Help, please - going out of control

Hi all,

My first post here, and unfortunately it's not really a positive - this is one to reach out and hopefully gain some of your experience to help me until I can get in with my Dr this week.

I have been REALLY struggling with endless hypoglycaemia. The first happened a couple of weeks ago when I went unknowingly high, and I couldn't return my BGLs to normal. Out of nowhere my blood sugars crashed and I was lucky to catch it while it was happening.

Recently, this has been unbelievably tough to control. I am hardly bolusing at all, and when I do bolus to correct I am going at about 25 per cent of what I used to for the same results/carbs.

For example, today I woke up, had breakfast and waited to see where I would end up. One and a half hours post prandial I had my spike (to 21mmol) and corrected with 2.6 units (I would usually have 4). My blood sugars came back to normal pretty soon after.

For lunch I had 40g of carbs in noodles and waited again to see if they would spike. This time, they didn't. It was like the carbs didn't even register. I went out with my girlfriend in the afternoon and saw a movie (had some popcorn) and waited again. Still, my blood sugars did not move one inch.

For some background:

Type 1 since October 1988
Insulin - NovoRapid (have been using it since 2000, in pump since May 2008)
Typical TDD - Around 40 units (20 basal/20 bolus)
Pump - Animas 2020 (since May 2008)

I am testing my levels around 30 times per day trying to monitor what is going on. As you can imagine, I am completely frustrated and worried about what is happening.

Any help would be so greatly appreciated. I find a lot of comfort in other Type 1s and hope that someone may be able to shed some light on this before I get in with my doctor or before I really get so frustrated I need to book a builder to repair some walls. :)

Thanks so much,


I find that noodles can be a bit odd as the spike is more like 3-5 hours out instead of a couple. I'm not big fan of them but will eat them and, as long as I sort of arrange things, I can get them to work out ok. If you're running that low all the time, there's sort of two possibilities, either of which or possibly both of which could be true: 1) basal rate too high. I usually check this w/ pre-meal #s. If it's low before a meal, and the last food bolus is gone, I turn the basal down .05U/ hour, try couple of days and see if the numbers improve. 2) bolus ratio too high. If the 2 hour post meal (and if you are testing after meals, you must have every 1/2 our or so, so plenty of data?) is low, then turn the bolus ratio down a click.

I don't totally ascribe to the "you can't eat noodles and need to eat only low carb" theory but I do often use that for a shortcut to get the ratio set more accurately quickly, since I find the margin of error goes down with smaller heaps of food.

So you seem to have identified two patterns that are causing problems. First, you had a high and despite correcting (multiple times?) it wouldn't come down and then you suddenly crashed. The second is that you havingn high variability in your bolus requirements.

This points to something along the chain that is causing high variation in your insulin delivery, absorption or effectiveness. So, let me ask you. How long have you been pumping? Do you rotate your sites diligently?

Until you figure out what is going on, as acidrock suggests, eating lower carbs can reduce blood sugar swings and reduce the effect of this variability. You can also experiment using a syringe and vial (or pen) to bolus for meals and correct and see if this can isolate the issue to your pump and insertion site.

Thank you so kindly.

I think you are onto something with the basal rates and ratios (my sensitivity has gone through the roof).

My blood sugars did not move all day after the noodles and tonight after one cup of pasta they went up 1mmol (probably within margin of error).

I reduced my basal rates yesterday to prevent the crashes and it’s helping a lot.

It seems my 9am to midday rate is on they money (spiked after breakfast without bolus), but perhaps my afternoon and evening need to be reduced more.

It really does suck sometimes not knowing why this is happening but your posts help me so much. Probably the first time I’m really suffering from management stress and fatigue.

Off to see my GP tomorrow and specialist hopefully on Friday.

Hi Brian,

Thank you very much.

I’ve been pumping for 4 years and I do change my sites diligently.

I have been wondering if it is my sites that have been causing the problem so have been rotating as often as possible (2 days over the last week for each site).

Again, have been feeling so lost recently and this is giving me much more hope and confidence that I can be back under control ASAP.

Hi MegaMinxX,

I have been dreaming of having a CGMS for the last few days - it would be a HUGE help! Unfortunately no CGMS trials in Australia are currently running and it is so expensive.

It’s 4am and I noticed my BGLs have dropped 4mmol since I went to bed at midnight - so the basals are definitely high. I am recording all the data and info to arm my endo with. I’ve just got to keep monitoring and making some adjustments as I go for now.

Life change - if anything a little less stress, but there were some changes to my life a couple of months ago - moving cities.

Now that I mention it, I moved from a minus winter climate to a Sydney summer - so my body is doing less to stay warm (possible influence on the higher results?). Mind you, before this winter I lived in Sydney for most of my life.

Many people find that change in climate or weather affects insulin needs. I have had the opposite issue recently where my insulin needs went up following cooler weather here in the U.S. Oddly enough they didn't go down the previous spring/summer when it got warm, but who knows. I sometimes have changes in blood sugar patterns that I can't explain. I always try though for awhile and then just do what I need to do to get numbers back in line. (My basals had ranged from .375 to .500 and now they are all .525 to .550; my I:C's rarely change). It takes what it takes, by I know unexplained lows can be scary, especially if they are frequent!

I have absolutely no scientific data to back this up, but I know there have been various discussions on here about some Type 1's perhaps retaining SOME beta cells. There are times just totally out of NO WHERE my basal/bolus rates will just go totally bonkers, and it's like either eat a TON of carbs to keep the blood glucose levels up, OR turn everything down really low. Like I said absolutely no scientific data to back that up though.

I've also have recently started taking ultram and flexeril for chronic low back pain, and I've noticed for me, those two medications really seem to make me more insulin sensitive. Weather changes also have some effect as well.

I don't super low carb, I shoot for around 30 to 40 grams a meal, for ME, that works out great, but I think there is a lot of truth to in the smaller the carbs, the less insulin you need to cover it, and you are less likely to run into problems. Diabetes is all trial and error, and what works for one might not work for all.

Hi Christy,
Haha yes, the thought of some beta cell function came to mind when trying to think about what it could be!
I think I might go for the low carb and low insulin option from now until endo visit.
I know what you mean now about basal rates going bonkers - I’ve had these rates since 08, with some very fine tuning from myself and my endo. I’ve never had to make changes like this before (obviously this has never happened!).
Thank you :slight_smile:

Lows are so exhausting. I've had a good few this week out of nowhere, forgot just how tiring the are. Probably have a week of highs to look forward to this week, who knows.

This happens to me sometimes too. Usually, it means I’m going to get sick - seems wrong, I know, but it happens. And then, as soon as you get everything adjusted correctly, your blood sugars straighten out and you’re flying high.

Have you considered a CGM? I use one, and find it so valuable, can’t imagine being without it.

Contact your doctor…that’s what they’re for. Take care.