I don’t think I’m insulin resistant, just carb sensitive. I’ve noticed this sensitivity increasing recently, perhaps it’s due to LCHF? My diet is pretty liberal, though (60 or 70 carbs a day). Here are some examples:
My bg reading was 3.9 and I ate 1 (one) glucose tablet. 4 carbs. About half an hour later my reading was 7+ and rising, according to my sensor… I had to correct to prevent it from going too high.
Before I went to bed it was 4.3 so of course I panicked about going low overnight… I had one tootsie roll (5g carbs) and it rose to 12 and stayed there overnight.
yesteday I went low at 3am so I woke up to eat 1 glucose tablet… also a cookie… ~10 carbs in total and I even bolused 0.6units (not wise to do while low, I know) in fear of a spike later… well it rose to 12 and in the morning lowered slightly to 11.6
So now when I’m low I just take 1/2 of a glucose tablet and wait it out. Extremely difficult since all I want to do is eat more…
My basal rates are quite low (17.8U/day) but my insulin:carb ratio is just ridiculous… 1:5 or 1:6 depending on the time… No idea why.
My carb sensitivity is bad, but yours sounds like it is worse.
Early on in my diabetic life I did a couple of tests of a single glucose tab when I was on the verge of going low, like you did. My BG went up 32 - 40 points in one hour, so I calculated that I could likely assume that one gram carb would raise my BG 8-10 points. On that basis, I decided that unless my BG when tested was lower than 40 or I had reason to believe my BG would go lower than when I’d tested (like if I still had insulin on board or given myself Novolog instead of Lantus by mistake) that there was no need to take more than one glucose tab. So that’s the rule I’ve followed since.
My rule for myself is that a glucose tab doesn’t need to raise my BG to more than 70. After that I can wait for my next meal if it is to be soon, or I can decide what “real food” might be best to tide me over until the next meal. By waiting until I’m over 70 to decide, I don’t decide in a panic, when decisions are likely to be poor.
Like you, I often take just half a glucose tab when low, as that will raise my BG by 16-20 points.
My basal rate is a mere 8u per day. Depending upon which fast-acting insulin I’m on at the time, my I:C ratio is between 3.5 and 5:1 for breakfast and 7 or 8:1 for dinner. Yet my correction factor is 42.
Any idea why you went low in the night? I’ve tested my basal dose and adjusted it so it keeps me almost dead level all night, so I’ve only had one low at night in approaching three years on insulin, yet I have an A1c in the 5’s on MDI. I’m an old-timer, though (age 74). If you are much younger, especially if you are in your teens or early 20s or a woman up to about age 50, I think keeping a stable BG through the night is much harder.
Thanks for the reply! You sound like you’re in very good control… Yes I’m in my teens so hopefully after a few more years everything will stabilize. My correction factor is usually 1:2 or 1:3, depending on how high I am, but typically it’s 1 unit to 3mmol ( 54 mgdl). So obviously I’m not insulin resistant just very sensitive to carbs…
I think my basal rates are causing me to go low. I’ve adjusted it, will need to check it tonight.
Bernstein suggests that a normal weight person will have their blood sugar rise 5-10 mg/dl for each gram of glucose. I call this the Carb Ratio (CR). I suspect that it is very much dependent on your weight (or blood volume).
When testing to see what your Carb Ratio (CR) actually is you need a controlled test. This test should not be done by have a low. I should be done with a normal fasting blood sugar when it has been like 5 hours since your last food or rapid insulin. If do the test when treating a low you may get confusing results as your body may release glucose as part of a counterregulation response. Simply take a precise amount and measure how much your blood sugar rises at it’s peak. Even this test isn’t necessarily accurate as your basal and other regulation processes may affect your response.
It is also possible to estimate your carb ratio from your ICR (insulin to carb ratio) and your ISF (insulin sensitivity factor). Simply divide your ISF by your ICR. If your ICR is 1:5 and your ISF is 50 then your CR is 10 mg/dl/g which is pretty normal. If your ISF is 150 and your ICR is 1:5 then your CR is 20 mg/dl/g which is quite high.
John Walsh in Using Insulin gives different figures, and that’s what I’m basing my “higher than average” conclusion upon. His chart is based upon weight. If your weight is and 1 gram carb will raise you about
50 lbs (23 kg) 8 mg/dl (0.44 mmol)
75 lbs (34 kg) 7 mg/dl (0.39 mmol)
90 lbs (41 kg) 6 mg/dl (0.33 mmol)
120 lbs (55 kg) 5 mg/dl (0.28 mmol)
160 lbs (73 kg) 4 mg/dl (0.22 mmol)
200 lbs (91 kg) 3 mg/dl (0.17 mmol)
Who’s right? Both Bernstein and Walsh are seen as authoritative. Walsh didn’t give the source(s) of his figures. Did Bernstein?
I’ve seen the average adult’s BG increase listed elsewhere as 4 mg/dl per gram carb a number of times, but they never say where they got their information either.
Agreed! I did my tests first thing in the morning when my BG happened to be in the low 70s. My terminology “on the verge of going low” was a poor choice of words as it could be interpreted as treating a low in the making. It wasn’t. “Low normal” would probably be a more accurate phrase. I don’t like doing a test like that when my BG is higher, since I prefer not to raise my BG too much without taking insulin.
The OP’s BG of 3.9 mmol/L was also not a low either, as I interpret “low.” Close enough to consider treatment if he/she was nervous about being that close to a low, though. I didn’t think about the fact that she might have interrupted what might have been a low if she’d let it continue, though, so you are right. That probably wasn’t a good test.
The correct way to approach any expert advice is to take what you can use and leave the rest. Bernstein’s figures, as with everything he writes, are based on the empirical data he accumulates treating his patients in the real world. So the makeup of his patient population determines what data he can collect. I don’t know that Walsh arrives at his figures in the same way, but it’s a good bet. So unless their patient populations are exact, perfect mirrors of one another, the numbers can obviously come out looking different.
This just illustrates—again—the basic principle that dominates everything concerning diabetes: individual variation. “Your diabetes may vary” is a mantra that should always be kept in mind. My results may be (probably will be) different from yours for any particular metric.
The bottom line is that each case is individual and you have to determine what the right yardsticks are for you. If your numbers don’t fit the bell curve—so what? They’re your numbers. For whatever reason, they are what they are, and your strategy must be based on what they are.
I’m the same way. The 15:15 rule makes me laugh! For a normal low (40 -60) I eat 6 carbs, one roll of smarties, then wait 20 minutes to retest. Under 40 I’m not able to make sound decisions and will eat everything, resulting in a high that needs to be corrected.
On the other hand, my correction factor is around 1:100.
my correction factor is, 1:000, for me, a normal low, (40-59) i eat about, 5 carbs, & i wait, 20 to 30 minutes to retest, if i’m under, 40, I’m, can never, make, a decisions, so i want to eat everything, but i try hard not to, but sometimes i do,.
