Any advice?

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Ivostas66

Ivostas66

Well-Known Member
Relationship to Diabetes
Type 1
It's been some time since I posted on here, probably because my control/ management has been generally really good for the past 12 months but also because I have been so busy with things happening out of my control.

Anyway, I am currently experiencing big swings in levels. From Sunday I have not been above 5 and several lengthy periods in the 3s (not really experiencing usual hypo symptoms, but just exhausted). Food doesn't see me increasing. I was 4 at dinner, ate without Insulin and 2 hours later was just below 5. Then overnight, I leapt to 16 at 4am, Libre woke me, I injected and then was back to low levels this morning (hypos at 8am).

Despite my consultant and DSN pushing for it, I have just been denied a pump (Omnipod system) as my BG control is apparently "excellent" and "far too well managed" for it to be signed off.

I am keen to know the impact of stress upon my body. How much do you think could be linked to the following, as I have not had time to stop and think since June?:
  1. Following a long and slow illness, my father-in-law died in June. We should have had time to grieve as a family, however...
  2. We attended a wedding in Scotland in July and whilst on holiday my wife slipped and badly broke her ankle. It is a very slow process to return to full movement and I have been doing all driving on top of everything else I do until fairly recently.
  3. After about 6 weeks of feeling unwell, my father was rushed into hospital a few weeks ago and diagnosed with a serious health condition - difficult to come to terms with as he is extremely fit and healthy. My half term (teacher) was spent driving to and from my parents to help out, whilst also looking after my family at home. I took time off work last week to help with his rehabilitation at home.
 
Yes. I also changed my Insulin pen in case it was a 'dodgy' batch.
 
Hi and welcome back.
So sorry to hear you have had a stream of difficult and sad circumstances to deal with and that now your diabetes is playing up. That makes things extra tough when you really don't need it.
I too would ask if these lows are Libre or other CGM lows and if you are double checking them with finger pricks and follow up 15 min finger pricks to check recovery. It is very easy to overtreat hypos if you just rely on CGM and they will show you low for far longer than you actually are. What can happen if a sensor comes slightly loose is that the filament gets slightly kinked and that can cause it to read permanently low, when in fact your levels are not.
Can I also ask which basal insulin you use and have you considered adjusting it if these are genuine lows and are happening regularly.
Can you post an attachment of some of the CGM graphs which show the issues to see if we can spot something obvious.
 
Oops sorry! I have Covid so not firing on all cylinders physically or mentally at the moment. Think I must have glanced at @Satan's little helper 's profile for signature info on insulin instead of yours @Ivostas66
Have you tried reducing your Toujeo? How many units do you currently take?
Have you been more active recently or had a Covid/Flu vaccination? Some people have found that dropped their levels.
 
Satan’s little helper said:
Your profile suggests you use Toujeo & Fiasp. Is this correct?
Click to expand...
Yes. Recently had my consultation with DSN and consultant, which showed my 'doses' were correct, although I have started to see the odd post-prandial spike in the evenings due to having to rush dinner (for various reasons)
 
rebrascora said:
Oops sorry! I have Covid so not firing on all cylinders physically or mentally at the moment. Think I must have glanced at @Satan's little helper 's profile for signature info on insulin instead of yours @Ivostas66
Have you tried reducing your Toujeo? How many units do you currently take?
Have you been more active recently or had a Covid/Flu vaccination? Some people have found that dropped their levels.
Click to expand...
I hadn't considered that - I had my Covid jab in mid October and they 'doubled up' with the flu jab, which made me feel a bit rough, but able to function with fairly stable levels for a couple of days.
 
Unlikely to be the vaccinations if you had them mid October and you are only just seeing these problems this week. I would have expected to see a response to the jabs in the following few days not weeks later.
 
Ivostas66 said:
Yes. Recently had my consultation with DSN and consultant, which showed my 'doses' were correct, although I have started to see the odd post-prandial spike in the evenings due to having to rush dinner (for various reasons)
Click to expand...
I assume this appointment was before things started going haywire?
Insulin needs change and you have to be prepared to change your doses when your body tells you that they need changing. If you have double checked with finger pricks and these are genuine hypos then it would indicate that you have too much insulin. If there is a particular pattern, like they only happen after lunch, then you would look at your lunch ratio but if there is no particular pattern or they are happening at night then it is likely your basal insulin. If you are not confident adjusting that then get in touch with your nurse and explain the situation and he/she will guide you.
The other possibility is that a Toujeo dose somehow got trapped in tissue and then has released perhaps days or weeks later, causing a significant hypo event. Toujeo is a Glargine based insulin and Glargine has been known to do this very occasionally. It is to do with how it's slow release mechanism works I believe. Can you recall a day when your levels were consistently high like your Toujeo hadn't worked and you needed lots of corrections?
 
I'm awaiting a call back from my DSN and also my Doctor (hopefully today!). I have a feeling they will tell me my body is waving the white flag as I am exhausted.
 
rebrascora said:
I assume this appointment was before things started going haywire?
Insulin needs change and you have to be prepared to change your doses when your body tells you that they need changing. If you have double checked with finger pricks and these are genuine hypos then it would indicate that you have too much insulin. If there is a particular pattern, like they only happen after lunch, then you would look at your lunch ratio but if there is no particular pattern or they are happening at night then it is likely your basal insulin. If you are not confident adjusting that then get in touch with your nurse and explain the situation and he/she will guide you.
The other possibility is that a Toujeo dose somehow got trapped in tissue and then has released perhaps days or weeks later, causing a significant hypo event. Toujeo is a Glargine based insulin and Glargine has been known to do this very occasionally. It is to do with how it's slow release mechanism works I believe. Can you recall a day when your levels were consistently high like your Toujeo hadn't worked and you needed lots of corrections?
Click to expand...
My appointment was about 2 weeks ago. She an dietician were suggesting the possibility of increasing basal by 1, as my levels have been a touch higher than they were and I have been seeing 'foot on the floor' spikes. I kept the basal as was (I inject 11 when I wake). I also inject bolus about 25-30 minutes before breakfast to reduce the post prandial spike.

On 18th November, I was at my parents helping them to re-settle my Dad as he was released from hospital the day before. Hypo at midnight (Jelly babies) remained around 6 /7 until I ate breakfast. Big post prandial spike (16) that I had to then correct at 11am, but didn't really fall (back to 6ish) until 6pm. Big post prandial spike after dinner (15) which dropped back to 5 by 6am.
 
Was there a lot of physical activity involved in settling your Dad into his home. I am wondering if you had to move a bed downstairs and shift furniture, that sort of thing?
 
Maybe. I suppose it was more the shock. Ex football referee, very fit and healthy 75 year old, told he has severe heart failure and a clot in the heart. I was dashing around getting hold of the things that they need, medication, other supplies, batch cooking healthy meals that they can freeze.

Just spoke to the DSN and she has suggested dropping Basal to 10 units instead of 11. Also sending me Keytone kit/ strips as mine has run out (long time since I had to use them!)
 
Let us know how you get on with the reduced basal. You might need to increase it again at some point. My basal doses needs regular tweaking to keep me on an even keel. I am currently up 7 units because of Covid, plus nearly double my usual Fiasp. Hoping now I am over the worst, I can start lowering it again.
 
When I went to bed my BG was around 6mmol. My Libre shows that it remained between 6mmol and 7mmol until 5:30am. It began to rise slightly to 8mmol over the next 2 hours. I injected at 8am and my BG has remained between 6mmol and 7mmol since.

I think my Basal is OK, but will fast for a bit longer and keep an eye on things. I might try another test tomorrow as I have lowered my Basal from 11 to 10.

Thank you for your help!
 
Can't ask for a better result than that! Well done!
 
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