Major Crashage of Glucose Level

Hi folks, (is crashage even a word? need a new Oxford diabetic dictionary)

Wondering how common this type of thing is.......

Every day I'm at work I have lunch at the same time, 12pm, every day at work I have insulin at the same time, usually 12:45pm - 1:00pm, every day before I leave work I test, usually between 15 - 20 mmols, walk home from work, 20 minute walk, hypo when I get in, so I basically drop anywhere between 12 and 15 mmols in 20 minutes, this happens every day, I could get my levels down before I left work no bother, just increase my lunchtime QA ratios, but am terrified of doing this considering I drop so much on the walk home, how does 20 minutes of brisk walking do that to my glucose level?

My background insulin is Levemir, 16 units at 8am and 20 units at 8pm, I've thought about decreasing my morning QA but don't see how this would help as it's probably running out come 5pm anyway, any thoughts?

Forgot to say in previous email, it's almost as if the QA insulin at lunchtime is on a major time delay as I seem to shoot up very quickly after lunch (various days of testing every 10 mins after lunch seem to confirm this) and not notice any kind of "dip" until the crash hits at around 5:00pm. Not sure if this is at all possible but that's how it looks.

I've had a few "carb free" lunches and the same thing happens although not on such a dramatic scale, my levels will rise during the afternoon and then fall off the cliff at 5pm and I register 0.1 keytones when I've done this, which on one hand leads me to believe I need more BI, but on the other hand, with levels crashing like this I was prepared to cut BI, 21 years a type 1 and there are still things which throw me! :?

Just to clarify,I usually take inuslin around 5-10 mins after lunch, the reason I do this is that I've taken insulin before lunch on occasions and then been distracted by something else and had a major hypo, it's just the way I do it and I won't ever change that, I've discussed this with consultants and they agreee it's absolutely fine to do as the humalog is so fast acting that taking it after lunch is no problem.

The mystery here is that I take my lunch hour 12-1, have lunch about 12:20, have injection around 12:40ish (apologies, should hav ebeen more specific with times in my original post, it's a bad habit of mines!), and then come 5pm (over 4 hours since humalog), my levels suddenly drop off a cliff, now I know that after 4 hours whatver humalog is left in my system is minimal and should not be bringing my levels down up to 15 mmols in 20 minutes.

For what it's worth, this has stumped pretty much everyone and it's been put down to me being "sensitive" to exercise, ie it crashes my levels, but seems to be ok in the morning on the walk into work!

Have some 'lipo's' in my upper thighs, haven''t injected there for the past 3 years.

Morning readings are pretty much bang on, get the odd one which I can't explain but always usually within DAFNE targets.

Lunchtime's usually consist of either a sandwich (chicken) or soup and bread, all home made so I know exactly how much carbs are in them. (also usually have some crisps and a biscuit, sometimes chocolatey sometimes not, my lunchtime ratio is 1.25 units - 1cp)

Think I've covered everything! Also think it's obvious that for the past 20 odd years I've just kind of chugged along without giving it much thought, although never missed an injection and tested often, mainly been living with big swings in blood glucose levels so my Hba1c's tend to be quite good, it's only since being on DAFNE that I've started to understand a lot more and notice trends etc but this one's got me stumped!

Would love a pump but I live in Scotland so my health board is under no obligation to provide a pump and have cancelled them all since last year, was on the waiting list so long term I'm hoping that is an option but doubt I'll ever get to even have a look at one.

I have tried the quick glucose hit before leaving work and it does work, I'll take 200mls of Lucozade and that will prevent me from going hypo, so that's generally what I do at the moment, only thing is though it shoots my levels up to over 20 before I leave work, I only walk a mile to get home so it's not as if it's a major walk, only tkaes 20 mins too as I walk quite briskly, I think one day this week I will completely forego lunch (something I've never done, makes sense when you think about it!), and keep testing every couple of hours, I'm actually considering calling up my consultant and asking for a CGM for a day to see what the heck is happening, I know it's expensive though and they're not keen on using it unless it's a dire emergency.

Thanks for all the replies folks, been most helpfull

Hi Pneu, injection sites are fine, I don't use my legs anymore as I overdone it there when I was a younger and are fairly useless now, but have 12 other sites I use and they're all fine. My post meal readings are fine for Breakfast and Evening meal, they hardly ever rise above 10 when I've tested, it's just the lunch time level which seem to rocket up post lunch and stay there until 4 hours later when they suddenly take a dive, I haven't noticed this on weekends at all so it is assumed it's to tdo with the walk home. I wasn't aware the depth of the injection would be a factor, I was told by HCP this was not the case as I use 4mm needles (for info I've had this problem with 8mm needles also, so not the size of the needles, if it was the size of the needles or depth of injection then surely this would affect me all day rather than just lunchtime?)

Re the lucozade, would that make much of a difference just sipping it while walking along the road? I'm only walking for 15-20 minutes so I'm not sure that would make much of a difference, but willing to try it to see how it goes, will try that at some point this week or next to see how that goes, will be fasting during breakfast and evening meal tomorrow so will post results of how that goes.