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Low BG Day

ElkBond

Well-Known Member
Messages
356
Type of diabetes
Type 1
Treatment type
Insulin
Every time I think I get my basal level right it comes back to bite me. I thought I would post my worst day recently to see if you guys have any tips. The dexcom was pretty accurate as I verified it a lot today. Rarely do I hit the threes but today it was on a vengeance.

Today I had to consume so much to keep my levels above 4 even though I was just sitting down at work all day, not very active at all.

I am currently on tresiba which when correct is so stable, but when I change the dose it takes 48 hours to take effect. I will drop it again to 6 units tonight (honeymoon period). I suffered from really bad night time lows followed by a gradual rise when I was on Lantus.

The dotty bit is when I went for a quick run after a phantom high - started rising rapidly even though I hadn't even had my dinner yet, after a day of struggling to keep it out of the 3s!

Enjoy!

 
Morning @ElkBond - Can you try some basal testing ? I found Tresiba took about 3 days to adjust so once you adjust today, give it 3 days and then try some basal testing, you don't have to do a full day so try some split days:

http://www.salforddiabetescare.co.uk/index2.php?nav_id=1007

If you want a basal test buddy I may well do one next Tuesday morning as i'm changing mine a bit at the moment ?

It's also pretty hard managing the honeymoon period with your basal rates as the odd squirt will throw your numbers so try not to act too hasty.
 


Hi Juicyj. I dropped it to 6 as I said last night and I would definitely like to do some testing. Thing is looking at the link you sent me there no way I can go for those hours without snacking on something at the moment (unless I am completely asleep!). Its like every time I drop it my body works harder. I was on 11 only a few weeks ago, every time I go through a few days of this I drop it again one unit. At least its predictable, Lantus sent me all over the shop, I didn't know whether I was coming or going.

For someone who never had a sweet tooth, this is very frustrating. I actually had my first low BG of 3.8 during the night, my first one since being on Tresiba, my body is definitely resisting my efforts.
 
Hi @ElkBond Can you try doing from breakfast till 12 ? I don't and can't do a whole day, I don't eat carbs so eat little and often but eat nuts for snacking when I do. The most I can do is from waking till 1pm, but am ravenous by 1!

Keep a hypo treatment next to your bed if you don't already
 
I have a fair few things by the side of my bed I can try breakfast until 1, I will try it when my basal has settled.

Thanks
 
@Juicyj

P.S about the snacking comment I made! I mean't I would fall low BG not succumb to hunger!
 
Hi @Juicyj so the 6 units has settled, but as before I have had one good day where i was steady in the 5s all day, followed by the next day dropping to the low 4s and today full swing again to dropping the the high 3s.


My day so Far:
This morning I woke on 4.0, had some muesli and milk (35ish G of Carbs) one unit as i tend to need one unit if over 20gs of carbs. Slowly ate this, rose to about 6ish. Went for shower - dropped to 5.

Had lunch, no insulin (20ish G if that) and since been surfing 3.8 on CGM. I have done one check and when it read 3.9 my BG meter said 4.4. I have had a fair few sips of coke and a piece of bread. I haven't been particular active today (compared to yesterday where I was walking most of the afternoon)

I was going to basal test with you tomorrow but I am not sure I can survive the missing a meal and not eating in between. Would you recommend dropping it down again to 5? Or should I give it a little longer to settle.

Rather frustrating to say the least. I have seen forum members on even less basal so its appears the honeymoon period can be this intense. I think?
 
I'll share the problem I have and let you decide if it might be something you're dealing with too:

I'm not able to set a specific basal rate yet because my body still produces enough insulin to throw that calculation off pretty significantly.

The specific problem I have is that my pancreas can't keep up with a high(er) carb meal after about 3hrs. In practice, what happens is that I bolus for that meal and my levels are fine up until about 3hrs after. At that point, my blood sugar slowly rises which is particularly annoying if it happens when I go to sleep.

Consequently, when I'm off my low-carb diet, my basal needs will increase SIGNIFICANTLY. On a low-carb diet (<50g) I need about 10units of basal, and maybe 2-3 units of bolus a day. However, on a higher carb diet (200-400g) the only way to keep my levels in check is to increase may basal to as much as 20-24 units a day and increase my bolus to about 10-15 units.

The point I'm getting at is that if you're still honeymooning like I am, you're probably wasting your time try to get things perfect. Obviously, still producing some natural insulin is a good thing, but it comes at a major disadvantage (at least for me) in the sense that I don't have specific insulin:carb ratios or set basal doses.
 


I think you are right Torq, there is no guessing. Mine just seems to want to keep dropping. Since I last posted I ate half a creme egg (fondant (quick) and chocolate (slower)) to cure the low and I have been sitting high 5s for the last few hours. I would prefer it a little lower but I was getting fed up of the beeps every 10 mins.

I definitely do not have any sort of carb ratio, I just seem to guess if i need any units based on my current level and past experiences. I am just getting worried that If i keep dropping it, I will get to 1 or 2 basal and then it'll shoot up one day soon as I have worn it out. I try to stay low carbs (reduced any swings if I am wrong which is often as there is no ratio) unless treating lows.
 
I understand the fear, but that's why I feel that my Dexcom is so valuable. Even if my honeymoon phase decided to last this long (1+ years) but suddenly stop in a matter of hours, I'd get 12 alerts (every 5 minutes) an hour as soon as my blood sugar rose above 8 mmol/L.

I also had to accept that that wasn't a realistic fear and the chances of it unfolding that way are incredibly unlikely, and it wasn't worth dealing with lows all the time based on the .0001% (arbitrary number I made up for this post) chance it could happen.

Honestly, I don't click on the "How much insulin do you need?" threads on this forum because it I tend to compare my needs with the needs of others. I try to just focus on doing what works for me. If it seems odd, I discuss it just like we're doing now.
 
I'm wondering whether Tresiba is actually a good insulin for someone who is yet to get out of honeymoon.

Whilst it's great if you are producing next to no insulin, you have next to no flexibility in a 24 hour period as it takes 3 days to change. As a result, with fluctuating production only endogenous insulin, you will get lows and highs that persist much longer.

I'd be tempted to go back to Levemir simply due to using it twice daily you have way more flexibility in how much you give when.
 
That's exactly why I haven't looked into Tresiba more (plus, Levemir is working great for me).
 
I got switched to Tresiba to combat my frequent nightly lows, I mean it was 3+ times a night, then I would rise lunchtime onwards (I was on Lantus though not Levemir). I think one of the advertised things on Tresiba was nocturnal Hypos. Also, when I am going down its never seems as sharp as Lantus either, I don't know if thats to do with Tresiba or honeymoon period.

Even from the second day on Tresiba I had my first full sleep and its been that way ever since. Difference is when I have a low day it will be consistent-ish all day. So while the three day thing is annoying I think the sleep is worth it. Plus I kinda feel like I know where I am with it even when acting up, I never felt that the time I was on Lantus.

I feel more comfortable now that other people (Torq) have the same problem so I will take it as it comes.

I will bring what you guys have said next appointment however, to see what my consultant thinks. Thanks for your advice Always nice to discuss.

Edit: O yeah I had one minor low during the night, but thats it.
 
@ElkBond morning. Yes I can see the benefits in preventing the nighttime hypos with Tresiba, it's the day to day activity with a part functioning pancreas. It is very much track and record your results and test frequently. Just ensure you are always carrying a carby snack as well as your fast acting glucose which I'm sure you are doing
 
I always carry food around at the moment and I have a CGM which helps me keep on top of it. I will bring what you guys said up with me next appointment.

The sleep definitely outweigh the snacking, I did figure out even on my bad day I probably didn't manage a full bottle of coke (500ml) in the day (and then some long acting food). Whereas in the past I could have had a bottle in 10 mins casually. Its only a few swigs each time.
 
This is exactly my problem! I had a high-carb/high-fat Chinese meal last night and happily went off to bed at 6.5mmol (with downward arrow). I'd usually take a correction dose before bed because I am well aware it will start to spike upwards in the night, but since I'd had alcohol last night I wanted to play it cautious.

This is up to midnight when I went to bed:


This is after!


The downward trend started 30 mins after I woke up and took a correction dose.

That's where Dexcom's alarms would have come in handy.
 
@pinewood I do agree, I feel so much better going to sleep knowing I will get a buzz if things go south. I actually found a spare use for my dexcom receiver, I have the parameters set differently to my phone as I don't expect to go higher than 7ish in my sleep and lower than 4.0 so it buzzes in my pillowcase to wake me up. Rather than having a loud and shocking alert tone, its much more subtle and less jumpy than the audible alert. I can then leave my phone on silent as emails and apps love to come through in the early hours.

I had another funny turn last night, rose up to 9.4 mmol/L at 11:20pm for no reason, nothing was consumed since dinner. I took a 2 correction dose and walked about a bit to steady it, when it started coming down I went to bed. However my brain could not let me sleep because I was worried I would drop too low (even though I have Dexcom alarms - paranoia set in). I finally slept after 2am.

After a snooze, I have had a really good day today, little rise post lunch (just above 7), probably could have done with an extra unit but aside from that no snacking!

P.S. @pinewood - I can see your mac keyboard, Good choice!
 
These are exactly the problems I am facing too. I found that moving my Levemir injection to around 6:30 pm has helped tremendously. In this way the Levemir peaks when I go to sleep and prevents my BS from rising.
 
Finally starting to get some stability (for how long, who knows), this is today, and its been like this for the last few days.

 
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