Major Crashage of Glucose Level

[the_exile]

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?

 

[the_exile]

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.

 

[SophiaW]

Have you tried fasting over lunch and then testing through the afternoon until after you get home from work to see what's happening to your BG? This might help you to identify if it's the background Levemir or the rapid acting insulin you take with your lunch that's causing the problem.

 

[the_exile]

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! :?

 

[Dillinger]

What are you eating for lunch and how much insulin are you giving yourself?

Also, why are you injecting your Humalog after your lunch? Humalog should start working within 10-15 minutes so surely you should be injecting it before you eat?

If you are eating a fast acting carby lunch then your blood sugars will shoot up and your insulin will take longer to bring it down; possibly resulting in your hypos.

Best

Dillinger

 

[noblehead]

The excile,

Could I ask what your morning readings are like prior to lunch? I notice in your sig that you have already done the DAFNE course so I assume your lunch ratio is correct, I would do as Sophia says and try a fasting test, but just remember a carb-free lunch will still need insulin if you are eating protein, protein in the absence of carbs can convert to glucose by around 60%.

I would speak with your diabetes team for further advice, a bg of 15-20 post-meal is unacceptable and hopefully they'll will analyze your diary and advise accordingly.

Good luck!

Nigel

 

[moonstone]

Could you have a lipo thing forming perhaps? Sounds a bit like what they said could happen if you inject in one of them.

 

[josie38]

Hi,

Why are you injecting up to an hour after you have eaten?

With humalog you can inject up to 15 mins after you have eaten, I used it for 10 years. Surely if you inject an hour after eating the insulin is playing catch-up hence the hypo.

Speak to HCPs again

josie

 

[the_exile]

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!

 

[sugar2]

Hi, I am sensitive to exercise as well.

I agree with Sophia though, you do need to do some fasting through the day...to see if this is anything to do with your fast acting insulin. I wonder, though I don't know, if what you are getting is a peak in your levimir, just at the time you walk home? I assume you take it morning and bedtime...if the morning doseis peaking, but the bedtime dose is still acting, you are going to get a peak, which, combined with the exercise could make you crash.

I also assume that you walk home from work at 5pm ish...does that mean that you BG has been 15 all afternoon? I guess that suggest sthat someting is worng with your lunch time rapid insulin as well???

I guess, what I am saying is that you need to know what is causing what problem. personally, I would try and get the background insulin improved first. Over a couple of days, fast for period of around 8 hours and test every 2 hours of so. If you BG holds steady, no peaks, and no hypos, then your background is OK..then look at the meal times.

I ended up witha pump, but I am sensitive to exercise all the time...this was evident to the consultant, as I would often need to gobble down a few dextrose in my clinic appointments, as the "exercise" of getting to the appointment would send me hypo. I guess teh difference was though, that I had dropped for a reading of 7 ish, not 15. A pump may help you perhaps, but from what you hae said, there is more than 1 thing going on? It is never easy this diabetes is it!

 

[josie38]

would having a mid afternoon snack help like a piece of fruit or low fat yoghurt? Nothing too big but maybe just enough to help with the walk home. if you have been busy at work and then walking home maybe you just need a bit more like a snack

 

[the_exile]

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

 

[Pneu]

Couple of things I would check... firstly the injection site.. make sure that you are injecting correctly at the right angle and to the right depth.. this could delay the onset of the insulin.

If you are not very active in the afternoon i.e. sat at your desk then its likely your circulation is quite poor when you get up to walk home all of a sudden your circulation improves rapidly and the insulin kicks in and drops your blood sugars... if its anything like my novorapid then left over insulin at 4 - 5 hours can still be pretty potent in combination with sudden exercise.

The other thing to look at is your Levemir... do you by chance inject it in the morning? despite what the HCP's like to tell us Lantus / Levemir do not have a flat profile.. this can be especially skewed in my experience in individuals that are over-weight and having to inject some large volumes. You could be finding that by the afternoon 8 hours post injection that your Levemir is really kicking in... if this is the case then splitting the dose may reduce the spikes.

Finally as others have said your post meal readings are really high.. I would suggest talking to your HCP about those.

 

[SophiaW]

You say that you drink 200ml of Lucozade before leaving work. It looks like this may cause a spike in your blood glucose, not a surprise as Lucozade is very quick acting. The other thing you could try is experiment with different foods and try to get one that releases glucose as a more steady rate to match your walking. Perhaps a piece of fruit or a cereal bar will give you that more gradual release of carbs that you need to avoid a spike before leaving work but give you a gentle release of energy to keep up with the walk and prevent a hypo. A digestive biscuit may also be a good option, there's a bit of sugar which will act quickly but the rest of the biscuit will cover you later on in the walk. When my daughter goes for a walk rather than using a quick acting glucose which we'd use in a hypo to bring her reading up quickly she'll have a biscuit which releases the carbs gentle throughout the period of the walk. Otherwise if you want to stay with the Lucozade maybe take sips of it over the period of your walk rather than drinking it all at the start of your walk.

 

[the_exile]

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.