Does anyone have any suggestions???

[Dragonflye]

Hi,

I've been havings problems recently and I have very little idea of whats going wrongs.

I am hypo 4+ times a day and 2 or 3 nghts a week I will have a severe nighttime hypo (hubby would get an A* in giving glucogon injections)

I am using insulin pump so am testing very regular and to my GP's dismay have gone from around 10 tests to approx 15 :?

I have done some fasting tests to check the basal and that seems pretty good, results range between 5 and 6.5 so thats not the problem, tried reducing my carb ratio and im still having random hypo's. the annoying thing is they are unpredictable, yesterday during the day i was fine then evening sugars went south... today ive been going south all morning... it's been like this for a few weeks now.

The only thing i can think is i am loosing weight, not much but some, but i cant see this having such a big impact can it?

 

[CarbsRok]

How are you testing your basal?
What insulin are you using and what duration have you got it set at?
What times are you hypoing in realation to your meals?
Night hypo what time?

 

[Debloubed]

If you have lost weight, your basal WILL need to be adjusted. If you are getting normal fasting results which show your basal rate is correct then you should adjust your bolus ratio, not forgetting to look at the insulin sensitivity. Are you waking with night time hypos? are you performing the fasting tests correctly? Don't forget, the daytime/afternoon one is a bind as you have to fast from 10am to 6pm to avoid your breakfast bolus interfering.

Keep at it, you'll get there

 

[sugar2]

This sounds familiar. Could it be exercise related? Even driving makes me go low, while sitting at my desk does not. I often use temp basals. It works for me...What kind of bolus do you do...single shot, multiwave? Sometimes I have come a cropper for using teh wrong bolus type...I need to match them to food really carefully.

 

[Dragonflye]

Hi again

How are you testing your basal?
What insulin are you using and what duration have you got it set at?
What times are you hypoing in realation to your meals?
Night hypo what time?

Im testing my basal by checking sugars on an hourly basis during the periods I am fasting, usually between 7pm and 12pm and 11am to 6pm and 3pm to 8pm - I dont eat at least 2 hours before "fasting" but do aim more for 3+ hours before

Im using Humalog insulin with a "active" of 2 hours

Nighttime hypos range from anywhere between 12pm and 7am (eg. Saturday night my husband woke at about 2am and this morning it started at 6am)

Daytimes are almost as random for example Monday I went low at 10am and then at 3pm but tuesday was 7pm and that was with eating the exact same food (i like knowing how many carbs I'm eating so when at work I dont usually try "new" stuff)

@sugar2 Im using single - still cant figure out multiwave, Im thinking exercise may have a relation but i'll do the same activity 1 day and go low as another day and stay OK.

@Debloubed I unfortunately do not wake during the night hypos, usually the first I recall is my hubby figthing to keep my sugars up, we keep multiple glucogon kits in the house at any 1 time for him to use on me

 

[Debloubed]

are you setting your alarm to test at night? If you have done, are you able to pin point when you are going so low? I would advise trying to sort the night time basal first as usually bolus/carbs are not around to confuse the situation. Once that is sorted, onto the next 6 hours (6am to midday) and so on.

 

[iHs]

From using Humalog in the past myself ... I would guess that it has an action of about 3-4hrs at least.

Also what bg target are you using to keep yourself safe? My target is now set at 5.5. - 7.5

 

[xMenace]

I'd try some longer-termed, more vigilant basal testing. Such problems are almost always basal related. Make sure you do not eat anything for at least six hours before your test period. Yes, I said six (6). Humalog lasts about 6.5 hours, and you need to eliminate all bolus effects as well as food, exercise, stress, etc. Test at least every hour, and test twice to confirm the values. Test more if off. Try staying up all night if you can, say a Friday night. Eat a 5pm or 6pm dinner, then test every hour or better starting at midnight. Go as long as you can. Go nuts, rule out basals with authority!

My next suspect is inapproriate boluses. I know many try to get that 2hr peak down to under 6, but that plan can create hypos later. If you eat carby foods, you need to live with the spikes. Sorry.

There's anotehr possible mismatch you might need to investigate, but I'd like to see your basal patterns first. If your patterns are roller-coastery, like mine are, bolusing during a peak can result in a basal when your metabolism troughs, and the converse is true too. My 8 AM I:C is 1:4 or 1 unit for every 4gm of carbs. My 10am to dinner I:C is 1:10. Remember I said Humalog lasts 6.5 hours (ignore your pump setting, that's different). My 8 AM bolus is fine for my 8 AM needs, but the lingering isnulin then becomes too much from 10 AM to roughly 2:30 PM -- I inadvertently overdose on insulin. I get around this by not eating until 10 AM or superbolusing - running a reduced temp basal during my OD periods. Make sense?

Also, take a look at this page. It may help you sort things. http://www.diabetesnet.com/about-diabet ... lin-action

 

[CarbsRok]

Im using Humalog insulin with a "active" of 2 hours

I think you will find that's your problem.
If you have your basals set correctly and your durration of insulin is set at 2 hours then your pump will be over delivering insulin at bolus/correction times. IE, stacking insulin because of this. Stacking then equals hypos as you have found out
Who the heck told you to set it at 2 hours? :shock: 4 or 5 hours would be the the normal.
Do you have the book pumping insulin by John Walsh? If not it's a good investment.

 

[Dragonflye]

hmmm thats strange a lot of people saying humalog active for 4hours+... my DSN set the 2 hours but I have found when I've been compensating for high sugars after 1hr30mins my sugars wont drop any further :? me thinks im going to text my DSN and arrange another appointment LOL

 

[CarbsRok]

hmmm thats strange a lot of people saying humalog active for 4hours+... my DSN set the 2 hours but I have found when I've been compensating for high sugars after 1hr30mins my sugars wont drop any further :? me thinks im going to text my DSN and arrange another appointment LOL

Are you sure you haven't become confused with active insulin and peak of insulin?
I think you will find if you look in your patient leaflet it says in there what the durration is.

I'm also shocked you are correcting after 30 mins. The insulin has only just begun to work by then. Try setting your durration to 4 hours and bolusing at leat 15 mins before you eat.
If you are still having problems look at your carb ratio.

 

[Dragonflye]

I dont correct after 30mins, I started doing the 2hour after eating and when high I would correct, 1hour 30mions after the correction my levels are usually acceptable and remain at that level for quite some period of time until recently when they are dropping but they can drop anywhere between 1hour after food to 6 hours after food (before my next meal) - unfortuantely I cant tell when they are going to drop or whats causing it, which is why Im so frustrated at the moment.
Regarding bolusing 15mins before eating that is almost impossible unless I want my meal cold as I never know carbs until its all cooked and I can weight it all and then othertimes I may not feel as hungry as I was previously by the time food is in front of me

 

[CarbsRok]

I dont correct after 30mins, I started doing the 2hour after eating and when high I would correct, 1hour 30mions after the correction my levels are usually acceptable and remain at that level for quite some period of time until recently when they are dropping but they can drop anywhere between 1hour after food to 6 hours after food (before my next meal) - unfortuantely I cant tell when they are going to drop or whats causing it, which is why Im so frustrated at the moment.
Regarding bolusing 15mins before eating that is almost impossible unless I want my meal cold as I never know carbs until its all cooked and I can weight it all and then othertimes I may not feel as hungry as I was previously by the time food is in front of me

Sorry misread the 1 hour 30 mins.
Well unless you time the insulin to coinside with the food and use the correct type of bolus you are on a hiding to nothing in that dept.
If you are cooking the food surely you must know what you are eating and how much carb wise it contains? Simple solution is think ahead as to what you are going to eat and or have a set amount of carbs for each meal. If you are feeding a family then cook yours in a seperate dish so you know exactly whats in it.

So what it all boils down to I suspect is not timing insulin to food absorption, wrong type of bolus for foods and wrong durration of insulin.
Stick to simple carbs until sorted ie skip the likes of pasta,rice, pizza. Then change your durration as already suggested and do not do any corrections at all for the meal eaten and test 2 hours after 1st bite then 3 and 4 hours. If you are sky high after 2 hours then look at your ratio. Just sit out the high though until your next meal.