Utterly confused about what my BG is doing. Help!

[devexity]

My GP is useless to me, so have stumbled here for help. Please help!

I developed T1 during pregnancy 8 years ago. My HBA1Cs have ranged from 6.2 to 8.5 since then, and generally my control has always been easy. Takeable for granted. The last one was 9.5, so I went low-carb. Low-carbed for 6 months, then went on an ill-advised carb-mental bender for one birthday week. Result: BG stuck in the 20s, blurred vision, confusion, dizziness, dehydration, but no DKA.

After a visit to urgent care, I raised my glargine from 38 to 42 units on Dr's advice, and got my fastings in the 5s for two days. Then my BG started to drop. Precipitously. And constantly. For the last week I've been stepping down the glargine one unit a day, and my fastings have gone from 5 to 4 to the low 2s. Whatever I eat, I end up hypo again 30 minutes later (2.2 - 3.6). I work with teenagers, so have had to take time off work because of diabetes for the first time, and am very frustrated. I'm now on a lower basal dose than I was when flirting with DKA, and the bottom is still falling out of my day, all day.

I don't want to step it down more than 2 units tonight because I've only just got my eyesight back from the hyper phase. Advice? Or similar experiences?

 

[microfazer]

if it were me, i'd drop back to 39-40u glargine, and bump boluses as needed. sugars dont care which insulin knocks them down, as long as they get knocked down. if you are following a relatively sensible diet, it shouldnt be that tough to make up for a lessened basal w/a bit more bolus.



it'd make sense, surface-level anyways, that as your body was running more properly/efficiently, that its insulin needs may adjust. ive always found it easier to adjust using short-term tweaks (bolus vs basal) until more of the big pic becomes apparent.


insulin can also decrease in efficacy due to exposure to a high temp (as low as 80 degrees even), among other things. is there a chance your stuff has "worn out" a bit?

 

[Fallenstar]

Through my own experience on Glargine not great to be honest, if I was going through a "low period" I would be more aggressive in my Basal reductions, ie drop it back by a third, it was the only thing that worked to get me out of the Hypo mess. Then It could just swing again out of the blue :shock:
I would drop your Glargine by at least 10 ,and as Micro says , adjust increase your Bolus which is much more controllable than a strong Basal that's in there working for hours on end.

see if this helps, being Hypo soon after eating will probably be Bolus to high, but if you are dropping 5 hours or so ,or are generally just "low" all the time it will be basal...Basal is supposed to be a background insulin...not effecting your levels when you eat.

Lantus was a nightmare for me ,dropping me all over the place, no matter what did. A whole different story for me now on Levemir.

Adjust and test Good luck

 

[devexity]

Thank you both for the quick responses.

Had dropped two units of basal this morning, and am stupidly low again. Will experiment with a significant drop tomorrow as you suggest.

Maybe Glargine has ceased being my friend and I should look into Levemir...

 

[Fallenstar]

It happens Glargine,I was not too bad on but ran into troubles, so swapped onto Lantus for a number of years ,now that one was a nightmare for me....one I'm so glad I'm out of :crazy:

Sometimes adjusting by one or two units just does not cut it....I was told this all the time with Lantus,made not a jot of difference. It was just a bad match for me.

Speak to your DSN, but if you are dropping like that ,for that duration ,a couple of unit tweaks ain't gunna cut it.

My Control on Levemir is so stable now on exactly the same routine, I'm hoping for a great Hba1c this time, as not always trying to stay out of the Hypo zone and needing to run them high anymore through fear really.

Good luck

 

[RussG]

I would agree with posters saying be a bit more adventurous with dropping basal dose. You can always top up with some bolus as others have said. Think about it in terms of percentages. On 48u, 2 units is 4%. I'm on 24u basal, so that would be an 8% change for me. If you're on 12u per day, as some are, that's 16% change for the same change in dose. I'd maybe think about 6-8u at least and try that for 2-3 days. I have read that Lantus / glargine takes a couple of days for a change to kick in, but if you're running very low, as it sounds you are, I'd worry more about hypos.

Micrograzer and fallenstar are right that you should also look at bolus doses. If you are hypoing 30 mins after food, that feels like a bolus issue, not solely basal. If you were newly diagnosed, I'd say this sounds a lot like honeymoon - pancreas kicking out insulin in bursts, then dropping, hence shifting insulin requirements.

I'd also try to eat consistently as much as possible until it settles down. I have the same thing for breakfast every day, so I can see if my adjustments are working, otherwise you don't know what change is due to the ratio or what is because of your food.

Have you spoken to your DSN?

 

[devexity]

Lots to think about there.

Still confused by it all. BG was slipping into the 2s all afternoon yesterday, so ate a 70g carb meal without bolus. 4.4 one hour later, and 4.7 two hours later. Had a 16g snack before bedtime, then woke up high. Ugh.

Have dropped the glargine by 7 units. We'll see what happens today. Agree that it sounds honeymoon-ish. Do you think it's possible that going from 60g carbs a day to a week of 400g a day, then back down to 60g could have sent my pancreas into a honeymoon state?

 

[Andybanbury]

Don't forget that you need to give a couple of days for long lasting insulin changes to have an impact on your sugars.

 

[jopar]

No I don't think that the swing from one extreme of carb eating to the other caused a honey period

It just knocked everything out of kilter..

With the low carb diet which is based on an higher fat intake, this slows down the adsorption of insulin and increases the insulin residence after a period of time and insulin needs increase..

When you hit the body with half a ton of carbs, then the body has a easier time of converting the carbs to energy, and with the drop off in fats the insulin residence lessens. So when you go back to extreme low carbing your insulin requirements take a nose dive

So what your insulin dose will be a lot lower than when you were low carbing before for a while.. You will probably find that you will drop back to a pretty low dose, then over time your dose required as your residence builds will increase back near to where they normally would have been..


So you need to rework both your basal and your bolus again

 

[devexity]

Thank you all so much for your help! Dropping my basal by 7 units has done the trick with my fasting BG and I only crashed once yesterday.

Without the advice here it would have taken me another 3 days of perpetual hypos to get to this point...