2 Day lows - what could be causing it?

[TDavies]

My mum takes Humalog Mix 25, 9 units in the morning and 3 in the evening, with extra NovoRapid to counteract any highs.

This is because she is elderly and cannot cope with too many injections in a day because calculating it all is a bit too confusing and she has memory problems so it is safer this way.

This regime is working ok most of the time but sometimes she is a bit too high most of the day, despite not eating very much (she never eats much at all).

However, a few times now we have experienced a worrying phenomena:
Suddenly, without any insulin injection, her blood sugar will start to shoot down by something like 5 in one hour and then will continue to power downwards for around 2 days. She has to take something like twice as much carbs as usual to just stay above a hypo. One day she kept going under 3 for around 12 hours. She has lost her sensitivity to hypos so she did not really notice!

Could this be the insulin getting stuck somewhere, not working, and then coming out all at once? What other problems might be causing it? I am worried that if it happens at night we will not notice and won't be able to treat it, so am considering getting some kind of CGM system. It has happened 3 or 4 times in the last 4 months.

 

[phdiabetic]

Has she been doing more exercise then usual? That can make people much more sensitive to insulin even many hours after the exercise ceases.

 

[TDavies]

Has she been doing more exercise then usual? That can make people much more sensitive to insulin even many hours after the exercise ceases.

Thanks
No, no more exercise than usual but I'll watch out for that!

 

[dancer]

I don't know Humalog Mix 25 but presume it should be gently "shaken" for it to be mixed properly, like long acting insulins. Has this been done before every injection? If not, this could affect blood sugars.

 

[KK123]

My mum takes Humalog Mix 25, 9 units in the morning and 3 in the evening, with extra NovoRapid to counteract any highs.

This is because she is elderly and cannot cope with too many injections in a day because calculating it all is a bit too confusing and she has memory problems so it is safer this way.

This regime is working ok most of the time but sometimes she is a bit too high most of the day, despite not eating very much (she never eats much at all).

However, a few times now we have experienced a worrying phenomena:
Suddenly, without any insulin injection, her blood sugar will start to shoot down by something like 5 in one hour and then will continue to power downwards for around 2 days. She has to take something like twice as much carbs as usual to just stay above a hypo. One day she kept going under 3 for around 12 hours. She has lost her sensitivity to hypos so she did not really notice!

Could this be the insulin getting stuck somewhere, not working, and then coming out all at once? What other problems might be causing it? I am worried that if it happens at night we will not notice and won't be able to treat it, so am considering getting some kind of CGM system. It has happened 3 or 4 times in the last 4 months.

Hi there, how old is your Mum? My Mum was the same when she reached 80, we were told her requirements were changing (understandable) so they tweaked her fixed (basal) doses. It was difficult because like your Mum she was low for a few days and then would shoot high so there was a period where her doses were being altered every few days.

 

[TDavies]

Hi there, how old is your Mum? My Mum was the same when she reached 80, we were told her requirements were changing (understandable) so they tweaked her fixed (basal) doses. It was difficult because like your Mum she was low for a few days and then would shoot high so there was a period where her doses were being altered every few days.

Thanks! x
My mum is 84.
She tests a lot (usually around 5 or 6 times a day) so we have a pretty good idea of what's happening. She is only meant to test twice a day - before each humalog injection - and then only change the dose after 3 days of consistent highs or lows - but she used to take NovoRapid and can't get out of the habit of testing all the time.
I don't think it's that because we have got the dose about right now. It has got more inconsistent and unpredictable though and goes between very high and very low...
When this happens though, it is really worrying: the downward rate of glucose really noticeably increases, she has to eat twice as much and still goes low, it's a very marked effect and lasts for nearly two days each time.

 

[TDavies]

I don't know Humalog Mix 25 but presume it should be gently "shaken" for it to be mixed properly, like long acting insulins. Has this been done before every injection? If not, this could affect blood sugars.

Yes it does have to be shaken but I don't think that could cause this. Thanks.