Hypoglycemia and sudden need for less insulin

Hi, everyone. This is my first post on here and I'm not really sure where to start. I'm 24 years old and have been a Type One Diabetic for 6 years. I use an OmniPod pump and a Dexcom CGM to manage my diabetes.

Over the past few years, I have noticed an increase in my A1C and my insulin intake at every doctor's appointment. (Mind you- I was diagnosed with an A1C of 6.7 and my last one in December was 7.3.) I watch what I eat, exercise regularly, and still can't seem to lose weight or get my A1C back under 7.0-- but that's for a different post.

I saw my doctor in the beginning of February and she raised my insulin to carb ratios, basal ratios, and correction factor again. (Slight changes to adjust for my 200s that I'd been having after meals.) Everything was okay and my numbers were stable for about a week. Since the week of Christmas, I have had severe hypoglycemia that I can't seem to control. I have called the doctor twice, have had my numbers adjusted, and am still seeing the hypoglycemia. I'm 30-40 constantly after meals and I am having random lows throughout the day. I tried setting a temp basal for exercise, but that didn't work and I can barely walk a block without seeing a decrease on my CGM.

Side note-- I had my thyroid check and my TSH was normal-- 1.82. (My doctor didn't run a T3 or a T4.) Since that came back normal, she wants me to have a PCOS work up and have my prolactin levels checked this week.

I am so frustrated with the lows. I know that I might not be able to "fix" them until I know for sure what (if anything) is going on with my body, but it's exhausting to try my best and still be low at every turn.

Does anyone have advice? Has anyone been in a similar situation? I'd really, really appreciate any help.


I know I'm rambling by now, but a few other notes-- I am exhausted, have headaches constantly, been having trouble losing weight, and haven't had a period for 8 weeks even though I'm not pregnant.

There may be many reasons for this and it's good that you're checking with your doctor.

I've found that one of the common reasons for me to start running higher or lower blood glucose levels is due to a basal rate need that changed and I failed to change my pump basal setting in response. Diabetes is a dynamic disease and we need to learn how to respond in a timely manner. In the past I've often stuck with old basal rates for far too long.

Have you ever run a basal rate test? I've found that my insulin needs change and if I stick with old basal rates then my control degrades. It sometimes trends high, sometimes low.

Gary Scheiner's Integrated Diabetes site shows his protocol for basal rate testing. I've used it and it works. It does take some patience and persistence, however.

Succesful insulin pump therapy is built on a foundation of well-calibrated basal rates. This may not be the source of your problem but it's a common one. Good luck!

I have had so many lows it was ruling my life. I had nocturnal lows, especially after exercise. It has been very severe at times of my life, and less so, at other times....

I suggest you read about adrenal fatigue. I am treating myself for it. I have had many problems with sugar that seem to worsen with exercise. If you google Addisons and Hypoglycemia you will see the effect of adrenals on blood sugar.

I go for the alternative medicine route.

Some things to investigate regarding sugar control
1) Dr. Bernstein's low carb regime for diabetics and his book (the Bible for BG control)
2) adrenalfatigue.org The book helps a lot with understanding relation between BG and adrenals.
3) hypoglycemia associated autonomic failure. This ties in with the adrenal fatigue theory.
4) adrenal, thyroid, hypothalamus glandulars as treatment.

Also, you could be having gastric problems. Things to check into for better food absorption:
1) pancreatic enzymes
2) oxbile
3) apple cider vinegar
4) betaine HCL with pepsin

5) quality probiotics

I can certainly go into more detail.....if you are interested. Believe me, there is no easy fix and I am a work in progress. I am just at work, not proofreading my message too well. Feel free to contact me for more info.

I have had significant blocks of time over the years where my basal needs have changed. In my case, I have gotten to the point of making the changes myself on an as needed basis. My endo gets a fresh basal rate listing at every appointment (if necessary).

Not having a period for 8 weeks would suggest(?) that there may be other issues that could be impacting your blood glucose levels, so I would keep working with your doctors to find solutions.

If I were having constant lows though, I would start lowering my basal rates as well as changing my I:C ratio. 30 - 40 after a meal means you are getting too much bolus insulin before the food is getting into your system (could be a digestion problem?). If that is coupled with too much basal then it is a double whammy (as I am sure you are aware). Headaches can be a direct result of having frequent, wild, blood sugar swings.

Is your doctor the one adjusting your basal/bolus insulin still or are you making corrections as needed? I agree with Terry about doing basal/bolus testing and making adjustments. Dr Bernstein's Diabetes Solution has some good information. His approach is controversial, but the book is a good read. Also, cutting back carbs temporarily would make BG management easier until you get things controlled.

Maybe it is a hormonal issue, I would do the testing to see. And reduce your insulin basal and bolus to try to cut back on those horrible hypos.

Just an added note. I was complaining of changing basal rates for years in my 30s. There were no answers provided, and very little investigation done by the medical system here in Canada. A lot of shrugging did take place and a suggestion to accept it and wait it out.

I exercise regularly, eat clean and fairly low carb. In my thirties, my problems may have resembled yours. As far as monthly cycle,it was erratic at the time (sometimes 8 weeks, sometimes 3 week cycles.) I felt that the more I exercised, the more fat I put on, due to hypos.

I went to the specialist for years trying to figure it all out. Headaches, changing basal rates, severe nocturnal lows and eventually fatigue. The lows were worsened with exercise. It got to the point that I was hardly needing insulin to paint a room all day (light exercise.) I was tested and had zero production of insulin, because it seemed suspicious that I may be producing some. I ended up setting the alarm a couple times per night so I could check my sugar before the severe lows hit me, even on as little as 12 or 15 units per day- total insulin. There was no help or explanation available. The nighttime lows, I believe were causing brain injury, and severe fatigue set in.

I was fine for a few years, taught Zumba and continued teaching school. Now, at 45, I find my instability is back, so I am back to treating adrenal fatigue. The fluctuation of cortisol goes up with treatment of adrenals, which puts my basal insulin needs up, but more steady. The hypos are decreasing and have not reached the severity of my last problem run (around 10 years ago.) I am very tired and I seem to be very sensitive to everything (exercise, food, stress, sleep changes.) Blood sugar is steadily becoming more predictable and my insulin needs are climbing. This is over the course of 8 months now.

My insulin dose is around 35 units while eating low carb and remaining active. I have gained about 20 pounds and I am patiently waiting for that to go down when things stabilize. WIth the way I am eating, it should be falling off me! As much as this should not be a priority, it is pretty frustrating.

What happened? I am only making educated guesses. For one thing, I think my pancreas has not been producing adequate enzymes (makes sense for type 1 diabetic.) This is exhausting and affects food absorption. When my sugar is low, it sometimes does not come up very quickly. I believe this is due to malabsorption problems. I think digestive problems tired my entire system which may have caused adrenal fatigue. Although the adrenal fatigue may have been there the entire time.(?)

I have consulted with message boards for diabetes, Naturopathic Doctors, read books like Sara Gottfried's "The Hormone Solution", Eric Berg's "The 7 Principals of Fat Burning, and listening to podcasts by John Bergman to better understand our hormonal systems. Some of the best help I received came from a Dynamic Blood Analysis/ Live Blood Analysis which pinpointed low magnesium and some of the malabsorption problems. Also, my consultant had some excellent sources for supplements and glandulars. It is a relief to find people with similar issues.
I had my saliva cortisol profile tested by my ND, which showed low cortisol for most of the day. High cortisol results in insulin resistance, low cortisol results in insulin sensitivity. Some suggestions I have not yet pursued: checking into celiacs and milk allergy. Some have suggested this is my problem. Much of my research shows that Paleo eating is best for metabolic problems. Since I hardly eat bread and only some cheese, I have put off this line of reasoning. I am also afraid of the commitment of absolutely no grain or milk. Low carb is enough for now. If I cannot stabilize, I may just try this route in the future.

If this sounds like you, then check into some of my treatments. I could find nobody to help when I had all the lows. All I could do is spend days poring over studies and researching hypoglycemia.

I have had my basal requirements drop out abruptly several time and then eventually recover to a higher level. It comes with the territory.
Do you have a copy of Think Like a Pancreas by Gary Scheiner or Pumping Insulin by John Walsh? DO you use a CGM? The books will help you understand the how, when and why of adjustments to all of your pump settings.
Take the time to do basal testing, followed by checking your duration of insulin, correction factors and IC ratios. Knowing how to do this sadly yourself will let you stay on top of changes as they happen to you, rather than waiting for a doc to make adjustments periodically.

Lets see the Dexcom data, if you feel comfortable posting it. Ten years ago, when I was 22, I lost 20 lbs in one month, but I didn't notice the change. This was before I was educated on how to adjust my basal. I completely stopped taking bolus and was still getting low all the time. I wouldn't worry, in the immediate term, about whats causing the low bg, maybe just drop your dosages back to what they were before and see if the problem resolves itself. Persistent lows are a pain. I think you can fix them without knowing, precisely, what physiological change has happened.

All of my bloodwork has come back and I have PCOS. I'm not sure where to go from here, but at least I have an answer! Thank you so much for all of your input!!!