My partner T1) has good averages but at the expense of extreme highs and lows. These wipe him out and frequently result in emergency hospital visits to A&E for fairly severe lows. He seems to count carbs and match with appropriate insulin but seems to have an absorbency of food or insulin problem and just won’t have mid morning/afternoon snacks. We have tried many ways of f inding out what’s going on - any suggestions? It is beginning to drive me mad. Is there a more appropriate thread?
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Why won’t my partner follow advice re mid-morning/afternoon snacks?
- Thread starter tadumac
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eggyg
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- Type 3c
Two thoughts. His basal needs tweeking and/or his bolus ratios need adjusting. Can you give me an idea of his carb to insulin ratio? You mention highs, as well as lows. When do these occur? Everyday? Does he have a Libre or such like? What insulins is he on? Is he a new or veteran diabetic? Has he been on a carb counting course recently? Has he spoke to his DSN/consultant re this? Sorry for all the questions but it’s difficult to advise without some detail.
Happy to provide. Tried 1:10, 1: 8. Highs and lows almost every day. After lunch, especially . Has a libre so can see what’s happening. On Tresiba and humalog - one overnight. Sorry, he is in bed now (again) having had a low to 2.9 then glucose sweets, but still at 2.9 so sleeps every afternoon. Veteran . Consultants are happy because of the averages. Have spoken also to private consultant and specialist dieticians
He was also type 1.5 for a while
Bruce Stephens
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Libre has alarms. I'd suggest turning on at least the low alarm and putting it above 4 (5, say) so he has a decent chance of avoid hypos altogether for a while.
I think that's the usual advice: when you're bouncing between highs and lows a lot, try to concentrate on the lows first. (And Libre (or other CGM) makes that easier.)
Inka
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So when is he going high? Has he done a recent basal check? Is he also eating slow-acting carbs after his glucose when he has a hypo? Has he had a recent coeliac screen (can cause unexplained hypos)? Does he have different ratios for different meals eg I need more insulin at lunch than at evening meal, so my ratio reflects that.
Alarms both high and low are turned on, thanks.
Not sure … basal check good idea. not sure about different ratios though dietician suggested 10 for evenings though carb load theoretically needs less as we eat less than we used to.
Bruce Stephens
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And yet he's going really rather low (even though Libre (and test strips) aren't so accurate for low values (or high ones)).
Regardless, the advice to focus on reducing the lows first still makes sense, I think. They're usually easier to attack (eat something sugary, and reduce the relevant insulin a bit the next day), and quite often highs follow lows (because we're overcorrecting, or because our body is). And they're unpleasant in themselves, so reducing them improves mood a lot.
trophywench
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- Type 1
Yes BUT what level does the low alarm actually operate at?
We ask this because the standard level out of the box is 4.0 but when you're trying to avoid having frequent hypos, it is far better to get that alarm at a higher level than 4.0 so you have more time to ward off the hypo with a small snack of carbohydrate before you plunge below 3.0.
He might well still need a nice siesta after lunch if people his age (I assume he's over 90 as well as you) don't jolly well deserve one, I don't know who does! We're only in our 70s and we quite like one ourselves
Inka
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10 units or 1:10g? Once he’s done a basal check it’s worth him taking one meal at a time and working out the ratio for that meal. It’s surprising how much a slightly wrong ratio can affect blood sugar.
Setting the Libre low alarm at 5.6 will give him/you some warning of an impending hypo. If he’s dropping fast, you need the Libre alarm to kick in early because it will always be behind actual blood sugar and can be quite inaccurate at low levels eg it can say you’re in the 5s when you’re actually in the 3s. So setting the Low Alarm at 5.6 will catch those drops whereas setting it at 3.5 could mean he’s dangerously low by the time it sounds.
Pumper_Sue
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- Type 1
Try different ratios for different times of day. There's no law that says you can not do this. 🙂 I have a 1/18 for lunch and a 1/17 for evening meal.
Does your partner adjust his insulin to take into account his blood sugar readings before his meals?
As your partner was still in bed due to a very low blood sugar then that would also suggest he is on far to much basal.
Perhaps consider asking for a basal that can be split into two doses thus he can then reduce either night or day basal to suit himself.
Also consider doing a basal test so it can be determined where and when he is low without the hypo treatment and foods hiding all the problems.
Also check the sensors with finger pokes to make sure the hypos at night are not compression lows.
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Welcome to the forum @tadumac
Hope you can find some ways to reduce the extremes of your husband's glucose variations.
If you think it might help, you could call the Diabetes UK helpline next week (9-6 Monday-Friday) - the number is at the top of each forum page 🙂
It does feel like a combination of reducing the number of nasty hypos, and hopefully not over correcting any highs (I know just how frustrating that can be!) would be my strategy in your husband's shoes.
Good luck and let us know how things are going
Hope you can find some ways to reduce the extremes of your husband's glucose variations.
If you think it might help, you could call the Diabetes UK helpline next week (9-6 Monday-Friday) - the number is at the top of each forum page 🙂
It does feel like a combination of reducing the number of nasty hypos, and hopefully not over correcting any highs (I know just how frustrating that can be!) would be my strategy in your husband's shoes.
Good luck and let us know how things are going
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