Dangerous Lows, even with the Pump and Sensor

My sugars are dropping so quickly lately and I cannot feel it until it is too late. Oh, and that CGM Sensor that I pay good money to wear all the time and continuously ruins my skin? Yeah, that cannot keep up either. NO WARNING equals NO CONTROL.

Three days ago, I spent 3 hours below 45 despite eating pizza, fruit snacks, juice, milk, and toast with peanut butter. My body was so exhausted after that, but I kept pushing onward.

Two nights ago, I could not sleep and finally checked my sugar (75) and had a little juice. I went back to bed and laid there until 3:30am when I started having delusions and freaking out. Blood was 31. My poor dog did not understand why I was yelling and crying and laying on the floor. Some more juice and a protein bar brought me up after awhile.

Last night, around 4am I woke up and was low again. I had a brand new jug of juice and tried to open it… with a knife. Why a knife? I have no clue. Maybe someone else can fill me in on that thought process? I ended up with a knife sticking out of my hand and still no juice.

I am so afraid of going to sleep tonight. I should not have to live in fear of myself.

I think the really sad part is, I currently have the best control over my sugars ever (A1c of 6.4) compared to the rest of my 12 years of T1DM. Obviously, this is due to the large amount of lows. However, my lovely diabetes care team does not seem to comprehend this. My basal insulin makes up 77% of my daily insulin average! I remember reading somewhere that it should be more like 60/40, but now I cannot find that source. Anyone familiar with the basal/bolus ratio recommendations? I would appreciate some feedback. I need someone or something to back myself up at the appointment in a couple weeks…

hi jessie,im type 1 for 35 years now and i just started on the Ping pump,my Endo wanted me on the pump because of all my lows with multiple injections but i have had soo many lows this past 2-3 weeks so i dont get it? whats the point of the pump?

I was put on the pump for lows as well. That was over 8 years ago. Statistically, the pump does reduce the number of dangerous lows… but that means it is an AVERAGE benefit. Some Endos forget that part and just assume that the pump will get rid of the lows for everyone.

I recently switched Endos (and I am hating the new one, UGH) but my previous was so great. She really helped me see that my rollercoaster blood sugars (low, high, low, high, low in one day… I’m sure you understand) were started from an over correction at the beginning of the day and then playing catch up for the rest. The pump leads to SO much over correction because I become obsessed with my sugars. That constant reminder in your pocket can make it so hard to turn off our minds. I would recommend that you contact your Endo every 2 weeks until you work this out… but I know that is relatively impossible (my current Endo refuses to discuss anything with me outside of a doctor’s appointment, no phone calls, no emails, nothing). I have taken matters into my own hands and reduced basal rates by VERY TINY amounts. However, I have been doing this for 8+ years and I can usually tell if it is basal rate, bolus, or insulin sensitivity. I have a basal rate “test” you might find helpful… Basal Testing

Good luck and I hope you have better communication with your Endo than I do!!

thanks jessie…what pump do u have?

i used to wear the dexcon to tell me when i was going low or high and it bever worked. I know what u mean about all the lows. The last few days i have been running in the 20s,30s and 60s. I would wake up and be shakeing and then would check my self and be 23. Than today after schoool my mom dropped me and my younger brother off at our house and she went to the store. I started to feel dizzy and cheacked my self. 28. With my brother who is 2 years younger then me and his older sister who is 28 and out of it must have been kind of scary for my brother.

I have the Minimed paradigm. It’s a crazy good tool, especially when I can use the sensor and actually see what’s going on… but there are always bad days.

My younger brother and sister have similar stories watching me low and out of it, Anna. I have apologized to them multiple times for those scary experiences… but they saw me and are now trying to help in their careers. My sister went to school and now works with veterinarians and helps diabetic animals. My brother is going to college this fall and wants to be a doctor or maybe sports medicine (he loves sports and he has seen my horrible lows, with seizures and vomiting, after exercising).

I always wanted to protect my siblings from my diabetes, but they were trying to protect me from it too. If only we could have supported each other through the process… maybe we wouldn’t have felt so alone in our troubles. I am so sorry you are going through these lows too. IT REALLY SUCKS!

I used to have really bad lows, and for me I really didn’t want a CGM of any kind. Alternative? Diabetic alert dog! I got mine, Shyla, last summer and she’s AMAZING! Plus she can do 2 things the CGM’s can’t: 1) go get help if my blood sugar wont come up fast enough and 2) alert me up to 20 minutes BEFORE the low or high happens, which gives me time to prepare in case its a low (she alerts to highs too).
I’m not sure if you’re that much of a dog lover (you said you have a dog, so I’m guessing you like them) but if you are, an alert dog may work well for you.
I’m also pretty hard to get out of bed, but if I’m having a low, Shyla will stop at nothing to make me get up and check my sugar. She’s done everything from whining/barking at me to sticking her cold wet nose in my mouth to jumping on me. If someone happens to be in the room with me (friend spending the night or something) she’ll wake them up, too.

I have had my share of lows that won’t go away for hours. I tend to really bulk up on the protein but it does take quite a bit to work. The pump can help reduce overall number of lows but does not really rid you of the problem. I know my doctor was convinced a pump would get rid of most of my lows. I am here several years later still having a lot of lows but blesssed to have my diabetic alert dog Dutchess. I have also had seizures from lows as well. So i really understand the struggle. I know when im stressed out i have issues raising my blood sugars back up. There is so many things that can cause the blood sugars to stay low. Glad to hear you are trying to tweak the basals that can help sometimes.

My endo wants me to be on a 50/50 of basal and bolus…but that doesn’t work for me. If I listened to them I would be having the same problem as you and defensively eat (not good for weight control either!) They have learned in the short 3 years I have known them that I know my body best and they let me do what works.
My lows now are only from misjudgingIC ratios and food guessing.
I have athe Omni Pod, works fabulous (I did not want to pump but was forced due to my pregnancy. Kept it because it was too much of a pain to revert toMDI).
I would suggest doing a food log for at least a week. Eat the same thing with known carbs so you can judge if your ratios are good or even iff your basal is good.
Set your alarm for 3am and check too. Expect to test more than 8 times a day when figuring it out. I test about 10 times a day if things seem out of whack.
Your endo should be more concerned about these lows.
I am sorry you are going thru this.

Basal/Bolus recommendations are based on a particular diet (ADA) which contains 45-65% of calories from carbs. If you are following a low carb diet, you will likely have a higher proportion of basal insulin in your total daily dose. However, you can run your basal higher and eat to cover your insulin and result in a higher basal. That can also be a recipe for weight gain. So let me ask you? How many grams of carbs are you eating?

Also, the hypos you describe are hypos at night, a prime time for basal to reak havoc. Given what you have said, I’ll presume you have your basal set correctly, but in my mind it would be the first suspect. One thing that can make life a nightmare is exercise at night, which can lead to hypos a few hours later. Did these events happen after exercise or a particularly busy/active day?

And as a final note, the symptoms you describe are indicating a highly variable insulin effect. If you have really been on the pump for 8 years, you may be starting to have some scaring. Do you rotate your sites well? Have you noticed any hardening?

I love all of these suggestions so far! I was originally going to attempt training my dog to alert me (WAY too much work for an already busy grad student, unfortunately). My grandma has a service dog for her Menieres and she has given me loads of information. I am super jealous of those of you with diabetes alert dogs!

BSC, thank you SO much for commenting. I think I get about 180g carbs a day. Is that typical? I know that my basals were set originally higher when I saw the pediatric Endo because he did not trust me to enter all the carbs… so it has become a strange cycle that has turned me into a muncher. I usually eat multiple snacks throughout the day and typically see my numbers dropping around 4pm, I will eat a larger meal around 6pm, and again will see numbers drop around 10pm. I think you are right on in saying it is a recipe for weight gain…

As for exercise, I walk (25 minutes) to school in the morning and walk back (25 again) at that 4pm low. I then feel like I have to play catch up with my lows all night long.

My hardening and scarring has been reduced since switching to the silhouette set, as I can adjust the angle of insertion. I have difficulty rotating to new sites because the sensor takes up room as well, so I will be extra careful with my site selection and hopefully that will make a difference. Thanks again!