Newly diagnosed T1DM, 2 months on insulin therapy.. troubles with low blood sugar right before meal times and hypo treatments

[cbooth5]

Hi guys,

Overall I'm doing well with a new T1DM diagnosis roughly 2 months ago, with ~70% time in range, I'm still in my honeymoon period where my body still has an amount of its own insulin and I only need either 1 or 2 units of novorapid for meals, using the Libre 2 sensor. The only issue I have is mainly for decently sized evening meals (say 50g carbs plus), I'll try time the meal so that I'm eating when it is lowish (anything from 4.5 to 8mmol/mol worst case - UK units) to use the full stretch of green graph.

Sometimes I'll get caught out right after eating a big meal, where I've definitely eaten enough carbs, but maybe its the gap of where insulin is working but the food hasn't digested yet if its a big meal (>50g carbs). Sometimes the graph will appear as though it is shooting up (e.g. reading 7.0 diagonally upwards), but then 10 minutes later my alarm goes off and its 4.2mmol/mol. This really creates a problem and anxiety then, as my sensor may temporarily read 3.7 after treating hypo for example, I'll panic being newly diagnosed and drink half a pint of orange juice. 30-60 minutes later, everything arrives together and my blood sugar is 12.0, really frustrating and ruins my time in range for the day. This also happens at nighttime, say my alarm goes off, glucose 4.2 - ill have a hypo treatment and it'll dip into 3.8 in 10 mins time, I'll try my best to follow the 15/15 rule but always overcompensate with too much sugar.

I think the fear comes from knowing that if I go too low, then I may lose consciousness - does it have to be below 3.0mmol ish for this to happen? I have finger pricked, but this will be 10 minutes after as I'm trying to sit still and the last one read 12.0mmol/mol after orange juice, whilst my Libre 2 read 6.0 at the time alongside each other?
What do you guys do to avoid this happening? Would a rule help, for example if blood sugars are >5.0mmol/mol wait the full 10 minutes for novorapid to kick in. But if they are <5.0 just eat straight away? Should I be more patient and just wait, even if the sensor is reading as low as 3.5, this happened today and I phoned a closeby neighbor just in case it dropped any lower. Thanks in advance.

 

[jackois]

I think a lot of it is down to holding your nerve...

I had similar problems on diagnosis, and my honeymoon period went on for around a year and a half... it's now very stable which is excellent.

You'll get a feel for how your sensors work... if I'm worried about falling rates, I have 2 or 3 jelly babies, wait 15- 20 minutes, see how I'm doing and then have some more. It can be scary as one of the symptoms of low sugar is the need to gorge your self, which you know, already, doesn't work...

Hang in there, the early days are the worst, mine is so stable now, it's rediculous..

 

[Helen40]

Hi and welcome, wow you're doing great! I wish my control had been that goid in the early years, for hypos I set my alarm to go off at 5 I then check and see what direction the arrow is in, if it's going down I have 2 jelly babies so even if it did continue to drop it won't (hopefully) be as severe before I can treat it properly. As above it is a question sometimes of holding your nerve, I've over compensated many times. It's hard when you're watching the clock and can feel that shaky feeling coming! The extreme hunger i used to get to eat anything and everything was like a scene from the film species lol, you will get through that as your body adjusts. Please don't beat yourself up about the odd high, it's sustained highs that cause the most damage and 12 isn't too horrendous for a short time. X

 

[EllieM]

Do you have symptoms when you go hypo?
Non diabetics can have blood sugars that go down to 3.5 and just feel a bit hangry....
Personally I find my sensor a bit useless during a hypo (though great at warning before) because a combination of sensor lag and rapidly changing bgs means that it can tell me I'm still falling into the depths of a hypo when my glucometer tells me I'm coming back up. Also, I find my sensor tends to under read for hypos, so if I've let it go out of control (low 3s or lower) I just get my glucometer out and keep testing.

I've been conscious with readings below 3 but an issue is that very low bgs can affect your cognitive ability. The advantage of a cgm is that you can edge things up before you hit the floor.

But my advice would be to try not to panic, you will get the hang of this. And yes, after 53 years I still overtreat hypos sometimes (those eat the fridge symptoms can be hard to withstand).

 

[cbooth5]

Thanks all for the great advice so far! I think the problem was being newly diagnosed I took the sensor as gospel and in real time and it's so hard not to panic in a hypo. I'm starting to finger prick when alarm goes off and have found some pretty big discrepancies! Ill do the 2-3 jelly baby trick as that way, I can't have too much sugar hopefully

I don't really have any symptoms of hypo until I reach around 4-4.5 and feel bad, crashing headache and anxious/irritable. But hopefully with time I'll be able to spot the signs earlier

 

[RD02]

Hi guys,

Overall I'm doing well with a new T1DM diagnosis roughly 2 months ago, with ~70% time in range, I'm still in my honeymoon period where my body still has an amount of its own insulin and I only need either 1 or 2 units of novorapid for meals, using the Libre 2 sensor. The only issue I have is mainly for decently sized evening meals (say 50g carbs plus), I'll try time the meal so that I'm eating when it is lowish (anything from 4.5 to 8mmol/mol worst case - UK units) to use the full stretch of green graph.

Sometimes I'll get caught out right after eating a big meal, where I've definitely eaten enough carbs, but maybe its the gap of where insulin is working but the food hasn't digested yet if its a big meal (&gt;50g carbs). Sometimes the graph will appear as though it is shooting up (e.g. reading 7.0 diagonally upwards), but then 10 minutes later my alarm goes off and its 4.2mmol/mol. This really creates a problem and anxiety then, as my sensor may temporarily read 3.7 after treating hypo for example, I'll panic being newly diagnosed and drink half a pint of orange juice. 30-60 minutes later, everything arrives together and my blood sugar is 12.0, really frustrating and ruins my time in range for the day. This also happens at nighttime, say my alarm goes off, glucose 4.2 - ill have a hypo treatment and it'll dip into 3.8 in 10 mins time, I'll try my best to follow the 15/15 rule but always overcompensate with too much sugar.

I think the fear comes from knowing that if I go too low, then I may lose consciousness - does it have to be below 3.0mmol ish for this to happen? I have finger pricked, but this will be 10 minutes after as I'm trying to sit still and the last one read 12.0mmol/mol after orange juice, whilst my Libre 2 read 6.0 at the time alongside each other?
What do you guys do to avoid this happening? Would a rule help, for example if blood sugars are &gt;5.0mmol/mol wait the full 10 minutes for novorapid to kick in. But if they are QUOTE]

Hi
I was diagnosed back in December and had quite the rollercoaster ride like yourself, now is completely a difference story and much more stable. Just a few points of interest, you say try to eat when it’s between 4.5 to 8 mmol.

I Don’t care about this, the trick is your carb/ insulin ratio and where you want your level to end up at.

If it’s starting higher than were you want, I include a correction dose with my meal if it’s above my target. If it’s starting lower than your target then less insulin is required.

I also found the timing of taking NovoRapid to be important as well. Generally i would Bolus 15 mins before eating a known amount of carbs.

Even if you don’t have diabetes it is normal for blood sugars to rise rapidly, the difference is a none diabetics blood sugars may drop just as quickly.

I actually had my wife wear a freestyle libre 2 sensor who is not diabetic and it changed my approach, I don’t beat myself up about fast rises, it just means my carbs have hit quicker than my insulin. Again as long as it is back down with 2 hours of eating to your target all is good.

Use technology to your advantage and when you get it right your be achieving more than the Gold standard 70% in range. There is a wealth of Apps out there that make it much easier that I use. If you want further info there is always the message button