Does this happen to you?

[Silkroad77]

Hello all,

Before I go on, I am aware of the dangers, yet I decided to go ahead and do this anyway, yes it may seem irresponsible, however, I did this on a hunch, and not a single time has this failed me.

So I take Toujeo and Novorapid.

It started over 5 months ago, I was often getting low blood sugar levels during the night, and in the morning when I awoke.
So before taking any insulin I would try to eat something sweet ( like a biscuit) and then time it carefully and then make my breakfast (by then the blood sugar levels would rise) and then take my insulin just before eating.

Anyway over 5 months ago something told me to not eat anything when my levels were 2.5, 2.6, 3.5, 3.0 etc, and so I went with this.

I had a shower and got ready to make my breakfast, however, before eating my breakfast I would measure my blood sugar levels-and every single time they have been between 5-7, every single time!
Not once has this ever failed me!
This is without taking any insulin, or eating anything-even when my blood sugar levels have been 2.2!

I do get lows during the night-but of course then I eat something, as I'm not taking risks falling asleep and things getting worse.

The above hasn't happened just 3 or 5 times in the more than 5 months, it's happened often enough for me to notice this.

Is there a reason why this is happening?
If so, then what is it?

Has this happened to anybody else?
If so, what has your approach been to it?

 

[j@mez]

Hello all,

Before I go on, I am aware of the dangers, yet I decided to go ahead and do this anyway, yes it may seem irresponsible, however, I did this on a hunch, and not a single time has this failed me.

So I take Toujeo and Novorapid.

It started over 5 months ago, I was often getting low blood sugar levels during the night, and in the morning when I awoke.
So before taking any insulin I would try to eat something sweet ( like a biscuit) and then time it carefully and then make my breakfast (by then the blood sugar levels would rise) and then take my insulin just before eating.

Anyway over 5 months ago something told me to not eat anything when my levels were 2.5, 2.6, 3.5, 3.0 etc, and so I went with this.

I had a shower and got ready to make my breakfast, however, before eating my breakfast I would measure my blood sugar levels-and every single time they have been between 5-7, every single time!
Not once has this ever failed me!
This is without taking any insulin, or eating anything-even when my blood sugar levels have been 2.2!

I do get lows during the night-but of course then I eat something, as I'm not taking risks falling asleep and things getting worse.

The above hasn't happened just 3 or 5 times in the more than 5 months, it's happened often enough for me to notice this.

Is there a reason why this is happening?
If so, then what is it?

Has this happened to anybody else?
If so, what has your approach been to it?

 

[EllieM]

Is there a reason why this is happening?
If so, then what is it?

When your blood sugar goes low your pancreas produces glucagon, and this signals the liver to release stored sugar (in glycogen), so your blood sugar goes back up. This depends on
1) your glucagon production being normal (tough for 3cs who have pancreatic damage and may not be producing the full amount)
2) your liver having enough glycogen available (if you've used it all up with too many hypos or are keeping the liver busy processing alcohol the glycogen may not be there)
3) there isn't too much insulin in your system for the liver to cope. A non diabetic would be easing up on the insulin production at the same time, but as a T1 you've injected it and can't suddenly cancel the injection (unless you're on a pump and can suspend your bolus).

So that's why it's been working for you but I'd be very cautious. If there's a bit more insulin in your system than you think, you're going to find that you go just a little bit lower that 2.5, which can send you unconscious, irrational or even give you a seizure. Personally, I wouldn't risk it, as the consequences of getting it wrong are too grim. (You can play Russian Roulette and be fine 5 times out of 6, but that doesn't mean you'd willingly play it.)

 

[In Response]

Have you tested your night time blood sugars with a finger prick or are they with a Libre?
The reason I ask is that they may be "compressions lows". These are not really low blood sugars but low readings frm your Libre caused by applying pressure to it which may happen when you lie on it.
When you get up and shower, you are no longer lying on it so you get a truer reading.

Another Libre issue I have noticed is a spike when I shower. I assume this is another sensor oddity, probably caused by my "scorching hot" (according to my partner) which my sensor does not like - it can jump 2mmol/l whilst I am in the shower and, without any insulin, fall back close to the original value less than 30 minutes later.

 

[Silkroad77]

When your blood sugar goes low your pancreas produces glucagon, and this signals the liver to release stored sugar (in glycogen), so your blood sugar goes back up. This depends on
1) your glucagon production being normal (tough for 3cs who have pancreatic damage and may not be producing the full amount)
2) your liver having enough glycogen available (if you've used it all up with too many hypos or are keeping the liver busy processing alcohol the glycogen may not be there)
3) there isn't too much insulin in your system for the liver to cope. A non diabetic would be easing up on the insulin production at the same time, but as a T1 you've injected it and can't suddenly cancel the injection (unless you're on a pump and can suspend your bolus).

So that's why it's been working for you but I'd be very cautious. If there's a bit more insulin in your system than you think, you're going to find that you go just a little bit lower that 2.5, which can send you unconscious, irrational or even give you a seizure. Personally, I wouldn't risk it, as the consequences of getting it wrong are too grim. (You can play Russian Roulette and be fine 5 times out of 6, but that doesn't mean you'd willingly play it.)

Thanks for the explanation EllieM.

You're right in that it is playing Russian roulette but I thought I'd ask on here as I had no clue as to why this was happening.

So do you think it'd be best to always eat something then?
Probably a simple question but the whole process of what I've described confuses me

 

[Silkroad77]

Have you tested your night time blood sugars with a finger prick or are they with a Libre?
The reason I ask is that they may be "compressions lows". These are not really low blood sugars but low readings frm your Libre caused by applying pressure to it which may happen when you lie on it.
When you get up and shower, you are no longer lying on it so you get a truer reading.

Another Libre issue I have noticed is a spike when I shower. I assume this is another sensor oddity, probably caused by my "scorching hot" (according to my partner) which my sensor does not like - it can jump 2mmol/l whilst I am in the shower and, without any insulin, fall back close to the original value less than 30 minutes later.

I wasn't aware of this.
I'm on the Libre sensor and so applying pressure on the sensor make sense, I hadn't thought of this.

It must be the same with me, as in I must also get spikes when I am having a shower.

So when this happens, when do you take your medication?

 

[Silkroad77]

Oh and also another thing.

I was told by my Diabetes team, that being on basal and bolus, gives me greater flexibility.
I was told that if I don't have carbs for lunch, or don't have lunch, there's no need to worry, just simply don't take the Novorapid.

If I don't have lunch, or have non carb lunch I very often get lows.

If I reduce my Toujeo I get consistent highs for days and all the time, even when I cut the carbs, it stays like this until I increase my Toujeo.
When I increase my Toujeo I often get lows

I increase or decrease my 1 unit at a time, or if that doesn't work 2 units at a time.
If I increase or decrease 3 units of Toujeo at a time, it's constant highs or constant lows-despite watching my carbs and portions etc.

 

[In Response]

I wasn't aware of this.
I'm on the Libre sensor and so applying pressure on the sensor make sense, I hadn't thought of this.

It must be the same with me, as in I must also get spikes when I am having a shower.

So when this happens, when do you take your medication?

I don't understand your question.
The only medication I am on is insulin and I take it before I eat and, sometimes to correct a true high (not a quick spike from the shower). I am on a pump so don't have a basal injection

 

[In Response]

If I reduce my Toujeo I get consistent highs for days and all the time, even when I cut the carbs, it stays like this until I increase my Toujeo.

If you are eating very low or no carbs, your body will break down protein into glucose.
Therefore, I have found even for no carb meals I may need a small bolus.

 

[Silkroad77]

I don't understand your question.
The only medication I am on is insulin and I take it before I eat and, sometimes to correct a true high (not a quick spike from the shower). I am on a pump so don't have a basal injection

What I mean to say is when you get your compression lows, do you eat something straight away, or wait to see what happens, and then do something about it?
Or do you wait like me and watching it go up, take your insulin just before eating?

 

[EllieM]

What I mean to say is when you get your compression lows, do you eat something straight away, or wait to see what happens, and then do something about it?

The libre isn't desperately accurate at hypo levels, so if I'm not feeling even slightly hypo (my hypo awareness isn't great but I do get symptoms) I'll do a glucometer test before treating a libre hypo. (And at least then you'll find out if the compression lows are real).

I now use a dexcom (my body no longer agrees with the libre) and I've found it to be pretty accurate (except in the first 24 hours of a sensor when it reads low). So if I think a low is real, I eat for it without fail. If I think it's a sensor error, I'll do a blood test first. Using a dexcom allows me to mostly avoid hypos because I get a warning at 4.4. At that point, I either treat immediately or do a blood test or wait if I'm literally 10 minutes before lunch and my trend arrow is reasonably flat.

I consistently lose hypo awareness if I have too many hypos. This appears to be a real risk for long term T1s and believe me you don't want to go there. (I get it back if I keep my levels higher for a few weeks but my normal hypo awareness is much less dramatic than it was 30 or even 10 years ago.) You only realise what a vital tool hypo awareness is for T1s when you lose it. I'd strongly advise any T1 to minimise the number of those hypos - it's not worth risking your hypo awareness.

 

[LucySW]

Have you tested your night time blood sugars with a finger prick or are they with a Libre?
The reason I ask is that they may be "compressions lows". These are not really low blood sugars but low readings frm your Libre caused by applying pressure to it which may happen when you lie on it.
When you get up and shower, you are no longer lying on it so you get a truer reading.

Another Libre issue I have noticed is a spike when I shower. I assume this is another sensor oddity, probably caused by my "scorching hot" (according to my partner) which my sensor does not like - it can jump 2mmol/l whilst I am in the shower and, without any insulin, fall back close to the original value less than 30 minutes later.

That’s very interesting. It chimes with my experience actually.

 

[TashT1]

I was told to always confirm a hypo with a finger prick test. Obviously if your hypo symptoms are so severe that you can’t do so, the symptoms demonstrate it’s a true hypo & you treat it straight away.

From the description it sounds like there are no/ few symptoms of the hypo so I would finger prick test before deciding to treat. If that confirms it’s low I’d always treat rather than relying on my body to just pull me out of it.

My libra also reads higher after a shower I don’t do anything to treat it as it will come back down in 30mins.

If you are going low after a zero/ low carb lunch & can’t adjust your basal I’d try increasing the carbs slightly to prevent the low. Keep track of amounts & reactions for example I can eat 10-15g carbs before needing a bolus but I’m still producing my own insulin.

 

[In Response]

What I mean to say is when you get your compression lows, do you eat something straight away, or wait to see what happens, and then do something about it?
Or do you wait like me and watching it go up, take your insulin just before eating?

Compression lows are not real lows they are an inaccuracy on the sensor so I test with a finger prick before treating a low.
I treat "real" low straight away. If you don't, you risk your body getting used to being low losing hypo awareness.