Confusing day of so much low BG

CathyFP

CathyFP

Well-Known Member
Relationship to Diabetes
Type 1.5 LADA
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She/Her
I’ve had such a confusing day today with my BG constantly rapidly dropping low despite eating my normal meals and taking my normal amounts of insulin. Does anyone else get days like this? What should I do? I feel I hardly dare move, it’s so restricting, and frightening.
 
Seems to happen to me quite often. As well as the usual being more active I've found sunlight and warm days seems to make the insulin much more effective. If I'm going to be active I take less insulin ditto if its warm and bright. If I get it wrong then snacking is the answer. I normally have cheese and crackers or digestives for the longer, smoother blood glucose increase. Glucose tablets and jelly babies wear off quite quickly and you're back at square one again.
 
Hi @CathyFP sorry that you have had a weird day.

You are still likely to be in the Honeymoon Period and have some beta cells lurking and hiding from those antibodies. Once they have had a bit of a rest, with you now injecting insulin to do most of the work, they sometimes do the unexpected and chuck out some extra insulin without you asking them to. I found this very frustrating and it could cause days like you have had recently.

Are you confident enough to reduce your insulin doses. It may be that you temporarily need to reduce the basal insulin, then keep a watch on your BGs, and adjust back as necessary.
 
SB2015 said:
Hi @CathyFP sorry that you have had a weird day.

You are still likely to be in the Honeymoon Period and have some beta cells lurking and hiding from those antibodies. Once they have had a bit of a rest, with you now injecting insulin to do most of the work, they sometimes do the unexpected and chuck out some extra insulin without you asking them to. I found this very frustrating and it could cause days like you have had recently.

Are you confident enough to reduce your insulin doses. It may be that you temporarily need to reduce the basal insulin, then keep a watch on your BGs, and adjust back as necessary.
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Hi @SB2015 well my Consultant did a blood test to check if I am still producing any Insulin (CCP ?) and told me that my beta cells are completely dead- lovely turn of phrase! So I think my honeymoon is over but maybe my basal is still too high. I have gradually reduced it from 10 to 7.5 - if I have another day like yesterday I may try taking it to 7.0.
 
CathyFP said:
Hi @SB2015 well my Consultant did a blood test to check if I am still producing any Insulin (CCP ?) and told me that my beta cells are completely dead- lovely turn of phrase! So I think my honeymoon is over but maybe my basal is still too high. I have gradually reduced it from 10 to 7.5 - if I have another day like yesterday I may try taking it to 7.0.
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That sounds like a good plan Cathy. I always try to bear in mind my consultant saying ‘You need the insulin you need’ so if you need less basal that is what you need. Our needs change with so many variables so our diabetes definietely keeps us on our toes.
 
Are you checking with a finger stick blood test. I had the very same issue on Sunday low on Libre but my bloods were running at 9/10. Checked it for a couple of days with continuing large discrepancies and decided to abandon the sensor which was coming to the end of its life anyway which may have been the issue. First time in 3 years of Libre use I've had that happen but I've read that it can be an issue.
 
Yes if Libre says I am low I mostly do a blood test to be sure now. I generally find blood result is even lower than Libre!
 
Sorry to hear you have had One Of Those Days @CathyFP

As you say, they can be frustrating, draining, exhausting, and frightening all at the same time!

If your fingersticks and sensor readings are aligning, and your nurse is confident that your beta cells are kaput(!) then it does seem like you have a bit too much insulin active? And if it’s a general drift downwards I’d wonder about basal if it were me.

Hope tomorrow is easier for you 🙂
 
everydayupsanddowns said:
Sorry to hear you have had One Of Those Days @CathyFP

As you say, they can be frustrating, draining, exhausting, and frightening all at the same time!

If your fingersticks and sensor readings are aligning, and your nurse is confident that your beta cells are kaput(!) then it does seem like you have a bit too much insulin active? And if it’s a general drift downwards I’d wonder about basal if it were me.

Hope tomorrow is easier for you 🙂
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Thankyou @everydayupsanddowns. I haven’t reduced my basal more yet as I’m a bit nervous to do so but what seems to happen is between meals I drift down to 4 or lower. I’m trying to stay above 5 but it’s really difficult. Does that mean I’m taking too much basal at night. I’m scared if I reduce it I won’t get through the night without going low? I am trying to speak to a nurse but it’s so difficult.
 
Which basal insulin are you on? Do you take it once a day?

CathyFP said:
I’m scared if I reduce it I won’t get through the night without going low?
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Reducing your basal dose would generally help guard against overnight hypos - so you should be less at risk of going low on a lower dose.

The job of basal is to deal with the trickle of glucose emitted from the liver 24 hours a day. So in an ideal world your basal insulin would keep you more or less level (+/- 1.7mmol/l) throughout the night, and for as long as you left it between meals so no rapid insulin active.

So if set ‘right’ basal should mean you go to sleep and wake on pretty much the same number, with only gentle wobbles in between. Similarly you should be able to skip a meal or two, or delay a meal and your basal should just keep you pottering along at roughly the same BG.

Of course the body doesn’t always play along, and there’s some natural variation in liver output, stress, exercise, and all the other variables.

But that’s the theory at least!
 
everydayupsanddowns said:
Which basal insulin are you on? Do you take it once a day?



Reducing your basal dose would generally help guard against overnight hypos - so you should be less at risk of going low on a lower dose.

The job of basal is to deal with the trickle of glucose emitted from the liver 24 hours a day. So in an ideal world your basal insulin would keep you more or less level (+/- 1.7mmol/l) throughout the night, and for as long as you left it between meals so no rapid insulin active.

So if set ‘right’ basal should mean you go to sleep and wake on pretty much the same number, with only gentle wobbles in between. Similarly you should be able to skip a meal or two, or delay a meal and your basal should just keep you pottering along at roughly the same BG.

Of course the body doesn’t always play along, and there’s some natural variation in liver output, stress, exercise, and all the other variables.

But that’s the theory at least!
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Thanks Mike that’s really helpful . I take Tresiba once a day at bedtime. I certainly can’t skip or delay meals without going low so maybe I’m still taking too much Tresiba.
 
CathyFP said:
I certainly can’t skip or delay meals without going low so maybe I’m still taking too much Tresiba.
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Sounds quite likely
 
I get a day like this just before I come down with a cold (and then run high), if you're the same, get well soon!
 
Could it be your menstrual cycle @CathyFP ?

I get random lows and need less insulin just before I come on.

Also with diabetes it can be anything, form the weather to how active you have been or as @SimonP said looking illness.

Main thing is how you combat it and you’ve had some good ideas, how you get it sorted, these days can be so draining.
 
So I have reduced my Tresiba by 0.5 unit and it has made a massive difference so far! In fact much more than I expected. I am running a bit higher generally - around 8 but going low a lot less, which is a bit less stressful and I think is helping with my anxiety issues. Thanks for all the help everyone.
 
So pleased you seem to have worked out a new regime to manage your anxiety over going low.
In the last few days I have been going lower in general so basically have stopped taking bolus and although I am a little higher than “ normal” it seems to be OK and nice not to have to calculate ratios etc.
I don’t really want to adjust basal as that keeps me pretty much in synch but important thing is to find out what works for you.
Good luck
 
CathyFP said:
So I have reduced my Tresiba by 0.5 unit and it has made a massive difference so far! In fact much more than I expected.
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Hehe! I know just what you mean!

One of the Big Changes I made to my diabetes management (thanks to this forum among others) was to properly take notice of my basal, and fine tune it as much as I could.

I was always amazed by how much of an effect a very modest change to my basal insulin (which is then spread over many hours) had! From a day when I’d be guzzling sugary treatments right left and centre, or a day needing units and units of correction doses, to suddenly meekly pootling along and behaving itself - and all from a single unit change in basal (or a half unit if you have a fancy pen!)

This became clearer on a pump where you have a ‘basal profile’ and can adjust ‘units per hour’ delivered in preposterously small amounts, and see similarly dramatic improvements.

It just seem to be part of the craziness of ‘Diabetes Maths’
 
Yes, I too find it amazing how a very small adjustment to basal insulin can have such a dramatic impact. For me, I can be needing 10 or more correction units of bolus insulin in a day to keep levels in range and yet increasing my basal by 1 or 2 units sorts it all out and then things tick over nicely again. It is why I love my Levemir insulin so much because it allows regular adjustment to match my needs and without that adjustment, I am fighting my diabetes and it is frustrating and sometimes scary. I see my basal as being so much more powerful than my bolus insulin. It is why we say that getting your basal insulin dose correct is so important, like a level foundation for a house. If it isn't right nothing works right or makes sense, but when it is adjusted for what you need, it is such a relief and diabetes becomes much easier to manage. It isn't just the dose either, the type of basal insulin is also important and finding one which has a profile which suits your body and your lifestyle.
Well done for taking the reins and making that adjustment. Sounds like you did a great job!
 
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