Does going low in the evening affect the next day?

[RobertJ]

Recently I have been trying to get my levels in an overall lower state. My HbA1c has never officially been lower than 53 (NHS records) and has never been below 50 according to data from my Libre. I used to think 53 was "really good" but in retrospect I think the NHS does not set ambitious enough targets for people. Before I was active on this forum, I had no idea there were people out there with an HbA1c in the 40s.

When I go through phases of the average glucose being below about 8.2, I go low all the time. By all the time, I mean at least once a day.

Currently, my average glucose is 7.5. Yesterday evening I went for a meal out and split the doses but hugely overestimated things and gave far too much for the second dose. I had a terrible hypo lasting over an hour and it took a lot to make it go up and stay up. I had to delay going to sleep because of it.

This morning I left the gap between my bolus and eating breakfast too long. After a bowl of muesli and a banana it was 3.1. I had a fun size pack of maltesers and some fruit juice, thinking it would go up soon anyway once the muesli kicks in. Then on the train to work it was still 3.1 so I had a fun size twix bar. Walking to work it was 5.4 so I thought mission accomplished, but getting to my desk the low glucose alarm was going off and it was back down to 3.2.

So it went low, went up, then went low again.

For most of the 20 years I've had type 1 I've had huge problems with being high after breakfast and a situation like this is quite shocking. It's also exhausting when a low becomes so drawn out. Could it be that going low last night has had an effect on today?

 

[Antje77]

Possibly, yes.
From what I understand the liver helps you out by dumping glucose in your bloodstream when you're low, but that storage has to be replenished before it can be used again.

I was warned to watch out for hypos after a hypo for this reason.

 

[plantae]

I'm only new to this but today was a complete disaster. I was "low" but I'm sick so had a banana for mid-morning snack. I took bolus dose... BIG mistake. I was hypo very soon afterwards and had a lot of trouble getting BSL back up. I've been relatively high (but within range) since then but I took bolus for dinner and now I'm in the low 4s again. A bit of a learning curve for me

 

[RobertJ]

Thanks, @Antje77. I guess next time I have a big evening/night hypo I'll reduce the the basal a lot the next day, at least the next morning. Even now, as I type, it still keeps dropping back into the low zone.

I actually think in a strange way I'm pretty close to good control. I've just become so determined to avoid big spikes that I end up overdoing it and going low. This is a problem with larger meals.

For example, in the past I always used to go up to 16 or 17 if I had a meal at Wetherspoons that included one or two beers. The last two times, I barely went above 10. But the price I paid was going low later on. So my new strategy is not working either. I have been carb-counting using their menu, which is all online, but clearly my ratio for these occasions was wrong.

 

[Antje77]

I'm only new to this but today was a complete disaster. I was "low" but I'm sick so had a banana for mid-morning snack. I took bolus dose... BIG mistake. I was hypo very soon afterwards and had a lot of trouble getting BSL back up. I've been relatively high (but within range) since then but I took bolus for dinner and now I'm in the low 4s again. A bit of a learning curve for me

I think with T3C it's different. The mechanism that makes T1's have their livers dump glucose in case of a hypo is impaired in T3C's if I remember correctly. Something to do with it being the pancreas that triggers this reaction which doesn't work if the pancreas doesn't work.
It's a long time I read about it though so not sure if I remember correctly.

 

[Antje77]

Thanks, @Antje77. I guess next time I have a big evening/night hypo I'll reduce the the basal a lot the next day, at least the next morning. Even now, as I type, it still keeps dropping back into the low zone.

I actually think in a strange way I'm pretty close to good control. I've just become so determined to avoid big spikes that I end up overdoing it and going low. This is a problem with larger meals.

For example, in the past I always used to go up to 16 or 17 if I had a meal at Wetherspoons that included one or two beers. The last two times, I barely went above 10. But the price I paid was going low later on. So my new strategy is not working either. I have been carb-counting using their menu, which is all online, but clearly my ratio for these occasions was wrong.

Personally, I find it impossible to dose for high carb meals so I avoid them.
But this is just me, there are others who can dose for such meals with great results.

As an aside, alcohol can keep your liver from dumping glucose as well for as long as it's busy dealing with the alcohol.

 

[plantae]

I think with T3C it's different. The mechanism that makes T1's have their livers dump glucose in case of a hypo is impaired in T3C's if I remember correctly. Something to do with it being the pancreas that triggers this reaction which doesn't work if the pancreas doesn't work.
It's a long time I read about it though so not sure if I remember correctly.

I think you might be right. My pancreas doesn't produce the enzymes it should. I'm too tired and waiting for an ambulance to look it up right now but I bet you're right.

 

[plantae]

In fact I feel sick. I just wish they'd get here. Edit. although my BSL is in the "safe range" now I was very, very low an hour or so ago

 

[Juicyj]

Hi @RobertJ Personally I don't find hypos one evening affect the next morning, I tend to find my body does a reset during the night and also a rebound hypo would happen within 3-5 hours of the first event.

My thought process would be looking at the way you treated your hypos in the morning and the chocolate you ate to treat the hypo, ideally you need fast acting carbs like glucotabs/glucogel or just the fruit juice, ditch the chocolate due to it's fat content as it will delay the carb absorption.

 

[plantae]

Hi @RobertJ Personally I don't find hypos one evening affect the next morning, I tend to find my body does a reset during the night and also a rebound hypo would happen within 3-5 hours of the first event.

My thought process would be looking at the way you treated your hypos in the morning and the chocolate you ate to treat the hypo, ideally you need fast acting carbs like glucotabs/glucogel or just the fruit juice, ditch the chocolate due to it's fat content as it will delay the carb absorption.

I was devastated when my DN said not to use chocolate to treat hypos because of the fat content. I want choccie!

 

[Deleted member 527103]

I was devastated when my DN said not to use chocolate to treat hypos because of the fat content. I want choccie!

The advice I was given was to eat fast acting carbs to treat a hypo and then eat 10 to 15g of slower acting carbs to maintain the higher level.
With that advice, you can have choccy once your hypo has recovered.

But as you and @Juicyj say, fatty food like chocolate is not absorbed fast enough to recover from a hypo and is a waste of orange juice if you eat it at the same time.

 

[MrsA2]

Before I was active on this forum, I had no idea there were people out there with an HbA1c in the 40s.

I think you'll find most of those are type 2, which is a very different ball game.
Don't compete with others. We are all different. Just find the level that suits your body