Avoiding lows

Hi. I was diagnosed with type 1 nearly 2 years ago and have been on MDI since then. I have good control (last A1C was 5.1), but I get my share of lows. I recently got a Dexcom 7+ cgm, which has been really helpful in catching the lows before they get bad. I’ve heard that being on a pump can help you avoid lows better than MDI, Have you found that to be the case? Thanks!

Hi Ann,
I’m sure you’ll be able to manage both your lows and highs with a pump. Your glucose level “graph” or “curve” will be much “smoother”, without as many “peaks” and “valleys”.
Your CGMS will help you catch any excessive lows before they get bad but try no to depend on it for that. Your A1C is excellent, so you have room to potentially decrease your insulin intake and avoid those lows.
I’m not “technically” qualified to give you advice. You should probably talk to your CDE or endo and revisit that calculation.
Wish you the best.

At first I thought I would have frequent lows when on the pump (from the basal insulin constantly being delivered), but I have found the opposite to be true. As previously mentioned, other types of insulin have peak times when they are most active. This is what often causes the lows. On the pump, you don’t have those peaks, just a slow, steady stream of fast acting insulin. Therefore the risk of lows isn’t as great. I’ve had maybe 2 or 3 lows since starting almost 2 months ago. On MDI I was having probably 2-3 lows a WEEK.

Ann, I used the DexCom 7+ for 6 months before I started on the OmniPod. The biggest difference I see during times when I don’t eat (especially nights). The customized basal rate keeps my BG stable. I experience less highs and less lows.

Thank you all – that’s just the info I was looking for. I ordered my demo Omnipod and put it on my arm today. It’s amazing how much I don’t feel it!

I still have almost daily lows on the OPod, mainly I think because I haven’t made the effort to get my basals completely correct. With mid-life hormonal swings, it seems like an impossible task. However, using the PDM info on recent boluses to not over dose or correct, the ability to dose in smaller increments and the extended bolus function are great tools to help limit them. Great job and good luck.

Marianne…Good luck, I think you’ll love the Opod.


Please take this the right way but with such amazing control 5.1 A1c it would seem to me that you are more likely to be subject to lows. That is a really impressive A1c that I could only dream of but my doctors have warned me that too tight of control can present their own set of problems. I would suggest you chat about this with your diabetes team and see what they think. I would be really curious to hear what their feedback is on this topic. The folks at Joslin have been cautious on me lowering my A1c too much below 6 as it will likely generate many low BS readings which present their own set of problems.

Once you go on the pump you will likely be using somewhat less insulin since the delivery method is more efficient than MDI.

Please keep us posted on what you find out.

My A1C is much higher than yours, 7.6. Three months ago it was 7.1, so I am headed in the wrong direction. I had three hypoglycemic incidents when I was on MDI, so I am wary of tight control. My endo says I am very labile, and he doesn’t want my A1C to be much below 7.0 because of the risk of hypoglycemia.

I have been able to avoid lows on the 'Pod for the most part. It took a while to get my overnight basal rates correct, and even after being on the pod for 7 months, my endo “tweeked” them when I saw him last week. When I was on MDI I had to try to eat the same number of carbs for each meal based on my injections. I didn’t attempt corrections between meals and my sliding scale didn’t work all that well. Now, if I am not very hungry, I can eat a smaller meal and the bolus calculator takes the reduced number of carbs into account and adjusts my bolus. No, it is not perfect. I still have meals where I estimate the number of carbs incorrectly, but if I end up going high, I just do a correction bolus between meals. Of ocurse, if I go low, then I have to eat to fix it.

Overall, my quality of life is much better on the 'Pod and I have a more normal life. I will not go back to MDI.

Hi Seth,

Just curious – other than the risk of hypos, what other problems are associated with “too low” an A1C? I know most endos want you around 6.0. After I was diagnosed, I went to Richard Bernstein, who advocates a super low-carb diet along with MDI – he says his A1Cs are always under 5. It was through strict adherence to his program that I got my 5.1. I feel great on the diet, but wonder if I’m messing myself up in some other way.

Hi Ann,

I really can not comment on the “other” risks associated with lows but it was represented to me that a level BS sugar is much better than peaks and valleys. You clearly do not have the peaks.

My concern with such tight control is one of safety. If you are having frequent lows the associated problems to me are just basic activities like driving. I suspect most of us do not know our BS before getting behind the wheel. The reality is that it is a potential bad situation. I almost always test or know i just ate etc to be sure.

I participate in endurance sports so a low carb diet for me is not a great idea. I try and eat mostly fruits and veggies but I do not always do the right thing:). If you feel good that is great but I would worry about a serious low episode which can be as ugly or even worse than a bad high. My worst experience was feeling woosey while swimming. I immediately got out of the water and tested my bs. It was 45 which scared the heck out of me. Passing out face down in water is not a good thing.

I am not qualified to say this but here goes… why not try to be less tight on your a1c and see if you have fewer low episodes. I am not suggesting go to 7.0 but since you are so good at targeting your bs try a little higher see how it goes. You might find the sweet spot where you have great control and few if any low episodes.

I have not been able to do that after being injured all winter I am just happy to get active again and lose some weight.

Please let me know how you do.

Be well


Would you mind sharing what your BG standard deviation is?

I share Seth’s concern of hypoglycemia. Here are three examples from when I was on MDI. I ended up face down on the table in a restaurant by myself while on a business trip. That ended up with a visit to the ER. I also ended up in the ER while on vacation in Orlando. Finally I woke up one Saturday morning with a glucose drip in my hand surrounded by three EMTs, two Police Officers and my wife. I have been more careful and things are better with my OmniPod and CGM.

Just downloaded my Dexcom, which says my SD is 20. Not sure how good or bad that is.


SD=20 is fantastic. SD is typically 20-30 for T2s and 50-60 for T1s. Before OmniPod my SD was 30 with a BG mean of 99 ml/dl. Now my SD is 25 with a BG mean of 94 ml/dl. I experience mild lows.

I expect that you will enjoy the more predictable insulin delivery of the OmniPod.

I am curious about the guidance that you receive from Dr. Bernstein. I read his book “Diabetes Solution”. I was a fan until I reached the chapters where he discounted pumps and CGMs. Has Dr. Bernstein changed his opinion about these gadgets?

No, he is very “old school”. I’m not really clear on why he is against pumps and CGMs, especially CGMs because they can give you so much information. I insisted on getting my Dexcom, because I was afraid of my nighttime hypos. He predicted that I would find it more trouble than it’s worth which, needless to say, has not been the case. I have found his advice about diet very helpful – that and his insulin regime have allowed me to keep my A1c low. But if you want to live in the modern world, and have a pump or CGM, he’s not your guy!

My son often can’t remember which arm his pod is on - I love that!