Going low after the same meal with the same bolus

It’s been 1 month since starting my T1D journey and this morning I had a “first.” I’m on MDI and trying to learn my body. Today I ate the same breakfast that I ate yesterday, with the same bolus I used yesterday. However, this morning just after the start of my usual post-breakfast BG rise, I tanked from 125 down to 53 in about 30 minutes. My question is, what factors could have contributed to this unexpected low?

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Welcome to the diabetic community! As your journey begins, you will find lots of information here to help you on your way.

What you experienced with your breakfast has happened to probably all of us, so first know that you did not do anything “wrong.” Your body is just getting used to this new state of being, so expect to see lots of changes as you learn your new routine of self-care.

As for why that dose worked one day and not the next, no one has a definitive answer to that. Possibilities include what kind of activities you did just before or just after the meal, how absorbent the tissue was where you chose to give yourself the injection, what kind of mental or emotional stress you might be under today that is different than what you had yesterday, what time of the month you are in regarding hormones, how restful your sleep was last night, and probably hundreds of other variables that I have not mentioned.

The important thing is that you pay attention to what is happening, start to recognize patterns, keep trying to do what does work for you, take care of the lows and treat the highs, learn each day as you and your body adjust what you need to do, and understand that the more you learn, the better control you will achieve. We each are unique in our own needs and reactions to medication, but our communication with each other and with our healthcare professionals are our best chance to lead a happy, healthy, “new-normal” life. You are not alone, so keep on learning and keep in touch.

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Welcome to TuD, @Leah4! Congrats on your curiosity about your diabetes health.

Don’t despair but glucose levels don’t depend on insulin and food alone. Myriad other factors can and usually do complicate things. Sleep status, for example, can play a role. Compromised quality or quantity of sleep can cause another hormone, cortisol, to be released, which in turn causes insulin resistance.

Your insulin resistance can go up and down. It makes controlling blood glucose with insulin a less than certain enterprise. Stress, monthly hormone fluctuations, and other factors make our glucose metabolism complicated.

Treating diabetes with external insulin is a dynamic game. That’s why many of us believe our CGMs are a required piece of tech. They not only allow us to respond to our daily glucose variability but also to learn our own unique metabolism.

I don’t mean to discourage you! You can (and probably will) learn your own patterns and get better at anticipating your changing insulin needs.

I use an automated insulin dosing system (insulin pump + CGM + algorithm) to help manage this dynamic nature. It’s not perfect and can introduce its own problems!

I recommend writing stuff down. Keying info into digital devices works too. A daily journal is a potent tool. Good luck!

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Diabetes definition of insanity is “doing the same thing over and over again and expecting the same results!” :upside_down_face:

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Gosh well I hate to break it to you but diabetes is unfortunately an unending crash course on variability. My intentions when I was diagnosed four years ago aged 33 was, track everything, and then I can know exactly what to give for any meal. Haha! There are very general similarities/trends you can pick out from data, but the variability from hour to hour, day to day, week to week, month to month, etc. really makes you humble fast.

Of course, even us T1Ders live in a world of basic physical cause and effect. It can just be complex and therefore hard to know/unpredictable. But there are–good news–still things you can learn and patterns you can observe that can give helpful, if not fully accurate, understanding, and you’ll probably get a little bit better at it continually over time.

Biggest factor that makes me go low is physical activity. The effect is more pronounced the more insulin I take, both in absolute terms and relative to the carb amount of the meal. If I overshoot my unsulin even a tiny bit–a portion of a unit, say–I can go low fast if I do chores or exercise too soon after eating (so I try to account for physical activity and not do this–emphasis on “try”).

Other factors that can contribute are: what you ate before a meal on that same day; what you ate the day before your meal; how much exercise (or not) you did the day of and even the day before your meal; how many more (or fewer) carbs than normal you ate the day before; stress/hormone changes; accidentally giving too much insulin; bolusing too soon or not soon enough prior to eating; what other types of food your meal consists of; and…well, that’s all I can think of off the top of my head, but there’re probably more…

My main advice is: expect variation, then you won’t be disappointed; and, know that even with variation, if you stick with it and pay attention and try your best, you can still manage better than if you didn’t do any of that, for sure. You got this! If you’re like me, it’ll be easy to get frustrated/disheartened, but power through, your next meal is another time you have to give it another try… :slight_smile: :slight_smile:

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Hi Leah,
I asked myself the same question last night! And, I’ve been Type 1 for 45 years! There are several possible/probable causes but you will most likely never know the reasons with any certainty. The long walk you took on Tues may have significantly lowered your sugar x number of hours later. However, the same walk on Sunday may lead to a different outcome. At least that’s been & still is my experience. When I’m not angry & frustrated I remember that this is one of the hardest things to accept about treating Type 1. It just happens regardless of how diligent you may be. And, it will happen again. There are too many variables (stress, exercise, bolus, basal, carbs, etc., & too much that is not understood about the disease. Teenagers I used to work with often said, " Whatever." For me, it’s least stressful to say that & just move on.
It sounds as though you’re being careful, consistent, & trying to do everything right. Take pride in that & see if you can ignore the weird stuff that crops up from time to time.

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When I set my basal insulin rates, I might look at 2 weeks of data, and take into account the different reactions to the insulin that I have on different days. The trick will be to find a dose that doesn’t result in dangerous low or intolerable highs. The patterns change over time. Mine might change every 3 months, especially if my weight changes. Sometimes I go through periods where there isn’t a “perfect dosage,” and I just know there’s a lot of variability in the system currently. I just set it to something I can work with, knowing that my physiology/lifestyle will drift eventually into a more predictable pattern that is easier to work with. Sometimes I set the dose a little high, knowing that will result in a little weight gain, but fewer high BGs. Sometimes I do the opposite. Might depend if I can tolerate the lows or not. If I am commuting a long distance daily, then I’ll be more risk adverse and error on the side of higher BGs.

You’ll figure out what is right for you.

Know that if you have too much bolus on board, you might not see a resulting low until 4 hours after you took the shot. Extra bolus hangs around for a long time and it can take you by surprise.

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Have to say type 1 is a learning experience for all. Some days the heavens open up the angels shine down upon you and all is right with the world and other times hell opens up and no matter what you do you can’t get it right. Been a type 1 for 56 years been healthy with no problems, butttt some days no matter what I do nothing works. Bad infusion set , bad new bottle of insulin , getting sick aka cold. They, doctors , np can give you advice but in the end YOU are your own advocate to keep your self healthy. It’s tuff sometimes but we all learn from our body’s what works and what doesn’t. Sometimes I get sooo tired of everything but I like seeing the grass from the green side not the other way around. The best of health to you and keep the faith. Al

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