Going low too often

[shiffcam13]

hi Everyone. Looking for advice as experiencing too many lows. Have been exercising more and think that may be the culprit.
Have reduced my basal by 1u so now on 9 units Lantus in the morning. Am still using a ratio of 1:10 bolus but wondering if I should reduce that slightly.
Find am having to eat more than I would like to prevent lows.
Just changed my libre alarm so I’m alerted earlier.
Really annoying - any suggestions greatly appreciated

 

[mashedupmatt]

Hi @shiffcam13 - can you let us know when the lows are occuring more specifically? Night time/Morning/after meals? How long have you been experiencing the unexpected lows? And have you been confriming with a finger prick? (Sorry for all the questions!!)

 

[shiffcam13]

Thanks so much for replying. Yes, readings confirmed with fingerprick tests
First low today about 90 mins after eating second one before dinner. Then stopped a third after dinner.
This month has been erratic - the joys of diabetes - substantially more lows than would normally have.

 

[Inka]

If you’re going low 90mins after eating, that sounds like you need less bolus for that meal @shiffcam13

 

[mashedupmatt]

Agree 100% with @Inka - I need less bolus with dinner than breakfast - I am 1:10 or 1:8 for breakfast/lunch (depending on what it is) but usually 1:12 or 1:15 (again, depending on what it is) for dinner - I have a marked change in insulin requirements depening on time of day - may be a little tweak in your ratios would help - Do you have a half unit pen? You can make very slight changes very safely with one

 

[shiffcam13]

Thanks for your replies. Really appreciate it. Will try changing ratio slightly. Don’t have a half unit pen but will experiment with 1:8 and see how it goes.
This yo-yoing around a bit frustrating. TIR still ok but way too many spikes !
Libre alarm always goes off at the most inconvenient moments too
Hope you’re both having a good week

 

[shiffcam13]

Actually that’s the wrong way round - will try bolus ratio of 1:12 …. 1:8 not a good idea at all!

 

[mashedupmatt]

Try 1 unit to 12g of carbs (not the other way around) and ask for a half unit pen definitely

 

[SB2015]

Hi @shiffcam13 glad that your recovery goes sorted the change in your meal ratio.

If you are going low too often you definitely have too much insulin of some sort. With your lows happening both soon after a meal and also before a meal it sounds like it is good that you have changed basal and bolus.

If you are doing more exercise as well that will definitely use up more of the glucose, so you may find you need to reduce your bolus just before your exercise. I remember how surprised I was at the impact on my levels of simply walking into town (20 min). As a general rule I found it easier to exercise just after a meal as I could make an adjustment to the bolus. If I wanted to exercise before a meal I found I needed to snack.

A half unit pen is well worth persuing. A change of a half unit can make all the difference.

 

[helli]

I find exercising first thing in the morning can be easier - the effect of the exercise using more glucose can counteract my Foot on the Floor so my BG will remain stable(ish).
The only fly in that ointment is intensive exercise on one day usually reduces my FotF the next day.

But remember that all exercise is not equal when it comes to BG effect. I often give the example of cycling:
- a pootle along a flat tow path whilst chatting to my mates will have very little impact on my BG
- a sprint around country roads will reduce my BG
- a slog up a steep hill in the rain against the wind will raise my BG

However, the effect of all types of exercise will reduce my BG for the next 24 hours.
I was advised to reduce my basal by 20% after intensive exercise.
(The definition of "intensive" exercise will vary for each of us but I think of it as raising my heart rate for more than 20 minutes.)

 

[Proud to be erratic]

Actually 20% reduction can be relatively insignificant. In his paper on Exercise Dr Alistair Lumb talks about 50% adjustments as fairly normal , even 75%. He is a Consultant in Diabetes and Acute General Medicine at Oxford University Hospitals NHS Foundation Trust. He is Chair of the Diabetes Technology Network-UK (DTN-UK), clinical lead for the National Diabetes Inpatient Safety Audit and a member of the ExTOD (Exercise in Type One Diabetes) Faculty team. This very much depends on individual circumstances, personal starting levels of fitness, type and degree of exercise and activity and so on.

We frequently say that we need the insulin we need - when someone wants to compare their doses with other people and want external reassurance that we are taking the right amounts. This equally applies to how much exercise adjustment we need to make, PLUS how much correction is needed with any single bolus, PLUS how much prebolus time someone needs.

This is not so straightforward, @shiffcam13. But unless your insulin doses are constantly in double figures, you absolutely do need a 1/2 unit pen. These are reusable pens with disposable cartridges inside. You need 2 of these pens, for each insulin, with different colours for basal and bolus. One is a complete reserve, in case you lose/damage it or your in-use pen just fails. In that scenario a reserve pen is vital and essential!

 

[trophywench]

I've never in my life had to change an insulin dose by vast amounts - on MDI or otherwise - once I'd got the doses right in the first place and I'm a right PITA on this, by continually insisting that once you get your basal insulin dose(s) as smack on as necessary for you - only then is it time to start considering more permanent bolus ratios.

So for heaven's sake - get a full 24hr basal test done, first.

@Admin - Can someone please post the link to the instructions for the basal test, for @shiffcam13. Yeah, bo-o-oring to do, I'm well aware. Necessary evil I'm afraid.