I’m sorry for posting this same topic multiple times. This is the last one I will be posting. I had another low at work tonight, right around the same time all the severe lows would happen if I had used insulin a few hours before. I started becoming weak and dropping things. I drove from one customer to another one in the same complex, because they have sugar packets next to the coffee maker. I ate four packets of granulated sugar and then felt better again after 20 minutes. I worked for another hour and then started to feel low again. I drove home not feeling well, and once home I checked BG again and it was 90. I was starting to get really weak again. I ate nothing all day. Just my usual three cups of coffee and 1 diet iced tea. I’m getting real tired of this. All of these lows leave a hangover effect for quite a long time. I don’t know what else to do to prevent these. Is this the same thing as brittle diabetes? I am scared now that every time I go to work or drive I’m going to go low and have an accident. This never happened every single work day for weeks on end. It only happened occasionally. I had everything under control. Some insulin in the morning to correct fasting numbers and 1 meal a day with BG under control within 2 hours. No food in between. My last A1C was 5.3. Maybe this current set up isn’t going to work for me any longer?
It would be helpful if you summarize your current treatment and diagnosis. I believe you are type 2? How long ?
But also take insulin- what kind? 40 units as one injection each day, without a meal ? Few people have experience with fasting and one meal per day, that you mentioned.
Were you recently diagnosed, or has something changed recently?
Have you had antibody testing or C-peptide test?
What other meds do you take ?
Feeling weak at 90 doesn’t make sense, especially with 5.3 A1C. Non-diabetic is often 70-80 without symptoms. However a fast drop can give similar symptoms as being low.
90 on its own really isn’t a severe low—it’s exactly where you want your blood sugars to be. If you’re feeling bad though it might be related to several things. One, not eating all day can make you feel bad even if you’re not low, especially combined with caffeine. You need food, regardless of blood sugar! A lot of non-diabetics who report feeling “hypoglycemic” I suspect often just feel hungry and forget that that alone can make someone feel off without an actual low blood sugar. Relatedly, if you aren’t eating, you might not be consuming enough electrolytes, which can make a person dizzy/off feeling. Two, if you’re used to running too high, 90 can feel low even though it isn’t. I might be a sign you want to work on bringing on your overall blood sugars down. Three, you could have been dropping precipitously—a Libre or Dexcom could be useful if you can get one prescribed and covered because it tells you not only what your blood sugar is but the whole pattern. Then you know if you’re 90 and flat (great! no need to treat, although still a need to eat something lower carb if you haven’t eaten anything) or 90 and dropping fast (then treating some makes sense to head off a low).
Also, to answer the question implicit in your title, no this is not what people mean when they use the label brittle diabetes, which is also typically reserved for Type 1s whose diabetes is very hard to manage, although I believe the label is out of favor these days. Just to put into perspective, as a T1, I know when I’ve had things out of control, I’m talking about swings from the 300s to 50s and back within a day.
I’m uncomfortable with that 40 unit meal bolus. That makes me very uncomfortable.
If I took 40 units of Humalog, I would die, no matter what I ate.
Could you cut that dose in half until this gets figured out - just to be on the safe side?
Normally, I wouldn’t ask someone to cut a dose in 1/2, but we are all in a high risk period of time and I have no idea whats up with your situation. But, that seems like the most ‘suspicious’ part of this pie.
Maybe your body is able to overcome the 40 units, to some degree, but it might really be doing a number on you.
What are you using to test your bloodsugar?
I know you feel at risk. Would your Doc borrow you a Dexcom for the week so we could see the complete data? I think that is warranted.
I don’t think your getting enough eyes on this post. Seems urgent. I’m gonna flag some names who I have seen lurking around. Lets get some more feedback today.
This is the link to the original post: A low happened without insulin
Recent blizzard adjustments post: Thanks for advice got it figured out finally
(Can you organize your original post a bit into seperate paragraphs, @blizzard2014 ? Its hard to read and weasel out relevant information.) Maybe this makes it more readable. You have important clues in here that are hard to find. Your the best!
"I’m sorry for posting this same topic multiple times.
I had another low at work tonight, right around the same time all the severe lows would happen if I had used insulin a few hours before. I started becoming weak and dropping things. I drove from one customer to another one in the same complex, because they have sugar packets next to the coffee maker. I ate four packets of granulated sugar and then felt better again after 20 minutes.
I worked for another hour and then started to feel low again.
I drove home not feeling well, and once home I checked BG again and it was 90. I was starting to get really weak again. I ate nothing all day. Just my usual three cups of coffee and 1 diet iced tea.
I’m getting real tired of this. All of these lows leave a hangover effect for quite a long time. I don’t know what else to do to prevent these. Is this the same thing as brittle diabetes? I am scared now that every time I go to work or drive I’m going to go low and have an accident.
This never happened every single work day for weeks on end. It only happened occasionally. I had everything under control. Some insulin in the morning to correct fasting numbers and 1 meal a day with BG under control within 2 hours. No food in between.
My last A1C was 5.3. Maybe this current set up isn’t going to work for me any longer?"
Physical activity after taking insullin can trigger hypoglycemia, as exercise increases insulin sensitivity. It sounds like that might be involved, if your involves physical labor. There’s also a thing called reactive hypoglycemia that some people get where their own insulin production kicks in too hard after a meal. Might be worth a google.
But it would help us help you if you could give us more specifics. What KIND of insulin, to begin with, because “insulin” isn’t just one thing–there are a number of different types, and their effect curves all differ. If you’re dx’d as T2, the usual thing would be Lantus, which has a flat, long-acting effect curve. Usually a fairly high dose–I think you said in another post that you took 40 units first thing, which sounds like a Lantus dose. It would be a HUGE dose, possibly a killing one, of fast acting mealtime insulin.
Might also be time to re-evaluate ISF, Onset/Duration, Correction, etc again. The type of food, quantity, protein vs fat, (as in Glycemic factor) can weigh heavily on insulin absorption too. As @DrBB stated exercise can also “encourage” the insulin to work faster; so too can where you take your shot - intramuscular vs abdominal. Might be time to make contact with a CDE to get help/insights.
A CGM is great for tracking food digestion and insulin curves if you have access to one.
Until you get this sorted out, you should plan on very very frequent bg testing, and especially before driving. Do you carry any form of fast acting glucose with you? Will your Dr prescribe Glucagon for an emergency?
I could not have good control without low lows if I had your schedule. I have very good control only when I have some consistency in my schedule. I had lows when I was keeping my A1c in the 5.5-6.0 range. I had a new endo who advised me to use the 6.0-6.5 range. That took some doing and some time, but I have been in the higher range for seven years. I rarely have troublesome lows now.
I eat meals at the same time each day, snack between meals when needed, and exercise in the afternoons. I am retired though, so consistency in my schedule is easy. You are younger, and employed, so that kind of consistency may be impossible.
I had trouble like you are having when I was employed. No two days at work followed the same schedule. That made it very difficult for me.
I don’t feel low unless I am in the low 70s. A 90 is very good. I feel great then.
Dizziness can be caused by several things other than lows.
My BP med, my water pills and my neuropathy have caused me to feel dizzy when I did not have low blood sugar. I am now on a lower dosage with those meds. That has helped. I had physical therapy for the neuropathy in my legs. That has also helped.
He has said:
1 meal a day- what time of day
High’s in the morning
40 units of ?
Eats higher carb.
We have a disease that is self monitored in what we eat, medicate and exercise for. I am not sure what to say to a one meal a day Type 2. I would say regroup as the 1 meal a day is not working well. Try something new. Good luck. Nancy50
This is Novolin R. You take more units on the older stuff. The unit ratio is very different for Humalog. That is why the units are so high.
One meal a day at 9 PM. Most mornings I am between 100 and 200 BG. Before a few weeks ago it was always between 100 and no higher than 140, with 120 being the norm. I never worry about 120 fasting. I use between 30 and 80 units for my 1 meal. Only use 80 for 1 medium pizza. I used to eat 2 pizza’s a month. Now that the Corona is here, I do not eat my 2 pizza hut pizza’s a month anymore, so 40 units is the norm. It is Novolin R, the old, old original insulin. That is why the units are higher. You use way less units on the newer stuff. My doc is not well educated on diabetes. I kind of took self-care into my own hands. I actually started experimenting with insulin on my own as you do not need a script. Now the doc prescribes it. Eventually I will see an endocrinologist once this pandemic is over. I have been putting it off because I already need to see so many specialist for unrelated illnesses I got doctor burn out. I am tired of all the doc appointments and pharmacy trips. I can’t eat a lot of different foods because I am on blood thinners and keep a really high INR level to prevent blood clots and to not want a roller coaster ride with that. Ironically, that is one of the only things that remains stable as I test here at home. Some days I eat a lot of carbs a lot of days not a lot of carbs. I used to have my iceberg salad days with a huge bowl of lettuce and chopped ham with blue cheese dressing and 10 hot wings. The carbs mostly came from the dressing on that meal and it wasn’t even 20 carbs for the entire day. I would still need 15 units to stop my BG from being 150 for 7 hours after the meal. I know, I checked a few times without insulin. So, it isn’t all high carb. I am a human and having a pizza 2 times a month is something that I will always do. Moderation. I hope this info helps some.
Iceberg lettuce has almost no Vitamin K in it. So it does not mess with my INR and blood thinners. That is why I eat only Iceberg lettuce. It has the least amount of vitamins of any lettuce out there. I am not all high carbs, just a few times a week. I am human and value quality over quantity of life.
Blizzard, I eat a lot of iceberg also. You have a lot going on. We all eat a different item once in a while. As you said we are human. Hope you can find an endo who will help you with this puzzle. We aren’t doctors but can give you things to think about and support. Tonight for supper I had a pork chop and grilled zucchini. I will have a few crackers and hot chocolate for a snack to show you part of what I eat…Nancy50
This is just getting really weird. I just checked my BG, only been awake for a few hours and it is 88. I only had 1 large cup of coffee so far. I don’t know why I am bouncing around all crazy like this before when for a week straight BG was 150-200 all day after waking every day. I guess my body is crazy. I am 88 and feel something, but it isn’t the severe low feeling I had last night. I have done nothing today, changed nothing. I wanted to let you and everyone else know that I have had lows ad low as 38 before, a few times when getting my insulin ratios down and never felt the shakiness or anything at all.
I also have high standing BP again though. It was just 150/110 and second reading 145/106. But it will go down to normal sitting. I am not going to mess with the Lisinopril anymore. A lot of weird stuff going on. Could also be a form of what they call autonomic failure. Sometimes it can be chronic, some forms are fatal, some are caused by diabetes. It means your body have trouble regulating BP, HR and other autonomic functions. Too much stuff on the medical plate. I try and ignore it. Same with enlarged right heart. Doc could not tell me why it is enlarged other than due to blood clots in lungs. I can never even get 15 minutes in a room with a doc and all they do is type the entire time. Makes me frustrated and I just stop going to the docs because I learn more from online forums than I do from doc’s.
I will let you know if my current 88 BG will go lower or make me feel weak or anything. Right now I feel fine.
Thank you all for listening. I know my explanations are winded and my train of thought is not good. But I try and convey my situation as best as possible.
The heart doc only spent 1 minute with me. Came in room told me my right heart is moderately enlarged but pumping well and walked out. It was like an assembly line type of deal. Turned me off and I dropped him as a specialist. Same with vascular doc. I have a growing distaste for the medical field. My pulmonary doc would not help me get used to BIPAP machine because my pressure settings has to be the highest level to stop the breathing disruptions at night. I can handle the lower pressure when machine is ramping up, but once it is full force at 21, it feels like a hurricane is blowing wind into my mouth. I simply cannot sleep. All I wanted was a sleep aid to knock me out so that I could get used to sleeping with the BIPAP on and could only see the guy for a few mins and no adjustments, no support. Made all that money from two sleep studies and wanted another one after I had lose 30 pounds. I did lose some weight when going to 1 meal a day. I used to weigh 276 pounds. Now I weight 250, but it stays there no matter what. It does not go higher or lower. Any how, thanks for the help. I am taking notes and figuring out a new plan.
Ahhh, I see. I have some Novolin R in the fridge, but I haven’t had to use it, and they did warn me about that at the pharmacy. ANybody know what the conversion is from one to the other?
145/106 = standing BP. I don’t know what “normal” is for you, but in general that BP shouldn’t change by more than 20 points if you sit down. If it does then you have “unusual” orthostatic BP.
El_Ver is recommending that you run some tests in order to figure this out.
In the morning, do this:
1.) Check sugar, write it down.
2.) Eat 12 - 15 grams of carb (maybe, 1 piece of bread) and see how high your blood sugar gets. Dont take any insulin for it.
3.) Check sugar 30 minuites or an hour after eating. Write it down.
4.) Take 1 or 2 units of insulin.
5.) Wait 2 hours. Check BS. Write it down.
6.) Wait another 2 hours (without eating or taking insulin). Check BG. Write it down.
Do this once in the morning, once mid-day, and once near dinner time.
That will be enough data to get you started. It will probably take you a few days to complete this process. Do it more than once, if possible.
Bring us the data.
I’ll do it too. I need to check all this stuff. My stuff is messed up, too.
Sitting down it is 120/120 over 80/85. It used to go along with a huge increase in HR. I would go up to 130 BPM standing. It is orthostatic hypertension and happens a lot. Mostly it will stay at 130/105. I just leave it alone now as BP was dropping to 90/65 when sitting. On some days I can be 150/116 which is hypertensive crisis, but I just sit back down to fix it. My doc has no idea what it is and calls it Labile Hypertension.
I meant to say sitting down BP is usually 120/125 over 80/85.