Need urgent help with bizarre blood sugar drops

[RyanJH]

Hi. I've read this forum a lot in the past but never made an account until now. I'm trying my hardest to get to the bottom of a seriously weird change in blood sugar behaviour. Also, this turned out to be a very long post, sorry about that. Once I started I felt like giving as much info as I could.

So a little history. Mid 30s. 20 years diabetic. Very poorly controlled for first ~10 years. Plus smoker. Plus alcohol. Yeah I know. Ten years ago quit smoking and drinking, started exercising and losing weight. Wasn't enough as my retinopathy worsened so about 1.5 years ago embarked on a journey to control sugars as well as I could. Discovered very low carb and Bernstein etc. I've been on the same very low carb diet for almost a year and things have been going great. Sugars are very rarely over 7, and I get lows about as often as before.

Now, the past week and my current problem. Put simply, my blood sugars are going down as though I've injected insulin a couple hours before bed, even though I always skip dinner (have done for many years to help control overnight sugars). So it's past the 2-5 hr peak of the Humalin S I use for meals. This drop continues after correction with sugar tabs and for the first ~3 hrs of sleep, causing a bunch of overnight lows, really messing with my sleep. When it started happening, it wasn't so severe so I figured my basal was too high. I recently started reducing calories slightly (nothing crazy), and thought that could be part of it. I've also heard of T1Ds who go on these very low carb diets and say they need very little basal, so I thought maybe this was a physiological change which just took a while since starting the diet.

But this past night... it was just insane. I am on vastly reduced basal, and I use Levemir which (despite what they claim) doesn't last a full 24 hrs. And this was coming up to 24 hrs since the last basal shot! Yet at one point I tested at 3.3, took two sugar tabs, and tested as 3.5 ten mins later. Barely any change. Earlier in the night it went from 5.9 to 3.8 within 30 mins. All this with what should be close to zero insulin on board.

I'm been googling here and there and can't come up with an explanation. It's as though one of my insulins is being massively delayed. This would make a degree of sense as I've slowly had to increase how much of the Humalin S I do with each meal. I assumed it was just decreased insulin sensitivity. But... is it possible for insulin to have such massively delayed release? My Googling couldn't find anything. Any thoughts / help would be greatly appreciated.

 

[becca59]

Welcome @RyanJH Nothing wrong with a long post. It helps provide people with as much information as possible to be able to suggest ideas to help.
You talk about a seeming delay with your insulin. One thing to look at first would be injection sites. Any lumps and bumps that could be preventing the usual absorption. 20 years in its worth a look at. Do you rotate areas and check regularly? I am sure others will come forwards with ideas.

 

[jackois]

What you are seeing could be down to your diet changes.

I started a calorie controlled diet in January, which is going to plan, having lost 10kgs steadily. My insulin needs have altered drastically since I started, starting with a drop of my basal from 18 units down to 10 units, and a reduction in mealtime bolus to only needing it occasionally. My carb intake varies between 180 and 200 grams a day (not sure if this is considered low or not).

My blood sugars are steady, however, and don't exhibit any of the rapid dips you report. I use a dexcom G6 cgm with occasional cross check blood finger tests.

Living alone, I've always made sure I have supper to avoid lows through the night.

Hope this helps.

 

[StewM]

Hi. I've read this forum a lot in the past but never made an account until now. I'm trying my hardest to get to the bottom of a seriously weird change in blood sugar behaviour. Also, this turned out to be a very long post, sorry about that. Once I started I felt like giving as much info as I could.

So a little history. Mid 30s. 20 years diabetic. Very poorly controlled for first ~10 years. Plus smoker. Plus alcohol. Yeah I know. Ten years ago quit smoking and drinking, started exercising and losing weight. Wasn't enough as my retinopathy worsened so about 1.5 years ago embarked on a journey to control sugars as well as I could. Discovered very low carb and Bernstein etc. I've been on the same very low carb diet for almost a year and things have been going great. Sugars are very rarely over 7, and I get lows about as often as before.

Now, the past week and my current problem. Put simply, my blood sugars are going down as though I've injected insulin a couple hours before bed, even though I always skip dinner (have done for many years to help control overnight sugars). So it's past the 2-5 hr peak of the Humalin S I use for meals. This drop continues after correction with sugar tabs and for the first ~3 hrs of sleep, causing a bunch of overnight lows, really messing with my sleep. When it started happening, it wasn't so severe so I figured my basal was too high. I recently started reducing calories slightly (nothing crazy), and thought that could be part of it. I've also heard of T1Ds who go on these very low carb diets and say they need very little basal, so I thought maybe this was a physiological change which just took a while since starting the diet.

But this past night... it was just insane. I am on vastly reduced basal, and I use Levemir which (despite what they claim) doesn't last a full 24 hrs. And this was coming up to 24 hrs since the last basal shot! Yet at one point I tested at 3.3, took two sugar tabs, and tested as 3.5 ten mins later. Barely any change. Earlier in the night it went from 5.9 to 3.8 within 30 mins. All this with what should be close to zero insulin on board.

I'm been googling here and there and can't come up with an explanation. It's as though one of my insulins is being massively delayed. This would make a degree of sense as I've slowly had to increase how much of the Humalin S I do with each meal. I assumed it was just decreased insulin sensitivity. But... is it possible for insulin to have such massively delayed release? My Googling couldn't find anything. Any thoughts / help would be greatly appreciated.

So weird coincidence. I’ve also been altering my Calorie Intake recently. In my case, I was losing weight so I decided to increase my Calorie intake to stop the rot, but I was already eating the maximum amount of Carbs I thought was healthy. So I increased my Calorie intake exclusively by replacing certain parts of my meals and adding zero carb calories to my diet. Since doing this, even though the Calorie increase has been modest my Basal Insulin needs have spiking into the stratosphere, particularly between the hours of 2-6am.

So this is totally anecdotal but our shared experiences might suggest there’s a link between Calorie Intake and Basal Needs*. That said, like you, I’ve been unable to find any imperical evidence to support this.

Would be interested if other forums had similar issues? Or if others had changed their Calorie intake and it had zero effect on their Basal needs.

*Also as a pump user I can be reasonably certain this is my Basal Requirements that is the issue as my Boluses (using the exact same Insulin and Pump) still work reasonably well.

 

[jonathan183]

antibodies to insulin you are using or something interfering with liver glucose production ...

 

[RyanJH]

Thanks for the replies <3

Welcome @RyanJH Nothing wrong with a long post. It helps provide people with as much information as possible to be able to suggest ideas to help.
You talk about a seeming delay with your insulin. One thing to look at first would be injection sites. Any lumps and bumps that could be preventing the usual absorption. 20 years in its worth a look at. Do you rotate areas and check regularly? I am sure others will come forwards with ideas.

Nothing external. I'm not 100% on what to look for though. I've had temporary hard lumps under the skin rarely in the past - the kind which come immediately after an injection but go pretty quickly. I always apply pressure for like 30 secs. I do have a certain amount of lipohypertrophy in my abdomen, but I've never had a problem with abdomen absorption. In fact it's so fast that I tend to prefer it for correction Humalog shots. Now I think about it though... my increased daytime insulin needs recently... there's been times I've had to take a surprising amount of Humalog for corrections. I rotate as much as possible. But perhaps I will try avoiding abdominal injections today and see how this evening goes.

So this is totally anecdotal but our shared experiences might suggest there’s a link between Calorie Intake and Basal Needs*. That said, like you, I’ve been unable to find any imperical evidence to support this.

I would go as far to say I am 100% certain that total caloric intake affect basal needs based on my experience. This makes sense based on the logic that basal needs are known to increase when one is overweight - afaik due to changes in insulin sensitivity, but there may be other factors.

antibodies to insulin you are using or something interfering with liver glucose production ...

I'm not too familiar with either of these things but have done a little research. As for liver glucose production, I could only find that this is a problem which can cause non-diabetics to have low blood sugars, but only when they have liver disease. I'm not showing any signs of liver disease whatsoever and I haven't drank any alcohol for about 5 years which is the biggest risk factor. Also, my liver glucose production seems fine at most hours of the day. I get the standard liver dump in the mornings.

The antibodies thing is more interesting. I knew a little about this before but have been reading a lot today. My symptoms line up pretty well. From what I read, people with this issue find they get night time lows and day time highs. This is because insulin during the day is binding to these anti-insulin antibodies, so you're not getting enough. And then due to body PH changes at night, they uncouple, releasing insulin in to the blood stream which causes lows. My BS isn't high during the day, but I have had to start using more and more insulin recently without big changes to my diet. I'm going to get my blood tested ASAP for these insulin antibodies.

 

[becca59]

I would say using a totally different injection site would be a jolly good idea as an experiment. But just be hyper vigilant with quicker hypos.

 

[himtoo]

i have read through your whole post and it raises a question for me which might help you to solve the delayed dropping issue ------ Humulin S ( which you say you use for your meals ) is actually a fast acting insulin with a long tail ( can last 8 to 12 hours )
you also say you have humalog that you use for corrections.... maybe just using the humalog for meals might help as humalog activity is 4 hours ..also perhaps discuss with your care team

 

[Jaylee]

Hi. I've read this forum a lot in the past but never made an account until now. I'm trying my hardest to get to the bottom of a seriously weird change in blood sugar behaviour. Also, this turned out to be a very long post, sorry about that. Once I started I felt like giving as much info as I could.

So a little history. Mid 30s. 20 years diabetic. Very poorly controlled for first ~10 years. Plus smoker. Plus alcohol. Yeah I know. Ten years ago quit smoking and drinking, started exercising and losing weight. Wasn't enough as my retinopathy worsened so about 1.5 years ago embarked on a journey to control sugars as well as I could. Discovered very low carb and Bernstein etc. I've been on the same very low carb diet for almost a year and things have been going great. Sugars are very rarely over 7, and I get lows about as often as before.

Now, the past week and my current problem. Put simply, my blood sugars are going down as though I've injected insulin a couple hours before bed, even though I always skip dinner (have done for many years to help control overnight sugars). So it's past the 2-5 hr peak of the Humalin S I use for meals. This drop continues after correction with sugar tabs and for the first ~3 hrs of sleep, causing a bunch of overnight lows, really messing with my sleep. When it started happening, it wasn't so severe so I figured my basal was too high. I recently started reducing calories slightly (nothing crazy), and thought that could be part of it. I've also heard of T1Ds who go on these very low carb diets and say they need very little basal, so I thought maybe this was a physiological change which just took a while since starting the diet.

But this past night... it was just insane. I am on vastly reduced basal, and I use Levemir which (despite what they claim) doesn't last a full 24 hrs. And this was coming up to 24 hrs since the last basal shot! Yet at one point I tested at 3.3, took two sugar tabs, and tested as 3.5 ten mins later. Barely any change. Earlier in the night it went from 5.9 to 3.8 within 30 mins. All this with what should be close to zero insulin on board.

I'm been googling here and there and can't come up with an explanation. It's as though one of my insulins is being massively delayed. This would make a degree of sense as I've slowly had to increase how much of the Humalin S I do with each meal. I assumed it was just decreased insulin sensitivity. But... is it possible for insulin to have such massively delayed release? My Googling couldn't find anything. Any thoughts / help would be greatly appreciated.

Hi,

From personal experience your basal needs (regardless of diet.) are what you need.
This can sometimes change & need a tweak from time to time.
Basal testing would be the first port of call. You mentioned treating with sugar tabs? I use Lantus but find if my basal is wrong I can find just hitting it with fast acting sugar, there can be a recurrence of hypos. I normally follow up with some slow release carbs too?

Your meter reading 10 minutes later with your “barely any change?” There is a delay in a meter reading. (Up to 20 minutes ago, it’s a snapshot in that time frame, blood flow thing..?) testing so soon after treatment for me has seen a further drop, but that’s just the lowest point hit prior to the sugar taken actually kicking in!