Help - insulin needs have suddenly changed.

[Michele01]

I’m having a bit of a panic. Yesterday, my levels kept going low (despite me using my normal amounts of insulin). All night, last night, my libre3 alarmed every two hours. So today I decided I would take 2/3rds my normal bolus with every meal. The same thing has happened again. I’m literally watching the numbers drop. I don’t know what to do. My basal is only once a day so I can’t adjust that until tomorrow. What can I do please?

 

[Antje77]

I’m having a bit of a panic. Yesterday, my levels kept going low (despite me using my normal amounts of insulin). All night, last night, my libre3 alarmed every two hours. So today I decided I would take 2/3rds my normal bolus with every meal. The same thing has happened again. I’m literally watching the numbers drop. I don’t know what to do. My basal is only once a day so I can’t adjust that until tomorrow. What can I do please?

First, have you confirmed those lows with a fingerprick? Libre can be off.

If yes, what about having something to eat that keeps your BG up for hours to get you through the night, something like crisps for instance?

 

[EllieM]

Hi @Michele01 , worse case scenario you can call 111 for advice.

Some thoughts
1) It's probably worth checking with a glucometer because sensors can misread...
2) I see from your postings that your T1 is caused by damage to your pancreas via a DKA. Is it possible that your pancreas has recovered a bit and so you are producing more of your own insulin?
3) No chance you overdosed on basal/accidentally injected twice?
4) Insulin needs can and do change, keep the glucose (or equivalent) handy...

In your position I would keep testing, eat more carbs if you need to, and keep dropping the bolus insulin until things stabilise. But my first action would be to confirm that my sensor wasn't glitching.

Good luck.

 

[Michele01]

First, have you confirmed those lows with a fingerprick? Libre can be off.

If yes, what about having something to eat that keeps your BG up for hours to get you through the night, something like crisps for instance?

No I haven’t confirmed the lows but I will do now. Thank you. I actually had Japanese rice crackers last night that normally make me go high but although it went high it immediately peaked and started to drop.

 

[Michele01]

Hi @Michele01 , worse case scenario you can call 111 for advice.

Some thoughts
1) It's probably worth checking with a glucometer because sensors can misread...
2) I see from your postings that your T1 is caused by damage to your pancreas via a DKA. Is it possible that your pancreas has recovered a bit and so you are producing more of your own insulin?
3) No chance you overdosed on basal/accidentally injected twice?
4) Insulin needs can and do change, keep the glucose (or equivalent) handy...

In your position I would keep testing, eat more carbs if you need to, and keep dropping the bolus insulin until things stabilise. But my first action would be to confirm that my sensor wasn't glitching.

Good luck.

Thank you. I will do the fingerprick test because the numbers are changing so quickly.

I’m going to drop my bolus by 1 or 2 unit tomorrow but I don’t think it’ll kick in for a few days.

 

[Michele01]

Hi @Michele01 , worse case scenario you can call 111 for advice.

Some thoughts
1) It's probably worth checking with a glucometer because sensors can misread...
2) I see from your postings that your T1 is caused by damage to your pancreas via a DKA. Is it possible that your pancreas has recovered a bit and so you are producing more of your own insulin?
3) No chance you overdosed on basal/accidentally injected twice?
4) Insulin needs can and do change, keep the glucose (or equivalent) handy...

In your position I would keep testing, eat more carbs if you need to, and keep dropping the bolus insulin until things stabilise. But my first action would be to confirm that my sensor wasn't glitching.

Good luck.

Sorry I should add - they originally thought I was type 2 so gave me Forxiga that gave me DKA and blood tests showed that turned me to a type 1.5. However that was about 8-10 years ago so I doubt if my pancreas has kickstarted. The ONLY thing that has changed is around 2.5 months ago my basal was changed to a once a day type and it was amazing. For the first time I was achieving straight lines on my graph. Looking at my graphs over the past few weeks it’s been getting very spiky so I wonder if it could be the basal? Would that have such a strong effect and mean even with 2/3rd of my bolus I’d still be going hypo? Sorry to sound so thick. This is the first time this has happened and it’s given me a scare.

 

[EllieM]

Sorry I should add - they originally thought I was type 2 so gave me Forxiga that gave me DKA and blood tests showed that turned me to a type 1.5. However that was about 8-10 years ago so I doubt if my pancreas has kickstarted. The ONLY thing that has changed is around 2.5 months ago my basal was changed to a once a day type and it was amazing. For the first time I was achieving straight lines on my graph. Looking at my graphs over the past few weeks it’s been getting very spiky so I wonder if it could be the basal? Would that have such a strong effect and mean even with 2/3rd of my bolus I’d still be going hypo? Sorry to sound so thick. This is the first time this has happened and it’s given me a scare.

Hopefully you've managed to get a good night's sleep.

Look, diabetes and insulin are weird and wonderful things. There are no stupid questions and I'm still learning new stuff after 53 years. And hypos can be scary.

What basal are you using? And what time of day are you taking it?

 

[eventhorizon]

If you're using a long very long acting basel like Tresiba it will take a few days after a dose adjustment to see the full result of that change.

 

[jaywak]

Not much help but to just let you know from my own experience that this does happen occasionally , I have gone through stages where I have thought a miracle has happened i'me cured ! when my insulin requirement has gone down and down so much I've thought soon I won't need to inject only for it to go back a few days later to how it was .

 

[Michele01]

Hopefully you've managed to get a good night's sleep.

Look, diabetes and insulin are weird and wonderful things. There are no stupid questions and I'm still learning new stuff after 53 years. And hypos can be scary.

What basal are you using? And what time of day are you taking it?

I managed to control it over night by eating a crumpet and running a bit high so I’m hoping the blip has sorted itself out. My basal is Tresiba and I have decreased by one unit this morning but I know that won’t take effect for a few days. Thank you for your help.

 

[Michele01]

If you're using a long very long acting basel like Tresiba it will take a few days after a dose adjustment to see the full result of that change.

Yes I’m on Tresiba. I have taken one unit less this morning so hopefully I’ll see if that makes a difference Friday or Saturday.

 

[Michele01]

Not much help but to just let you know from my own experience that this does happen occasionally , I have gone through stages where I have thought a miracle has happened i'me cured ! when my insulin requirement has gone down and down so much I've thought soon I won't need to inject only for it to go back a few days later to how it was .

Thank you. That’s exactly how it’s happened to me also. I literally was watching the numbers dropping! Hopefully today will be a bit easier. Thank you for your reassurance.

 

[Michele01]

Thank you to everybody that has replied. I “think” this is a faulty sensor. Last night I did a fingerprick test but there was only a difference of one unit which can be normal. However this morning the sensor registered a low but the fingerprick showed otherwise. I checked 3 times just to be sure. Abbott are sending out a replacement. Please excuse the high numbers in the photo because I was intentionally trying to run high so I could at least sleep!

 

[Michele01]

Grrrrr unfortunately not a faulty sensor. I’ve now gone through 2 new ones. Reinstalled the app and collected a new fingerprick monitor from my diabetic clinic (to double check) and it’s clear that it’s none of those. For lunch I would normally inject 12-16 units and I did 8 today and have still had a hypo. So I’m at a loss and very stressed.

 

[EllieM]

Did you have a chance to speak to anyone from your clinic? I do find my insulin needs change from time to time, I just adjust my basal and bolus accordingly. The most common reason for my needs to go down is exercise....

 

[Michele01]

Did you have a chance to speak to anyone from your clinic? I do find my insulin needs change from time to time, I just adjust my basal and bolus accordingly. The most common reason for my needs to go down is exercise....

Unfortunately there wasn’t anybody apart from the administrators. Would you more than halve your bolus if you exercised? I have been a bit more active than normal because of Christmas but not overly so. I’ve injected 8 units tonight instead of the 18 I would for this meal to see what happens. I can always take more.

 

[EllieM]

Unfortunately there wasn’t anybody apart from the administrators. Would you more than halve your bolus if you exercised? I have been a bit more active than normal because of Christmas but not overly so. I’ve injected 8 units tonight instead of the 18 I would for this meal to see what happens. I can always take more.

My needs don't normally change so drastically, and I'm on a split dose of a 24 hour basal so I can change my basal quite rapidly.... I just find I need to nudge my basal down of I take more exercise.

To be honest, in your position I'd probably be tempted to do something similar, but we're all different so I find it's really just a question of what works for your individual body. And good records of carbs and insulin really help to let you work out what's happening.

Good luck.

 

[Michele01]

My needs don't normally change so drastically, and I'm on a split dose of a 24 hour basal so I can change my basal quite rapidly.... I just find I need to nudge my basal down of I take more exercise.

To be honest, in your position I'd probably be tempted to do something similar, but we're all different so I find it's really just a question of what works for your individual body. And good records of carbs and insulin really help to let you work out what's happening.

Good luck.

Thank you.