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Pre meal hypos

D

destype

Newbie
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Hi, I’ve been type 1 diabetic for 21 years and recently got the Libre on prescription. I’ve lost some weight and my insulin requirement has been changing. I’ve started doing low carb and that in combination with the Libre and pre bolusing has brought my predicted HbA1c down from 65 to 50. I’ve done so much tweaking that I can’t see the wood for the trees. My ratio is now 1:10 for all meals but I’m getting very low before meals and then when I pre bolus I hypo before every meal before going up. Any suggestions as to what I should do? Is it a basal thing or should I change my ratio?
Thanks in advance.
 
I would recommend basal testing.
If you have lost weight, it is likely your basal requirements have gone down.
 
Agreed with the basal testing.

How early are you predosing? I need to pre dose by different amounts depending on now active I've been that day. If not at all and just working at a desk in lockdown then up to 30 mins predose, but when I've been more active I might not need to predose at all.
 
I have tested and changed my basal only recently so post weight loss. It’s halved overnight but increased during the day.
 
I haven’t been active and I’ve been prebolusing 20 minutes before. If I prebolus 30 minutes before won’t that mean that I hypo earlier?
 
If you're going low before meals, it sounds as if your basal is too high. I notice you said you'd increased it during the day, so it would be worth doing another basal check. I was told not to change basal insulin without doing 3 basal tests. What insulin do you use? I use Fiasp and usually bolus 15-20 minutes before food, but if my levels are between 4 and 4.5 I give bolus 5 minutes before I eat. Similarly if blood test pre meal is high, I wait longer after bolus before eating.
 
destype said:
I haven’t been active and I’ve been prebolusing 20 minutes before. If I prebolus 30 minutes before won’t that mean that I hypo earlier?
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Yes, sorry if I wasn't clear, I just wanted to demonstrate that I need to change the pre bolus timing almost daily.

I wasn't sure if you were working on a fixed time of eg. 20 mins prebolus ahead of starting to eat, and then eg. 10 mins before eating you hypoed. This would be a bit more clear cut in that you probably wouldn't need to prebolus as early. Have you tried cutting it down to just 10 mins before eating?

Hope that has helped clear that up. How much before meals are your hypos coming? How long after your bolus? Eventhough you've recently lowered your basal it might need further tweaking as suggested above? Sorry my first post was confusing!
 
UK T1 said:
Yes, sorry if I wasn't clear, I just wanted to demonstrate that I need to change the pre bolus timing almost daily.

I wasn't sure if you were working on a fixed time of eg. 20 mins prebolus ahead of starting to eat, and then eg. 10 mins before eating you hypoed. This would be a bit more clear cut in that you probably wouldn't need to prebolus as early. Have you tried cutting it down to just 10 mins before eating?

Hope that has helped clear that up. How much before meals are your hypos coming? How long after your bolus? Eventhough you've recently lowered your basal it might need further tweaking as suggested above? Sorry my first post was confusing!
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No that’s fine. I thought I might have to test my basal but I’ve only changed it in the last two weeks and I haven’t lost anymore weight so wasn’t sure. And yes I’ve been doing a fixed amount of time regardless of how low I am because I’m trying to avoid the peaks after. I’ve only just started prebolusing for 20 minutes recently as 15 minutes wasn’t making a huge difference to my sugar levels post meal. But I think you and hopeful are right I need to adjust my prebolus time according to how low I am. Hopefully reducing the basal might fix the lows. It’s annoying that things don’t stay stable though when everything else is. Thanks.
 
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