diabetes to begin with. He is a very quiet person and keeps things to himself, including taking care of his diabetes.
All of this came about with septic shock, when they brought him to the hospital after he passed out 2 years ago, his sugar was 600 and he was in septic shock. He had been at the doctors a month before and his sugars were normal. He also had damage to his pancreas and liver apparently from the same infection, which is where the diabetes probably came from.
Maybe the liver involvement is why his sugars are so hard to control.
I always though the injection for low sugars worked with the liver, maybe that's why the doctor never gave us one. What I try to do is put the sugar gel under his tongue a little at a time until he comes to, and is able to drink something. Normally this works, but the last time I needed to call ems. He started to come out of it a little when they got there, and they were able to give him more of the gel.
How long can you wait,to see if they come out of it before calling ems? The last time was very scary as he was having what appeard to me to be a seizure, and I panicked.
After about a half hour he seeems fine, I'm the one that's still a wreck for the rest of the day.
Thanks again for all your replys.
Gail
According to my husband's doctor and diabetes educator, 20 units of 30/70 mix novolog isn't a large dose. He doesn't take it every time he eats just before breakfast and dinner.
He is not overweight, in fact he had lost about 30 pounds when this first happened 2 years ago. He is 6 foot tall and weighs 165. His weight has been steady for the last year, but he is having trouble gaining weight. The way I understood it from the doctor he is type 2.
He has another appointment in a few weeks, we will be sure to ask about different size doses.
It's good to know that I have some time to see if the gel works.
This is all still pretty new to me and I get very panicky when it happens. The last time he had fallen on the floor and passed out. This is the first time that had happened, and it really scared me. Twice before he was sitting on the sofa and I noticed him shaking, but he didn't pass out, (although he didn't know what was going on and couldn't help himself) I was able to get him to drink some soda.
Thanks again for all your answers,
Gail
Regular use of a meter will give you the information you need to make informed treatment choices. Until you get used to it, test the blood sugar before injecting/eating and every hour for the next three hours. You will then be able to see exactly what is going on. The obejective needs to be to get the blood sugar into the target raange before meals and to inject only enough insulin to get it back down there after 2 hours.
Because of his medical history and normal weight, your husband may need to be treated more like a Type 1. And if you are serious about wanting to stop the hypos and get in control, you need to separate out the basal and bolus shots. Get him onto an intensive therapy insulin regimen, which involves one long-acting shot a day and short-acting shots befort each meal. It will give him the control he needs to avoid hypos.
Cheers,
Mark
I see that your hubby is tall and weighs 165 and that he lost weight upon diagnosis. Type 1 is an autoimmune disease, and since your hubby had such a terrible infection around the time of diagnosis, it wouldn't surprise me if his immune system took quite a beating in the process.
It is interesting to me that his doc has dx'd him with Type 2. Type 2 *is* a lot more common in adults and yet they usually are overweight. Has your hubby been tested with an antibody test (as Markie asked a few comments ago)? Is he being followed by an endocrinologist or his general practioner?
Endocrinologists are specialists in diagnose & treatment of diseases like diabetes.