Unexplained hypos

Hi all,

Does anyone have experience with frequent hypos that don't respond well to sugar for apparently no reason? I'm on a Medtronic 640g pump.

I moved to Fiasp 6 months ago and all was going great until a month ago. Since then I've been on a rollercoaster and haven't been able to get off. I keep having hypos when I don't have any insulin on board. I'm pretty sure it's not basal related as I will put a heavily reduced temporary basal on for 4+ hours and will still be going low. I will treat the hypo, rise and then drop back into another hypo. I think I've been hypo every day for the last 3 weeks at least. I've put on half a stone with the swings and sugar consumption. I changed back to Novorapid yesterday, and there's been enough time for the Fiasp to be completely out of my system but I've still had two hypos this morning. I'm pretty sure it's not gastroparesis because my blood sugar does initially rise when treated and in a timely fashion, just not for long enough!

I haven't changed my general routine or exercise routine at all. I want to up my exercise but this is obviously holding me back. If anyone has any idea as to what is happening I will be very grateful!

Juicyj said:

Hello @Cbmod Insulin needs can and do change regularly so it would be a good idea to do some basal fasting tests to confirm your background ratios are set at the right levels. There's some tips on doing it here: https://mysugr.com/en/blog/basal-rate-testing

If this were me i'd be checking my basal levels first and foremost as this is the foundation for your control.

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Hi Juicyj,

I have tried 6 times to do basal tests in the last couple of weeks. Each time I either can't start as I'm hypo or I have to quit an hour or two in as I'm hypo. Even when I've started at 12.9 I've gone hypo within an hour or two of starting!

I wrote this post whilst hypo (my 5th in 24 hours) so was extremely fed up. To me, I'm thinking it's not basal because it's completely random when I'm low, there aren't any patterns. Also I will treat a low, put on a temp basal of 50 percent for 3 hours (sometimes 0 percent for 1 hour) and I will still have hypos 2 or so hours after the first hypo.

I will attempt another basal check tomorrow, which may be easier as fluctuations should be slightly less with a slower acting insulin.

I am tempted to just set all my basal rates to a lower level and start from scratch working out what they should be rather than trying to tweak!

novorapidboi26 said:

Why do you think it couldn't be the basal that is out......?

Hypos are a result of too much insulin ultimately.....

How much of a temp basal did you use as explained above?

You can speculate as to why this is happening but in the end all you can do is observe your levels and adjust the insulin until you stabalise.....thats the only tool we have..

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Hi novorapidboi26,

More recently I have been stopping insulin all together, with a 0 percent basal for 30 minutes to an hour. I have also tried 50 percent for 3 hours, which I have extended when blood sugars still aren't coming up!

You are right that it must be to do with insulin. But the random nature of the lows makes me think it's unlikely to be basal as would all of my basal rates change at the same time? My pump did malfunction last week, so I should double check that it is actually giving me the correct units...

Juicyj said:

Hello @Cbmod

Unfortunately when your levels are unstable it doesn't help your mood and you can find yourself clutching at straws trying to pinpoint the issue, and unpredictable levels can indicate basal levels are out of synch, so once you go hypo your liver will feed glucose into your system then try and claw the stores back at a later time, so there is no pattern then so you do need to go back to basics and check your basal fasting rates first.

Speak to your nurse too - I cannot give insulin advice but avoiding hypos is important so they may want you to change your basal rates straight away, but best to check first with your team.

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Hi Juicyj,

Ah that makes sense thank you! I will make basal checking a priority.