Can hypoglycemia be the result of eating fruit or other carbs ?

[JAT1]

I usually have below normal BG readings after midnight, getting lower and lower and not followed by the Somogyi rebound effect or the dawn effect. I have lessened the amount of basal I take once a day in the evening (even below what the endocrinologist prescribed) but I still get this. The solution I found is to eat a small amount of fruit when I wake up at night (such as a quarter of an apple each time I wake). I drink plenty of water before going to bed and some during the night to ensure I will wake up. Could the carbs intaken cause a sort of opposite rebound effect and result in a lower than normal BG ? Is there such a thing as the opposite to the Somogyi effect ?

 

[Antje77]

There's reactive hypoglyceamia, where people get a low some time after eating carbs because their pancreases react to the carbs with producing too much insulin. But as you are on insulin that sounds very unlikely.
I'd look into your insulin first. What type of diabetes do you have and what insulin(s) are you on?

 

[JAT1]

There's reactive hypoglyceamia, where people get a low some time after eating carbs because their pancreases react to the carbs with producing too much insulin. But as you are on insulin that sounds very unlikely.
I'd look into your insulin first. What type of diabetes do you have and what insulin(s) are you on?

I'm type 1 and I take Basaglar for the basal and Novorapid before lunch and dinner. Thank you for your reply. I am now researching reactive hypoglycemia and have found (at last) the info on this on this site.

 

[EllieM]

I usually have below normal BG readings after midnight, getting lower and lower and not followed by the Somogyi rebound effect or the dawn effect. I have lessened the amount of basal I take once a day in the evening (even below what the endocrinologist prescribed) but I still get this. The solution I found is to eat a small amount of fruit when I wake up at night (such as a quarter of an apple each time I wake). I drink plenty of water before going to bed and some during the night to ensure I will wake up. Could the carbs intaken cause a sort of opposite rebound effect and result in a lower than normal BG ? Is there such a thing as the opposite to the Somogyi effect ?

Surely the carb intake from the fruit is just raising your blood sugar and preventing the hypo....? I would revisit your basal amount and possibly reduce it even lower....

 

[Alison54321]

Long acting basal insulins often have peaks. Basaglar is biosimilar to Lantus, and Lantus is well known for having a peak at night, which can send blood sugars low.

The fruit is probably stopping the hypo.

Also because you're newly diagnosed, taking insulin may be having a honeymoon like effect, and you may be producing small amounts of insulin.

 

[kitedoc]

Hi @JAT1, can I ask how long have you been diagnosed with Type 1 diabetes and how much Lantus you were prescribed previously and what amount have you changed the dose to?
And is there a reason why you are not prescribed NovoRapid before each meal not just 2 out of 3?
Thank you - I hope the answers can help tom provide more answers or affirm what others have said already.

 

[Antje77]

Surely the carb intake from the fruit is just raising your blood sugar and preventing the hypo....? I would revisit your basal amount and possibly reduce it even lower....

You could switch your timing to the mornings, to prevent having your basal peaking when you already tend to go low.

I'm type 1 and I take Basaglar for the basal and Novorapid before lunch and dinner. Thank you for your reply. I am now researching reactive hypoglycemia and have found (at last) the info on this on this site.

Reactive hypoglyceamia and type1 don't go together as far as I know.

 

[Bluetit1802]

Reactive hypoglycaemia happens when there is an over-production of insulin as a reaction to eating carbs, which causes the crash after eating.

 

[JAT1]

Surely the carb intake from the fruit is just raising your blood sugar and preventing the hypo....? I would revisit your basal amount and possibly reduce it even lower....

Yes, I believe the fruit is preventing a hypo, but I am wondering if any amount of carbs while raising blood sugar at first would result in a consequent low in proportion to the increase in BG. I understand you can have a sugar crash after consuming a high carb meal (something I personally don't do) but maybe the same effect can occur after any amount of carb? Thank you for your advice. I agree with lowering my basal further.

 

[JAT1]

Long acting basal insulins often have peaks. Basaglar is biosimilar to Lantus, and Lantus is well known for having a peak at night, which can send blood sugars low.

The fruit is probably stopping the hypo.

Also because you're newly diagnosed, taking insulin may be having a honeymoon like effect, and you may be producing small amounts of insulin.

Yes, maybe I am experiencing the honeymoon effect. When I was diagnosed the endocrinologist said I was producing less that 5% of the insulin I need, but that is still something and maybe sometimes it's a bit more than that. Thank you for your reply.

 

[JAT1]

Hi @JAT1, can I ask how long have you been diagnosed with Type 1 diabetes and how much Lantus you were prescribed previously and what amount have you changed the dose to?
And is there a reason why you are not prescribed NovoRapid before each meal not just 2 out of 3?
Thank you - I hope the answers can help tom provide more answers or affirm what others have said already.

I was diagnosed type 1 on July 31 2018. I was originally prescribed 6 units Basaglar every evening. Then when I went for the follow up appointment with the endo, I had to point out to her more than once my fasting reads in the early 2s. I had to stress I woke feeling awful so she said to reduce it to 5 units. Since then I reduced it further to 4 units and didn't bother contacting the endo to tell her. I'm planning now to reduce it to 3 units further to thoughts raised by a prior posting here (EllieM).
The endo said not to take any Novorapid before breakfast because of my very low fasting reads. I usually have breakfast at 9:00 am and lunch at 12:00 and am fearful of stacking which one time I accidentally did and consequently had a severe hypo, luckily I didn't end up in hospital. So I have a low-carb breakfast so as not to need the Novorapid: 3 scrambled eggs in ample butter and about 100 grams cheddar cheese.

 

[JAT1]

You could switch your timing to the mornings, to prevent having your basal peaking when you already tend to go low.
Reactive hypoglyceamia and type1 don't go together as far as I know.

How would a switch in time have to be done? Slowly over a few days or how? Would it result in stacking with the dose of Novorapid I take before lunch?

 

[JAT1]

Reactive hypoglycaemia happens when there is an over-production of insulin as a reaction to eating carbs, which causes the crash after eating.

I gather from internet research that reactive hypos occur within 4 hours after eating so it doesn't seem to fit lows after midnight. However I definately have had several incidents of reactive hypoglycemia early on after diagnosis because the amount of insulin I took was more than needed for the subsequent meal. The endo just instructed me to take a certain amount and increase it if my post-prandial was over 10 and never told me about relating insulin taken to food eaten. I learned about that later after the incidents I have just mentioned. Now for the 4 units Novorapid I take before lunch and later before dinner, I make sure I have approx(but as exact as I can be) 50 gr in carbs, not more, not less, all in veggies or fruit for lunch and for dinner. Thank you for your reply.

 

[Antje77]

How would a switch in time have to be done? Slowly over a few days or how? Would it result in stacking with the dose of Novorapid I take before lunch?

Cant't advise you on this one, as per forum rules, but you can either ask your doctor or figure out some trick yourself.

 

[Antje77]

I definately have had several incidents of reactive hypoglycemia early on after diagnosis because the amount of insulin I took was more than needed for the subsequent meal.

Reactive hypoglyceamia has to do with your pancreas splurting out too much insulin after food. What you destcribe is taking a wrong dose of insulin resulting in a hypo.

 

[Lamont D]

I gather from internet research that reactive hypos occur within 4 hours after eating so it doesn't seem to fit lows after midnight. However I definately have had several incidents of reactive hypoglycemia early on after diagnosis because the amount of insulin I took was more than needed for the subsequent meal. The endo just instructed me to take a certain amount and increase it if my post-prandial was over 10 and never told me about relating insulin taken to food eaten. I learned about that later after the incidents I have just mentioned. Now for the 4 units Novorapid I take before lunch and later before dinner, I make sure I have approx(but as exact as I can be) 50 gr in carbs, not more, not less, all in veggies or fruit for lunch and for dinner. Thank you for your reply.

I have RH!
Usually, having RH, means that you should not be needing insulin injections.
There are many types of Hypoglycaemia, and no two are the same, it is the insulin response after carbs! I would definitely say that if you are injecting, it won't be RH!
I hypo after about three and a half hours, depending on what I ate, some RH ers, hypo after an hour.
However, I was misdiagnosed, as a T2 diabetic.
Also, as with some T2s, the initial insulin is weak, so a spike is the usual outcome, and this might happen if you use too much insulin as a T1, but I would defer that to someone who is T1!
Fruit can be a quick source of glucose, it all depends on how you metabolism it, and which fruit, an apple could be okay, but pineapple could be really bad!

Hope this helps

 

[kitedoc]

I gather from internet research that reactive hypos occur within 4 hours after eating so it doesn't seem to fit lows after midnight. However I definately have had several incidents of reactive hypoglycemia early on after diagnosis because the amount of insulin I took was more than needed for the subsequent meal. The endo just instructed me to take a certain amount and increase it if my post-prandial was over 10 and never told me about relating insulin taken to food eaten. I learned about that later after the incidents I have just mentioned. Now for the 4 units Novorapid I take before lunch and later before dinner, I make sure I have approx(but as exact as I can be) 50 gr in carbs, not more, not less, all in veggies or fruit for lunch and for dinner. Thank you for your reply.

According to what I have read you do not have RH. Just my personal view from reading.

 

[kitedoc]

I was diagnosed type 1 on July 31 2018. I was originally prescribed 6 units Basaglar every evening. Then when I went for the follow up appointment with the endo, I had to point out to her more than once my fasting reads in the early 2s. I had to stress I woke feeling awful so she said to reduce it to 5 units. Since then I reduced it further to 4 units and didn't bother contacting the endo to tell her. I'm planning now to reduce it to 3 units further to thoughts raised by a prior posting here (EllieM).
The endo said not to take any Novorapid before breakfast because of my very low fasting reads. I usually have breakfast at 9:00 am and lunch at 12:00 and am fearful of stacking which one time I accidentally did and consequently had a severe hypo, luckily I didn't end up in hospital. So I have a low-carb breakfast so as not to need the Novorapid: 3 scrambled eggs in ample butter and about 100 grams cheddar cheese.

Thank you, @JAT1. From my own reading and experience as a T1D, not as professional advice or opinion: So during the first year or more us T1Ds go through a honeymoon phase where the use of insulin injections seems to bolster the pancreas's ability to produce some insulin of its own from the remaining beta cells that produce insulin. During this phase we become very sensitive to insulin. (See home page : type 1 diabetes, Newly diagnosed with diabetes and right at the bottom - honeymoon phase) An old rule of thumb I was given by my specialist was that if an adult has their pancreas gland removed the insulin requirement might be ? 20 to 60 units depending on all sorts of factors. Your current insulin requirement is well below those figures.
The mix of internally produced insulin (not sufficient on its own) and injected insulin makes for a tricky situation as one cannot always predict how much insulin the pancreas will produce. Hypos are a frequent issue because of this. Given time insulin by injection requirements increase as the pancreas's beta cells finally become unable to produce any insulin at all. Enjoy the capacity for your body to handle food better during this phase.
Insulin stacking is about overlaps in insulin effect and is usually referring to about short-acting insulin. (see parentingdiabtetes.com) What is Insulin On Board, Active Insulin or Insulin stacking? ( the article refers to BSLs in a different set of units - some countries like USA use mg/dL rather than mmol/l ( if you divide the figure in mg/dl by 18 you get the figure in mmol/l so 100 mg/dL = 100 divided by 18 mmol/l). Speaking with your DSN might help in understanding this further as it sounds like you have had a bad experience or two with it.