Hypoglycemia after morning injection

[cheftux]

Hello, I'm another newly diagnosed Type 1 as of Feb 19th. I was diagnosed after my wife & I had just moved to Sint Maarten (dutch side) and have not had an opportunity to travel back to the states yet to see my GP. The medical care here on the island is not the most thorough or reliable, when I say reliable it is almost impossible to get ahold of a doctor or a nurse via phone like I was told if I had questions. So... I found your forums & I'm hoping that you all can give me some advice.

My biggest question/concern is I believe I'm experiencing hypoglycemia quite frequently, not every day but more than twice a week so far. I'm taking 24 units of Lantis each night as well as NovoRapid with each meal, after I was hospitalized I was instructed to take 12-16 units of NovoRapid depending on what my glucose levels tested.

In the mornings my tests are usually between 80-120 (usually closer to 80) and I take either 12 or 16 units of NovoRapid respectively. I'll eat a pretty healthy breakfast, 2 egg omelette w/ veggies, 1 slice of deli ham & a little cheese and usually a piece of whole wheat toast. I feel fine while I'm eating but then within maybe 30 minutes to an hour tops I start to feel very shaky, this morning I ate a bowl of plain greek yogurt w/ strawberries & some splenda and I felt fine after I ate something else.

Any thoughts, advice etc? I really only notice it in the mornings, lunch & dinner meals go off w/out a hitch.

 

[Antje77]

Hi @cheftux , and welcome to the forum!

I feel fine while I'm eating but then within maybe 30 minutes to an hour tops I start to feel very shaky

You need to test when you feel like that to see what's happening.
Many of us need less than your 16 units for breakfast, but the only way to find out is to test so you can treat accordingly and adjust your dose next time.
Ideally dose adjusting is done in collaboration with your HCP, this is pretty important. However, if your meter confirms you're regularly below 70 after eating, it's clear you need either less insulin for that meal or more carbs.

How often do you test? Testing really is an important tool, both for yourself and for your HCP. Without knowing what's going on they can't advice you on adjusting your doses either.

Good luck, and keep trying to contact your health care provider!

 

[cheftux]

I test 4 times a day, each meal and before bed & I'm keeping track of glucose levels & daily injections w/ Glucose Buddy. Thanks again for the advice, I know how important it is to get ahold of my HCP, it just seems like it was a lot easier back stateside to be able to get ahold of someone even for questions like this. I'll keep plugging away!

Any advice on the carbs as well? I saw another post about a gentleman that felt like he was always hungry and I can definitely relate to that, I feel like I can't eat enough sometimes but I want to make sure I'm eating healthy. I was also supposed to get in touch with a dietitian here on the island, same issues that I'm running into w/ HCP. I've been trying to eat lots of veggies, hard boiled eggs, greek yogurt snack portions w/ fruit. Any other recommendations for in between meals or snacks to keep me full & still in a good glucose range? I'll try and look through the forums for existing topics too.

Thanks again.

 

[EllieM]

Any advice on the carbs as well? I saw another post about a gentleman that felt like he was always hungry and I can definitely relate to that, I feel like I can't eat enough sometimes but I want to make sure I'm eating healthy. I was also supposed to get in touch with a dietitian here on the island, same issues that I'm running into w/ HCP. I've been trying to eat lots of veggies, hard boiled eggs, greek yogurt snack portions w/ fruit. Any other recommendations for in between meals or snacks to keep me full & still in a good glucose range? I'll try and look through the forums for existing topics too.

As a T1 you are not carb intolerant like T2s so you can eat carbs, but you have to inject for them. So I would urge you to get the hang of carb counting as soon as possible, so that you can learn to adjust your insulin to your meals. For a T1 on a basal bolus regime your basal is designed to keep your levels steady all day if you did not eat or inject anything at all, and then the bolus should be adjusted to cope with whatever meals or snacks you want to eat. Your team is meant to help you calculate an insulin ratio eg 1 unit of insulin to 10g of carbs. Insulin ratios vary massively between people, and can even vary by time of day. One T1 may need only .5units of insulin for 10 carbs, another might need 5 units, so blood testing are food records are the only way to tell.

Be careful with fruit, as though it may be healthy most fruit other than berries has a surprising amount of carbs in it. (The T2s on here mostly can't touch them.)

In the future you may or may not want to go on an insulin pump and/or a continuous glucose monitor. These allow much more flexibility in insulin dosing and testing, but are expensive if you have to self fund. Personally, I don't use a pump but find the cgm as life changing as the first glucometer I received in the early 80s....

Good luck.

 

[Jaylee]

Hello, I'm another newly diagnosed Type 1 as of Feb 19th. I was diagnosed after my wife & I had just moved to Sint Maarten (dutch side) and have not had an opportunity to travel back to the states yet to see my GP. The medical care here on the island is not the most thorough or reliable, when I say reliable it is almost impossible to get ahold of a doctor or a nurse via phone like I was told if I had questions. So... I found your forums & I'm hoping that you all can give me some advice.

My biggest question/concern is I believe I'm experiencing hypoglycemia quite frequently, not every day but more than twice a week so far. I'm taking 24 units of Lantis each night as well as NovoRapid with each meal, after I was hospitalized I was instructed to take 12-16 units of NovoRapid depending on what my glucose levels tested.

In the mornings my tests are usually between 80-120 (usually closer to 80) and I take either 12 or 16 units of NovoRapid respectively. I'll eat a pretty healthy breakfast, 2 egg omelette w/ veggies, 1 slice of deli ham & a little cheese and usually a piece of whole wheat toast. I feel fine while I'm eating but then within maybe 30 minutes to an hour tops I start to feel very shaky, this morning I ate a bowl of plain greek yogurt w/ strawberries & some splenda and I felt fine after I ate something else.

Any thoughts, advice etc? I really only notice it in the mornings, lunch & dinner meals go off w/out a hitch.

Hi,

Welcome to the forum.

A couple of thoughts, though you know you better than I do. Recently diagnosed? You could be "honeymooning?"
The pancreas does a "dying swan." A little like the bad guy in a "slasher movie" everybody thinks they killed & then he pops back up? Just kicking out the last spurts on insulin production at random times before its demise.

Finding out what your numbers are when you feel what could be the effects of low BG.
Lantus? I know how it works with me.. What time do you give your dose at night & what time do you rise for your breakfast?
This may help you work out what the baseline is doing.. https://www.mysugr.com/en/blog/basal-rate-testing/

& as others have mentioned. Working out your insulin to carb ratio for what you eat is key. Though i personally feel if you are dropping so soon after injecting for what you eat.? (Unless I've read your account wrong.)

It's quite possible your Lantus coupled with your pancreas as a newly diagnosed is doing a bit a "Jason, from Friday the 13th."

 

[cheftux]

I get your movie references but I'm trying having trouble connecting them to my pancreas. Are you saying because I'm newly diagnosed my pancreas may still be not working very well & that coupled with adding insulin could create that effect on me?

Lantis at night anywhere from 10-11p depending on the night and I eat usually right around 9a give or take 30.
On that note breakfast at 9, lunch at 1-2p and dinner at 8-9p but sometimes later. Could the timing of my eating & NovoRapid be better?

 

[becca59]

@cheftux can I recommend you get a copy of Think like a Pancreas by Gary Scheiner. An excellent read written by a medical person with diabetes. The key to Type 1 management is to get your basal insulin dose correct first and then sort out your bolus. It sounds to me that you need to carb count and work out how much insulin you require. If you are not getting proper support at the moment, the book would be a good place to start.
@Jaylee comments on the honeymoon and pancreas are because you are newly diagnosed. The pancreas rarely just dies completely straight away and can give out insulin randomly for months or in some cases years. Periodically after 7 years my levels change dramatically and my pancreas has obviously spluttered into life again. Very unwelcome I have to say.
Also you need to be testing a lot more to see what is going on. I hammered the blood testing strips in the early days. A CGM would be useful too, either through your medical insurance or self funding. Get googling on this and carb counting. But I would seriously recommend that book.
As time goes on you will work out for yourself wether you want to eat low carb or not low carb. Both methods can be accommodated by insulin and it is a personal choice. Just because you have a type 1 diagnosis you shouldn’t be depriving yourself of food and be hungry.