BS dropping after eating during the day


#1

Please see attached pics from my libre. Just want to get some ideas as I currently have been told by members on here that maybe my basal is too high.

However, during the night I cruise along at a breezy 130-150. May be a little high but I’d rarher that than risk lows at night. Literally can stay around there from 11pm to 11am or until I eat. After I eat, I will spike and then drop way lower than where I started. This happens every time.

Reactive hypoglycemia? Over production by my honeymooning pancreas? Too many carbs? Need a split basal?

I have been reducing my basal (tresiba) to avoid the daytime and afternoon drops but they have continued albeit a little slower.

I was told to use mealtime insulin only if my pre meal glucose is above 150. That never happens.


#2

Just to clarify. You are for the most part using only basal and are NOT doing a bolus for food?

So on your “Daily Graph” screenshot where it shows the rise and subsequent drop around 10 AM (or so), you have background basal running but no additional bolus? This is strictly from food?

Were you able to use a meter to confirm the high of the rise and the low of the drop after you ate?

Anytime I have questions and/or things that are not really making sense, I like to take a step back and confirm as much of the data as possible to make sure there are no issues with the data that could be confusing the situation. IMHO, doing a confirmation of any cgm with a (good) meter is prudent.

Also, what specifically was the food you ate around 10AM?


#3

This is without any bolus insulin. Only insulin I am taking right now is tresiba. I am also taking 500mg of metformin 2 times per day.

My typical breakfast is 2 slices of wheat toast with a little sugar free jam, Greek yogurt and coffee. About 40g of carbs is what I am form.

And yes I have checked with a stand alone meter (accuchek aviva) and typically it is on the money.

For the record I have never technically gone “low”. I made it to 69 only once and once I get to around 80 or so the dropping slows down a little bit like it is starting to level out. I always grab a snack or something at that point to bring it back, but it will come back down again. Pretty much does this until bed time then it stops.


#4

It would be interesting to let it go (after eating) and see what happens.

Obviously when you are in a comfortable place and preferable with somebody else around in case you need assistance.

Does it continue to go down? Does it level out by itself?


#5

I think it would level out but never really let it get to that point lol.

Maybe I’ll try it but in the meantime I am reducing basal.


#6

Ironically today I had a low episode. Before meal my blood sugar was 135. Ate slowly, rode the wave up to about 185 then within the hour I was at 90 with a straight down arrow on my libre. Checked with my meter and was at 71. Starting to come back now, but this is just crazy without any bolus insulin.

I can feel the rapid change luckily but the libre is really saving me from some severe lows.

Something is off. I have reduced my basal from 20u to 15u now at this point I am at 12u and this is still happening. My c pep at diagnosis was .8 now my pancreas seems to be in overdrive.


#7

I am still not sure. There is low and then again there is low. Certainly not the same for everybody.

I am only suggesting to let it go, not treat it and find out if it comes up all by itself.

If it was me, I would want to know.

It is one thing for BG to go down to 65 and then rebound back to whatever range you are looking for.

It is something else for BG to down down into the 40’s or 50’s.

Certainly different people have their own target range they are comfortable with. My only question would be is this going to come back up by itself without extra carbs or is it either staying down or even going down further?

Particularly if you are wondering about reactive hypoglycemia, this could provide some addition data that would be helpful.

If it was me, I would not be overly focusing on basal in regards to what happens after eating.


#8

My endo gave a response back to me about reducing my basal to 6u for now. He keeps reiterating that it sounds like I am in a full honeymoon state - with pancreas kicking in at times and stacking insulin on top and driving me down. Today dropped 120 points in under 45 minutes.

I am certain I would go lower without treating. When libre shows straight down arrow at 90 and meter is reading 71 I am going to take action. I’m too scared not to. Being on metformin scares me also as it’s whole point is to reduce glucose release from liver, which wouldn’t help save me if got dangerously low.

Thanks for the responses Tim. I’m needing the advice now and it is greatly appreciated.


#9

That is good you have a response back from your Endo.

In terms of cgm and “arrows”, although we are on the Dexcom and I am not familiar with the Libre, I assume certain aspects are similar between the two systems.

I pay little attention to the cgm “arrow”. I find the cgm graph to be far more instructive. I am more confident in my ability to “eyeball” the graph and determine direction than I am in whatever algorithm generates the “arrow”.

Due to the lag of cgm systems (as compared to a fingerstick BG meter), I do not find a cgm super helpful on fast rise or fall particularly if I want to see where the top or bottom is. In that regard, I find a fingerstick meter to be preferable.

Certainly you want to do what you find to be comfortable and the best for you.

But, if you felt inclined to do so, when you are at 71 (per fingerstick meter), you could take a fingerstick five minutes later and see where it is. And then another five minutes later. Certainly normally we would not take an excessive number of fingerstick readings but if I was running a specific test where I really wanted to see where something was going almost in real time but didn’t feel the cgm was quite up to the task… well… Might be data that could show something useful.


#10

Yes. This is the third time in a few weeks that I have had a rapid drop in blood sugar to where I was basing my actions off of the prediction trend arrow of the cgm as well as fingersticks.


#11

How long after eating is that low hitting you? Looks like more than 2 hours…almost 4 hours? If its super predictable, although inconvenient, you could schedule to eat a snack at that time. I only recommend that because your basals look so stellar. Thats nice flatline data. I hate to monkey with it. Another experiment might be to eat more frequent, smaller meals and see if you still get that large drop. Does adding protein to the meal help? I think you should gather data after a pizza dinner.


#12

I agree that my overnight data is nice and flat. However, today after lunch I dropped from 180 or so to 70 in under 45 minutes. So something is way off.

Endo wants me to reduce basal to 6u starting tomorrow.

I’m diasspointed to say the least at the moment. My last a1c was 7.6 and that was before I got the libre. My average sugar since getting the libre is 137. But I can’t stand to chase the lows all day.

I’m going to try the lower basal and if my overnight sugars rise I am going to ask for a different type of basal insulin that I can split dose


#13

Wow, yea, that will drop you to your knees. Thats way too fast of a drop. Better safe than sorry. Especially if your new to lows, its way better to exercise caution. Running a little higher is fine. Its not permanent, just safety precaution.


#14

Yep and that’s without any bolus. Here is a pic of the drop on my libre.


#15

Could you feel that drop? Your numbers are excellent, I wonder if you have symptoms. Did you get lightheaded?


#16

Oh yeah I felt it. I was at brunch with some friends. I never actually got low - caught it on it’s way there and turned it around but it was scary.

Doc thinks it’s honeymoon and pancreas works overdrive when it wants. I was 0.8 c peptide at diagnosis. I ate some crappy stuff right before that rise and subsequent drop. Like biscuits, crackers, eggs Benedict. It’s happened before - I don’t know what to do at this point.

Between meals on a good day I am still dropping constantly just not always that fast.


#17

Sound like too much basal, then. Interesting. You are an interesting new animal for our collection, LOL. That’s a dangerous drop. Be careful, but your doing a really good job of catching those lows. You can feel your body’s physiology. That’s good, not everybody can. Check BG before driving.


#18

My dietician has been giving me hell for scanning my libre as often as I do.

I feel like I have no choice lol


#19

This suggests an alarming lack of empathy. People who enjoy the exquisite glucose control due to a healthy glucose metabolism are often ignorant of what living with a broken pancreas really means. With crude tools we try to simulate the exquisite performance of a healthy system.

When running a complex biological system in manual mode, taking readings as often as we feel is necessary is completely natural from my point of view. This can only be considered obsessive if one also sees breathing as obsessive.

I have little patience with this attitude. Your interest in frequent monitoring of glucose values looks healthy to me. Follow your gut on this one!


#20

I agree with Terry. You need to be proactive as a brand new diabetic who doesn’t have proper settings established. You are doing exactly what you ought to. It helps prevent heartache for you and the people who care about you in this time of transition.