BG drops after meals

[Susan64]

Hi all, I'm Susan, been type 1 for over 20 years.Last week i switched from mixed insulin to a bolus/basal regime after 20yrs + , hoping for more control etc. My problem is with evening meals, i bolus 5 minutes before or sometimes as i eat but 5 times out of 7 so far has resulted in steep drops in BG within 30 minutes, luckily the basal is too low so i have room but as i up it and get a sub 10 base i'm worried about hypos everyday.I'm not sure what i'm doing wrong, next appointment is DSN is 2 weeks away.

 

[rebrascora]

Hi and welcome.

So pleased that you are now on a more flexible system although I imagine you are used to being pretty regimented with your routine after being on mixed insulin for so many years.

Which insulins are you on?
Do you have Freestyle Libre or some other sensor system which is allowing you to see these drops in levels and could you post a screenshot showing a typical one?
Are you carb counting and what ratio are you using?
Have you been particularly active recently and could that be causing the issue? I think a lot of people are running around like crazy at the moment trying to get everything ready for Christmas and that can have a surprisingly significant impact on your insulin sensitivity.

Generally, levels dropping like that suggest the insulin is hitting your blood stream before the food, so maybe even taking it during or after your meal might be what you need. If it is a meal with lots of fat, protein or fibre then that can delay the carbs from releasing and people find splitting the dose can help, by having a portion of the calculated dose just before the meal and the rest an hour or two later. This is referred to as the Pizza effect because pizza with all its cheese (or pasta in creamy sauces) are renowned for needing this approach. Or perhaps you got the carb count wrong if you are new to carb counting and you simply had too much insulin or the ratio for your evening meal is wrong.

What happens after the drop? Does it rise again later? You say that it isn't a problem because your baseline is too high, so presumably you aren't eating any carbs to stop the drop? This is where seeing the graph if you have a sensor can be really helpful.

 

[rayray119]

What bolus insulin are you on? Some faster acting then others

 

[Inka]

Hi all, I'm Susan, been type 1 for over 20 years.Last week i switched from mixed insulin to a bolus/basal regime after 20yrs + , hoping for more control etc. My problem is with evening meals, i bolus 5 minutes before or sometimes as i eat but 5 times out of 7 so far has resulted in steep drops in BG within 30 minutes, luckily the basal is too low so i have room but as i up it and get a sub 10 base i'm worried about hypos everyday.I'm not sure what i'm doing wrong, next appointment is DSN is 2 weeks away.

It sounds like you might need to adjust your evening meal ratio @Susan64 I need less insulin for my evening meal. (Ratio is how many grams of carbs one unit of insulin covers, eg 1:8g, 1:12g, etc)

 

[Susan64]

Thanks for the replies, i'm on trurapi bolus and lantus basal. i'm certainly new to carb counting but it's not following a pattern so far. 4 units covers to white toast for breakfast(36g) and that sends BG from am 13 to 20 and back to 13 in 3hours. However wasn't hungry yesterday evening so for fish finger sandwich( i do eat properly most of the time) with was 42g of carbs i only took 3 units trurapi and BG dropped from 14 to 5 before i intervened with jelly babies.
Sorry i haven't individual replies yet.

 

[Inka]

So if your evening meal ratio (3 units for 42g carbs is a 1:14g ratio) didn’t work, try something like 1:16g carbs. Do you have a half unit pen for your Trurapi?

When do you take your Lantus?

 

[Susan64]

Hi and welcome.

So pleased that you are now on a more flexible system although I imagine you are used to being pretty regimented with your routine after being on mixed insulin for so many years.

Which insulins are you on?
Do you have Freestyle Libre or some other sensor system which is allowing you to see these drops in levels and could you post a screenshot showing a typical one?
Are you carb counting and what ratio are you using?
Have you been particularly active recently and could that be causing the issue? I think a lot of people are running around like crazy at the moment trying to get everything ready for Christmas and that can have a surprisingly significant impact on your insulin sensitivity.

Generally, levels dropping like that suggest the insulin is hitting your blood stream before the food, so maybe even taking it during or after your meal might be what you need. If it is a meal with lots of fat, protein or fibre then that can delay the carbs from releasing and people find splitting the dose can help, by having a portion of the calculated dose just before the meal and the rest an hour or two later. This is referred to as the Pizza effect because pizza with all its cheese (or pasta in creamy sauces) are renowned for needing this approach. Or perhaps you got the carb count wrong if you are new to carb counting and you simply had too much insulin or the ratio for your evening meal is wrong.

What happens after the drop? Does it rise again later? You say that it isn't a problem because your baseline is too high, so presumably you aren't eating any carbs to stop the drop? This is where seeing the graph if you have a sensor can be really helpful.

Hi, yes it rises again later but after the insulin has worn off as it goes high and i have to correct. i have had to eat carbs twice in the 7 days on this system.
I have a Freestyle libre, been using it for 20 days, i will try posting a screenshot shortly.

 

[Susan64]

So if your evening meal ratio (3 units for 42g carbs is a 1:14g ratio) didn’t work, try something like 1:16g carbs. Do you have a half unit pen for your Trurapi?

When do you take your Lantus?

Thanks for your response. No i don't have a half unit pen unfortunately. I take the lantus at approx 8pm, i was started on 10 units , increased to 11 after 3 days and the nurse said i need 12 so was going to up it tonight.

 

[Inka]

Half unit pens are very useful, especially for those of us who are quite sensitive to insulin. They also make correction doses easier. I don’t know if Trurapi even has a half unit pen. You’d be better off asking to have the proper Novorapid bolus insulin and then you could get a Novopen.

I’m not sure why you’ve been put on Lantus. The guidelines are to start on Novorapid and Levemir. Levemir gives more flexibility than Lantus.TBH, you’ve been diagnosed less time than me and should have been started on a basal/bolus regime at diagnosis. I was diagnosed around 30 years ago and took mixed insulin but went onto basal/bolus pretty quickly.

 

[Susan64]

To be honest after this first week i feel like going back to mixed insulin as i'm having nothing but problems so far. Every evening mealtime brings nerves not knowing which way the BG will move. Tonight was going to be jacket potato and chicken with salad but i'm not sure now. Here is a screenshot of yesterday

 

[rayray119]

To be honest after this first week i feel like going back to mixed insulin as i'm having nothing but problems so far. Every evening mealtime brings nerves not knowing which way the BG will move. Tonight was going to be jacket potato and chicken with salad but i'm not sure now. Here is a screenshot of yesterday

It takes time to work out radtios and Basel rights. It's case of trail of error so I wouldn't be discouraged after a week 🙂

 

[rebrascora]

Yes, that is a significant drop. Did you say you ate some fast acting carbs to deal with it yesterday and if so, what did you have?
The fact that the graph goes up to 20 afterwards suggests perhaps your digestive system is much slower than the insulin and you perhaps need to inject after the meal rather than before, but that the dose is probably about right and it is just the timing.

 

[Susan64]

Hi, yes, i had jelly babies, about 8 in total which is probably too many but was panicking. I have considered injecting after the meal but not sure on timings.

 

[Inka]

Hi, yes, i had jelly babies, about 8 in total which is probably too many but was panicking. I have considered injecting after the meal but not sure on timings.

Also, where about on your body are you injecting your bolus? Some areas are faster than others. So, changing to a slower area might help too, as well as injecting after your meal.

 

[Inka]

To be honest after this first week i feel like going back to mixed insulin as i'm having nothing but problems so far. Every evening mealtime brings nerves not knowing which way the BG will move. Tonight was going to be jacket potato and chicken with salad but i'm not sure now. Here is a screenshot of yesterday

Give it time. I remember disliking MDI to start with, but I gradually began to see the advantages. I don’t remember how long that took, but it was a number of weeks.

 

[rebrascora]

Hi, yes, i had jelly babies, about 8 in total which is probably too many but was panicking. I have considered injecting after the meal but not sure on timings.

Yes, definitely too much, (even a full hypo would generally only need 3JBs) so that is no doubt why your levels went up to 20 afterwards. I would have one jelly baby in that scenario because I know that 1JB will turn my levels around eeven when they are actively dropping in the low 4s, plus the food eaten before the drop would then bring me up.

I wonder if the Libre is causing you to overreact. Were you using Libre before when you were on mixed insulin? If not, the chances are that your levels were dipping like this before but you were unaware of it. Libre also exaggerates these things a bit. 🙄 You should never trust Libre in such situations and double check with a finger prick before taking action and check again with a finger prick 15 mins later to confirm that whatever action you took has worked because Libre will generally show your levels continuing to drop for 15 mins after you are starting to recover, resulting in you over treating a low if you rely on it in those circumstances.

I think @Inka's suggestion of possibly trying a different, hopefully slower site for your bolus might help a bit.
I am the other way in that I inject and then have to wait ages for it to kick in whereas my digestion is VERY quick.

 

[Susan64]

Also, where about on your body are you injecting your bolus? Some areas are faster than others. So, changing to a slower area might help too, as well as injecting after your meal.

I normally inject in either stomach or thighs but i don't record it so maybe that's something i should do.

 

[Susan64]

Yes, definitely too much, (even a full hypo would generally only need 3JBs) so that is no doubt why your levels went up to 20 afterwards. I would have one jelly baby in that scenario because I know that 1JB will turn my levels around eeven when they are actively dropping in the low 4s, plus the food eaten before the drop would then bring me up.

I wonder if the Libre is causing you to overreact. Were you using Libre before when you were on mixed insulin? If not, the chances are that your levels were dipping like this before but you were unaware of it. Libre also exaggerates these things a bit. 🙄 You should never trust Libre in such situations and double check with a finger prick before taking action and check again with a finger prick 15 mins later to confirm that whatever action you took has worked because Libre will generally show your levels continuing to drop for 15 mins after you are starting to recover, resulting in you over treating a low if you rely on it in those circumstances.

I think @Inka's suggestion of possibly trying a different, hopefully slower site for your bolus might help a bit.
I am the other way in that I inject and then have to wait ages for it to kick in whereas my digestion is VERY quick.

I only started the libre 3 weeks ago so i had 2 weeks on the mixed insulin. i've only ever had mild hypos before, during the night or late evening so i'm guessing they were slow,steady drops and 2 jelly babies were sufficient but now with the rapid it's sharp drops of 2mmol every 10 minutes and 2 j/babies doesn't stop it. I will try a slower site.

 

[rebrascora]

I only started the libre 3 weeks ago so i had 2 weeks on the mixed insulin. i've only ever had mild hypos before, during the night or late evening so i'm guessing they were slow,steady drops and 2 jelly babies were sufficient but now with the rapid it's sharp drops of 2mmol every 10 minutes and 2 j/babies doesn't stop it. I will try a slower site.

2JBs likely will stop it, but the Libre will suggest that it hasn't and watching it continuing to drop after you have eaten some fast acting carbs can make you panic and feel more hypo.

Don't forget that you were taking fast acting insulin before in the mixed insulin. It was just a set amount whereas now you are adjusting it.
Which mixed insulin were you on? If it was Novomix I wonder if NovoRapid would suit you better than Trurapi. Not all insulins are created equal and our bodies can respond very differently to different brands or types. I moved from NovoRapid to Fiasp which are both "fast acting" insulins made my the same company NovoNordisc, Fiasp being faster than NR and it took me 2x 3month, very frustrating trials of it before I figured out how to make it work for me. It takes time to get used to a new system and you are also coping with Libre as well which can really mess with your mind, wonderful as it is.

 

[Susan64]

2JBs likely will stop it, but the Libre will suggest that it hasn't and watching it continuing to drop after you have eaten some fast acting carbs can make you panic and feel more hypo.

Don't forget that you were taking fast acting insulin before in the mixed insulin. It was just a set amount whereas now you are adjusting it.
Which mixed insulin were you on? If it was Novomix I wonder if NovoRapid would suit you better than Trurapi. Not all insulins are created equal and our bodies can respond very differently to different brands or types. I moved from NovoRapid to Fiasp which are both "fast acting" insulins made my the same company NovoNordisc, Fiasp being faster than NR and it took me 2x 3month, very frustrating trials of it before I figured out how to make it work for me. It takes time to get used to a new system and you are also coping with Libre as well which can really mess with your mind, wonderful as it is.

I was on humulin 3 before. You are probably correct, the libre is fantastic in some ways but probably does make me panic more than i should. i will get used to it eventually.