Constant Low Sugar Levels

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scoobmeister1

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Type 1
Hi,
I have been a type one diabetic for 7 years and my sugar control has always been excellent, with an HBA1c of around 42. Recently my sugar levels have been constantly low. With the dawn phenom they max out at 8 to 9 and throughout the day they are dropping to just above 3. At night they are regularly between 3 and 4. I have recently dropped my lantus night time jab from 40 units to 36 as i thought this was the reason for low readings. In addition i have dropped the units for my fast acting insulin, but again the sugar levels are so low. i have tried eating snacks and this makes minimal difference. What is going on?
 
I see you've reduced your basal but have you done a basal test? It also seems like it's still too much basal so I'd reduce further until things are back on track xx
 
Insulin doses need adjusting from time to time, for all sorts of reasons. You’ve done the right thing by adjusting your basal, if you’re still too low it probably needs adjusting some more. Just keep gradually reducing the doses until your numbers are better. If you know how to do a basal test then that would be a good idea, that will tell you whether it’s definitely the basal or whether your fast acting doses are wrong.
 
It is frustrating isn't it @scoobmeister1
I have experienced something similar this week and have put it down to restarting my exercise regime after a Christmas interlude. From previous experience, I am expecting to return to "normal" once I am used to exercise again so, whilst I am in this transition phase a basal test is of limited use.
 
scoobmeister1 said:
Hi,
I have been a type one diabetic for 7 years and my sugar control has always been excellent, with an HBA1c of around 42. Recently my sugar levels have been constantly low. With the dawn phenom they max out at 8 to 9 and throughout the day they are dropping to just above 3. At night they are regularly between 3 and 4. I have recently dropped my lantus night time jab from 40 units to 36 as i thought this was the reason for low readings. In addition i have dropped the units for my fast acting insulin, but again the sugar levels are so low. i have tried eating snacks and this makes minimal difference. What is going on?
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It does rather sound as if you need to drop your basal a bit more doesn't it? Perhaps if you are going so low be a bit more aggressive with the reduction than you would normally be and then work your way up a bit as needed.
 
Thanks for all your responses. I now have the answer. Dodgy Freestyle libre sensor!! It was reading just over 2 units down all the time! How annoying. I did the traditional finger prick test and this is what showed a big difference in the what my freestyle said it was and the finger prick. Changed the sensor and readings more like what would expect. Really annoying when the sensors cost about £50 each!! Appreciate all the comments though.
 
How annoying for you @scoobmeister1

Have you contacted Abbott? They may be able to send you a replacement if the sensor was not performing up to their expectations.

Have you asked about getting Libre on prescription? You may fit the national funding criteria if you would otherwise need to check BGs 8 or more times a day?
 
I did ask but i don't qualify because of my job. I do check about 30 times a day though!! 🙂 I tried getting a replacement once but it was just too much hassle unfortunately.
 
@scoobmeister1 may I ask what your job is? I have never heard this be a reason not to get prescribed the Libre sensors, like @grovesy I've always found getting a replacement very east although possibly easier than grovesy as the last few times I haven't even had a wait, and I've had 14 replaced since around April last year so I'm not sure what you found a hassle about it? xx
 
@scoobmeister1 how often do you do a finger prick test? As you have seen Libre is not always accurate. I was advised it is definitely not accurate at high or low levels because it is calibrated for "normal levels" so you must always check with a finger prick before correcting. To be honest, I also calibrate at least once a day. I would certainly not be going for days without checking with a finger prick, especially if my levels were significantly lower than normal.

I second (third?) the comments about contacting Abbott. I have never found it a hassle to get a replacement for a faulty sensor.

I also recommend asking again about getting Libre prescribed as the rules have become more relaxed now. However, one condition is that you must contact Abbott when you get a dodgy sensor - the NHS does not have money to spare on faulty equipment.
 
Why not just report it online and save the hassle of staying on hold for ages
www.freestylelibre.co.uk

Home | FreeStyle Libre | Abbott

Discover how to manage your diabetes easily with Flash & Continuous Glucose Monitoring - user-friendly & discreet sensor-based glucose monitoring systems.
www.freestylelibre.co.uk www.freestylelibre.co.uk
 
I wonder if perhaps @scoobmeister1 has removed the sensor without doing the double checks Abbott like you to do to show evidence of it not working effectively, rather than the actual phone call to report it.

Personally I can manage fine with a sensor that is 2mmols out and I just make allowance for it, but I do check it more frequently for consistency. I usually find that they are out by pretty much the same amount over most of the 3.9-10 range over the lifetime of the sensor.... so if it is low by 2mmols on day one and two, it is usually still reading low by about that much on day 12 and 13. More than 2mmols and it gets reported.
I've only had 1 that was 2mmols out and one that was worse. Mostly it is just a consistent 1mmol lower than finger pricks and that is absolutely fine. I do a couple of spot checks in the first few days of a new sensor to check it and then only occasionally when it shows me low. I know we are supposed to double check all hyper and hypo readings but generally I know enough now to judge when I need to double check it and when I can take it at near enough face value.
It isn't a perfect system, but that doesn't make it any less than marvelous and I would not be without it for all it's faults and I am hugely grateful to get it on prescription.

I agree that the guidance for prescribing it has changed and you should keep asking and if possible show proof of how it has improved your control since self funding. I think it was initially people who worked in unsanitary conditions like farmers and sewage workers who could get it on grounds of their occupation but there are other criteria for prescribing it beyond occupation. Some CCGs make it as difficult as they can to obtain it on prescription and focus on particular guidelines whilst others seem to go as far as they can in getting it for more people. The usual postcode lottery seems to apply. Keep trying though. Don't take one NO as the only answer..... Keep asking and get them to give you the reasons for their refusal in writing, so that you can understand how it fits in with current NICE guidelines.
 
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