BS dropping after eating during the day


#21

Hi, I am LADA and was experiencing similar issue to you after initial diagnosis (fast drops after post-meal highs with no bolus insulin having been taken for meal).
My endo gave me this explanation: first phase insulin is the first to die-- the post-meal high is because your first phase insulin cannot cover. When you go high like that the remaining, undead second phase insulin overcompensates to then drive you low. In other words, you must not allow the post-meal high and then you won’t get the reactive hypo.

I was able to blunt this hi-low post-meal experience in the following ways:

  1. Very low carb meals that don’t typically cause a spike;
  2. Making sure to eat protein or fiber at meal outset to slow digestion of any carb intake;
  3. definitely not eating carbs on empty stomach;
  4. and/or using fast acting insulin (I use both humalog and afrezza based on circumstances/meal/etc) to stop any post-meal high from occurring, hence eliminating the reactive hypo.

Things that helped me through honeymoon phase with bolus insulin:
a) Using a Jr. pen with 1/2 unit dosing increments; and
b) Splitting afrezza cartridges in half.

Hope this is helpful!


#22

It is kind of common for folks to do OK with just basal and no bolus in parts of honeymoon phase. I certainly didn’t have a CGM when I was in my honeymoon phase almost 40 years ago but I imagine if the technology had existed, the graphs might look like yours.

And basal insulin requirement can go way down to zero for some for a while. I was there for a few weeks myself.


#23

So today I tried a high fat high protein lunch. Pretty much zero carb. No post meal spike and no quick drop. However I did eventually drop as usual but it just took 4 hours or so.


#24

I can’t tell you what I’d tell your dietician if she said that to me, at least not on this nice family friendly forum…

I’m in a similar boat and have been for some time. No bolus, low insulin production, (I’m not even on basal yet), but occasionally have “reactive hypoglycemia” in response to moderate carb meals. I’m also on metformin. My solution, so far, has been to cut out moderate carb meals. It feels constraining, and I don’t like it, but it is what it is.

The best tools I have to level my BG right now, with low insulin production but a fits and start pancreas, is exercise and diet. So low-carb eating, lifting weights, and a few miles a day of walking/running seems to mostly do the trick for me.

  1. and/or using fast acting insulin (I use both humalog and afrezza based on circumstances/meal/etc) to stop any post-meal high from occurring, hence eliminating the reactive hypo.

@Karin7, I’m glad to hear I’m not the only person in this same pattern! I suggested Afrezza to my doctor after reading about the whole 1st Phase/2nd Phase conundrum here on tud, and she followed up with a request to the insurance group. They laughed her and me out of the room. The response was very simple: “since he has good control, he clearly doesn’t need any insulin; he’s welcome to use it but we won’t pay for it.”

Seriously frustrating.


#25

I still think maybe my basal is too high, especially in the afternoon. Even with a no carb meal my sugars will continue to decline over a period of hours until I get to about 75. I have reduced my nasal insulin further, to 6u, at the direction of my doctor.


#26

@Rex2 - I would suggest again that you find a safe space and time with somebody present and see where your BG will go to using a fingerstick meter to see the real-time BG values.

75 is IMHO a good number.

I am certainly not advising anything against what your Doc has provided you as expert medical advice only suggesting that in conjunction with your Doc’s advice, it might be worth to see where the BG goes.

If the BG levels out and stabilized by itself then potentially you could have nothing to worry about in this regard.

Everybody is certainly different in what BG levels they are comfortable with.

In our particular case, if the BG is pretty level and is gently oscillating between 65 and 70 then I will just leave it alone and let it be.


#27

When I say it gets to 75, it’s normally because I’ll catch it and stop it.

I’m going to reduce basal as doc suggested. Even my gentle drops are about 1mg/dL per minute or two. Not a down arrow on the graph but still doing down more so than it should.

Once I get down to a comfortable level of predictability I am going to try your method, Tim.


#28

Interesting. My dietician also suggested me to talk to my Endo about some sort of medication that slows down digestion a bit while honeymooning.


#29

@David49, Yes, I forgot to add exercise; hugely important!
On the Afrezza front, my insurance company denied as well and I went through 3 (yes 3) appeals with the assistance of my Dr and the Afrezza rep. Finally got approval. (I realize my diabetes is different from yours, but you could contact Mannkind for assistance.) In addition, Mannkind had (& I assume still has) a program called “Mannkind Cares” under which it sent me free Afrezza during the insurance fight process! I have also been fortunate to receive samples from my Dr… Perhaps you could ask for same.

@Rex2, I hope you feel better soon as those fast drops are no fun! To reiterate what another said above, I have found my basal number is not always a constant, but changes (slightly) here and there due to “who knows what.” I think one of the hardest things to accept following diagnosis is how diabetes is an everchanging game. (Yours may be different. I hope so!) It’s sooooo frustrating to me to do the exact same exercise, eat the exact same food and inject the exact same insulin on two different days and have two totally different results! I wish you luck and hope the hints here will help blunt the highs.


#30

Update: trying a few different types of foods to see what happens. I’ve attached 3 pictures. One is yesterday (meal around 11:00am was bacon and eggs (zero carbs). The other two are from today. Only meal so far is a light and fit Greek yogurt at 8am (10g carbs or so).

Both circumstances resulted in a slowwwww drop over the course of many hours. Does this tell us anything?


#31

I think it tells us that your body wants to sit at BG = 90.

image

Question: Do you eat where these purple arrows are?

image

Do you know what happens at the four hour point after eating? That is the real important question here, I think. You may get hungry after a BG decrease like that and eat something. But, have you seen what happens if you don’t? Your body just might be correcting after you put yourself at 150, back to 90, where your body naturally wants to be.

But, if your gonna ride out to the 4 hour point, and not eat…just as an experiment to see what the data does (if it goes low)…then, I recommend you be somewhere safe (as TIm recommends) and be in the company of someone who is calm in an emergency, knows what to do (feed you), and is larger than you (for safety). Its best if you arm them with a variety of desirable treats to feed you - sweet and salty.

There is always a small chance that you go bat-■■■■ crazy and try and murder them, so they need to be larger than you - just to give them a fighting chance. You could become full of adrenaline and become stronger than normal. Ideally, they should be able to maintain a calming tone of voice and act like everything is normal so you dont produce even more adrenaline. They should be someone who is comfortable calling 911 if they loose control of the situation. And, someone who cares enough about you to not wipe their hands of the situation, if you become difficult. Sometimes people become “fight or flighty” so they need to be someone who will pursue you if you try to run away. They should bring snacks if it becomes a foot race. They can always just wait it out (hide or linger in the background) until you pass out. Once you are weak, it will be easier for them to move in and take care of biz. If you loose consciousness, they call 911 and let the medics take over. It wouldn’t be bad training for the people around you…to make a plan and then adhere to it.

But, its also very possible that your body self corrects the low and nothing happens at all.


#32

I did it today. I skipped lunch and rode out my drop from my 10g yogurt at breakfast. Work is the best place to try as I work at a hospital, lol.

Just as you suggested, I leveled out at 90. I did dip into the low 80s for about 30 min, rose back to 90 and I am gliding there.

So does this rule out reactive hypo? If my basal is keeping me around 90 six hours post meal, then why is my overnight number so high?


#33

Although every ones’ diabetes is different, what you are going through at present, is very similar to what I experienced when I was diagnosed at the age of 56. That was just over 10 years ago Rex2.

The reasons why this occurs, given by the endo for Karin7, explains why I had so many problems when I was first diagnosed.

For 3 months after being diagnosed with LADA, I did not use insulin.

For those first few months, I could keep very stable BGL if my BGL did not fall below 5 mmol/L (90) and I could eat what ever I liked, within reason. If I saw my BGL rising it was much better to allow it to rise quickly to 18 mmol/L (324) by having a cup of milk based coffee. After reaching this level, my BGL would fall quickly and as long as it stabilized before 5 mmol/L, every thing would be OK.

When I woke of a morning and my BGL were above 8 mmol/L, it took me a long time to stabilize my levels. Even walking for over an hour, I would see my levels rise although I had not eaten anything.

While walking if my BGL rose above 10 mmol/L, my mussels would ache and joints become sore. I quickly worked out if I had my breakfast, allowed my level to rise to 18, I would have a good day.

A month before I started insulin, I had very little control and it was also a time of high stress for me which also contributed to high BGL.

My research showed Amylin is also produced by Beta Cells which may be a hormone linked with stabilizing levels. The hexokenase group of enzymes, 1 to 4, also play a big part with glucose metabolism along with glucose transporters. What I am saying there is no simple answer. If you have a scientific background there is a lot of interesting research you can do.

Wishing you all the best but I did progress very quickly to Type 1.


#34

One of those things, you have to ask God, lol.

If you try to describe system behavior to your Doc, you might say something, like “I have a night time pattern that puts me around 150 and a day time pattern that is self correcting to sit around 90.”

I like these patterns. I like this data. You are asking good questions and thoughtfully investigating system behavior. But, no reason to mess with the system, yet. Its behaving well.

Do you wear medical alert tags, yet? Med tags are the medics best friend. Be friendly with the nurses and EMTs. Its good karma for the future. When low blood sugar finally comes, you want a nurse or an EMT, probably not a Doc. A good street medic or nurse will stay calm and help.

Question: Are you afraid of professional judgment regarding your condition…working in a hospital? You may face that at some point. Depends how supportive your workplace culture is. Try to remember that any judgement will be a reflection on their culture as care providers (who might be burned out). You are very clearly making a strong, personal effort to do your best at managing this.


#35

I am the operations director for the food and nutrition department. All of my peers know about my condition and luckily it’s a quick dial from any phone to get the MET team anywhere pretty quickly.

My clinical dietician is a former diabetes educator and my Endo’s office is a quick walk up to the second floor. (I literally go to my appointments during work because it’s that easy).

I feel very safe at work.

I do need to get a bracelet though.

I am putting off the mealtime insulin as long as possible. I at least feel like I’m kind of getting this figured out a bit. I am at least a little relieved that my body is correcting itself from going too low, however I think a sharp drop would take a little longer to recover from, and is probably dip low for bit.

My big question: since I skipped lunch to do this test, am I going to be all jacked out of wack tonight?


#36

This is worth a try Rex2. When your levels are falling and before they fall below 105 eat some carbs and see what happens. I know I had my best control when I tried this approach.
They say from when you are first diagnosed to when your beta cells are wiped out is the “Honeymoon” stage. For me it was like the “Divorce from Hell” where your partner gets the house, the kids, the money and your pride and joy the Harley.


#37

Is your control easier now that you are out of honeymoon?


#38

I should let the LADAs answer that one because they will give you better first hand account. But, in general, I they call it a “honeymoon” period because it gets worse, not better. I don’t want to scare you, though.

I have been type 1 for 25 years and I haven’t even looked at my data in several days. Now, no one on here would say this is great data, but its also not terrible (for me). Just to give you an idea of what data might look like, down the line…

My BG = 75 as I write this, but I feel fine and may or may not eat anything. Note: If I was paying attention to these numbers, even with just a couple tiny adjustments that would take me only a few moments to make, this data could be better. Your data will probably be better than mine because you seem proactive. I’m lazy lately and this data rarely causes me any day to day difficulty. But, honestly, I’m probably running a little lower than I should. This data would make me happier if I could shift the whole thing up 25 points (which I easily could do if I made a minor effort).


#39

Eh. I learned a lot today but it definitely wasn’t my best day.

Truth be told, I am not even 100% sure what type I am. My mom, aunt and only cousin are all T1. When diagnosed I had lost 35lb, classic symptoms. However recently did the antibody tests - negative. C-peptide was .8 at diagnosis and the crazy fluctuations in treatment lately has my doc convinced I’m T1 or MODY.

I may never know for sure.


#40

@Brian_BSC