Severe hypoglycemia and shock

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Severe hypoglycemia and shock

Postby dm1hypopit » Sun Oct 15, 2006 7:06 am

Hey guys. Nobody replied so I guess nobody has gotten the new Minimed continuous monitoring insulin pump. Mine is on order but is going to take at least 12 weeks to get here. At the rate I'm going I might not even need it at that point. Since starting on treatment for my pituitary problems my hypos have become MUCH more severe. I require emergency treatment on a regular basis about once or twice a month depsite loosening my glucose control to an A1C level of over 8%. I just don't have any symptoms and then wake up to the paramedics hovering above me. About a week ago I apparently lost consciousness about 12:30 in the afternoon and stayed that way until my little girl found me when she got home from school at 3:30. After two shots of glucagon my sugar still wouldn't even register on the glucose monitor. I was in circulatory shock without any blood pressure and they couldn't get an IV line to give me IV dextrose. The paramedic quickly decided I was in extreme danger and called dispatch to send Air since I live 30 miles from the hospital. They finally got an IV and got my glucose up to 300, but I was still not responsive. The flight nurse was pretty well convinced that I had suffered permanent neurologic damage and they flew me in. My husband happens to be the dispatcher for the Ambulance Service and was scared to death when they called for Air. He met the helicopter at the ER and just about stood on his head to get them to give me some IV SoluMedrol. As soon as they did I came back around, my mind cleared up and I started talking.

Has anyone else had this kind of problem with severe insulin reactions? Looking at the problems I had after they got my glucose up, they seem to be consistent with adrenal crisis. I had severe hypotension leading to circulatory shock (which I figure is why the glucagon didn't work) and loss of conscioiusness or at least it didn't return when it should have. I have never seen severe hypoglycemia listed as a cause of adrenal crisis but it seems to do it to me. I'm very scared to think what would have happened to me if I had been there any longer. My heart rate had dropped so low my pacemaker was constantly going just to keep my heart rate at 60 beats per minute. If my pulse had dropped any lower and impaired my circulation any more I don't know if I would still be here. Geez, I wish I could go back to only worrying about diabetes.

Candy
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Postby Karen » Sun Oct 15, 2006 11:51 am

Hi Candy

Before I was diagnosed with pituitary problems, my blood sugars were plummeting. I was often in the ER, and once my husband called the paramedics. Once my adrenal insufficiency was addressed, the blood sugars stabilized. Are you sure you are getting enough replacement hormone for your adrenals? It doesn't sound like it. It is a very tricky business to get all the hormones balanced, and you probably need a good endocrinologist if you don't have one now. Good luck in getting stabilized.

Karen
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Oh no. Another one

Postby dm1hypopit » Mon Oct 16, 2006 8:35 am

Rats. I had another one last night. At least I can tie this one to a cause. I had a bunch of grapes right before bed and took a bolus for that. I did skimp on my insulin, thinking I was playing it safe, but obviously it wasn't enough. I woke my husband up at 3am having seizures. Fortunately, glucagon and some SuloMedrol woke me right up and the paramedics didn't have to take me to the hospital. Thank goodness! You always end up worse off if you go in. My husband called the Minimed rep to see if they could expedite my order for the new system.

To Karen,

I think you are on track with the changing steroid levels being the heart of the problem. I have worked out a kind of complicated regimen with both prednisone and hydrocortisone involved, but I find that certain things tend to use it all up and then my blood sugar will fall. I don't do well on higher doses of steroid and it has been really hard to determine when and how much extra steroid to take when these things happen. I kind of see it after the fact. My adrenal problems being secondary and caused by my lack of pituitary function seems to cause me problems related to other hormones as well. I have to replace both growth hormone and female hormones as well as steroids and I have found that these definitely have an effect on my blood sugar also.

My endo has reduced my basal rate once again but I'm afraid all that's going to do is make my high sugars higher and then crash my sugars back down when I have to bolus more and more to get them down. I am so very frustrated with this right now. Hopfully I can get the new pump with continuous glucose monitoring soon.

Candy
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Postby Karen » Mon Oct 16, 2006 8:49 am

Hi Candy

Your endo is definitely NOT on top of this situation. I also take grwoth hormone (Humatrope), and that can make your blood sugars high if you're not on the correct dose. I hope your endo is aggressively testing everything on a regular basis as it really is a balancing act. I am surprised that you are left to juggle your own steroid dose, and I hope your endo gets more involved in the process. I think you need more steroids, even though you say you don't do well on "a lot" of steroids. The idea is to give you only what you need for replacement of the natural hormone, and not more. Things sound out of whack, so you definitely need aggressive testing and direction from your endocrinologist. I am so sorry you are going through this -- I have been there, and it's not fun.

Karen
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Postby Wanda » Mon Oct 16, 2006 10:48 am

Candy,

Are you splitting your steriods into smaller doses & taking it 4 times a day? I have read this helps.

Wanda
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Postby dm1hypopit » Tue Oct 17, 2006 9:45 am

Karen and Wanda,

Thanks for your answers. I need all the help I can get. In the morning I take 2 mg of prednisone and 5 mg of hydrocortisone and at suppertime I take 1 1/2 mg of prednisone. The endo clinic prescribes my prednisone as 5mg once a day. I convinced them to give me 1 mg tablets so I could take it in divided doses. I found that out on this message board, they certainly didn't suggest it there. I started on hydrocortisone only, broken up into three times a day dosing. It was very difficult not to miss the lunchtime dose on occasion and that caused my blood sugar to drop about 2 pm, when I am likely to be out driving my car. That's when I asked to switch to the prednisone because it is longer acting (yes I had to ask, they didn't suggest it) and pretty much had to figure it out on my own. I started on 3mg AM and 2 mg PM of prednisone but I couldn't function before noon so I replaced 1 mg of the morning dose with 5 mg of hydrocortisone to get a faster steroid boost in the morning. I reduced the evening dose by 1/2 mg because I couldn't sleep. That worked fairly well for a while, but I have been under a fair amount of physical and emotional stress in the last 3 weeks or so with moving to a new house. The endo has just pounded it home that you don't take extra steriod except in the case of illness. Maybe I just need to take an extra 1mg of prednisone at each dose? When I was on 20 mg/day of hydrocortisone that was too high for me and I kind of got a little nuts. They diagnosed me with steroid induced psychosis and put me on antipsychotic medication. They lowered my hydrocortisone dose to 15 mg/day and I was able to stop the psychosis medication. That's the main reason I keep my steroid dose fairly low. Maybe I just need to try to bump it up a bit. I live in a fairly rural location and don't have much choice in the way of endos.

Candy
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Postby Wanda » Tue Oct 17, 2006 1:13 pm

Candy,

Each mg of prednisone equals 5mg of hydrocortisone. Looks like you are taking the equivalent of 22.5mg hydrocortisone daily. 1mg prednisone tablets do make life easier.

Wanda
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Postby SueM » Tue Oct 17, 2006 1:45 pm

Hi candy,
I find taking all my steroids in the morning work for me.
Like you on HC I kept crashing HC would run out as insulin peeked so asked for a change took a lot of demanding before I got it endo refused the change but GP didn't have a problem.
I use 5 pred and 5 HC in the morning and find that works well for me.

You might find the going nuts on the HC was because it is a lot quicker in acting. pred is a slower release so try say 4mg pred am and 5 hc and save 5 hc for late afternoon.
Everyone is so different that what suits one will not suit another. Some do well on pred some on a combination etc,.

Also have you thought about an insulin change? If you are hypo unaware it might be worth a change to see if you can get that awareness back.
A last observation as your adrenals are naff why are the medics shoving glucagon into you? Read the instructions that come with it. It states not to be used if adrenal insuficient. (basicly means it doesn't work)

Sue
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Postby dm1hypopit » Wed Oct 18, 2006 8:36 am

Sue,

Glucagon works most of the time for me, but not always. Maybe it has something to do with my adrenal problems being secondary instead of primary. I think I got the dose of glucagon from the paramedic because he couldn't get an IV line to give me dextrose. My husband tells me the flight nurses on the helicopter are much better at getting a line started because they are always dealing with shocky trauma patients. My poor veins are a challenge at the best of times so the flight nurse must have been standing on his head to find any of mine when my blood pressure was too low to measure.

I did get great news yesterday that Minimed is going to ship me one of the new continuous monitoring pumps by the end of this week. I'm really looking forward to it because my sugars have been all up in the 300's since they lowered my basal rate after the last episode. I feel like complete trash. You know, kind of wilted, from the high sugars. I should get some adjustments on my settings today and maybe I will get some energy back.

Candy
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Re: Severe hypoglycemia and shock

Postby denniscarrara » Sun Jun 03, 2012 10:03 pm

I just found this site and glad I can finely connect to people experiencing the same problems I am. I have had auto immune pilyglandular syndrome 2 for 12 years now been on the pump 2 now and have had some serious lows the lowest I have been was 22 thank god my family found me!. First time for myself being able to talk to people who can relate and hopefully help out with so many questions I have!
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