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Type 1 and hypos immediately after eating if bolus given beforehand

M

MB1

Member
Relationship to Diabetes
Type 1
I have been Type 1 for 30 years and currently on a closed loop pump. The last few weeks I have had to delay taking my bolus insulin due to bg's dropping immediately after eating and and going hypo. Previously I would bolus about 10 mins before eating with no issue. I then tried bolusing immediately before eating and the same thing happens. There have been no changes in activity levels, diet etc that I can think of to explain it. It is very strange and is almost as if my body is releasing insulin as soon as I eat, which I know is not possible. BG's do start to rise but not until about an hour after eating.
Have any other type 1's experienced similar and was any cause identified?
 
Wonder if it's to do with your digestive system if bg doesn't start to rise untill hour after eating, any issues there?
 
Have you changed your diet or the insulin you use?
Regarding diet, I think @nonethewiser and I are thinking along the same lines - your body is digesting your food slower than it takes the insulin to start working. This maybe a digestive issue or maybe because you are eating fattier food - fat slows down digestion of carbs.
Regarding insulin, I use Fiasp and I find the speed at which is works is very dependent upon my BG when I bolus. If my BG is in the 4s, the Fiasp will start to work immediately - before the carbs I am eating are digested. Therefore, I need to adjust my pre-bolus time dependent upon my BG and, if my BG is in the 4s, I need to bolus after eating.
 
Thanks for replying. No change in diet or insulin used. BG's pre food are pretty steady and insulin is adjusted based on bg's before eating etc. I have reduced my carb ratio and still having same issue.

I did wonder about possible gastroparesis but it seemed to come on quite suddenly. I have been having nausea, and an ache/discomfort under left rib that wraps around to my back and left lower back, intermittent nausea and disgusting sulpher burps the past few months so possibly all related. I have contacted GP for an appt to discuss further.
 
Hi @MB1 had the same thing this morning and hit 2.8 whilst eating my breakfast, made worse because by then I had ‘hypo brain’ and started debating with myself why I would be having a hypo whilst eating breakfast … I eventually did a Bg and that seemed to trigger me into automatic response and got some juice. That took longer to react as I had a stomach full of yogurt etc. Another gulp and remembered @Inka (I think) about highest absorption in the mouth so took my time to swirl the juice.

No obvious reason and had sat flat through the night at around 5, and usually have a rise as soon as I get up. This came out of the blue with all variables the same as usual. Good to read the suggestions so far and will certainly adjust my pre-bolus time in light of SG (thanks @helli ). I look forward to reading more.
 
Sounds like you may need a scan of your pancreas.
 
rebrascora said:
Sounds like you may need a scan of your pancreas.
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Interesting observation Barbara (incidentally, was that for @SB2015 , @MB1 or both?). Not that the idea is relevant for me, but I'm curious about what you think might be revealed by a scan of the pancreas.

Ideally such a scan needs to be requested by the "right" Consultant who can interpret the results. Even if a GP initiated such a request I suspect the initial NHS triage pont would reject a GP'S request; can one self-refer to a private Consultant to request a scan of one's pancreas? I think part of the difficulty is in deciding (guessing?) the fundamental cause. Gastro or Endocrinology? The medical world increasingly functions in tiny silos of excellence which seems to prohibit lateral thought.
 
@Proud to be erratic My comment was aimed at the OP ie @MB1.
The pain under left ribs and wrapping around to the back and nausea and sudden change in insulin needs to me all suggest there may be an issue with their pancreas. I know that a limited amount of insulin production can remain after 50-60 years in Type 1 patients as found by the Joslin Institute and just wondering if perhaps an insulinoma developing in the pancreas could cause sudden increase in release of insulin after eating. It's probably a very long shot. Not sure about the sulphur burps. They are often mentioned on the forum together with nausea in relation to GLP-1 agonist medications like Ozempic which I am guessing is not relevant in this case unless they are the naturally produced ones, but I am sure there are many other causes.
 
Of course, thinking about it, sulphur burps are likely due to delayed digestion from whatever cause.
 
I think we need to be very careful with any diagnosis or speculations about cause of symptoms based on what we have learned from this forum but with no medical training.
The best advice is to contact GP which has already been done.
The GP can then suggest tests, etc which may or may not include a scan of the pancreas.

It is easy to get carried away (and I am not squeaky clean in that regard) but diagnosis or expressing our suspicions without making it clear it is only our personal experience or something we read about can be dangerous even with the best intentions.
Even someone with medical training should be reluctant to diagnose or openly speculate based on something written on the forum. If we are correct, it can have mental health implications (i.e. no better than scaring ourselves by asking Dr Google).
 
If you are on a pump do you know how to do extended boluses? I.e. dripping the bolus in over an hour or two (or longer if necessary) rather than shooting it all in at once. That should help to stop the drop, although it takes a lot of trial and error to find out exactly what works!
 
Thanks Barbara. I was almost musing out loud. I'm still mildly intrigued about how anybody, without an inside portal to an HCP, might progress the idea of needing a scan of their pancreas to the point of not just getting a scan, but also getting the appropriate individual to review that scan.

My diagnosis of Pancreatic Cancer (PC) started with me getting jaundice. I was towards the end of a 3 week walking holiday in Sicily and my yellow appearance alerted my wife that something was amiss. After a nonsensical 4 hrs waiting to not be seen in a Sicilian Hospital A&E, I found (by complete chance) that the small town we were staying in had a "walk-in" medical laboratory where for very modest fees anybody could choose from a menu of blood tests, wait a couple of hours and get the results. So a few hours later I did just that, paid Èuro52 for the "complete works" and a further 2 hrs on got several pages of results. I also got for my Euros a scientist, who stressed he was not an HCP, but who happily translated and explained what these results meant. I am not aware of anything resembling that sort of service in UK for phlebotomy, never mind a walk-in scan service.

Hence my musing about the whole idea of getting a scan (even by just ultrasound) of any part of one's body - just because a non-medical patient might consider there was a requirement. I've sought private health care a few times, but on each occasion this has needed a referral from my GP; and the first time I had such a referral I got the wrong "expert" with an expensive and useless result because the wrong question was asked. I never saw that referral request because of the inherent secrecy then, ever since I have always politely insisted on having my own printed copy just to try and make sure we were all in pursuit of the same goal.

But the wider and more abstract problem is that NHS Consultants don't like Patients or GPs doing a preliminary diagnosis and somehow undermining their specialist knowledge. This can sometimes be a degree of arrogance. Incidentally, my Sicilian laboratory report was not considered by the UK A&E that I was advised to go to straightaway (by email from my GP) 72 hrs later, after abruptly ending our holiday. A full triage was conducted over several hrs, with several hrs extra delay while A&E debated whether I needed to be seen by "Surgical or Gastro". The Sicilian laboratory report included the guiding result (of course); the Surgical Team took another 6 weeks to see me again and still failed to provide a stent to clear my blocked bile duct in the interim. I got my own diagnisis from NHS online within a few days, including the comment that a sent would be put in to bypass the blockage. But that is all another story.
 
Sorry to hear about your diabetes giving you the runaround recently @MB1 - always frustrating having to chase the moving goalposts.

Sounds like it’s a good idea to get it checked out, in case there’s something specific going on.

Which closed loop are you using? Some of them base their adjustments on a profile (or parts of a profile) that you set, while others take over more entirely.

Depending on which system you use, you may be able to tweak the settings a little while your diabetes is having its little strop.
 
Sally71 said:
If you are on a pump do you know how to do extended boluses? I.e. dripping the bolus in over an hour or two (or longer if necessary) rather than shooting it all in at once. That should help to stop the drop, although it takes a lot of trial and error to find out exactly what works!
Click to expand...
You can't do extended on closed loop as far as I am aware.
 
icowden said:
You can't do extended on closed loop as far as I am aware.
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You can on the t-slim, it's temp basals you can’t do any more. I don’t know about other systems of course.
 
icowden said:
You can't do extended on closed loop as far as I am aware.
Click to expand...

You can't on Omnipod 5 in automatic mode, but there's a manual mode you can switch to if you want to use extended bolus.

Mind even in automated hcl mode there's nothing stopping you from splitting dose, as in give some upfront then more say 1 or 2 hours later.
 
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