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Author Topic: 3AM Low Blood Sugar  (Read 660 times)
PrimeTimer
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« on: May 02, 2018, 07:00:26 PM »

My husband and I are curious to know if it is common for diabetics on hemodialysis to experience frequent low blood sugar levels. Do you just keep adjusting your insulin?

I've read some of the older threads here about low blood sugar. Seems dialysis and weight loss can play a role. My husband recently lost some weight. He's been on dialysis for almost 5 years and on insulin. He's very good about testing his blood sugar level thruout the day and before/after meals. He's also very good at taking his insulin injections. Lately he keeps waking up at 3am feeling the effects of low blood sugar. His levels have gotten down to the low 30's (not good!). He says luckily the effects wake him up because some diabetics do not feel the symptoms and can go into a coma. We keep glucose tabs handy. ALWAYS. Am wondering if it's the weight loss or the dialysis that is causing these lows. He knows to adjust his insulin levels. Just wondering if this is a frequent occurrence among diabetics who are on hemodialysis.
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Husband has ESRD with Type I Diabetes -Insulin Dependent.
I was his carepartner for home hemodialysis using Nxstage December 2013-July 2016.
He went back to doing in-center July 2016.
Paul
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That's another fine TARDIS you got me into Stanley

« Reply #1 on: May 03, 2018, 01:34:21 AM »

Do you just keep adjusting your insulin?

Yes. And use a blood glucose meter to measure your blood sugar levels to help you work out the quantity you need to take. I know that in America this will be an extra expense (and I doubt those strips are cheap), but it will seriously extend the life of the diabetic if you know your blood sugar level and adjust your insulin level to match. Going low or going high too often is bad for the heart, and other organs.

Another thing to note is that the quantity of sugar and carbohydrate eaten are not the only things that affect your blood sugar levels. For example, the amount of fat eaten will affect it. I think (N.B. "THINK" not "KNOW") the reason is that fat in the blood makes it harder for the insulin to do it's job. Also, physical exercise burns up sugar, even things you would not consider as physical exercise (tidying up, walking, playing with kids/grandkids, etc.).

And you are right about weight loss. The less fat on the body, the less insulin you need to do the same job. If your husband is still using the same ratio of insulin to blood sugar reading that he was using before loosing weight, that is probably the reason for the 3am wake up calls. He needs to adjust the quantity he takes of an evening because although his body wakes him up for sugar, before he gets that hit his heart will be screaming "Aaaaaaargh". Plus, there is always the risk that one day his body won't wake him up in time.

BTW: I have found that jelly sweets are a fast way to get sugar into your body, and they are tastier than boring glucose tablets (although in my case I'm allergic to pure glucose, so I don't have the choice).
« Last Edit: May 03, 2018, 01:38:18 AM by Paul » Logged

Whoever said "God does not make mistakes" has obviously never seen the complete bog up he made of my kidneys!
Paul
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That's another fine TARDIS you got me into Stanley

« Reply #2 on: May 03, 2018, 01:36:33 AM »

Sorry, once again I hit "quote" instead of "modify" and ended up duplicating my last post. I have deleted this because it was just a copy of my previous post in quote form.
« Last Edit: May 03, 2018, 01:40:12 AM by Paul » Logged

Whoever said "God does not make mistakes" has obviously never seen the complete bog up he made of my kidneys!
Paul
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That's another fine TARDIS you got me into Stanley

« Reply #3 on: May 03, 2018, 01:37:53 AM »

Oh ****,. I did it again when I tried to modify my original post for a a second time. Someone really needs to put a child proof lock on that "modify" link. (Or ban me from posting when I am still "fuzzy" from dialysis.)
« Last Edit: May 03, 2018, 01:43:27 AM by Paul » Logged

Whoever said "God does not make mistakes" has obviously never seen the complete bog up he made of my kidneys!
PrimeTimer
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« Reply #4 on: May 03, 2018, 05:46:17 AM »

He uses the Reli On Confirm test monitor and strips. All day, every day. And yes, the strips are pricey. He doesn't do anything without first testing his sugar level, he's very good about that. He had a feeling that he might be "overshooting" his nightly insulin so adjusted that last nite and sure enough, no "3am wake up call". His Endocrinologist has always told him to adjust accordingly but hubby is not yet use to his recent weight loss. We also wondered if dialysis and getting cleaned out has anything to do with low blood sugar. His level is fine right after a treatment, it's just been the nitetime that has gotten scary.

Ha...that's funny about jelly sweets. My husband likes to raid the grape jelly if he runs out of glucose tabs. And sometimes just becuz it's so darn delicious. Do we need a reason? lol
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Husband has ESRD with Type I Diabetes -Insulin Dependent.
I was his carepartner for home hemodialysis using Nxstage December 2013-July 2016.
He went back to doing in-center July 2016.
Paul
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That's another fine TARDIS you got me into Stanley

« Reply #5 on: May 03, 2018, 05:56:23 AM »

We also wondered if dialysis and getting cleaned out has anything to do with low blood sugar.

Dialysis does remove sugar, but it is very varied. My blood sugar is tested before and after dialysis and the drop can be anything from less than 20 mg/dl (1 mmol/l) to well over 100 mg/dl (6 mmol/l).
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Whoever said "God does not make mistakes" has obviously never seen the complete bog up he made of my kidneys!
Paul
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That's another fine TARDIS you got me into Stanley

« Reply #6 on: May 03, 2018, 06:02:47 AM »

Ha...that's funny about jelly sweets. My husband likes to raid the grape jelly if he runs out of glucose tabs. And sometimes just becuz it's so darn delicious. Do we need a reason? lol

As you are probably aware, being British my medication is paid for by the state. Because of my glucose allergy I was once told I could get a prescription from a doctor for jelly sweets, then the state would pay for the jelly sweets. I didn't bother, because a small bag with enough sweets to bring me back from a hypo costs about the equivalent of 15c, but I did consider doing it just so I could tell everyone "The government buys me candy!"
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Whoever said "God does not make mistakes" has obviously never seen the complete bog up he made of my kidneys!
Charlie B53
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« Reply #7 on: May 03, 2018, 11:04:25 AM »


I was on PD my first 3 1/2 years before switching to Hemo.  Because I used Ico for the long 12 hours dwell I was told I had to use the "One Touch' glucose meter as many of the other brand meters could/would give a false 'high' sugar reading. This could become a serious problem if someone was to take too much insulin because of this false reading.

My first 2 years feeling so 'full' all the time because of the PD Fill, I seriously downsized my eating and started losing weight.  Because my physical activity was far less for far too many years I had become quite 'heavy'.  All this weight also contributed to my insulin resistance.  I was taking 70 units of Lantus nightly.

Two years eating less I had lost 100 lbs.  Evidently my insulin resistance went away, I was 'crashing' all the time until I figured it out.  I am now somewhere in the 15 to 20 units a day, still getting that dialed in.

Dr and Nurse have directed me to test before bed, then again first thing in the morning, compare those two readings.  If the mornings is LOWER then decrease Lantus a couple units.  Mornings higher then Increase.  Only change a couple of units at a time and hold there for days before making another adjustment.

Learning how much fast insulin to take with meals is a trick.  Gauging the carb load of foods takes a lot of practice.

I am still learning.
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PrimeTimer
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« Reply #8 on: May 05, 2018, 02:45:10 PM »


Two years eating less I had lost 100 lbs.  Evidently my insulin resistance went away, I was 'crashing' all the time until I figured it out.  I am now somewhere in the 15 to 20 units a day, still getting that dialed in.

Dr and Nurse have directed me to test before bed, then again first thing in the morning, compare those two readings.  If the mornings is LOWER then decrease Lantus a couple units.  Mornings higher then Increase.  Only change a couple of units at a time and hold there for days before making another adjustment.



Hubby's weight loss seems to have played a role in the 3am wake up calls....he decreased his night time insulin dose and so far no crashes. We always keep glucose tabs on hand for emergencies plus a jar of grape jelly. The glucose tabs are for him, the grape jelly is for my morning toast.   :P
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Husband has ESRD with Type I Diabetes -Insulin Dependent.
I was his carepartner for home hemodialysis using Nxstage December 2013-July 2016.
He went back to doing in-center July 2016.
Charlie B53
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« Reply #9 on: May 05, 2018, 05:47:31 PM »


Wife has become even more in-active the last 18 months due to losing vision in one eye and the left has remained cloudy. Somewhere during that 18 months she also developed water on the brain, which I think is contributing to that left eye cloudiness.  We finally jumped through most all those hoops and have a surgery date coming on the 15th to get an extra hole in her head.

I Pray that left eye clears as there is NO reason that it should not be working.  Both eye specialists are puzzled.

Due rto her inactivity she has gained weight and her sugars have been difficult to control, remaining high too long and taking a LOT of insulin.  I have had to keep increasing her Lantus and finally have her night/morning numbers balanced, but she is now at 75 units of Tijeo, (Sp?) which is supposedly stronger than Lantus.  He Dr told her to listen to me and is letting me manage her care.
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PrimeTimer
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« Reply #10 on: May 05, 2018, 08:27:56 PM »


Wife has become even more in-active the last 18 months due to losing vision in one eye and the left has remained cloudy. Somewhere during that 18 months she also developed water on the brain, which I think is contributing to that left eye cloudiness.  We finally jumped through most all those hoops and have a surgery date coming on the 15th to get an extra hole in her head.

I Pray that left eye clears as there is NO reason that it should not be working.  Both eye specialists are puzzled.

Due rto her inactivity she has gained weight and her sugars have been difficult to control, remaining high too long and taking a LOT of insulin.  I have had to keep increasing her Lantus and finally have her night/morning numbers balanced, but she is now at 75 units of Tijeo, (Sp?) which is supposedly stronger than Lantus.  He Dr told her to listen to me and is letting me manage her care.

I'm sorry to hear about your wife's troubles. Hope the surgery goes well and helps her eye. Do you think switching to another kind of insulin would help or already tried that? My husband uses Novolin N (for nite) and Novolin R for day. He gets them at Walmart and then uses BD insulin syringes. He doesn't like insulin pens, he doesn't think they are as effective but that's just him. He says he knows some people carry the pens in their shirt pocket, which he thinks gets too warm from being against their skin and thus making the insulin ineffective. He's an old-fashioned kind of guy and doesn't like to mess with things that work well for him. Hopefully something will kick in and start working right for your wife. It would be hard to be active when you can't see and re-learning how to get around and do things without your sight would be an enormous hurdle to overcome. I think if I had to and had the right inspiration to turn to I could do it but I'd probably find it pretty miserable at first.
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Husband has ESRD with Type I Diabetes -Insulin Dependent.
I was his carepartner for home hemodialysis using Nxstage December 2013-July 2016.
He went back to doing in-center July 2016.
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