Crazy Numbers - Lows!

Usually when I post a question I have some theories as to what is happening, this time I have none. I’ve been on my pump 6 weeks and have been slowly tweaking basals to reduce highs in the morning. (slow as in .025 change every couple or more days) and the results are great. I watch those morning numbers lowly return to normal. I had also been having an occasional low, but that’s life, right?

Then the last 3 days I have been having unexpected lows, mostly in the afternoon and evening. Normally my lows are very easily treated: 2 glucose tabs if I’m in the 50s, 3 if I’m lower. No need to eat protein later, they are up, and stay up. Two of those nights they were low close to bed so I took glucose and tested and they came up and then drifted down again - very unusual for me.

My I:C ratios have been stable for quite sometime, and I also noticed in the last couple days I was going down 20 points after my lunch or dinner. Also unusual. Then a couple times I noticed I overcorrected, and went low using the same ISF (1:30) I’ve used for a long time. I’ve never overcorrected, I’m very conservative!I’ve kept track a few times and see that my ISF is resulting in more like 1:45!

Then last night I changed my set close to bedtime (yeah I know I shouldn’t). I was at 48 at night so I corrected and was 84 before bedtime. I woke up this morning at 34!! 34!! That is scary. Doesn’t help that I’m almost out of glucose tabs and will have to make a run to Walgreen’s today.

So what could be going on? As I type this I realize it seems like all of my insulin seems to be working “more”. I actually posted this in the Animas Board and then after I read it wondered if it could be a LADA thing, like an insulin spurt? I’m at 3 1/2 years since diagnosis, 2 on insulin, but I guess it is possible.

Any ideas?

Have you opened a new bottle of insulin? Is this current site in a “faster” area of the body. Both those things along with any increase in activity will cause my numbers to be a bit lower. I will adjust my basals within a certain parameter if I find I’ve got an aggressive site working.

Sorry I have no advice for you as this is all so new to me but I hope you get it figured out soon you must be a nervous wreck! That would really scare me, especially with not having an explanation. Are you liking the pump better than MDIs?

No, no new bottle. I actually extracted some from a pen that I’ve used before because I’ve been running low on my vials.

I’ve actually been using my thighs instead of my stomach which I assume is a slower area. I haven’t been walking a lot as it’s been pouring here. But I will think about the sites as more of a variable. It seems the lows started several days after I started using my legs. I definitely will do some temporary basals until whatever this is straightens out. Thanks.

Thanks, Jenn. No, I’m not a nervous wreck, it kind of comes with the territory, though that 34 at waking was a little shocking.

The pump is a major learning curve and I’m still working on it, but even given that, yes, I like it a lot. Like many others I couldn’t imagine going back, which is what keeps me still trying to work out the kinkds.

Hi, Zoe. I was diagnosed 17 1/2 years ago, had Diabetes for years before that, LADA for sure. From the beginning, the patterns have shown that I make insulin from about 11:00 AM to 3:00 or 4:00 PM. That means that both on the pump or on MDI, I have to give myself very low basals during those hours. The only thing that I could suggest to you from my own experience is to keep a complete log to discern any patterns showing when/if you are making insulin. The advantage of the pump is that you can program accurately for any such time period(s). Good luck.

Hi Zoe. I have been using a a minimed pump for 11 years. When I change my pump at bedtime I too get really low sugars in the middle of the night, I don’t know how the animas works but on my pump I was priming too much insulin after changing the set. I was using 3 units instead of .3 units. ( I misread the instructions. ) Another suggestion is to avoid changing your site before bed. Try to do it in the morning or sometime during the day so you can monitor what is going on.

When I tweak my basal rate I have to consider the length of time takes for insulin to work in my body when deciding what time to tweak the basal. I have to tweak the basal 2 hours before the time I want to correct.

Also, I keep a small can or bottle of regular soda (sweetened with sugar) by my bed so that if I wake up in the middle of the night with a low, I can drink the soda to correct.

Hope these ideas are helpful. Ultimately it is a good idea to check with your Endo or Diabetes educator for suggestions. They are really good at spotting the problems when they look at the data from your pump.

Wow, Trudy, that is fascinating! You are still making significant insulin 17 years later! I had .38 and .70 c-peptide (two labs) two years ago so I assumed I wasn’t making any at all anymore. Also since I started on the pump I really believed that to be true. I had a site go bad sometime during the night one day and woke up at 175 (crazy for me). By noon I was in the high 300s! (Higher than I’ve ever been since I started on insulin).

That’s a very interesting idea that I maybe make insulin during certain times. I definitely have had to set different basal rates different times of the day/night but I assumed everyone does that. And this pattern wasn’t going on consistently until a few days ago. But on MDI I found every few weeks I had to shift my basal up or down a few points so maybe I am producing sporadically. I wish it did have a pattern. I LIKE patterns! LOL

I don’t have an endo or diabetes educator, Den, Just me. LOL. That’s why I come on here and use the combined wisdom of so many other diabetics. Thanks for all your suggestions. I have to get on Skype shortly but I want to read over yours and the other posts so I can think things over a bit more and see what applies. Off the top of my head the "changing the set too close to bed sounds like a culprit. I had thought that danger was from highs, but I see it can be lows as well. That helps me to hear that happens to you, too. (sorry it does!). Maybe I’ll treat this morning’s severe low as separate from the other patterns, and just keep tweaking.

I keep glucose tabs next to my bed and need to make a store run today because I’m out!

These lows are getting to be all the time, not in one particular time frame. Like this morning I ate a breakfast I’d normally bolus 4.55 for, I bolused 3.50 and went down 6 points 2 hours later. At the 3 hour mark after a leisurely walk (to Walgreen’s for more glucose tablets!) I’m now down to 56. I can’t see it as anything more than my body just all of a sudden producing insulin or being more insulin sensitive. Any other thoughts that I’m missing? I’m usually very good at problem solving and tweaking numbers but this one puzzles me!

I can only go by my own experience. I did become more and more insulin sensitive with time. If it were me, I’d decide to further lower my bolus ratio of insulin to carbs. After three days, if there is still a problem, lower the basals. Or vice versa! Small amounts, not both at once. But you will get good results in the end, I’m sure.

Zoe, I find that the insulin absorbs more "expedientely " if I use my legs as infusion set sites. I have to take from .05 to .10 units less per hour if I insert in my legs. On a particularly active day, the leg i nfusion set will will throw me in to a hypo tailspin . Plus I find I have to tape the quick set dwn to keep it on my leges or thighs, and sometimes it will still rip out… On multiple days If I am sick and bedridden. or just lazy readimg a book or on the internet for several hours ( an inactive, 3-dog night winter cold weekend) and have to up my basal rate any way, I will usemy legs.

I find that I need about 20 -25% Less insulin on the punp than on the needles. That is to be expected, and did read somewhere that the nature of pump therapy is that “the highs are HIGHERr and the lows are LOWER” I have found that to be somewhat true, particularly in the initial months it took me to get used to it… The learning curve is LONG,Zoe, But you will master the pump and its intricacies.

God bless


Thanks, Trudy and Brunetta. Every single word everyone contributes gives me another piece of the puzzle so I appreciate everyone taking time out of their busy lives to share. I didn’t know that legs could be better absorbing than stomach! Most of my days are like your “3-dog nights”, Brunetta - the joy of retirement (or working only on the internet anyway). But I did notice the worst lows yesterday were the day the rain let up enough for me to walk the 12 blocks back and forth to the grocery (not mentioning round and round the aisles hunting my favorite ingredients. I don’t mind at all if I need to take less insulin, as long as it’s consistent. Yeah, I know, good luck with that!

My I:C ratios have been steady for soooo long, Trudy, that I think I’ll just do some rounding down for awhile and maybe lower basals a bit more until I see if this is a longterm change or short term fluke. That’s always the question, no?

Thanks Brunetta, for reminding me it is a LONG learning curve. Maybe that is the most important thing I needed to hear! I was prepared for a learning curve, but to me a month of learning and I think I should have it down! (Being facetious). I’m actually down to 25% less on the basals, but I’m going to lower it a tad more at least for now. Thanks both of you for the vote of confidence, I’m nowhere near giving up because I know what a great tool the pump is, but it can be frustrating.

I can’t find the pages right now but John Walsh also says it can be like 6 months until you maximize the effects of using a pump and he also says that it is a tool that anyone can get good results with once the do that.

This may be a strange question but sometimes several days before I am going to show that I am sick my blood sugar will start acting strange. Could go high but sometimes I could also starting going low.
Were you getting the flu or infection?

I have always problems with my glucose control in the change of seasons. This coming from minus to plus temperatures is triggering a change in my body. As if I am going from heating back to cooling mode ;-). It is also the different activity pattern that will burn more glucose per hour it seems. With your pump you can make a quick test. Just use the TBR feature and turn down your basal profile to 90% of normal. Within one or two days this should reduce the rate of lows. Then you can decide to create a new basal profile.

Thanks for the input. No infections and no change of weather (I live in the Bay Area so changes are pretty mild). It’s always interesting when a thread pops up again awhile later, because you can see how things have changed for you since then. I continued tweaking my basals and now only have the occasional high or low from the “whatevers” of living with type 1. I think I had underestimated that it would take a couple months to get my doses stabilized!

So glad to hear everything is working well (as well as it gets for us). It took me awhile to get everything straight once I started the pump a few years ago. Now I only occasionally (few times a week) get any surprise from what I expect when I test.