One extreme to another - advice

[digihat]

Hello Everyone

Hope your all doing well and having a good week

Last night I've run in to a situation that has happened a few times now. I had a curry and snack bar around 86 carbs all checked as I usually do. Took insulin left about 20 minutes as usual had food carried on rested get ready for bed libre goes off so check and take something noticed it doesn't seemed to have caught up check again dropping lower took another sugar hit leave 15 minutes drops lower ultimately to 2.6. Then took another round of sugar which eventually got it back to 5.2 I think it was then in typical fashion all the other previous ones caught up shooting me up about 17 corrected this morning was nervous after the evening. These were finger prick checked each time to just mention.

A few times now I've had this experience where food doesn't seem to trigger a blood sugar rise and just crashes. Has anyone else ever had any experience like this?

My ratios and Basal are in flux at the moment keep adjusting them observing patterns to hopefully settle that down main suspect honeymoon period as these were settled for quite awhile at 32 basal and 1:10.

32 seems to much basal as it's gradually dropping me where as 31 isn't just enough as my overnight levels rise need like a 31.5 ha. I'm going to lower basal for now let that catch up for 4 days then will start tweaking carb ratio currently 1:12

 

[rebrascora]

By the sound of it you were going by your CGM rather than finger pricks for assessing your hypo recovery. CGM almost always shows your levels continuing to drop 15 mins after your hypo treatment, because it is still extrapolating the previous trend of a sharp drop and hasn't caught on that things have changed and your blood glucose is coming up, because the glucose hasn't made it's way into the interstitial fluid 15 mins post hypo treatment, but it is in your blood, which is the important bit. .
It has always been recommended that when hypo, you confirm with a finger prick before treatment unless you feel hypo and then check recovery 15mins later with another finger prick because CGM is not reliable in this situation and will almost always lead you into over treating a hypo.

You may also find that your need to split your dose for the curry, depending upon how fatty it is, is the same way as pizza and creamy pasta dishes often need a split dose, so some insulin before you eat and the rest perhaps an hour after. This helps to prevent your levels dropping during the meal or shortly after and then spiking later.

 

[digihat]

By the sound of it you were going by your CGM rather than finger pricks for assessing your hypo recovery. CGM almost always shows your levels continuing to drop 15 mins after your hypo treatment, because it is still extrapolating the previous trend of a sharp drop and hasn't caught on that things have changed and your blood glucose is coming up, because the glucose hasn't made it's way into the interstitial fluid 15 mins post hypo treatment, but it is in your blood, which is the important bit. .
It has always been recommended that when hypo, you confirm with a finger prick before treatment unless you feel hypo and then check recovery 15mins later with another finger prick because CGM is not reliable in this situation and will almost always lead you into over treating a hypo.

You may also find that your need to split your dose for the curry, depending upon how fatty it is, is the same way as pizza and creamy pasta dishes often need a split dose, so some insulin before you eat and the rest perhaps an hour after. This helps to prevent your levels dropping during the meal or shortly after and then spiking later.

Just to add I was finger pricking before each one I took I don't rely on CGM. For any dosing I always finger prick over a CGM just what I prefer. I forgot to double check after the first sugar hit. Thanks for re explaining the lag of CGM which I'm aware of but easy to forget occasionally!

There is one other possibility which is where my basal didn't take which has happened before and crashed me like this. Lantus low I think the term is although I take Tresiba it has happened once or twice before.

In regards to the split bolus that could be the solution in this case however with this particular one never had a problem before I do split bolus for certain other fatty means as you say which works a treat normally 🙂

 

[rebrascora]

Good to hear you were finger pricking.
Another possible issue may be that you swallowed your hypo treatment too quickly and it ended up in a stomach full of food which was already slow to digest. Hypo treatments absorb most quickly in the mouth through the cells that line your mouth, so chewing well and/or swilling it around inside your mouth will have a faster effect and a couple of chews and/or swallowing it straight down, especially when you have a full stomach, but also works when you have an illness which involves vomiting and you can't keep anything down. The mouth is also closer to the brain, so the glucose gets absorbed closer to where it is most needed.
If you haven't had problems with this meal before, it may be that your digestive system is perhaps just getting a bit slower. Also meals with more fibre like a dahl which is high in lentils would be slower in the same way as fatty foods.

There is one other possibility which is where my basal didn't take which has happened before and crashed me like this. Lantus low I think the term is although I take Tresiba it has happened once or twice before.

I think it is a particular feature of Lantus or possibly insulin Glargine in general, where I believe it crystalizes when injected and then slowly dissolves but can sometimes get trapped in solid form and not release for days/weeks/months. I don't believe that Tresiba has the same mechanism and I haven't read of any issues like that with Tresiba, but I am no expert and hopefully someone will correct me if I have got any of that wrong.

 

[helli]

I find curry can often be a challenge. All the advice we are given about injecting 20 minutes before eating assumes all carbs are digested at the same speed. We are advised to use fast acting carbs to treat a hypo but less is made of slow acting carbs. These are typically ones eaten with fatty foods - fat slows down the absorption of carbs - and include curry, pasta with a creamy sauce and pizza loaded with cheese and meat.
Your fast acting insulin will have a similar profile for you whenever you take it - the "activity" of the insulin will rise to a pike and then slowly drift downwards (if you Google "NovoRapid Profile" you will see what i mean although the timing of the peak can vary from person to person). The instruction to inject 20 minutes before eating is to attempt to line the peak of the insulin profile with the peak of the carb digestion for the average food. With these slow acting carbs, the peak of the digestion is often later and, as a result, the insulin starts working faster before your BG has started rising so your BG falls. We take hypo treatment to stop this BG fall and then, later the carbs from the curry/pasta/pizza/... are digested your BG rises higher than planned.
The way to manage this is to bolus later or split bolus for these fatty meals.

 

[Inka]

Lantus low I think the term is although I take Tresiba it has happened once or twice before.

If you’re not on Lantus, it’s not a Lantus Hypo. Those are caused by the Lantus dispersing incorrectly. They’re very specific hypos.

Possibly you just injected your bolus a little early. For larger/fattier meals, I bolus just before eating and/or split my bolus.