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Hypo right after meals.

blueeyed81

Well-Known Member
Messages
218
Type of diabetes
Type 1
Hi all, hope you're all well.

Right, so for the last few days I've been having my insulin as usual before meals and I keep having hypos not long after I've finished my meal. I have the same amount of carbs for the meal as I'd normally have, but end up hypo. It doesn't matter what my bg is either. I'm baffled by it and completely blank as to what's happening. All ideas and things to try to combat this welcome.
 
Do you test before meals and adjust according to results? Do you carb count?
If you inject insulin for carb-counted food when your blood sugars are low then it’s likely that you’ll rise briefly but return to low.
If you don’t carb count but just inject a pre-set amount of insulin the you’ll hypo if you haven’t eaten enough carb to cover the dose.
It could also be that more exercise, less stress, and seasonal changes are affecting the amount of insulin you need.
 
Gastroparesis ??? As in your insulin is hitting the blood stream before your food gets absorbed. It is a common diabetic thing. Does your blood sugar rise later on instead? Anyway something to think about if the other good suggestions don't fit your story.
 
Is it every meal? Have you done a basal test?
 
If you are taking an early prebolus maybe it is too early. Perhaps more likely that you were already dropping before the meal. Would it possible to try a Libre or CGM to get a better handle on it?
 
Thanks all, I'm on the minimed 640g pump and currently using the libre, I bolus maybe 5 minutes at the most before a meal, I like to make sure I know how much is on the plate for the carbs lol.

It's been the last few days x
 
blueeyed81 said:
I have the same amount of carbs for the meal as I'd normally have,
Click to expand...

Hi, blueeyed81, could be just another bit of T1 randomness or the colour of your socks, but I'm wondering whether it might be the type of carbs in the meal?

Even though the amount in terms of grams might be the same, 40g of toast, for example, is going to get in stream a lot quicker than 40g of beans/pulses, so it might be if your recent meals have been lower gi, the insulin is getting to work before the carbs get in stream?

The pre-bolusing, splitting and amounts I dose for toast will be way different compared to pulses, even though the carb count is the same.
 
Presumably the Libre graph doesn't help? It does sound odd. The meals weren't higher fat than usual? I tend to get a dip after a high fat meal then climb later on. I'm new to pumping & currently experimenting with extended boluses to cope with it.
 
Are you detecting the hypo with Libre only or have you tested with a finger prick?
I do not find Libre very accurate so it may not really be a hypo.
As you have noticed it the last few days, it could be a low reading Libre.

Or it might just be the colour of your socks
 
Possibly my socks lol, I do check with my contour metre too, there's bout 0.6 difference, the contour being the higher of the 2.
 
It's in general the same meals or similar, I don't vary too much as I'm happy with the meals I have and know how my bloods usually react.
 
DunePlodder said:
Presumably the Libre graph doesn't help? It does sound odd. The meals weren't higher fat than usual? I tend to get a dip after a high fat meal then climb later on. I'm new to pumping & currently experimenting with extended boluses to cope with it.
Click to expand...
I use dual bolus for take aways, pizzas and Chinese especially, I'm still fairly new to the pump, I'm only 2 years in lol
 
blueeyed81 said:
It's in general the same meals or similar, I don't vary too much as I'm happy with the meals I have and know how my bloods usually react.
Click to expand...

It's definitely the socks then!

There's been some speculation, and one or two studies, about how different batches of fast acting have different potencies.

I hadn't paid much attention to those, but after using cgm for a few years now, I've seen situations where some boxes of novorapid just seem to be "stronger" than others, so there might be something in it.

I suppose it's possible - we like to think every batch of novo or whatever we get is going to be consistently the same, but in a mass produced factory situation, there's a whole lot of things which might go wrong.

I've been re-reading Stephen Ponder's book Sugar Surfing recently. It's reminded me that, depending on how a person's biology is running that day, a lot of insulin can be destroyed long before it gets anywhere near doing its job, because insulin antagonists will be having a field day. The flip-side is true too: there'll be days when the antagonists won't be in play, so the same dose might have a much greater effect. It's one of those known unknowns which we can't measure (but fortunately sortable with some Jaffa Cakes!).
 
@blueeyed81 , I'm neither T1, nor an insulin user, but could it be the change in the weather? I've been overseas for a while, so for me, I haven't seen any improvement in the weather, but I know from previous years some users find their insulin needs change with the weather.
 
Hi @blueeyed81, Sorry to hear of your troubles.
Several thoughts based on my experience as a T1D on a pump, not as professional advice or opinion::
1) could it be that the cannula has been inserted into muscle rather than under the skin into what is
called the subcutaneous(s/c) tissue?
Insulin is absorbed more rapidly from muscle and can lower BSLs more quickly.
a) The cannula could end up in muscle at the time of insertion, with it causing stinging and pain more
widespread then the usual pain after insertion or
b) maybe the tip of the cannula is close to the tissue layer between s/c and muscle tissue and with pressure
perhaps laying on the area at night pushes the tip through into the muscle?
When I have suspected one of the above has happened I have changed the cannula and chosen a different site.
2) problems with Medtronic pumps have been reported - including errors in infusion rates - could
your pump be inputting more insulin than programmed into your tissue?
Some of that may be excess insulin from the basal program giving you higher insulin levels before you eat
and maybe the bolus dose in excess tips you over the line for a hypo to occur.
3) as others have suggested hypos can be due to the described effect of delay in absorption of food due to
gastroparesis - where the stomach holds onto food and releases it very slowly so that the insulin is acting
well before the food reaches the small intestine to be absorbed. You would need to check that out with a doctor.
It is a known complication of diabetes but that is after many years of diabetes usually.
see mayoclinic.org gastroparesis - diagnosis and treatment
4) if the problem of hypos soon after eating is persisting and getting more common and worse - that has
happened to people whose kidneys for some reason are not working well and insulin is not being broken down.
That is an urgent situation and needs immediate medical attention. see https;//doi.org/10.1136/bmj.d567
5) I do not know what else - somebody else might !!
So please contact your health team asap to discuss your troubles and see what they have to say.
What do they suggest you do whilst the cause is being sorted? ? change cannula site? ?
What about insulin dose?
Check what the pump is recording as amount of insulin delivered? Are you having to change the pump's
reservoir more often than usual?
Best Wishes for an easy answer and solution.
 
Hi and thank you, I'm going to email my diabetes team and see what they say. I'm currently only using my arms as when in my stomach 9 times out of 10 it's sore and an infection occurs. (my diabetic dietician is going to talk to the medtronic rep about what options are best for cannula, I've asked to try a different one, currently using the minimed mio). I am going from left arm to right and chaniginf every 3 days unless my bgs are high and won't come down. I'll see what my dsn comes up with.
 
I'd say split the bolus on the pump 60/40 over the 5 hour time period and see how that goes.
 
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