Low BG (and BP?) and rebound

[Fagor]

I had a funny turn before bed last night.
Yesterday was pretty normal, usual meals, activity and insulin.

A bit low at 22:15, but carbs at dinner but may have been a little less than normal. Had usual fix - toast and hot drink. After 20 mins, felt worse, couldn't eat, but managed a Dextrose, as didn't want to over-correct. After 20 mins, felt the same so had another Dextrose, and started to feel better.

To complicate matters, think BP may have also plunged. Feeling clammy, almost sick, funny tummy, grey vision and tunnel vision. Had some of these before when BP dropped, checked by nurses as in hospital or with doctor.

Libre shows BG started rapid increase at 02:00. Woke up at 04:30 with BG of 22.3. At 07:45 before breakfast it was 23.1 so corrected. Feel relatively Ok this morning, but flushed, BG down to 13.7 mid-am.

Would it have been sensible to take smallish QA correction at 04:30, about 3hrs before breakfast?

Not keen on taking extra QA between meals in case of insulin stacking. I did it once and BG plunged hours later.
The usual problem with reacting to low BG - don't think logically.

Apologies if a bit long.

 

[rebrascora]

You don't mention any of your readings when you felt unwell after dinner You say a bit low, but how low and did you continue to test when you felt unwell rather than just keep having some carbs.

The symptoms you describe are all hypo symptoms as far as my experience goes and many of them I get after I am coming back up from a hypo about 10-15 mins later. I think it is a delayed reaction to the adrenaline released by the body in response to the low BG level, so you may be clouding the issue talking about BP. It is important to test when you are low and keep testing every 15 mins with a finger prick until you come up into range. Quick acting carbs should start to bring you up out of a hypo in 15 mins so if your first 15g doesn't work you should take a second treatment 15 mins after the first. If you weren't as low as a hypo (ie below 4) and you were having a false hypo then a smaller 5g carbs might be enough.

My guess would be that you had a meal which included a bit more fat or fibre which slower the release of the carbs and your quick acting insulin dropped you, but it depends what time you ate your evening meal. The delayed carbs then released through the night along with your hypo treatments. Alternatively if you had perhaps been drinking the alcohol stopped your liver producing glucose so your basal insulin dropped you and then the carbs all kicked in later with your liver to take you too high.

Yes, I would definitely have taken a correction if I woke up at 4.30 with a reading that high. If you are having breakfast within 4 hours of that, give some consideration to the fact that there may be a little active insulin still in your system from that previous correction and reduce your bolus accordingly, but to be fair the majority of the QA insulin will usually have been spent after 2.5-3hours.

 

[Fagor]

Thanks @rebrascora for confirmatory reply, so here are some details.

Dinner was salad, steak (not the best I've had) & veg, and est 15g max of carbs at 18:00, BG 9.8. Took 6 QA plus 1 correction (ratio of 4 QA for 10g carbs as seem sensitive to carbs at dinner, but that seems to be changing). These are typical dinner values.

BG was between 3.2 and 3.6 from 22:10 onward, tested before toast and each Dextrose

I don't think I could have taken a finger BG due to shakes and vision. I've been around this value before, but not normally with such strong symptoms, unless BG was actually lower.

Being sleepy at 04:30, I didn't think of correcting till nearer breakfast, so decided best to wait. If it recurs, I'll try a correction.

 

[PattiEvans]

I've been having low BP issues recently and the symptoms do feel like a hypo, except when I scanned my Libre I was not low. Do you have a home BP monitor? They are reasonably cheap these days and probably worth investing in one to test when you are feeling like that. Unless of course you can definitely say it was a hypo.

 

[Fagor]

@Pattidevans thanks for the reminder. I've got two - wrist (unsure about accuracy) and arm (difficult to adjust without assistance, I live alone).
But it's the usual problem - co-ordination & thinking reduce with BG.
I thought about BP as I don't usually have all those symptoms when low, but suspect it was bad hypo.

 

[everydayupsanddowns]

Sorry you had such a rough time @Fagor

Hope things settle for you this week.

 

[SB2015]

It sounds like you tackled things with more sense than is often possible when hypo.
Well done. I hope that you have a better day today.

 

[Fagor]

Had another couple of overnight highs this week, each corrected with QA.
Never corrected at this time before, unless ketone checking. Sometimes corrected before bed but effects were inconsistent - morning check might be low, high or no change, so don't usually correct now.

Tuesday evening low (between 3 & 4) from 2030 to 2230, corrected with 30g carbs. 5.6 before bed at 2230, tested at 0300 and 18.7, corrected down to 10.9 at breakfast. Thought high might be partly due to slow uptake of carbs.

Wednesday 8.1 before bed (had a very small snack), tested at 0200 and 15.3, corected down to 9.6 at breakfast. No obvious reason.

Could this be DP?

 

[trophywench]

How long since you did a basal insulin check?

 

[rebrascora]

I was just wondering if you have had the Covid vaccine recently as that caused many of us BG turbulence