4 days of constant hypos

[Barnardine]

Hi, diagnosed t1 last June, been on MDI tresiba and novorapid since, usually 10-14 units basal depending on activity. All of a sudden last four days levels consistently dropping below 3 mmol, and too often lower, without any fast acting insulin. Initially I thought a response to activity the day before was why, but four days later without activity and with reduced basals the same experience. My question is, can this happen of itself from time to time, e.g. if the pancreas randomly generates some insulin? I didn't experience a honeymood period after diagnosis, can one come along spontaneously nearly a year later? Or anything else? I'm considering taking almost no basal today, but at the time of writing levels have suddenly risen to 10mmol. It did this occasionally over the last four days also, but unsure if it was a response to hypo, or decreased sensitivity? (Went "lo" on the libre last night, could be due to that.) Any thoughts would be appreciated after 4 nights without sleep.
Thanks

 

[Deleted member 527103]

@Barnardine unfortunately, in the early days of our diagnosis, our pancreas is fickle.
We are al different but the honeymoon period can last years rather than a few months - mine lasted about 8 years.
So, you could be experiencing a spluttering of self-created insulin during your honeymoon.

There are lots of things that can affect our blood sugars - food, alcohol, exercise, drugs and stress probably have the greatest impact. But there are others.

Night time hypos reported on Libre are often (but not always) red herrings caused by compression lows - applying pressure to the sensor when you lie on it will cause it to record a false low. I can usually tell if a Libre reported night time low is real or not by how I feel in the morning. If I have a "hypo hangover" (headache and feeling nauseous but no alcohol involved) it was a real hypo. Otherwise, it is usually a compression low.

We cannot (and should not) advise on insulin doses because we are all different. Even after 4 days of lows, I would be reluctant to take no basal but I would be reducing it.

I would also be testing a lot with finger pricks to check the accuracy of my Libre.

 

[Barnardine]

Thanks for your response. I knew that the libre can vary alot, but I didn't know pressure specificaly could cause this, so thanks. Unfortunatley last night's hypo was legit, tested on strips etc. And I'm also reluctant to completley cease basal, so will likely just continue to decrease.

I'll have to keep in mind the honeymoon which I'd originally discounted, although for times like these, when basal side-effects can impact for 24 hours and longer, I've been reconsidering the benefits of a pump, with the flexibility in background insulin levels it can provide?

@Barnardine unfortunately, in the early days of our diagnosis, our pancreas is fickle.
We are al different but the honeymoon period can last years rather than a few months - mine lasted about 8 years.
So, you could be experiencing a spluttering of self-created insulin during your honeymoon.

There are lots of things that can affect our blood sugars - food, alcohol, exercise, drugs and stress probably have the greatest impact. But there are others.

Night time hypos reported on Libre are often (but not always) red herrings caused by compression lows - applying pressure to the sensor when you lie on it will cause it to record a false low. I can usually tell if a Libre reported night time low is real or not by how I feel in the morning. If I have a "hypo hangover" (headache and feeling nauseous but no alcohol involved) it was a real hypo. Otherwise, it is usually a compression low.

We cannot (and should not) advise on insulin doses because we are all different. Even after 4 days of lows, I would be reluctant to take no basal but I would be reducing it.

I would also be testing a lot with finger pricks to check the accuracy of my Libre.

 

[KK123]

Hi @Barnardine, you say you didn't have a honeymoon period but can you say why you think this? A honeymoon period doesn't just mean how long a person soldiers on without ANY insulin for example, it also means a person using smaller or varying amounts of injected insulin because their bodies are still producing SOME itself. The 'end' as it were tends to mean your pancreas has given up pretty much completely hence the injected insulin rises. I'm 3 years into diagnosis, I use 6 units of basal per day and a unit or two of novarapid if required. I haven't had to take any novarapid for a few days now (my meals have been low carb) and so I also had to reduce my basal from 10 to 6 because I was hypoing (like you) constantly. People sometimes forget that the amount of basal one needs in a day works in conjunction with how much bolus is required, reduce or increase one and it CAN affect the other.

Just be aware also, that any change made (especially to basal) can take a few days to bed in. I think that's why we are always being told to stick to a 'routine', eat at the same times, inject at the same times in order to control it..I do NOT do that because my lifestyle has never been routine. x

 

[Barnardine]

Hi @Barnardine, you say you didn't have a honeymoon period but can you say why you think this? A honeymoon period doesn't just mean how long a person soldiers on without ANY insulin for example, it also means a person using smaller or varying amounts of injected insulin because their bodies are still producing SOME itself. The 'end' as it were tends to mean your pancreas has given up pretty much completely hence the injected insulin rises. I'm 3 years into diagnosis, I use 6 units of basal per day and a unit or two of novarapid if required. I haven't had to take any novarapid for a few days now (my meals have been low carb) and so I also had to reduce my basal from 10 to 6 because I was hypoing (like you) constantly. People sometimes forget that the amount of basal one needs in a day works in conjunction with how much bolus is required, reduce or increase one and it CAN affect the other.

Just be aware also, that any change made (especially to basal) can take a few days to bed in. I think that's why we are always being told to stick to a 'routine', eat at the same times, inject at the same times in order to control it..I do NOT do that because my lifestyle has never been routine. x

Thanks. In retrospect I overlooked the variety of kinds of honeymoons there are, and combined with the high levels post diagnosis I dismissed the idea. But after reading your response and having experienced these levels for nearly a week it's now the best explanation. Thanks for highlighting the idea of bolus dose influencing the effectiveness of basal insulin, besides everything else, this is something I hadn't seriously factored.

As someone who also lives without much virtue of routine I wonder, as you live with the condition for more time do you come to take more and more factors into consideration and refine what you do, acting based on expectations, or do issues like basal adaptivity remain inherently unpredictable and depend largely on reactive behaviour? For instance, I also go days with few carbs and minimal fast acting insulin. You mention that you experienced lows after something like this and reduced your basal accordingly. I'd be grateful to know, in your case, can you sometimes reduce your basal in advance, since you can expect the lows to follow in the coming days, or do the effects vary too much to be predictable, and so you cannot alter basal in advance?

Thanks again for your reply.

 

[KK123]

Thanks. In retrospect I overlooked the variety of kinds of honeymoons there are, and combined with the high levels post diagnosis I dismissed the idea. But after reading your response and having experienced these levels for nearly a week it's now the best explanation. Thanks for highlighting the idea of bolus dose influencing the effectiveness of basal insulin, besides everything else, this is something I hadn't seriously factored.

As someone who also lives without much virtue of routine I wonder, as you live with the condition for more time do you come to take more and more factors into consideration and refine what you do, acting based on expectations, or do issues like basal adaptivity remain inherently unpredictable and depend largely on reactive behaviour? For instance, I also go days with few carbs and minimal fast acting insulin. You mention that you experienced lows after something like this and reduced your basal accordingly. I'd be grateful to know, in your case, can you sometimes reduce your basal in advance, since you can expect the lows to follow in the coming days, or do the effects vary too much to be predictable, and so you cannot alter basal in advance?

Thanks again for your reply.

Hi there, good question! I can only speak for myself obviously because there are many different approaches, (as you know). I try to make most of my adjustments in advance rather than having to do so reactively as that way I can try to minimise any 'foreseen' lows or highs. That is easier said than done I know, because that in itself sometimes requires a 'routine'!!! For example, if I know I am going to start a week of night shifts, I **may** change the times I have my basal to compensate working during the night and sleeping during the day.

If I've been for a run in the morning, I may have a unit or 2 less bolus for my evening meal because I know that around 8pm that day I will go low as a consequence of the run that morning.

When I was first diagnosed I spent a LOT of time trying to get things perfect but I don't think that's possible. No matter what I did I would ALWAYS go low around 4pm, I spent weeks changing dosages, trying different timings all to no avail. Now I predict it, so I have a 15 carb snack before it happens (good excuse eh!!!!).

It sounds complicated but you learn as you go along. Now sometimes it all goes to pot, this week for example I can barely rise above the 4s which sounds fine but I keep having to have snacks, that's why I reduced my basal. Next week, I might decide to have more carbs because I'm at work and cannot afford to be in the 4s because part of my job is to drive and respond to chaotic occurrences and I do not want to run the risk of dropping further. On a day off I'm happy to sit in the 4s...unless I'm going for a run and then I like to be in the 5s!! You see what I mean, mind boggling BUT it does get easier.

Also, because I believe I am still in the honeymoon period, I believe I am sometimes helped by my own body also producing insulin. If I don't take enough injected insulin (gleaned from loads of testing, etc) then have a carbier meal, my levels are still ok after 2 hours. If I take too much however (and how do you really get it spot on!) then my own can sometimes kick in and send me hypo.

I hope this helps but I fear I may have confused you further! It really is test, test, test and even when you do, sometimes it throws you a curve ball. x