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Blood sugars now dropping

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Clarkey

Clarkey

Well-Known Member
Relationship to Diabetes
Type 1
I've been diabetic for 15 years. Generally my blood sugar levels have been managed well, slightly on the high side but i've gradually got my HbA1c down to a good level.

However, over the past couple of weeks my blood sugars have suddenly become lower and I don't quite understand why. I've not changed anything in my diet nor have I changed anything in my routine. I'm on Novorapid and Lantus.

For example, Saturday morning I woke up on 2.9 and then this morning again on 2.9. My doctors have always said don't go to bed under an 8.0 without having a snack. Last night at 23:30 my reading was 12.3, so i went to bed. Woke up on 2.9?

I'm going to see a specialist soon to discuss it once i've got a load of readings to take to them. But wondered if anyone would know why my levels are suddenly much lower when i haven't changed my diet or lifestyle or insulin?
 
Errm. No. Can only think of lifestyle changes such as inceased exercise, less stress, etc.

It's an interesting one.

Rob
 
Unless you've recently changed injection sites to somewhere a bit fresher ?

Rob
 
No I haven't changed my injection sites.

However as you mentioned "less stress" I did find this on a website somewhere:

When one becomes stressed for whatever reason, one releases stress hormones in order to allow one to cope with that stress. Insulin is such a stress hormone and has the effect of shunting sugar in the blood stream into cells. This produces a drop in blood sugar levels and also causes hypoglycemia.

Therefore, hypoglycemia can be both a cause of stress and the result of stress, indeed, another one of those vicious cycles that are so often seen in disease states.


Would that not suggest an increase in stress could cause blood sugars to drop?
 
You need to take a good look at your lantus and see if you can't get it closer to your actual requirements. I'm pretty fortunate in that my lantus worls very well and predictably for me - I can go to bed on 5.0 and wake up at 5.2, for example. You certainly shouldn't need to go to bed on 12+, or even 8.0 if your lantus dose is correctly set.

I used to be on 20 lantus and was getting levels like you describe so I had to start reducing it. I'm currently on 6 and have been as low as 3 units! No real explanation why it suddenly went down from 20 to 10 - my novorapid needs also reduced by 40% - I just had to keep adjusting the dose until I reached a level where I wasn't dropping more than 1-2 mmol/l overnight. Might be worth doing some 3 am tests to see where you are at that point - it's possible that you are getting a surge of absorbtion akin to a lantus 'peak' if your injection sites have become compromised from too much use.

I also get seasonal changes in my lantus requirements, but also when I step up my running I have to start lowering doses too. If you haven't changed anything then it must be something that has changed about you - but that can be very hard to pin down! I would start reducing lantus doses though so you avoid those morning hypos, especially if you are waking up to them rather than them waking you up! 😱 A good question fr your consultant or DSN I think! 🙂
 
Clarkey said:
No I haven't changed my injection sites.

However as you mentioned "less stress" I did find this on a website somewhere:

When one becomes stressed for whatever reason, one releases stress hormones in order to allow one to cope with that stress. Insulin is such a stress hormone and has the effect of shunting sugar in the blood stream into cells. This produces a drop in blood sugar levels and also causes hypoglycemia.

Therefore, hypoglycemia can be both a cause of stress and the result of stress, indeed, another one of those vicious cycles that are so often seen in disease states.


Would that not suggest an increase in stress could cause blood sugars to drop?
Click to expand...

Stress can work differently in different people. Stress may indeed produce the effect your describe, but it also releases adrenalin and cortisol which prompt the liver to release extra glucose, raising blood sugar levels. This is the classic 'fight or flight' scenario, where you get more glucose to give you energy, and more insulin to help you employ it. In a non-diabetic person this probably evens itself out to some extent, but if you are Type 1 then your levels would usually go up, as you don't produce your own insulin. If the only insulin available is your lantus, then your body can;t suddenly start using this up because it 'dissolves' at a slow and constant rate.

So I think that is unlikely as a cause for you.
 
Clarkey

You should definitely not need a snack at that level before bed.

However I do know exactly where you are coming from because that is exactly what we used to be told (in my case it was 7.5 though)

But things have changed because we now have different insulins at our disposal and blood testing is universal - previous insulins were a mixture of fast and slow, sometimes medium, so you were bound by the insulin to do what it dictated. Now it's us that decides, the insulin has to do what we want - if it doesn't - change it to one that does. (Maybe by changing timing of jab, or splitting it)

The IDEAL maximum change in BG you want to see overnight - up or down - is 1.7.

First thing you need to do is test your basal - see http://www.diabetes-support.org.uk/info/?page_id=120 for how to do that.
 
Two things I would look at
1 is your carb ratio right for your evening meal and
2 the drop in blood sugars durring the night suggests to high a dose of lantus.

Do you carb count and are you used to dose adjustment?
 
I do carb count, but haven't been on DAFNE yet.

I think i'll reduce my lantus dose and see what effect that has in the mornings.
 
But test it first Clarkey!

It might be you'd be better off taking it first thing in a morning instead of at night or as I said splitting the dose. But you can't know any of this unless you test. Plus if your basal is wrong, then your carb ration probably is too .......

This is scientific, not guesswork LOL

Please? :D
 
Clarkey said:
I do carb count, but haven't been on DAFNE yet.

I think i'll reduce my lantus dose and see what effect that has in the mornings.
Click to expand...

Out of interest, how many units of lantus do you normally take, and do you alter this dosage from time to time (for whatever reason)? The quantity doesn't really matter, except insofar as the scope for changing dose exists. For example, when I was on 3 lantus, 1 unit up or down would have represented a 33% change in dose!
 
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