Some low questions

[rachel162]

Hi guys! Seeing as recently I seem to be low a lot (in the 2s 3+ times a day) I figured I'd see if anyone knew a bit more about it. When I go low in the night (which is rare) my liver kicks in and I end up feeling ****** but perfectly alive the next morning. How low do you have to be for this to happen, as I thought it was only when I'd had a seizure but low glycogen reserves could account for my recent issues:

Basically I have been low a lot, but each subsequent low is harder to recover from than the last (anyone know why?); my head's now almost permanently kind of fuzzy and am finding it difficult to focus at all. Also a lot of my lows have been taking a much longer time than usual to come up from regardless of what I eat, and/or are shortly followed by another low, or sometimes 3 or 4 over a couple of hours. Does your liver normally kick in to help you recover from a low even if it wasn't extreme, and could my repeated lows and lack of recovery time be the reason I suddenly seem to be less able to recover? Also I'm dropping very very quickly whenever I do even very moderate exercise (even a lazy jog/leisurely cycle has in recent weeks seen me plummet by more than 6-8 over just 20-30 minutes, which is annoying as a lot of this year I've been exercising quite intensely with few major issues)...any ideas why this could be happening?

I have moved down south for a month or so recently, but despite that my level of activity is pretty similar, and I work long shifts but have been doing that throughout my time at uni so that's not any different. I'm not under any major stress or anything (which would normally make me go low) but it's the repeated lows themselves that are getting to me! I got back from a 12-hour shift on friday, my auntie asked if I was ok cause I looked awful, and I promptly burst into tears cause I'd been low about 4 times quite badly that afternoon and my emotions were just all over the place! I'm starting to get worried to do anything, like I do have stuff with me in case I go low but it sucks the life out of me when it's happened a few times and I still have to walk the rest of that 5k/stay for four more hours at work/pretend I'm fine and want to enjoy a sociable meal out cause nobody would get it...I don't know how best to limit the effects/extent of my lows without just stopping doing anything Any advice welcome!

 

[AndBreathe]

Hi guys! Seeing as recently I seem to be low a lot (in the 2s 3+ times a day) I figured I'd see if anyone knew a bit more about it. When I go low in the night (which is rare) my liver kicks in and I end up feeling ****** but perfectly alive the next morning. How low do you have to be for this to happen, as I thought it was only when I'd had a seizure but low glycogen reserves could account for my recent issues:

Basically I have been low a lot, but each subsequent low is harder to recover from than the last (anyone know why?); my head's now almost permanently kind of fuzzy and am finding it difficult to focus at all. Also a lot of my lows have been taking a much longer time than usual to come up from regardless of what I eat, and/or are shortly followed by another low, or sometimes 3 or 4 over a couple of hours. Does your liver normally kick in to help you recover from a low even if it wasn't extreme, and could my repeated lows and lack of recovery time be the reason I suddenly seem to be less able to recover? Also I'm dropping very very quickly whenever I do even very moderate exercise (even a lazy jog/leisurely cycle has in recent weeks seen me plummet by more than 6-8 over just 20-30 minutes, which is annoying as a lot of this year I've been exercising quite intensely with few major issues)...any ideas why this could be happening?

I have moved down south for a month or so recently, but despite that my level of activity is pretty similar, and I work long shifts but have been doing that throughout my time at uni so that's not any different. I'm not under any major stress or anything (which would normally make me go low) but it's the repeated lows themselves that are getting to me! I got back from a 12-hour shift on friday, my auntie asked if I was ok cause I looked awful, and I promptly burst into tears cause I'd been low about 4 times quite badly that afternoon and my emotions were just all over the place! I'm starting to get worried to do anything, like I do have stuff with me in case I go low but it sucks the life out of me when it's happened a few times and I still have to walk the rest of that 5k/stay for four more hours at work/pretend I'm fine and want to enjoy a sociable meal out cause nobody would get it...I don't know how best to limit the effects/extent of my lows without just stopping doing anything Any advice welcome!

I'm not T1, so forgive me for not offering you any advice, but I will ask a couple of questions if I may:

Have you changed your insulin recently? By change, I mean dosages, bolus rates or even a new supply around all thjis happening?
When you're not low, what are your bloods like? What are your swinging ranges 2 - 10, 2 - 15, 2-5 whatever? (I hope that was clear.)
When you're doing long shifts, do you have regular breaks? Can you test yourself regularly, or do you have a CGM?


I'll tag a couple of T1s for you: @tim2000s , @donnellysdogs , @noblehead , @Jaylee . They're all experienced T1s, and a couple are current or past pumpers.

I do hope you find a way forward, because how you have been can't be good for you.

 

[RuthW]

Sounds like you have exercised yourself into greater insulin sensitivity and muscle mass. This is a great thing. However, it will only feel like a great thing once you've dropped your basal insulin by a unit or two, and probably reduced your insulin to carb ratios at meal times.
Right now, your liver's probably short on glycogen and that's why its hard to recover from hypos.
So, to stay at a stable weight, drop your insulin. If you want to gain weight, leave your insulin where it is and eat more carbs. (Since you're a young women, I'm going to guess you go for the first option, but do tell us if I'm wrong.)

 

[tim2000s]

Going on what @RuthW has said, what is the pattern of your lows? Do they occur within two hours of eating or are they mostly random?

Regardless of the above, you should undertake some basal testing to ensure that you are at the right level and if you are then look at whether you now need less insulin per 10g carbs.

I'd always suggest starting with a basal test though. That's usually the first thing to be slightly out that causes issues.

 

[rachel162]

@AndBreathe I'm generally between 1.5 and 12, with the higher end only after a high carb meal or miscalculation in dose. I've not changed anything for the last month or so, before that I was tweaking my basal rates a bit and now they're a lot better although still having slight issues in the afternoons. Shift breaks are a bit difficult, I don't often get many and never at regular meal times so its a bit of a challenge! I don't have a CGM (although I desperately want one) so for now just as many blood tests as I can, probably a max of 6x a day, I'm not used to doing many.

Ah @RuthW I never even thought about increased sensitivity etc, I have lost a bit of weight recently (and aim to continue) and am getting fitter so that might be helping. Might look at my afternoon basals again cause thats also generally when I'm busiest and most low throughout the day. It's difficult to complete a basal test with all my lows though!

@tim2000 mostly seem random although always afternoons at some point, but they just go on or I keep crashing for such long periods! I know I should maybe look at my afternoon basals again but it's difficult to even complete a basal test with so many lows and varied days depending on work shifts I'll look at the basals, just wish I knew why this has all changed so drastically and so quickly!

Thank you guys for replying

 

[slip]

@rachel162 What do you use to treat your repeated hypos in the afternoon?

 

[becky.ford93]

Sorry that I can't add plenty of info to this, but you mentioned that you wondered why it was harder to come back from subsequent hypos? I've been told whilst on a carb counting course that if you're lucky your liver may kick out some glucose to bring your blood sugar up. However, this takes time to replenish. So you made find your hypos get worse the more you have because your livers glucose stores cannot regenerate quick enough

 

[noblehead]

@rachel162, if your hypo's mainly occur in the afternoon even when you don't have a lunch then your basal rates definitely need adjusting, remember to reduce them 2 hours before the hypo's occur allowing for the changes to take effect, if it's impossible to do some basal tests for the time-being then you need to pre-empt the hypo's by having some snacks, why not eat something like a banana or oat bars around lunch which will hold your bg levels steady in the afternoon, any carby snack that can be eaten on the go will do and should hold-off or reduce the amount of hypo's for now until you get round to doing some basal checks.

 

[rachel162]

@slip generally something small and fast acting (juice, dextrose tablets) followed by something a bit longer acting (banana, cereal bar).

@noblehead I think I might just have to reduce my basal for the time being to enable me to do the basal tests! Or if not then maybe reduce my breakfast/lunch ratios so I'm starting a bit higher (much as I hate to be), then at least I'll be able to see whether it's the ratios or basal that's not right. I might come back and ask for more advice if/when I know what's wrong! Thank you