An update on lows

Type 2
1

It’s still happening like clockwork. Every work day the low happens. Some days 1 snickers bar fixes it, other days 2 snickers bars isn’t enough. One day, at home, the low came and I ate a meal and then 2 hours later had a BG of 105. I stopped all morning insulin for weeks now. On work days, I drive to first job site and then eat a candy bar. It doesn’t matter if my BG is 180. After the first two hours I am down under 100, sometimes well under 100 and I have to eat another candy bar just to finish the last 1 hour job. Last night I felt low after my first job, but since the second job was easy as no one was in the office since last cleaning, all I had to do was a walk through to check if it needed anything touched up. I bore the low, drove home, BG was 95 and I cooked dinner, used my mealtime insulin and all was good. But the drive home was not exactly safe at all. I was not 100 percent. This is happening more and more to me and it is also happening when driving.

What really got me worried was what happened last Sunday. I usually do a lot of vigorous work on Saturday and also on Thursday because those places are really dirty. Sunday was easy because I did all the hard work on Saturday and merely go to the first two jobs to tidy up in the chance someone came into the office on Sunday. I did not even walk fast, do any strenuous work, or even bust a sweat and I had a severe low that required two candy bars to get me well enough to drive home, then a low hit again and after those two candy bars, I was barely at a BG of 70. I had another half a bar, dinner, then insulin, and was 123 BG at the three hour mark. I mean, just walking around some is causing the lows.

I now leave things alone. Average BG is running at 160 most of the day and I correct it at night and somewhere in between it being good after the meal and next day, it does it’s thing again. I guess imma leave it like it is and just continue to live in fear of low BG every time I am in public, or at work. It is like clockwork now. It’s about as predictable as the sunset.

2

Out of curiosity have you asked your Endocrinologist about a pump? I understand how you feel, I used to go low every morning at 11:00 AM like clock work. This was solved with a pump. It might be an option.

3

I’m gonna have to look into all this with a endocrinologist soon. Once this COVID stuff dies down a little and also get the GAD test and the C-Peptide test as has also been suggested. I need to see a Neurologist for the swinging BP and have a formal tilt table test too. I know leaving the BG at 160 for hours on end is not good. I’m at 110 now finally after being 180 at 11 AM when I woke up.

4

Have you considered dexcom or libre cgms? Dexcom can alert based on BG, libre might, not sure if latest version is available yet.

I have variations every day, but when you can easily see bg and direction, its easier to stay in your target range.

5

I hear Dexcom is better. Be nice to see a low coming and then take action right away. To see all of it playing out in real time.

6

I have been here a million times.
You have too much insulin on board.

The system (which is you) is f*cked. Your running a complicated system with really crappy tools that aren’t cut out for the job. You need a Dexcom and a pump, and you need it now.

Make an appointment. You can do virtual appointments (even if you can’t, you need to go in). It’s time.

Do you currently have opportunity (time) to make room for learning how to operate new tools? We will help, but its gonna take some time (months) and commitment to do it successfully.

7

Yeah I have time to learn. I had not too many issues last night, was 111 and had my meal and then used my 40 units and BG did go down to 77, but I did not feel low and went to bed. Sometimes it feels low at 77 and sometimes it feels normal. I need another A1C as well to see what is going on. Is the pump an insulin pump?

8

Any Cgm will help immensely as long as it is set up correctly, which is a little easier with Dexcom, but you will need to check with your pharmacy and durable medical dealer/deductible info. I’ve used the libre and blucon, or now miaomiao2 for about 2 years now, and its much cheaper than the Dexcom with my insurance…I’d personally focus on the Cgm for now, your swings seem very dangerous… my endocrinologists are more concerned with keeping lows to a minimum because of the potential heart issues

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I personally prefer MDI and tresiba over the pump, however, the most important thing to research is the cost of the pump and whether it is an affordable option or not with your insurance.

9

Roger is right. CGM immediately, then you have time to shop around for an insulin pump.
Just because of your activity level (lots of exercise), I think it will be about impossible to manage without being able to see continuous data and trends in BG. Pump will help you respond to those trends.

10

Dexcom, although not perfect, is currently the gold standard of CGMs. That may change over time as technology improves with all manufacturers. The disadvantage of the Dexcom and major reason other CGMs are used is cost. If your insurance covers Dexcom, go with that. If you are self pay, then look at alternatives.

11

Insulin pumps are a personal choice. Many of us that are insulin dependent vastly prefer MDI (Multiple Daily Injections). A pump would be a great inconvenience for me and I can keep much better glucose control using a digital pen to deliver my insulin and keep my A1C’s in the low 5% range.

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12

Are you giving yourself injections of 40u of short acting all at once? That might result in a lot of variability in absorption given that it’s a very large injection. Some would suggest you should break that up into at least 4 injections—I would think at least 2-3 could vastly improve the reliability of absorption and thus day to day reliability in its effects. Even if you had a pump, you might have to spread that out over some time to get it all in there well.

13

@blizzard2014 Are you still using Novolin N or was it Novolin R ??? I think it was one of the older ones? That could be part of the issue as it has a weirder curve. Novolin N’s peak is 2-6 hours, but usually up to 10-14 hours.

If that is so, Novolin N is worn off by the next morning depending when you take it at night. But if you are dropping during the day, it is too high of a dose for the day.

It is possible you need a very small dose (only a couple of units) in the am to keep the 160 in check. You are doing more physical labor so that might drop your needs drastically, so on the highly physical days maybe none.

You could also be dropping lower when you sleep and then rising after. One of these days you might test at 2 in the morning and at 5 am.

14

Blizzard, have you ever tried some fruit juice to raise your blood sugar?? That seems to work faster than eating a candy bar/chocolate candy. You have to digest those and they have a lot of fat, which takes longer to digest and raise your blood sugar. Good luck to you.

15

Hi Blizzard,
the fastest way to raise your blood sugar in my experience is to take glucose tablets and/or fruit juice.
The glucose tablets are the fastest. I am partial to the taste of the CVS orange ones and buy the big bottles, I have one on my night table.
I do wear a pump and a CGM, they have changed my life!

16

Smarties and sweettarts are also functionally the same thing as glucose tabs (pure dextrose + flavoring, vs the sucrose in many other sugary things), but cheaper. They are my go to for a more severe or quickly dropping low.

17

To keep BG between 70-180 80/90% of time is challenge. If your insurance will not help get CGM, lot OF wrist or finger sticks seem needed. It’s a hard balance of how intense is exercise/ work, total medications, and try to eat lot protein , limited carbs. I am retired 76 year old not very active, try an hour walk and household items. I count carbs, try only 45 grams per meal carbs. I may get one candy bar a 2/3 weeks, it has near zero nutrition, but most of us like chocolate. I suggest counting carbs, unless you are very busy.

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18

I’m not writing with suggestions on how to resolve your low BG’, but to suggest a healthier and quicker acting solution to when you do have lows. I’ve been insulin dependent diabetic for 63 years this past May, diagnosed at age 9 in 1957. An endo told be a good 40 years ago to always go for fruit juice, preferably clear like apple juice or white grape juice. They are absolved more quickly by your body than food. This has always worked great for me personally. Juices are so easy to come by in all there many different size containers. I keep apple juice boxes/bottles on my nightstand and in the console of my car. In the fridge, I keep the larger bottles of white grape juice and I really like the V8 brand “V Fusion” assortment of blended juices. Welch’s makes a Dried “Fruit Snack” in many flavors and in small packages that work well at 24 carbs per pkg. and I keep these in my handbag. Think healthy with juices. Just a suggestion.

19

My contribution to this theme comes from a person who has not a medical or biochemical background, just a personal interest in diet and diabetes.

Just a little aside to drinking juices to counteract lows:

Fruitjuices are pretty tasty, but there are problems with using these long term for the following reason. They are made up of two sugars;

  1. glucose, which is stored in our cells using insulin and can be used as fuel by our muscle cells and brain cells, and
  2. fructose, which does not require insulin, but will be stored in the liver and cann’t be utilised for much. (In the past, Drs. Recommended fructose to people with Type 2 Diabetes, but it isn‘t recommended anymore as an alternative sweetener)
    If we eat or drink too much fruit or fruit juices, this can lead to a fatty liver (like the fatty liver which some people who drink too much alcohol get). I do give my son fruit (not fruit juice) if he is heading too low, but it is the whole fruit, and then I try to keep it under 30gKH per day (which may still lead to problems, but I like him to have the vitamins, fibre and minerals found in the whole fruit and it’s a tasty way to counteract lows).

Household sugar (called Saccharose) is also made up of 50% glucose and 50% fructose, so given the choice between saccharose (table sugar) that we put in our tea, in home cooking and baking, I go for fruit or fruit juice.

But there is an alternative, which is just pure glucose, which will ONLY give you the sugar which the insulin will put into the cells. I think you can buy special glucose solution, or tablets to suck to counteract a low. In Germany, where I live, such glucose tablets are sold under the name of “Dextro Energy”, dextrose being another name for glucose.

As I prefere organic foods etc, I have bought a glucose powder made of organically grown corn, (but this isn‘t high fructose corn syrup, which should be avoided at all costs- see Dr.Lustig‘s talks about that) which has been refined into this pure glucose powder (also known as dextrose). I put about 12 to 18g of the powder into 30ml of juice for my son to drink if he needs it in the night. At least that way we avoid the fructose.

I appreciate that the question of which sugars are best to eat is a complicated one, and the answer is not just a biochemical one, but also about how much you need, how often and what is more important to you. If this interests you, you will find many articles on line, and do double check what I have contributed to this, as I may need to be corrected on one thing or another.

My question to you, Kathlyn, you have obviously done alright with using fruit juice to counteract lows, and that over many years, but do you have any issues regarding a fatty liver?

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