Recent sugar crashing

Status
Not open for further replies.

Richard1985

Member
Relationship to Diabetes
Type 1
I'm quite new to diabetes 8months diagnosed. currently I'm taking 12 tuejo and 4 fiasp 1 metformin my bloods have been generally between 6 an 15 and over the last week I have had sudden sugar crashes which my bloods have gone down to 3 it's happen about 6 times in the last week I panic when it happens i have my jelly babies on hand just wondering if its normal for this to happen thanks
 
Hi and welcome.

Sorry to hear you have been experiencing some hypos. There are a number of things which can cause these although it is ultimately too much insulin. Figuring out which insulin dose was too much and why is the puzzle you need to solve.

The first thing to consider is when the hypos happened. Were they within a 3hours of a meal in which case it is likely your FIasp. It looks like you are currently on fixed doses of Fiasp which is surprising after 8 months. Have they not started you carb counting yet and adjusting your doses for what you eat? If you are on fixed doses and you had a low carb meal like an omelette with salad then that could have caused it or if you exercised within a couple of hours after a meal as the aerobic exercise will make you much more sensitive to the insulin you injected. Exercise can be anything from running or playing sport to hoovering the stairs or painting the ceiling, or digging the garden or mowing the lawn or cutting a hedge or having sex for that matter. The warmer weather can also make you more sensitive to insulin and drop your levels.... or.... if the heat stresses you, it can send your levels up, so how you respond to certain situations can be quite individual.

If your sudden drops in BG were overnight then it is likely your basal insulin (Toujeo) or if those drops were happening about the same time most days and not just after a meal, so if you experienced hypos in the afternoon 3 days out 4 that would suggest it was your Toujeo.

Were these your first hypos and what advice have you been given about treating them? ie. How much fast acting carbs and how to monitor that you are recovering? ie. Have you been told about the rule of 15? .... Test with a finger prick to confirm you are below 4 unless you feel hypo, eat 15g of fast acting carbs (3xjelly babies or 4-5 glucose tablets), wait 15 minutes and retest with a finger prick. If you are not above 4 by then you eat another 15g fast acting carbs and wait another 15 mins. When you are above 4, then you can consider whether another 10-15g of slower acting carbs might stabilize your levels. I have never used slower carbs because they generally send my levels too high, but that is the guidance until you learn how your body responds.
In my opinion, it is important, to learn how to treat hypos and having a routine of what you need to do to treat them. ie follow the rule of 15 and check with finger pricks rather than rely on CGM (Libre/Dexcom). I portion my jelly babies out into hypo treatments rather than carry a whole packet, so that I am not tempted to eat more than I need, because the raging hunger which sometimes comes with hypos can make it all too easy to over treat them and then end up high.

Hopefully that all makes sense. If you would like to post a screenshot of your Libre/Dexcom graph showing these crashes, we might be able to get an idea of which insulin was responsible. Do you note when you inject and when you eat meals on your CGM app?
 
Welcome @Richard1985 🙂 Sorry you’ve had sudden lows. They can be scary. A related question - why are you on Metformin? Also, are you carb-counting and adjusting your Fiasp appropriately? When are the lows? Have you been ill recently or had a stomach upset?
 
Welcome @Richard1985 🙂 Sorry you’ve had sudden lows. They can be scary. A related question - why are you on Metformin? Also, are you carb-counting and adjusting your Fiasp appropriately? When are the lows? Have you been ill recently or had a stomach upset?
Worse ones are early hours in the morning the alarm of my sensor goes off I do not know why I am on metformin the nurse just suggested I start taking them with my insulins I guess I'm on insulin and tablets because when I was admitted to hospital my bloods where 38 .my partner and friend helps me a lot with my meals carb countings been good I live in the middle of no where so the support since I got out of hospital has been pretty much non existent get the odd phonecall one in a blue moon ill post screenshots later. Onto my fiasp I'm scared to take it most of the time now due to a few weeks ago I went to spend a week with my children I left my diabetes kit on a train collected it 4 days later during those 4 days my bloods where between 5.5 and 8 before and after meals I got told whilst in hospital 1 unit of fiasp brings your blood sugars down by 3 so that tells me if I take my fiasp before my meal surely it would be dangerous for me to take it ? I've tried to ask my doctor and nurse this over the phone but they don't really answer my questions sorry to ramble on just about worries atm
 
Do you check the ones in the early hours of the morning with a fingerprick test @Richard1985 ? Sometimes you can get what are called compression lows where the sensor gives a false low reading due to it being compressed, usually in bed.

When you take insulin before a meal, eg if your blood sugar is 5.5, it shouldn’t drop you low because it will counteract the rise from the meal. As your blood sugar rises due to eating, the Fiasp will counteract that.
 
Worse ones are early hours in the morning the alarm of my sensor goes off I do not know why I am on metformin the nurse just suggested I start taking them with my insulins I guess I'm on insulin and tablets because when I was admitted to hospital my bloods where 38 .my partner and friend helps me a lot with my meals carb countings been good I live in the middle of no where so the support since I got out of hospital has been pretty much non existent get the odd phonecall one in a blue moon ill post screenshots later. Onto my fiasp I'm scared to take it most of the time now due to a few weeks ago I went to spend a week with my children I left my diabetes kit on a train collected it 4 days later during those 4 days my bloods where between 5.5 and 8 before and after meals I got told whilst in hospital 1 unit of fiasp brings your blood sugars down by 3 so that tells me if I take my fiasp before my meal surely it would be dangerous for me to take it ? I've tried to ask my doctor and nurse this over the phone but they don't really answer my questions sorry to ramble on just about worries atm
Hang on...you didn't take insulin for 4 days and your blood sugars were normal? You need to discuss this, and adjusting you doses, with the medical team.
Also, ask why you are still on metformin...its more a type 2 thing as it helps with insulin resistance, and there is no suggestion you are insulin resistant
 
Yes I use my fingerprick A few times through the day also I find 90% of the time it's .7 .8 difference from my sensor
As regarding the fiasp my bloods don't stay pretty much the same before during and after meals what scares me taking it as I said I've tried explaining to my nurse every time I see her and it seems like she can't explain to me weather I should still take it if my bloods are 5 before a meal and 2 hours after a meal wouldn't that mean I I shouldn't have took she looked at my readings on my phone and said I've been managing my diabetes very well I ain't told her I've rarely been been taking it
 
Just to be clear...do not stop your insulins without medical advice...those 4 days without insulin could have ended up in A and E for many type 1s.
It sounds as if your pancreas is still producing some insulin in a on and off again fashion. its called the honeymoon period
 
Yes I use my fingerprick A few times through the day also I find 90% of the time it's .7 .8 difference from my sensor
As regarding the fiasp my bloods don't stay pretty much the same before during and after meals what scares me taking it as I said I've tried explaining to my nurse every time I see her and it seems like she can't explain to me weather I should still take it if my bloods are 5 before a meal and 2 hours after a meal wouldn't that mean I I shouldn't have took she looked at my readings on my phone and said I've been managing my diabetes very well I ain't told her I've rarely been been taking it
You should tell her your blood levels are stable without fiasp...she can't give correct advice without correct info.
Sounds like you may need less fiasp, or maybe no fiasp, but at this stage, until you are confident with adjustments, it needs to be with medical advice
 
As @Inka has said, the sensors which monitor your levels are prone to what we call "compression lows" if you apply pressure to them for any length of time and the most likely way that this can happen is if you lie on the sensor in your sleep. Generally it takes about 20 mins for the compression to have an effect and start showing your levels as dropping and a similar time for it to "recover" when you release the pressure. You should always double check any lows where you don't feel "hypo" but particularly during the night. It may well be the warmer weather making you toss and turn in your sleep a bit more and making this more likely to happen. There are a couple of things you can try to prevent it. Placing your next sensor more towards the back of your arm and "learning not to lie on the arm that the sensor is on or developing a sleeping position which prevents the sensor being exposed to too much pressure. That may seem unrealistic but you do have spatial/positional awareness when you are asleep which is why you don't roll out of bed, even in a strange place like a hotel, so you can learn a different sleeping position. If I want to lie on that side I place my other hand under my arm just above the elbow and it lifts my arm off the bed enough to prevent compression lows. It sounds like a faff but together with better placement, has certainly worked and I can't remember the last time I had a compression low. Probably over a year.
Having said all that, they may be genuine lows caused by too much Toujeo and this may be due to you experiencing the "honeymoon period" which I will describe below. Double checking with finger pricks blood tests and a BG meter will help identify whether they are compression lows or genuine lows.

As regards Fiasp and worrying about it dropping your levels, what you have to understand is that whilst the insulin drops your levels by about 3mmols per unit, the carbohydrates you eat raises it and the guidance is that 10g carbs will raise your levels by about 3mmols. These are rough guidelines and will differ for everyone, but if for example you are going to eat a bacon buttie for breakfast, there will be about 45g carbs in a large white roll, so those 45g carbs will raise your BG by about 13.5mmols, so if you are on 6mmols before breakfast and you eat that bacon buttie you will end up almost on 20mmols if you don't take your insulin. Fiasp works over about 3 hours so it doesn't suddenly drop you as soon as you inject it and on a morning it is usually slower to be effective. So as that bread in the bacon buttie is digesting and releasing it's glucose, the insulin is starting to release to deal with it. The trick is to time the insulin and food so they both hit the blood stream at more or less the same time to sort of cancel each other out. Getting that timing right is a mixture of scientific experimentation, intuition and luck, but the important thing to understand is that the carbs make your levels rise and the insulin brings them down.

All that said, the early few years after diagnosis, your body is often still producing some insulin, and when you start injecting insulin, it gives your remaining beta cells (which produce insulin) a bit of a rest because up to that point they have been working flat out to try to balance your BG levels and because there are only a few left compared to what you need, they are effectively grossly "overworked and under staffed" The injected insulin can give them a bit of breathing space and takes the pressure off them and as a result they get a new lease of life and start managing to produce more insulin. This is called the "honeymoon period" where you have remaining beta cells able to produce some insulin, but sometimes it isn't consistent and you might need less insulin for a while or even no insulin at all, but sadly eventually your immune system will kill off those remaining beta cells and you will need to inject more insulin. Soetimes this "honeymoon period" will make your diabetes easier to manage and for other people it will make things more erratic and unfortunately you just have to muddle through as best you can until things stabilise. For you that might mean you don't need the Fiasp for a while or you need a smaller dose of Toujeo, if those overnight lows are genuine lows and not compression lows.
 
Hang on...you didn't take insulin for 4 days and your blood sugars were normal? You need to discuss this, and adjusting you doses, with the medical team.
Also, ask why you are still on metformin...its more a type 2 thing as it helps with insulin resistance, and there is no suggestion you are insulin resistant
I take my 24 hour insulin everyday my fiasp scares me taking it I just do what the nurse tells me to do I've had a few reactions to the metformin to be honest I feel like they don't know what's going on with me I feel like a get fobbed of Everytime I ask something went for a checkup a few weeks ago the nurse said they were very busy so they will discuss my diabetes on my next appointment practice hi you ok bye then
 

Attachments

  • IMG_20240726_090705.jpg
    IMG_20240726_090705.jpg
    58 KB · Views: 9
As @Inka has said, the sensors which monitor your levels are prone to what we call "compression lows" if you apply pressure to them for any length of time and the most likely way that this can happen is if you lie on the sensor in your sleep. Generally it takes about 20 mins for the compression to have an effect and start showing your levels as dropping and a similar time for it to "recover" when you release the pressure. You should always double check any lows where you don't feel "hypo" but particularly during the night. It may well be the warmer weather making you toss and turn in your sleep a bit more and making this more likely to happen. There are a couple of things you can try to prevent it. Placing your next sensor more towards the back of your arm and "learning not to lie on the arm that the sensor is on or developing a sleeping position which prevents the sensor being exposed to too much pressure. That may seem unrealistic but you do have spatial/positional awareness when you are asleep which is why you don't roll out of bed, even in a strange place like a hotel, so you can learn a different sleeping position. If I want to lie on that side I place my other hand under my arm just above the elbow and it lifts my arm off the bed enough to prevent compression lows. It sounds like a faff but together with better placement, has certainly worked and I can't remember the last time I had a compression low. Probably over a year.
Having said all that, they may be genuine lows caused by too much Toujeo and this may be due to you experiencing the "honeymoon period" which I will describe below. Double checking with finger pricks blood tests and a BG meter will help identify whether they are compression lows or genuine lows.

As regards Fiasp and worrying about it dropping your levels, what you have to understand is that whilst the insulin drops your levels by about 3mmols per unit, the carbohydrates you eat raises it and the guidance is that 10g carbs will raise your levels by about 3mmols. These are rough guidelines and will differ for everyone, but if for example you are going to eat a bacon buttie for breakfast, there will be about 45g carbs in a large white roll, so those 45g carbs will raise your BG by about 13.5mmols, so if you are on 6mmols before breakfast and you eat that bacon buttie you will end up almost on 20mmols if you don't take your insulin. Fiasp works over about 3 hours so it doesn't suddenly drop you as soon as you inject it and on a morning it is usually slower to be effective. So as that bread in the bacon buttie is digesting and releasing it's glucose, the insulin is starting to release to deal with it. The trick is to time the insulin and food so they both hit the blood stream at more or less the same time to sort of cancel each other out. Getting that timing right is a mixture of scientific experimentation, intuition and luck, but the important thing to understand is that the carbs make your levels rise and the insulin brings them down.

All that said, the early few years after diagnosis, your body is often still producing some insulin, and when you start injecting insulin, it gives your remaining beta cells (which produce insulin) a bit of a rest because up to that point they have been working flat out to try to balance your BG levels and because there are only a few left compared to what you need, they are effectively grossly "overworked and under staffed" The injected insulin can give them a bit of breathing space and takes the pressure off them and as a result they get a new lease of life and start managing to produce more insulin. This is called the "honeymoon period" where you have remaining beta cells able to produce some insulin, but sometimes it isn't consistent and you might need less insulin for a while or even no insulin at all, but sadly eventually your immune system will kill off those remaining beta cells and you will need to inject more insulin. Soetimes this "honeymoon period" will make your diabetes easier to manage and for other people it will make things more erratic and unfortunately you just have to muddle through as best you can until things stabilise. For you that might mean you don't need the Fiasp for a while or you need a smaller dose of Toujeo, if those overnight lows are genuine lows and not compression lows.
I
 
OK. Lets just look at that instance on the 24th July about 5pm. You were about 9mmols at 3pm and then dropped. Had you injected some Fiasp prior to that for lunch perhaps and if so what time and what was the meal? (it helps to notate on your Libre when you inject bolus (Fiasp) or basal (Toujeo) and when you eat, particularly when you are having problems so that they show on the graph and help enable people to interpret what is going on.

Just before 5pm Libre shows you at 3.5mmols with a vertical downward arrow. What did you do between 3pm and 5pm? Did you go for a walk, dig the garden or do some other activity?
Did you do a finger prick to check that 3.5 or just treat the hypo and what did you treat it with? ie What is your standard hypo treatment? Did you do a finger prick test after 15 mins to check that it had worked? Libre will take much longer to show that you have recovered from a hypo due to the algorithm it uses, so it is not suitable for assessing recovery from a hypo as it will almost always show your levels dropping lower 15 mins after treatment.
It is interesting to note that your graph does not show you going hypo at all and you will find that happens a lot and Libre overreacts to sharp drops (and rises) and then corrects itself later when it has more data and those lows do not appear as being below 4 on the graph or the highs as high as it suggests. All that said, you clearly had a sharp drop and assuming you treated that hypo with fast acting carbs, you clearly needed them so I would guess, if you had Fiasp for a late lunch, then you had too much..... that might be due to your own insulin production kicking in or perhaps a miscalculation or doing come exercise or activity after lunch or even possibly having some alcohol with lunch like a couple of glasses of wine.
If you didn't have any Fiasp for lunch that day then it would suggest your Toujeo dose may be too much.

Your graphs are quite spikey and I am wondering if you are having snacks between meals or if the extra spikes between meals are you treating impending hypos?

Can I ask what your Libre low alarm is set at? Many people here set it above 4 so that they have time to prevent a hypo rather than have to deal with one when it has happened. Mine is set at 4.5 but some people set it at 5.0 or even higher. If it is dropping fast at 4.5 I can usually turn it around with 1 or 2 jelly babies before I hit "the red".
 
OK. Lets just look at that instance on the 24th July about 5pm. You were about 9mmols at 3pm and then dropped. Had you injected some Fiasp prior to that for lunch perhaps and if so what time and what was the meal? (it helps to notate on your Libre when you inject bolus (Fiasp) or basal (Toujeo) and when you eat, particularly when you are having problems so that they show on the graph and help enable people to interpret what is going on.

Just before 5pm Libre shows you at 3.5mmols with a vertical downward arrow. What did you do between 3pm and 5pm? Did you go for a walk, dig the garden or do some other activity?
Did you do a finger prick to check that 3.5 or just treat the hypo and what did you treat it with? ie What is your standard hypo treatment? Did you do a finger prick test after 15 mins to check that it had worked? Libre will take much longer to show that you have recovered from a hypo due to the algorithm it uses, so it is not suitable for assessing recovery from a hypo as it will almost always show your levels dropping lower 15 mins after treatment.
It is interesting to note that your graph does not show you going hypo at all and you will find that happens a lot and Libre overreacts to sharp drops (and rises) and then corrects itself later when it has more data and those lows do not appear as being below 4 on the graph or the highs as high as it suggests. All that said, you clearly had a sharp drop and assuming you treated that hypo with fast acting carbs, you clearly needed them so I would guess, if you had Fiasp for a late lunch, then you had too much..... that might be due to your own insulin production kicking in or perhaps a miscalculation or doing come exercise or activity after lunch or even possibly having some alcohol with lunch like a couple of glasses of wine.
If you didn't have any Fiasp for lunch that day then it would suggest your Toujeo dose may be too much.

Your graphs are quite spikey and I am wondering if you are having snacks between meals or if the extra spikes between meals are you treating impending hypos?

Can I ask what your Libre low alarm is set at? Many people here set it above 4 so that they have time to prevent a hypo rather than have to deal with one when it has happened. Mine is set at 4.5 but some people set it at 5.0 or even higher. If it is dropping fast at 4.5 I can usually turn it around with 1 or 2 jelly babies before I hit "the red".
My alarm is set to 4 I think my nurse set it up I was out of hospital 4 months without any problems 3 months late when I first seen my nurse my blood went down to 3.5 my 6 jelly baby's my nurse recommended when my bloods go low it's been nearly 8 months and they still can't tell me weather I'm type one of two nurses whilst I was in hospital said I was more than likely 1 after my last blood test local nurse said it could possibly be two I have a next appointment on the 7th of August where I'll be asking questions. I take my toujeo every morning at 9 that apparently is a 24 hour insulin my fiasp I take if my bloods rise after I ate most of the time It rarely goes up. As I said I've practically been left to deal with this by myself since I got out of hospital I've learnt more off here in the past 24 hours than I have of nurses been waiting to get referred to a daphne course and some other course for 6 months nurse has been emailing me apparently but not received one email not very good with wording thing together either as you can probably guess but I'm sure you get the jist also currently waiting for dexcom 1+ or something as the disconnects on this libre2 are unreal
 
Yes, I get the gist of what you are saying but it will be really helpful to the nurses and yourself in time if you notate your Libre when you eat and when you inject insulin. Without that it is very difficult to know if those drops are due to Fiasp or your Toujeo. Keeping a fod diary will also be important. Tis doesn't have to be for the rest of your life but just until it can be worked out which insulin is causing the problem.
It seems to me that you are reacting to your Libre with insulin and carbs and this can set you on a roller coaster because Libre doesn't always show things as they actually are. There is also a delay in the insulin you inject taking effect, even with Fiasp which is one of the quickest ones, so if you inject it an hour or two after a meal when you have gone high, there will be very few carbs releasing glucose for it to work on at that time, so you are effectively injecting what we call a correction dose. If you are calculating that off your Libre reading then you are likely overestimating how much you need, plus your own body is likely still producing some insulin to bring that high level down, so the result is that you plummet because there are no carbs left releasing glucose.
If you know how much Fiasp you injected on the afternoon of the 24th July and when you injected it and what you had for lunch and when you ate it, then the picture can become a little clearer, but at the moment, you are not recording enough data to make sense of it and therefore give you suitable advice.
Do you know how to notate insulin and food on the Libre app? It will then mark the graph with a little syringe or an apple. to show you have injected or eaten. When I was first diagnosed I didn't have Libre or graphs and I just had to keep a written record of my readings and when I injected and how much and when I ate and what I ate and gradually you start to see patterns and develop strategies that work most of the time. Without those records it is just really difficult to see what is causing what.

I would also say that 6 jelly babies is generally too much for a single hypo treatment, but if you are injecting too much Fiasp well after a meal, then you may need double hypo treatments to counteract it. I appreciate that you have not been given enough support and hopefully that will improve.
Is the nurse you have contact with, a nurse at your GP surgery or a nurse from the hospital diabetes clinic?

They usually don't like to give people a DAFNE course until at least 6 months after diagnosis but do keep pushing to get on the list for that. You can also request an appointment with the diabetes dietician who will give you some help with carb counting if you haven't had that.

In your position, I would raise the low alarm a bit so that you have more warning of an impending low with your levels dropping quickly.

I also wonder if you might be better, injecting just a very small dose of Fiasp just before you eat. Maybe just 1 unit, rather than waiting until your levels go high an hour or 2 later and then injecting it and then having a big drop. If you can prevent the rise in the first place, that is much kinder to your body than going high and then low.

As regards learning, I think most of us here would agree that we learned far more from sharing our experiences on this forum and from experimenting on ourselves than we ever have from health care professionals. Not that they don't know their stuff, but just that diabetes and how our bodies respond to food and exercise and insulin and a whole host of other stuff is highly individual and those doctors and nurses don't live in our pocket every moment of every day to see what we are doing and eating and when we are doing these things. This is why keeping notes is really important when you are first trying to get to grips with it. .
 
I'm quite new to diabetes 8months diagnosed. currently I'm taking 12 tuejo and 4 fiasp 1 metformin my bloods have been generally between 6 an 15 and over the last week I have had sudden sugar crashes which my bloods have gone down to 3 it's happen about 6 times in the last week I panic when it happens i have my jelly babies on hand just wondering if its normal for this to happen thanks
When I started to manage my type one diabetes I was having hypos at an alarming rate..so I completely understand the situation you're going though.
 
Status
Not open for further replies.
Back
Top