Need help understanding this cenario

[gillrogers]

So yesterday lunch time. I bolused after my meal as usual, 4 units plus half a correction unit. , should have had another correction half on top but didnt after trying another tactic to get me down. So after about an hour of eating (45 mins after bolusing) i started coming down. I let it run but was worried about needing to go out. So waited hoping it would stop. And it did. My worry is if i had had that extra half i would have statted coming down sooner and faster and if i had been moving around it would have been even faster and usually keeps going to a hypo. To counteract this i had been giving the correction a bit later but then i end up with a huge spike. DB nurse has said that if i start dropping so early this means i have too much food insulin on board. So consequently im confused. Not sure what to do. After many years of not snacking due to misdiagnosis of type 2 i now find it difficult to.

 

[Evergreen]

Hey Gill!

Another LADA here

Did you do anything else before you took the insulin? Walking/exercise or anything? I can see there’s a drop before you took your insulin, assuming after breakfast?

If I’m active before taking insulin I can have something similar. Taking a shower also brings me down pretty fast, especially with insulin on board, but I know that’s not the case for everyone.

Also, do you prebolus? I often have to (depending on the meal), to prevent a big spike and in addition a fast drop after. Although in all honesty this can be a bit hit and miss. Eating foods on the lower side of the glycemic index and adding in some fats and protein helps me prevent the spike and the fast drop after. I suppose it can mimic the spike of the insulin a bit more like that.

Lastly, I also assume with having LADA you might still be producing some of your own insulin, I definitely do. Some days more than others and there doesn’t seem to be a clear pattern to this. On some days I seem to be much more sensitive to insulin and again I can have similar patterns to you on those days. It’s incredibly frustrating!

Have you set your hypo alarms? I’ve set mine slightly higher (between 4.5-5) to catch drops like this earlier. I’m also using Suggah as it gives an option to set a fast drop alarm which can be helpful.

Hope this helps a bit!

 

[gillrogers]

Hi @Evergreen , no real activity as I’m so sensitive I just kick it off. Long story, didn’t prebolus, I bolus after eaten at lunch as very little if no resistance now at lunch. If I prebolus then I’m dropping faster then my meal can keep up with. I have alarms set but I always drop faster than they can keep up with if I’m moving around even just doing something simple. I’ve found this happens unless I sit down for an hour to an hour and a half after my lunch and dinner meals. Breakfast has higher resistance so I can get up about 20 mins after start of rise and go to shop and get the paper. Can’t do that after lunch or dinner at all. I need my carbs, my lunch has actually less fat in it than my breakfast. I’ve been on the same food for lunch now for months trying to work this out.

I use suggah too. Not using the fasts drop alarm or it will trigger me too. much as I can do fast drops but not actually go anywhere with it.

 

[Evergreen]

This sounds so frustrating, I’m very sorry! What happens if you take a little less insulin with your meals? In theory it should fall slower right? I know our bodies don’t always adhere to theories though!

I’m going onto the omnipod 5 next week due to rapidly changing insulin needs. My consultant and diabetes nurse think it’ll be life changing for me, but in all honestly the omnipod specialist was a little dubious…it’s going to be a little experiment. Might a pump be easier for you?

 

[gillrogers]

This sounds so frustrating, I’m very sorry! What happens if you take a little less insulin with your meals? In theory it should fall slower right? I know our bodies don’t always adhere to theories though!

I’m going onto the omnipod 5 next week due to rapidly changing insulin needs. My consultant and diabetes nurse think it’ll be life changing for me, but in all honestly the omnipod specialist was a little dubious…it’s going to be a little experiment. Might a pump be easier for you?

I want a pump but Dbn says no as they think I can’t cope with things going wrong with it. After I saw what was involved when my head was in a very bad space with this I agreed but now I’m not so sure again.

That’s interesting as the Omnipod specialist said to me it would suit me down to the ground. And there’s not much really to go wrong as it’s tubeless. ‍♀️

 

[Evergreen]

Interesting. I suppose the pump is so new, they probably aren’t quite sure how it’ll work for people with changing insulin needs.

The omnipod specialist I spoke with said the pump is great at recognising patterns and this will be helpful overall, however it won’t recognise when my body is producing insulin (logically) and even though it will respond to this it might not work as well as for people who are out of the honeymoon phase.

It’s obviously a very personal choice and I can’t say what it will be like as I’m still on injections. From reading the user manual it is a lot to take in, but the support with it seems quite good.

I hope you’ll be able to find your way in it.

 

[Inka]

I’ve found this happens unless I sit down for an hour to an hour and a half after my lunch and dinner meals. Breakfast has higher resistance so I can get up about 20 mins after start of rise and go to shop and get the paper. Can’t do that after lunch or dinner at all.

Delay your bolus and take it longer after lunch @gillrogers Or, have a small amount of fast-acting carbs just before your lunch. I do that sometimes if I see my blood sugar dropping as I’m about to pre-bolus for lunch. It works well.

We are constantly balancing things. That means injecting when we need to and eating when we need to. It doesn’t matter if we have snacks or top-up carbs when appropriate. That’s what we’re supposed to do if we need to.

 

[gillrogers]

Delay your bolus and take it longer after lunch @gillrogers Or, have a small amount of fast-acting just before your lunch. I do that sometimes if I see my blood sugar dropping as I’m about to pre-bolus for lunch. It works well.

Crikey, I did think that. At the moment I’m bolusing around 14 minutes after start of eating. And dbn says bolus 15 minutes before eating . I’ve told her I just can’t!. I’m dreading the warmer weather. I’m in this mess at lunchtime now because of her insistence. ‍♀️

 

[Inka]

I missed out the word “carbs” @gillrogers (edited my post now). I meant if you’re dropping at lunch have some fast carbs just before.

 

[gillrogers]

I missed out the word “carbs” @gillrogers (edited my post now). I meant if you’re dropping at lunch have some fast carbs just before.

Yes I do, half a units worth. I cover those in my bolus.

 

[Inka]

Yes I do, half a units worth. I cover those in my bolus.

Ok, but I’d have them without covering in my bolus 🙂 The point being that they raise your blood sugar a little to give your body a chance to process lunch. I have to do that sometimes at or just before lunch. You could, for example, try a jelly baby or two with no insulin.

 

[Evergreen]

I second this, I also sometimes eat something before bolusing (without bolusing for it) and it works well.

I’m still wondering if maybe you are taking too much insulin…I try to wait a couple of hours regardless of what blood sugar does in the first hour or so (obviously only if I can, so I’d always treat a hypo). Sometimes it drops fast but only temporarily, then it comes back up. If it doesn’t I’m pretty sure I either miscounted my carbs or my insulin sensitivity/production has changed and I change my ratios (this can happen near daily and is a pain, but looking at it this way can make me feel a little bit more in control)

I was also wondering what types of food you are eating if you don’t mind me asking. Just because I have found that my body works better with the insulin if I eat carbs combined with some fat and protein.

 

[gillrogers]

I second this, I also sometimes eat something before bolusing (without bolusing for it) and it works well.

I’m still wondering if maybe you are taking too much insulin…I try to wait a couple of hours regardless of what blood sugar does in the first hour or so (obviously only if I can, so I’d always treat a hypo). Sometimes it drops fast but only temporarily, then it comes back up. If it doesn’t I’m pretty sure I either miscounted my carbs or my insulin sensitivity/production has changed and I change my ratios (this can happen near daily and is a pain, but looking at it this way can make me feel a little bit more in control)

I was also wondering what types of food you are eating if you don’t mind me asking. Just because I have found that my body works better with the insulin if I eat carbs combined with some fat and protein.

Yes , ill have a small satsuma 10 minutes before i start eating my lunch, then ill have a sliced beef and mustard sandwich with a little flora marg, a packet of plain ready salted crisps and then a choc and peanut protien bar.

 

[Evergreen]

Hmm that does seem to have protein and fats. Do you input your food in carbs and cals or fitnesspal or something similar? I’ve noticed for my body that if fat content of a meal is above 30-40 grams I could probably do with splitting my insulin dose. Not sure if that would work for you?

I think I’d probably try and reduce my bolus per meal a bit and see how that would work for me, but not sure if that’s an option for you.

It sounds very stressful.

 

[gillrogers]

Hmm that does seem to have protein and fats. Do you input your food in carbs and cals or fitnesspal or something similar? I’ve noticed for my body that if fat content of a meal is above 30-40 grams I could probably do with splitting my insulin dose. Not sure if that would work for you?

I think I’d probably try and reduce my bolus per meal a bit and see how that would work for me, but not sure if that’s an option for you.

It sounds very stressful.

Yes it does have protiens and fat. In the crisps and protien bar, beef and the gluten free bread. I use nutracheck.

 

[gillrogers]

I’ve found this happens unless I sit down for an hour to an hour and a half after my lunch and dinner meals. Breakfast has higher resistance so I can get up about 20 mins after start of rise and go to shop and get the paper. Can’t do that after lunch or dinner at all.

Delay your bolus and take it longer after lunch @gillrogers Or, have a small amount of fast-acting carbs just before your lunch. I do that sometimes if I see my blood sugar dropping as I’m about to pre-bolus for lunch. It works well.

We are constantly balancing things. That means injecting when we need to and eating when we need to. It doesn’t matter if we have snacks or top-up carbs when appropriate. That’s what we’re supposed to do if we need to.

 

[gillrogers]

@Inka , just occurred to me if i delay my bolus longer then im going to get a much bigger spike?

 

[Inka]

@Inka , just occurred to me if i delay my bolus longer then im going to get a much bigger spike?

Then try the small amount of fast-acting carbs just before your lunch 🙂

Yes, delaying a bolus too long will cause a bigger spike but it’s up to you to decide what you feel happy with in order to minimise your fear of dropping and going hypo. You might ‘need’ a bigger spike initially but then gradually feel more relaxed so that you can bring your bolus forward a little and reduce the spike.

 

[gillrogers]

Then try the small amount of fast-acting carbs just before your lunch 🙂

Yes, delaying a bolus too long will cause a bigger spike but it’s up to you to decide what you feel happy with in order to minimise your fear of dropping and going hypo. You might ‘need’ a bigger spike initially but then gradually feel more relaxed so that you can bring your bolus forward a little and reduce the spike.

thanks @Inka, makes sense ‍♀️

 

[Evergreen]

It sounds very frustrating @gillrogers, I hope you find your way in it soon.

If it helps, I’m having one of those mornings similar, where I seem to just be more sensitive to insulin or producing more today, really have no idea why. Nothing has changed.
Woke up to a hypo alarm and I’m dropping in between food (even without insulin). I’m going to reduce my mealtime ratios and probably will reduce my basal tonight. It’s not perfect and I’m feeling pretty anxious today but maybe hopefully it’ll make you feel you are not alone 🙂