I can't do it anymore

EllieM said:

Hope you are feeling better this morning @plantae . I have no idea what is causing your hypos but I strongly urge you to push for your DN to consider all possibilities.

If that means you need to change to a different basal, a different cgm or even a pump, so be it. (Not a recommendation to do any of those, just a sample of some of many possible changes that could be made). Is it safe to assume that you are under an endocrinologist that is experienced with T3C???

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I'll ask about all possibilities. She actually looked at my LibreView this morning and reckons that such a sudden and steep drop is unusual and maybe the previous reading on the Libre was incorrect (I.e. I was already low). Also she noticed that I had "stacked" (I think that's the word she used) my novorapid doses at 5PM and 8PM and that I had barely any carbs for dinner (at 8 PM) -- may as well say no carbs, it was the filling out of two meat pies and I logged it as 5 g which was a guess but seems reasonable... I didn't eat the pastry casing

JAT1 said:

Don't give up. Fight back instead. Good times may be just 'round the corner. Sorry if I'm asking a question you have already answered; but what is your insulin to carb ratio? I was wildly out of control at the beginning when I was on a fixed Novarapid dosage(set by the endo).

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I'm on fixed doses, so I had 4 units of insulin when I ate the meat out of my 2 meat pies. I made a guess as to how many carbs was in the meat and entered it as 5 grams because I didn't eat the pastry. Thinking now it good very well have been less than 5 grams. The only place I can think of that would have had carbs would be in the gravy so I looked on a packet of Gravox and just guessed. I don't have to log carbs because I'm on fixed doses but I do anyway and have done so since 2017

Edit: I just realised that maybe I should define "meat pie". In Australia when we say "pie" we mean meat pie (beef and gravy usually) and they're smallish -- meant for a single person not something you slice up to serve several people, we usually call those big ones family pies). So I didn't have a huge amount of meat

EllieM said:

I thought you were moved to a basal bolus regime

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I've always been on basal (lantus) and novorapid (bolus) regime. Maybe I'm getting the terminology wrong (?) I'm definately not on a fixed carb intake

The novorapid doses were initially the same for each meal, but now lunch and dinner are slightly lower. They've been adjusted twice. Lantus reduced as well, also twice.

I've asked to count carbs and even showed the nurse my records for the last 5 years because at the moment most of the carbs I eat are just to cover the bolus doses and I guess how many carbs I need to eat by looking back at my past graphs and how many carbs I ate with previous meals, because I haven't been told about ratios yet. Maybe I need to be more assertive with the DN about counting carbs... edit: because at the moment I feel like I'm doing things backwards if I'm allowed to say that

JAT1 said:

4 units of insulin and just the meat inside the pies with a little gravy would make my bs dangerously plummet too within about 15 minutes of eating. When I realized my endo was not helpful and my appointments were less than 5 minutes, I started counting carbs and dosing the meal-time insulin, without any medical permission. I learned all I could about insulin to carb ratio, mostly from this website, also about the time lag in the release of the carbs if you eat slower-to-digest stuff. You need this information so you can avoid hypos.

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I'll give my DN another chance... it's probably just me not being assertive or making my wants/needs known (my endo might not even know my doses as far as I know... I've not seen him since being diagnosed except when I was in hospital the other week, just the DN who is from a different hospital). The DN does seem good; e.g. she did ring be back this morning after all. I think it must be the way I'm expressing myself (or not expressing myself). I'll insist on counting carbs because, as said in previous message, I do feel like I'm doing things backwards right now: looking at my current BSL, looking at previous graphs to see how many mmol/L a certain amount of food "x" increases my BSL or counteracts/covers the insulin and then adding or subtracting that to my meal. That's not a normal way to eat and it doesn't work well, for me anyway, maybe because the same amount of the same food seems to affect by BSL depending on the time of the day! For example, if I have milk with breakfast my BSL will shoot above 11. If I have a glass of milk at, say, 2 PM my graph basically stays flat (and at 2PM that'd be without bolus although lunchtime dose, which is lower than breakfast dose, would probably not be worn off yet). So that strategy doesn't necessarily work for me

EllieM said:

People on insulin pumps can set basal rates to be different at different times of day.

I'm on a basal bolus regime and definitely need more bolus in the morning (maybe my liver is pumping out some sugar to help me out for the day) and less in the afternoon (when I believe I have a little too much basal in my system).

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Am I on a basal bolus regime even though my bolus doses before meals are fixed? Maybe I've been using the wrong words all along, I just assumed that lantus + bolus before meals was basal bolus regime... nobody has actually ever told me that I just googled it.

EllieM said:

The trouble is, just as basal needs can vary at different times of day, so can insulin ratios (bolus to carbs).
Add in the fact that everyone is a bit different and you also may have a random contribution from your pancreas, it's not surprising that insulin dosing sometimes seems more like an art than a science.

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Yeah I was just about to edit my previous comment to add that I don't have creon with my 2PM glass of milk, so that makes things different to breakfast as well. That complicates things probably

EllieM said:

My most important insulin dose is my lantus, when that it right and keeping me level (at least overnight) I find it much much easier to adjust my bolus.

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My basal might not be correct (still). In LibreView my fasting periods (night) are right at the bottom of the grey bar (4.1-4.6, average probably 4.2). The BSL line just skims along right at the bottom of the grey bar. Last night was in the 5s but that's probably because of the toast with honey and copious glucose that I consumed. In my uninformed opinion I'd prefer that fasting level to be in the 5s or low 6s. Something else to ask DN about

EllieM said:

On a positive note, you managed to treat the hypo without going to hospital this time, so I feel some progress is being made.

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Yes, I overcompensated but that's because I panic. It wasn't a disaster: I've gone higher just from breakfast before, but I check every 2 minutes and expect it to be back in the normal range. I made a spreadsheet this morning where I can write down what time I check, what my BSL is and what I consume, because I don't mean to check every 2 minutes I just go into a state of panic and start gulping down glucose and checking. I think this more methodical approach will suit my personality better. The glucose tubes do work very quickly for me though and now that I know that I'm a bit calmer. So, yes, progress!!

EllieM said:

To be honest, I'm not sure of the correct terminology here either, mainly because I don't really understand why your bolus doses are fixed.

As for whether your basal is correct, it's supposed to keep you level throughout the night, so if it is right and you start at 4.2 it'll probably stay there all night. Personally I take a small dose of carbs if my bg is flat but too low when I go to bed, though the definition of too low is one that may vary from person to person.

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I don't know why my bolus are fixed either. Doesn't make sense to me considering my carb intake is not really very consistent. Although maybe, I don't know. Dietician didn't seem too interested even though I know I eat fewer carbs than the Au Dietary Guidelines suggest

Yeah I stay level all night every night. If, as you say, I'm at 4.2 when I go to bed it stays there (except for my 3AM low which mustn't even last 15 minutes because libreview doesn't count it as a hypo/"low glucose event") and I wake up at 4.2

Daily carbs (these would normally be lower than this but I'm usually adding rice and potato etc to most meals to cover my bolus insulin)