Too many lows.

lely · Oct 10, 2017

Hi All. Looking for info off the active diabetics out there.
I'm normally an average diabetic with average at best BG results. Recently started to monitor, analyse and be more precise with all things diabetic. I've brought my average weekly reads down from 11.6 begining of Aug to 8.6 this week. Feeling quote pleased with myself. Then today I've had 5 low BG results. The point of my question is I'm not sure if it's now a matter of tighter control leading to these lows or the fact I've recently took up a class doing couch to 5k. I'm only in my second week and so I'm doing interval type training walking/running. My last session was last night could this be the cause due to a change in metabolism or something.
Thanks for any info.

GrantGam · Oct 10, 2017

lely said:
Hi All. Looking for info off the active diabetics out there.
I'm normally an average diabetic with average at best BG results. Recently started to monitor, analyse and be more precise with all things diabetic. I've brought my average weekly reads down from 11.6 begining of Aug to 8.6 this week. Feeling quote pleased with myself. Then today I've had 5 low BG results. The point of my question is I'm not sure if it's now a matter of tighter control leading to these lows or the fact I've recently took up a class doing couch to 5k. I'm only in my second week and so I'm doing interval type training walking/running. My last session was last night could this be the cause due to a change in metabolism or something.
Thanks for any info.

I do tend to find that I need less basal insulin on active days (push bike, running, HOOVERING!?, etc). I also find that I can need less bolus insulin after exercise, the more extensive, the longer the period where my I:C ratio differs.

Are you exercising at least 3 hours since your last bolus injection?

Good on you for couch to 5k Many people (including myself) have thought "is there any point in all this exercise, if all it means is lows and roller coaster BG's?" The answer is most definitely yes. Because once exercise because a constant in your life, then your insulin regime moulds around that - and will be as easy (but likely easier) to manage in the long run.

lely · Oct 10, 2017

Hi yes I dont exercise with insulin on board and as I use a pump I usually reduce by 50% for 1.5 hours prior. That's been working quite nicely.

GrantGam · Oct 10, 2017

lely said:
Hi yes I dont exercise with insulin on board and as I use a pump I usually reduce by 50% for 1.5 hours prior. That's been working quite nicely.

So it's possible that your basal rates and/or I:C ratios may need tweaking.

Anything different happen yesterday to warrant 5 lows today? Or has anything different happened today even?

lely · Oct 10, 2017

GrantGam said:
So it's possible that your basal rates and/or I:C ratios may need tweaking.

Anything different happen yesterday to warrant 5 lows today? Or has anything different happened today even?

No all the same, aside from the exercise.
I've only just tweaked all basal, bolus and ISF rates over last 6 weeks so it looks like I'll be going over them again.
The only thing other than the exercise different was the sausage roll for lunch. No time to make one this morning. Which I don't normally eat as I know there's no nutritional value to them and they are in and out you system quicker than the insulin. But I'd already woke on a low and had one round 11am. Porridge as usual for breakfast. And then 2pm and again Round 4pm.
When I'm trying to take control of the diabetes this happens then I loose heart with it and gp back to being an average diabetic instead of a good one. But I'm determined not to do that this time.
My next session for couch to 5k is tomorrow. I may reduce my basal for 24hrs after and see how that goes.

GrantGam · Oct 10, 2017

lely said:
But I'd already woke on a low and had one round 11am. Porridge as usual for breakfast. And then 2pm and again Round 4pm.

Often when we hypo, the liver throws out a heap of its glycogen stores to "give us a hand", so to speak. The liver has to replenish its glycogen stores once they've been reduced - and it will do that by robbing glucose from your blood stream. So that's a possible reason for your persistent hypos today.

Basically, you woke on a hypo so your liver was already a little empty. Then you bloused normally for your meals, yet your liver was already stealing some of the glucose from your blood stream. The result in my experience is recurring lows throughout the day.

I used to be really bad for correcting rebound highs, which only worsened further lows. I may be totally wrong, but always worth thinking about.

therower · Oct 10, 2017

Hi @lely. It appears that @GrantGam has thought of all the things that could be the cause of your lows.
I'm not a pumper, so can't offer anything with adjusting dosage.
Not the question to ask a lady, but did you have any weight to lose and have you lost any since getting better BS control since Aug and starting your couch to 5k. Losing a few pounds can seriously affect insulin requirements.
Stay positive, as mentioned you will be able to find the balance that enables you to continue being a great diabetic.

lely · Oct 10, 2017

therower said:
Hi @lely. It appears that @GrantGam has thought of all the things that could be the cause of your lows.
I'm not a pumper, so can't offer anything with adjusting dosage.
Not the question to ask a lady, but did you have any weight to lose and have you lost any since getting better BS control since Aug and starting your couch to 5k. Losing a few pounds can seriously affect insulin requirements.
Stay positive, as mentioned you will be able to find the balance that enables you to continue being a great diabetic.

Hi. No weight loss as yet. I had an increase of weight over 12 months which had resulted in my increasing rates and I was expecting to need to adjust again if weight loss happened.
I think your right about @GrantGam giving all info. The last post being new info to me. Interesting.

lely · Oct 10, 2017

GrantGam said:
Often when we hypo, the liver throws out a heap of its glycogen stores to "give us a hand", so to speak. The liver has to replenish its glycogen stores once they've been reduced - and it will do that by robbing glucose from your blood stream. So that's a possible reason for your persistent hypos today.

Basically, you woke on a hypo so your liver was already a little empty. Then you bloused normally for your meals, yet your liver was already stealing some of the glucose from your blood stream. The result in my experience is recurring lows throughout the day.

I used to be really bad for correcting rebound highs, which only worsened further lows. I may be totally wrong, but always worth thinking about.

I was unaware of this happening. Tho whole liver stealing glucose thing.
I find I understand better if I know the cause of things and this sounds like it could be the case. I do find if I have one Hypo it's followed by a few hours after. I was assuming that was because I was steering myself away from the whole ' eating the house' incidents which I was prone too.
Now if I Hypo I drink half bottle of luco or eat a pack of haribo roulette. It takes it up enough to stop the Hypo without causing a hyper some hours after which I'd then bolus for and I'd go back into Hypo.
I must research this a little more.
So today's events maybe nowt to do with the exercise directly!
I'll see what happens Thursday after another session of the couch to 5k run class.
Thank you for the info it's really helped.

therower · Oct 10, 2017

@lely . It was only a thought.
Yes GrantGam gives good practical advice.
I'm on mdi and with years of knowledge and experience, I still have days where nothing adds up or makes any rational sense.
When things go haywire I tend not to react to soon. If I had a day like you, I'd take a mental note but wait to see what the next 24/48 hrs presented. It's easy to make adjustments and then find everything settles down again the following day.
As I'm sure you are aware it's one of those annoying diabetic things.
Just spotted your post prior to this one.
Re hypos..... I fully understand the " eating the kitchen problem " but for me if I hypo , I always need some carbs usually complex ( bread, peanut butter , cereal ) to stop me plunging low again after a few hours.
Hypo treatments like juice and sweets are fine but they are soon gone and then you can be back to square one.
Maybe try a sandwich next hypo. I find malt loaf good and peanut butter with anything is really good .

lely · Oct 10, 2017

@therower it's only recently I've come to the thoughts you just put on paper. Talking of reacting too quick, recently I've started trusting I've got my boluses/basal right and trusting I know myself to feel when things are going off. I used to test 2 hours after eating, see my blood was, say 5.8/6 note I had 2u of insulin left on board of think. That's not gonna last till next meal time. And I'd eat or drink luco. Not taking into account the food still digesting.
Also realised that chasing the perfect BG results is a fools errand. I'm beginning to understand this doesn't exist, but getting close is OK.
Sometimes I feel I know nothing and other times I feel I'm an expert.

catapillar · Oct 10, 2017

lely said:
I was unaware of this happening. Tho whole liver stealing glucose thing.
I find I understand better if I know the cause of things and this sounds like it could be the case. I do find if I have one Hypo it's followed by a few hours after. I was assuming that was because I was steering myself away from the whole ' eating the house' incidents which I was prone too.
Now if I Hypo I drink half bottle of luco or eat a pack of haribo roulette. It takes it up enough to stop the Hypo without causing a hyper some hours after which I'd then bolus for and I'd go back into Hypo.
I must research this a little more.
So today's events maybe nowt to do with the exercise directly!
I'll see what happens Thursday after another session of the couch to 5k run class.
Thank you for the info it's really helped.

So, if you have one hypo, your something like 50% more at risk of another hypo the same day.

This is because if you have had a hypo that has caused you liver to release some of its glucose stores to nudge you blood sugar up you body will prioritise restocking the liver stores when the hypo is treated. So instead of sugar staying in your blood, it will be being locked away in your liver. So if you treat your hypo with a small amount of fast acting carbs only your body will still be focused on getting sugar into you liver when those carbs are glucose in your blood. That's why it's a good idea to do immediate hypo treatment with fast acting carbs and then when you are over 4 follow up with a small complex carb snack (a digestive,an oatcake, a rice cake) because that shoul help avoid crashing back down when the liver is restocked.

Also, be careful with the bolus calculator on the pump adding corrections on for mealtime bolus if the high it wants to correct is a high caused by a hypo treatment. Because you're more vulnerable to repeated hypos after one hypo just exercise a bit of caution with correction. I just mention because it seems like that could have happened with hypo at 11, then porridge (with bolus I guess?), then hypos at 2 and 4.

GrantGam · Oct 10, 2017

catapillar said:
So, if you have one hypo, your something like 50% more at risk of another hypo the same day.

This is because if you have had a hypo that has caused you liver to release some of its glucose stores to nudge you blood sugar up you body will prioritise restocking the liver stores when the hypo is treated. So instead of sugar staying in your blood, it will be being locked away in your liver. So if you treat your hypo with a small amount of fast acting carbs only your body will still be focused on getting sugar into you liver when those carbs are glucose in your blood. That's why it's a good idea to do immediate hypo treatment with fast acting carbs and then when you are over 4 follow up with a small complex carb snack (a digestive,an oatcake, a rice cake) because that shoul help avoid crashing back down when the liver is restocked.

Also, be careful with the bolus calculator on the pump adding corrections on for mealtime bolus if the high it wants to correct is a high caused by a hypo treatment. Because you're more vulnerable to repeated hypos after one hypo just exercise a bit of caution with correction. I just mention because it seems like that could have happened with hypo at 11, then porridge (with bolus I guess?), then hypos at 2 and 4.

@catapillar, thanks for clearing that up. Your explanations are always thorough and better to understand than mine.

Great point about having a complex carb chaser with your simple carbs.

catapillar · Oct 10, 2017

GrantGam said:
@catapillar, thanks for clearing that up. Your explanations are always thorough and better to understand than mine.

If you can understand my typos you're doing very well! I think I just have to simplify thing so that I can understand what's going on in my body to start with, I say simplify but I have try and visualise thing to work out what's going on, but I'm not actually very spatially aware so it becomes less diagrammatic and more anthropomorphic - I swear, in my head, my insulin is wearing a uniform...

GrantGam · Oct 10, 2017

catapillar said:
If you can understand my typos you're doing very well! I think I just have to simplify thing so that I can understand what's going on in my body to start with, I say simplify but I have try and visualise thing to work out what's going on, but I'm not actually very spatially aware so it becomes less diagrammatic and more anthropomorphic - I swear, in my head, my insulin is wearing a uniform...

You're putting yourself down! Time and time again you put forward brief and to the point explanations and examples that make it extremely tough to not understand the points you're putting across

I on the other hand, am about a quarter way though my bottle of whisky watching Metallica's "Some Kind of Monster" - so there's really no completion as to who's reply is more coherent

Jaylee · Oct 10, 2017

catapillar said:
So, if you have one hypo, your something like 50% more at risk of another hypo the same day.

This is because if you have had a hypo that has caused you liver to release some of its glucose stores to nudge you blood sugar up you body will prioritise restocking the liver stores when the hypo is treated. So instead of sugar staying in your blood, it will be being locked away in your liver. So if you treat your hypo with a small amount of fast acting carbs only your body will still be focused on getting sugar into you liver when those carbs are glucose in your blood. That's why it's a good idea to do immediate hypo treatment with fast acting carbs and then when you are over 4 follow up with a small complex carb snack (a digestive,an oatcake, a rice cake) because that shoul help avoid crashing back down when the liver is restocked.

Also, be careful with the bolus calculator on the pump adding corrections on for mealtime bolus if the high it wants to correct is a high caused by a hypo treatment. Because you're more vulnerable to repeated hypos after one hypo just exercise a bit of caution with correction. I just mention because it seems like that could have happened with hypo at 11, then porridge (with bolus I guess?), then hypos at 2 and 4.

Got to,agree... Just fixing with sugar alone will cause a recurring yo yo effect on BS. Digestives are "old skool." But still stand today as a follow up....

@GrantGam , Mettalica? Good choice.. Seen em live in the mid 90s.. But we go off topic.

Scott-C · Oct 11, 2017

catapillar said:
...and more anthropomorphic...

You could be on to something there:

lely · Oct 11, 2017

Always learn something new when I come here. And I do love a good explanation. Esp when it involves reasons that make sense. When it involves the ' it happens because' answers I take it all in.better. 11 years diabetic and did not know this till now and both explained it great. @GrantGam @catapillar.
Thanks all.

Edit to say I always knew the advice to eat carby snack after Hypo never been explained why this is important.

becca59 · Oct 11, 2017

So many interesting thought provoking reasons here. I've said, ah that's why, out loud, on more than one occasion. People's real experiences are such a help when addressing ones own conundrums.

hh1 · Oct 12, 2017

@GrantGam and @catapillar I agree with @lely & @becca59; great explanations here. For over 30 years I've also always followed the jelly babies with some complex carbs but never understood so clearly why until now. Thanks both

Too many lows.

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