Medical Forum / Diseases and Disorders / Diabetes / August 2006
Treatment of hypos
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guy - 21 Aug 2006 01:37 GMT First a hypo is where you are seriously non functional.
Now I have had a lot of 911 runs It happens when body fails to correct lows via glucose releases, I have been out for over two hours without recovery and the medic said later the first strip did not read.
All of the medics I have encountered do a routine to see if it is a hypo before they do any diabetic work. a person may be out for many reasons.
One essential test is a blood sugar after asking the emergency questions. If the test shows a very low blood sugar they can act on it. The medics do a defined dextrose IV,
They do continue to monitor closely and transport if indicated.
The 911 vehicle is well equipped and you are put on oxygen and an EkG unit.
As far as I know Glucagon in used in a less severe hypo to stop it's progress. My wife is well trained as to when and how to use it I do have oxygen available at home.
The routine is when what she does is not working of progress is too slow she goes 911.
The basic cause o f my hypos are well defined but not popular to discuss here. . Guy
Nico Kadel-Garcia - 21 Aug 2006 03:43 GMT > The 911 vehicle is well equipped and you are put on oxygen and > an EkG unit. Guy, you're apparently in a well-staffed city with good local ambulance coverage. I've been the first responder as an ambulance driver and attendant, and as a camp nurse at a Boy Scout camp. You don't always get to have such nice tools, especially EKG units. They not only take serious training, they're damned expensive and are usually limited to paramedic or physician's aid staffed units. And an ambulance often is not the first emergency vehicle on site: it's often a police car or fire vehicle, both of which are likely to have oxygen, but a cop car is quite unlikely to carry an EKG or personnel trained in its use.
> As far as I know Glucagon in used in a less severe hypo to > stop it's progress. My wife is well trained as to when and how > to use it I do have oxygen available at home. Oh, they're used for severe ones, too.
> The routine is when what she does is not working of > progress is too slow she goes 911. Ny wife calls 911 if she can't get me alert enough to drink juice, which has an almost mystical effect on me since I *know* I'm supposed to get better if I taste it, or if I'm completely out of it, she's tried glucagon, but I'm struggling too much for her to do it safely.
> The basic cause o f my hypos are well defined but not > popular to discuss here. . > Guy ???
guy - 21 Aug 2006 04:28 GMT >> The 911 vehicle is well equipped and you are put on oxygen and >> an EkG unit. [quoted text clipped - 28 lines] > >??? NIco,you are correct o all of you points. I posted to get the argument back to clinica;l diabetes.
If I am violent or disturbed, it an indication for 911. When I am in the nightmare mode it is a strange world. Every thing is moving and I am trying to hang on. As I recover a first it is all white, then I see outlines. And slowly I see real things but it is very strange.
The real world returns and I fell like an old rag.
The cost of my 911 runs run in the $700 range. But it seem to be a good setup for all emergencies.
They have a communication link to a doctor and before you reach the hospital they are ready
Now I do MDI and let the blood sugar run a bit higher. Stable now most of the time . Now for several years the complications seem to be stable.. Other problems have come up which has me very pissed.
Some docs should grow up or become a stock broker. Guy
A discussion like this might be useful for some new to this game. For me it was one hell of a scare to have a severe hypo and not know what was happening.
Elizabeth Blake - 21 Aug 2006 06:30 GMT > First a hypo is where you are seriously > non functional. I don't know. I've had hypos that I was able to treat myself, if even just barely. I know some people freak out over readings in the 70's and to them, that's a hypo, but technically I guess it isn't. I pretty much don't consider it a hypo until I get below 40!
> All of the medics I have encountered do a routine to > see if it is a hypo before they do any diabetic [quoted text clipped - 3 lines] > questions. If the test shows a very low blood sugar they can > act on it. The medics do a defined dextrose IV, Do they ask your wife the emergency questions? Because if you're unconscious, I don't think asking you would be any good! I'm not sure what they did to me since I was out of it every time the EMTs/paramedics came. At work, my co-workers weren't much help because they know very little about diabetes. All they could tell the EMTs when they came is that I had low blood sugar and was not responding.
> They do continue to monitor closely and transport if indicated. > [quoted text clipped - 4 lines] > stop it's progress. My wife is well trained as to when and how > to use it I do have oxygen available at home. The last 911 visit I had was February of last year. When I came to, one of the paramedics told me that they weren't able to get an IV in me so they "gave me a shot". I guess that was glucagon but I didn't think to ask (or didn't care) at the time. I have been given oxygen, not sure about an ekg. I know one time I wound up with the little electrode pads stuck all over but I thought they did that once I reached the ER, but details are fuzzy.
> The routine is when what she does is not working of > progress is too slow she goes 911. > > The basic cause o f my hypos are well defined but not > popular to discuss here. . > Guy You're lucky you have someone to help you out, Guy. I live alone and have had a bunch of severe hypos that really could have used a 911 call. When my liver finally decided to kick in, I would wake up seizing & freezing. It would take a couple of hours after waking before I could actually control my body enough to get up and get some juice/food. Until then, all I could do was lay in bed shivering & screaming. Fell onto the floor a couple of times, which is even worse.
 Signature Liz Type 1 dx 4/1987 Minimed Paradigm 715 5/2005
guy - 21 Aug 2006 10:01 GMT >> First a hypo is where you are seriously >> non functional. [quoted text clipped - 49 lines] >was lay in bed shivering & screaming. Fell onto the floor a couple of >times, which is even worse. Thanks for this input. We had more of this type of posting in the past.. The increase of very mild T@'s ave changed things.
At a blood sugar of 40 I as very normal recently. A bit chilled and knew thing were not normal. Time for a couple of glucose tablets and to be very calm.
The serious problem is a hypo when driving. When I drove, the thing was to get off of the road pronto. Then get n the glucose. I quit driving when I found myself on the wrong side of the road one day.
Oh yes, Mona is very good to me. She has a problem child in me.but does her job very well. Guy
Nico Kadel-Garcia - 21 Aug 2006 13:07 GMT > Thanks for this input. We had more of this type of posting in the > past.. The increase of very mild T@'s ave changed things. > > At a blood sugar of 40 I as very normal recently. A bit > chilled and knew thing were not normal. Time for a couple > of glucose tablets and to be very calm. Hey, Guy? One of the really interesting things out of some work by Dr. Santiago and his old research group at Barnes Hospital, decades ago, was measure the loss of sensitivity to hypoglycemia in diabetics. Apparently poor control contributed to hypoglycemic unawareness, and one theory they were pursuing was that really good control could help restore that unawareness. Unfortunately, that was before the human insulines with their noticeable hypoglycemic unawareness became popular, so I don't know how much awareness long-term diabetics like us can hope to recovers.
> The serious problem is a hypo when driving. When I drove, > the thing was to get off of the road pronto. Then get n > the glucose. I quit driving when I found myself on the > wrong side of the road one day. Amen, brother. Short trips are fine for me, it's easy to test before driving. But for long road trips, I much prefer to have my wife drive, and she wants me to test before I take a shift.
> Oh yes, Mona is very good to me. She has a problem > child in me.but does her job very well. > Guy Yeah, my sweetie has been an amazing angel, dealing both with me and our diabetic daughter. It's OK if she sometimes makes a caustic comment about which of us is easier to deal with.
Elizabeth Blake - 22 Aug 2006 05:55 GMT > Hey, Guy? One of the really interesting things out of some work by Dr. > Santiago and his old research group at Barnes Hospital, decades ago, was [quoted text clipped - 4 lines] > noticeable hypoglycemic unawareness became popular, so I don't know how > much awareness long-term diabetics like us can hope to recovers. I was on human insulins (Humulin NPH + R) since I was diagnosed. I was 19 with no insurance and stopped testing my BG after a couple of months. My control was very poor, I know that. I had clear hypo symptoms up until 6 years ago, maybe. I started running into trouble as I tried for tighter control using Humalog instead of R. My body got used to the lower numbers and eventually I lost all hypo symptoms. I've got my targets set higher now, hoping to regain some awareness. I do get some signs sometimes and will actually get sweaty once in awhile when my BG drops too low. Not every time, though. Fortunately I don't drop so low as often as I used to.
 Signature Liz Type 1 dx 4/1987 Minimed Paradigm 715 5/2005
Elizabeth Blake - 22 Aug 2006 05:38 GMT > At a blood sugar of 40 I as very normal recently. A bit > chilled and knew thing were not normal. Time for a couple > of glucose tablets and to be very calm.
> The serious problem is a hypo when driving. When I drove, > the thing was to get off of the road pronto. Then get n [quoted text clipped - 4 lines] > child in me.but does her job very well. > Guy I don't drive so at least I never had to worry about that. If I was a driver I'm sure I would be dead by now, or someone else would be. Since I'm hypo unaware I can feel fine as I drop lower and lower and then all of a sudden be totally out of it. Early last year, my last seizure at home, I woke up face down at the foot of my bed (on the bed, not the floor). I was very confused, didn't know where I was at first, just knew I was freezing to death and couldn't move without my limbs jerking all over the place. As I gradually regained some use of my arms I was able to roll over without falling off the bed and drag a blanket over myself. Eventually I realized that I was partially dressed (underwear), I was wearing my glasses, my bedroom light was on and music was playing in the living room. When I was able to get out of bed I saw that my cats had been fed and I had taken a shower. I guess I was getting dressed and just passed out on the bed. That was one time where I have no recollection of what happened before the hypo/passing out/seizure. I don't remember waking up, taking a shower, feeding my cats, turning music on. It really scared me, especially since I passed out at work the following month and had come close to it while Christmas shopping with my sister the month before, but she knew what to do. 3 bad ones in 3 months was my worst record ever.
Even now that I'm pumping, testing my BG a minimum of 10X a day and am trying to run my numbers a little higher to maybe get some hypo symptoms back, I still wouldn't trust myself behind the wheel.
 Signature Liz Type 1 dx 4/1987 Minimed Paradigm 715 5/2005
Nico Kadel-Garcia - 21 Aug 2006 13:02 GMT >> First a hypo is where you are seriously >> non functional. [quoted text clipped - 3 lines] > 70's and to them, that's a hypo, but technically I guess it isn't. I > pretty much don't consider it a hypo until I get below 40! Heh. Years ago, when I was having a rough time for various reasons involving a bad breakup and not taking good care, I had a problem in a hospital cafeteria. I couldn't bring my much-needed milk to my lips without spilling it, so I asked the cafeteria worker for a straw. They ignored my request. (I thought that was rude: I worked there, had been eating lunch there for six months, and they can't get a guy with crutches and a cast on his leg a straw?)
So the second one I asked, instead of getting a straw, trotted off to get the employee nurse. Bad, bad, bad move. The nurse hadn't gotten to deal with a real honest to ghod medical issue in years, and was way too excited. Summoned a wheelchair, had me wheeled aside, called the vampiers in to take my blood, and wouldn't give me the juice I asked for without getting blood drawn and tested first, said she'd have someone get my glucometer from my office downstairs but didn't do it. I finally saw someone from my office passing, called them over, sent him for my glucometer, and someone else from my office grabbed me some OJ.
By this point the nurse has gotten blood drawn, my glucometer is in, I'm sucking OJ, and I test while she's telling me "oh, those aren't that accurate" and I'm saying "but yours will take an hour and a half", which she denied, saying it was marked stat. As it turned out, she didn't get results for three hours. (I knew the hospital's lab better than she did.) Our numbers matched: 22 mg/dL. I had been getting more twitchy and incoherent during the 10 minutes or so while the drama played, and I had *just* gotten juice in my hands, after all the requests.
As soon as I got enough juice in me, I refused treatment from the crazy nurse lady on the grounds that she was overdoing it wildly.
>> All of the medics I have encountered do a routine to >> see if it is a hypo before they do any diabetic [quoted text clipped - 11 lines] > the EMTs when they came is that I had low blood sugar and was not > responding. I'm fairly scary. Even while quite out of it, I can often answer the standard emergency questions. Or while slightly out of it, I'll tell htem my vitals and try to save them the trouble of measuring it. I did that sort of work for a while. This led to enormous fun when I broke my leg, because I rattled off vitals (with a very good guess at my blood pressure from feeling my own wrist pulse!) and had harsh words for them when they tried to put my clearly broken and displaced ankle in a standard box splint. It was too bent to go in the box: If they were going to get fancy, they'd have to use a Hare traction splint that grabs the ankle and *pulls* the leg back into alignment in a metal frame, and since we were all right behind a major Boston hospital there was no point in trying to set it: just put it on pillows and take me around the corner., or better yet wheel me in the back door.
> The last 911 visit I had was February of last year. When I came to, > one of the paramedics told me that they weren't able to get an IV in [quoted text clipped - 3 lines] > electrode pads stuck all over but I thought they did that once I > reached the ER, but details are fuzzy. Probably. Did you have a stunning headache and nausea after that?
And yeah, details can get pretty fuzzy at that time.
> You're lucky you have someone to help you out, Guy. I live alone and > have had a bunch of severe hypos that really could have used a 911 [quoted text clipped - 4 lines] > screaming. Fell onto the floor a couple of times, which is even > worse. OUCH. Yeah, that sucks. I'm getting fonder of the "test and do Humalog at every meal" approach used by my daugher, and which I'm easing into under Lantus and Humalog. It seems to help prevent misadventures by not having the peaks of, say, NPH lurking if you mis-handle an individual meal.
Elizabeth Blake - 22 Aug 2006 05:50 GMT > I'm fairly scary. Even while quite out of it, I can often answer the > standard emergency questions. Or while slightly out of it, I'll tell htem [quoted text clipped - 9 lines] > just put it on pillows and take me around the corner., or better yet wheel > me in the back door. It's weird but I have very clear memories of some of my worst hypos. I'm sure at the time I thought I was making sense but I know I wasn't able to answer questions properly. Once my BG drops below 30 I get very stupid, I stammer and repeat myself and make no sense. I think even in that condition I was aware that I made no sense. I know I usually just agree with whatever anyone is saying to me.
>> The last 911 visit I had was February of last year. When I came to, >> one of the paramedics told me that they weren't able to get an IV in [quoted text clipped - 5 lines] > > Probably. Did you have a stunning headache and nausea after that? I don't remember. I usually end up with a headache after a really bad hypo anyway. I think I was too busy shivering, even though it was 84 degrees in my office, according to my co-worker. It takes me a long time to get warm, so I was wearing a sweater and my winter parka in my hot office for over an hour. I'm pretty sure I ate something after the paramedics left so probably didn't have any nausea.
>> You're lucky you have someone to help you out, Guy. I live alone and >> have had a bunch of severe hypos that really could have used a 911 [quoted text clipped - 9 lines] > Lantus and Humalog. It seems to help prevent misadventures by not having > the peaks of, say, NPH lurking if you mis-handle an individual meal. *All* of my severe lows/seizures/passing out/911 calls were on NPH. I was using it from diagnosis right up until March of last year. I used NPH + R until 1997, when I switched the R for Humalog. When I finally made an appointment with an endo last March she put me on Lantus and the difference was amazing. I only used it for 2 months before I got a pump, which was even better than the Lantus. I still have lows but they're so easy to treat now. With NPH I'd often have to feed a lot for hours. Sometimes I think I could have emptied my fridge and pantry and still be low. With a pump, 15g of carbs usually is enough.
 Signature Liz Type 1 dx 4/1987 Minimed Paradigm 715 5/2005
Nico Kadel-Garcia - 22 Aug 2006 10:02 GMT >> OUCH. Yeah, that sucks. I'm getting fonder of the "test and do >> Humalog at every meal" approach used by my daugher, and which I'm [quoted text clipped - 12 lines] > fridge and pantry and still be low. With a pump, 15g of carbs > usually is enough. Yeah, in my experience the human NPH is just not as good as the animal NPH was. It doesn't last as long, and I remember noticing the loss of hypoglycemic unawareness when switching to the human NPH.
guy - 22 Aug 2006 20:06 GMT >>> OUCH. Yeah, that sucks. I'm getting fonder of the "test and do >>> Humalog at every meal" approach used by my daugher, and which I'm [quoted text clipped - 16 lines] >was. It doesn't last as long, and I remember noticing the loss of >hypoglycemic unawareness when switching to the human NPH. I think that the older long acting insulin's were a kludge to cover a period when we did not have anything else. Their activity curves were fiction.
We are approaching the period when we will monitor blood sugar level instead of guessing. We will develop documented parameters for each patient These parameter will be numbers not vague ball park things.
Unless there is miracle in a cure. The pump or a more intelligent pump will be the norm.
And a lot of docs will learn that diabetes is a symptom not the basic problem.
Until then watch out for people with dogmatic answers for all.
We exchange experiences and our impressions from our own experiences
One liners are for comedians. Guy
Ma¢k - 21 Aug 2006 23:59 GMT >First a hypo is where you are seriously >non functional. false.
hypoglycemia is low blood sugar. not "just" seriously non functional.
that type of misinformation is dangerous to newbies and you should be ashamed of yourself.
someone not prepared for a hypo of 70 or 60 or 50 when their bodies are acclimated to higher numbers and driving or performing some other dangerous function could seriously injure themselves or others or kill themselves or others.
The hypo becomes dangerous when it even slightly impairs their judgment or coordination.
you should know better than that Guy.
 Signature Mâck©® Deltec CoZmore Pumper Type 1 since 1975 http://www.alt-support-diabetes.org http://www.diabetic-talk.org http://www.insulin-pumpers.org
"To announce that there must be no criticism of the President, or that we are to stand by the President right or wrong, is not only unpatriotic and servile, but is morally treasonable to the American public." ...Theodore Roosevelt
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Jesus never hated anyone.
DISCLAIMER If you find a posting or message from me offensive, inappropriate, or disruptive, please ignore it. If you don't know how to ignore a posting, complain to me and I will be only too happy to demonstrate... .
> >Now I have had a lot of 911 runs It [quoted text clipped - 30 lines] >http://www.newsfeeds.com The #1 Newsgroup Service in the World! 120,000+ Newsgroups >----= East and West-Coast Server Farms - Total Privacy via Encryption =---- stan.gula@gmail.com - 24 Aug 2006 18:17 GMT I wanted to thank all of you for the informative posts in this thread. I'm a T1 newbie and haven't had any serious hypos yet - I think it's a lot easier to learn from your experiences than to do it first hand.
 Signature Regards, Stan Gula
Ma¢k - 25 Aug 2006 06:25 GMT >I wanted to thank all of you for the informative posts in this thread. >I'm a T1 newbie and haven't had any serious hypos yet - I think it's a >lot easier to learn from your experiences than to do it first hand. for some reason I got the impression that you were a type 2 newbie.
Type 1 rule of 15 for hypos. if you feel hypo and can test your BG, do so, then consume 15 grams of fast carbs and retest in 15 minutes. If BG is still low consume 15 grams of fast carbs and retest in 15 minutes.
repeat until BG returns to normal. Then eat something like a sandwich with cheese and meat. This will prevent you from having a second hypo when the fast carbs burn off, especially if you over calculated and took too much insulin in the first place.
If you test at 50 mg/dl (discuss this with your doctor, he/she may want you to do this at 60 mg/dl) or below double or triple your carb load. Experience will tell you what you need to do. If you are not able to test because the symptoms are to severe don't worry about it until after you consume some fast acting carbs. When you are able test your BG.
ALL type 1s should have at least 1 glucagon kit in the home, know how and when to use it and have at least one (1) family member who knows how and when to use it on you, and how to test your BG for you when you cannot do so. You do not have to pass out and rely on a family member to use glucagon. If you the hypo is low enough or dropping quickly and low enough and you can manipulate the syringe correctly you can give yourself the glucagon. (try oral glucose/fast carbs first if at all possible glucagon tends to make you vomit)
It's always a good idea to test BG before driving. You could kill yourself or someone else with even a mild hypo.
 Signature Mâck©® Deltec CoZmore Pumper Type 1 since 1975 http://www.alt-support-diabetes.org http://www.diabetic-talk.org http://www.insulin-pumpers.org
"To announce that there must be no criticism of the President, or that we are to stand by the President right or wrong, is not only unpatriotic and servile, but is morally treasonable to the American public." ...Theodore Roosevelt
(o ô) --ooO-(_)-Ooo--------------------
"I don't know half of you half as well as I should like; and I like less than half of you half as well as you deserve." ....Bilbo Baggins
Jesus never hated anyone.
DISCLAIMER If you find a posting or message from me offensive, inappropriate, or disruptive, please ignore it. If you don't know how to ignore a posting, complain to me and I will be only too happy to demonstrate... .
Stan Gula - 25 Aug 2006 07:35 GMT >>I wanted to thank all of you for the informative posts in this thread. >>I'm a T1 newbie and haven't had any serious hypos yet - I think it's a >>lot easier to learn from your experiences than to do it first hand. > > for some reason I got the impression that you were a type 2 newbie. I can't imagine how. I've been trying to add a 'T1' somewhere in my sig whenever that's relevent. I posted about my one year anniversary as a T1 on a.s.d a few weeks ago.
> Type 1 rule of 15 for hypos. <etc>
Got it. I have Smarties cached everywhere. 3 rolls of Smarties, half a can of full sugar soda, a small glass of OJ, or cetera. Preferably nothing to slow down digestion. Make sure to test on the fingertips. I am much more concerned about the hypo than a short term hyper from overreaction.
> ALL type 1s should have at least 1 glucagon kit in the home, know how > and when to use it and have at least one (1) family member who knows [quoted text clipped - 4 lines] > you can give yourself the glucagon. (try oral glucose/fast carbs first > if at all possible glucagon tends to make you vomit) I don't have a glucagon kit because I live alone. I figure if I really needed it, and was alert enough to try using it, I'd be better off trying to call 911.
> It's always a good idea to test BG before driving. You could kill > yourself or someone else with even a mild hypo. I'm very clear on that and I'm pretty consistent about pre-drive testing, I've got a stash of Smarties and peanut butter crackers n the center console.
Thanks for all the advice!
 Signature Stan Gula, 53, late bloomer _T1_, full blown DKA in '05, 998mg/dl woohoo
Ma¢k - 25 Aug 2006 08:00 GMT On Fri, 25 Aug 2006 06:35:22 GMT, "Stan Gula" <sgula@verizon.net.invalid> Huffed and Puffed the following into the madness of usenet:
>>>I wanted to thank all of you for the informative posts in this thread. >>>I'm a T1 newbie and haven't had any serious hypos yet - I think it's a [quoted text clipped - 26 lines] >needed it, and was alert enough to try using it, I'd be better off trying to >call 911. I've used it while alone in the house. An ER visit costs 1300.00 to 2000.00 plus the 275.00 for the ambulance trip. When I didn't have insurance that was a bit of a problem. But even with insurance, the co-pays and deductibles can be a bit of pain. The kit was cheaper. I actually found out here in this newsgroup, after years of being type 1, that there are smaller glucagon kits, basically a child's dose, that an adult can use to treat a severe hypo before passing out. The smaller kits work just fine, and have less of a chance of causing vomiting in adults. "less of a chance does not mean will not cause".
>> It's always a good idea to test BG before driving. You could kill >> yourself or someone else with even a mild hypo. [quoted text clipped - 4 lines] > >Thanks for all the advice! Finally someone who doesn't have to learn the hard way like most of us with a few years under our belts chose to.
 Signature Mâck©® Deltec CoZmore Pumper Type 1 since 1975 http://www.alt-support-diabetes.org http://www.diabetic-talk.org http://www.insulin-pumpers.org
"To announce that there must be no criticism of the President, or that we are to stand by the President right or wrong, is not only unpatriotic and servile, but is morally treasonable to the American public." ...Theodore Roosevelt
(o ô) --ooO-(_)-Ooo--------------------
"I don't know half of you half as well as I should like; and I like less than half of you half as well as you deserve." ....Bilbo Baggins
Jesus never hated anyone.
DISCLAIMER If you find a posting or message from me offensive, inappropriate, or disruptive, please ignore it. If you don't know how to ignore a posting, complain to me and I will be only too happy to demonstrate... .
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