Insulin YOYO Roller Coaster

Today fasting was 290 at 0615 . Even took insulin correction before bed last nightat around 930.

At 0830 blood sugar sank to 59!! OMG!! What am I doing wrong? Breakfast was one piece of toast 17 carbs, two fried eggs. With 5 units of NOVOLOG.

Then called nurse, after devouring two pieces of candy and a square of chocolate, around 25 carbs total. She told me I did not have enough carbs at breakfast. Told me to drink juice next time

I think I may have taken two doses of Tresiba this morning. I keep it in upstairs bathroom. I am going to have to write down each day that I took it so I never double dose. Nurse thinks not Tresiba, that the 5 units of insulin this morning was too much.

I am feeling depressed. I am going to yoga over my lunch hour. I hope to feel better later. I am so tired of the yoyo and weight gain. I am determined to conquer this current roller coaster.

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Logging is important! We right now log all CGM/Pump/Insulin change outs and we log for purposes of testing meals for our son. I used to log SO much more, but I’ve “settled in” to the fact that Diabetes is a moving target. All we can do is our best from day to day and hope for a better day tomorrow. Don’t let it get you down! Try to stay positive and focus on the wonderful parts of your life!

Thoughts with you during this rough patch!

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A couple of questions for you:

  1. Do you know your correction factor (CF), i.e., how much 1 unit of insulin reduces your blood glucose? If you didn’t eat enough carbs and your CF is 50 points, you could indeed go low: 290 - (5x50) = 40!

  2. How long did you wait between your bolus and starting your meal? Starting your meal too late can also contribute to a low. This is a situation in which a CGM is a lifesaver!

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First of all, you’re doing nothing wrong. Learning your own body’s insulin requirements is a process.

How did you decide you should take 5 units for only 17g of carbs? That’s a very aggressive dose. When I first started bolusing I started with a 1:15 ratio (one unit for 15g of carbs). After a meal or two, it became clear that was not enough insulin. I then began changing my ratio until I landed on what was right for me.

Have you done any experimenting to figure out you insulin to carb ratio?

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they told me 15 grams carbs to 1 unit insulin. not sure this is accurate. how does one tell if accurate?

i bolused about 5 minutes before eating my eggs and toast! :slight_smile:

Your low of 59 mg/dL (3.3 mmol/L) after breakfast occurred when your 5 units of Novolog was peaking, so I agree with your nurse that the 5 units caused the low. In the past I have used two doses of insulin to control a relatively low carb breakfast with eggs.

I use an insulin to carb ratio of 1:4 in the morning so your dose would have likely worked well for me. Most people have a higher insulin to carb ratio which means less insulin. If your I:C is 1:10 then you likely only needed 1.7 units for that breakfast. If you wanted to cover the protein in the eggs, you might have calculated an additional unit or so delivered about an hour after eating.

You need to figure out your own I:C ratio, customized for you. You may need one for breakfast and another ratio for lunch and dinner. This is where personal experimentation can help you discover your actual needs.

Good luck. I’m glad you’re here!

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I’m a little confused. If that’s what they told you, then why did you take five units of novolog for 17 g of carb? Based upon 1:15, you should have taken one unit if you are using a pen and can only take full units.

As far as knowing what an accurate dose is, you can start with 1:15 and then see where you BG is at approximately two hours. If it’s high (say 180 or more to begin with, you can tighten up as you starting figuring things out) then you know you need more insulin per carb next time. If it’s too low at two hours, knowing that you still have a couple hours of the insulin being active (say 100 or less), then you know next time you need a bit less insulin per carb.

EDIT to add that it appears part of the five units was to correct the 290? As others have said, just like the I:C ratio, the correction factor also takes experimentation. One unit drops me 100 points over the course of a few hours.

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I feel your pain!

I think we all are destined to ride the rollercoaster to some degree while dealing with this chronic condition. Some days will be worse than others, but it really helps to develop your own toolkit so you can get off the scary parts of the ride as soon as possible.

I have a hard time logging, plus I consider the data I input into my meter to be plenty of log material, so having a separate log is just a redundant PITA.

Do you take Tresiba with a pen or syringe? Either way, you could try placing a marked, used syringe/pen needle next to the Tresiba AFTER dosing. That way you should know you have taken the dose. When it’s time for your next dose discard your marked sharp, dose with a new one and mark that one, leaving it as your reminder.

When taking corrections before bed, strongly consider waking up and testing during the night. This was especially helpful for me when I was first trying to set my basal rates.

I might have considered doing a second test in the morning if I was fasting @ 290 after an evening correction. For me, 5 units would have been about spot on though (but again, that’s me).

As others have asked, what was the timing between 5 units, breakfast and a reading of 59? One of the greatest mysteries we deal with as diabetics is the timing between insulin activity, digestion speed, our metabolic state at any given moment, etc.

I would strongly urge you to have one method to treat lows, glucose tablets or gels are my preferred method since they get into you the fastest (I buy mine in bulk). Others use smarties, or a combo of smarties and jelly beans. FWIW, most juices have a glycemic index of 50 which is much slower than the 100 of a glucose tablet.

Was the nurse saying you should have had juice with your breakfast? I can’t imagine many diabetics making juice a regular part of their meal—maybe Afrezza can handle that, but Novolog certainly can’t match that spike. If she was suggesting using juice to treat the low, I agree with @YogaO that there are more effective options—I like smarties and buy them in bulk and have the rolls stashed everywhere (the US kind, which are basically like tiny glucose tabs).

5u to cover 17g of toast at 290 seems like a perfectly reasonable dose to me (in the morning, that actually probably wouldn’t be enough for me, especially since waking up at 290 would likely indicate something weird going on). One possibility that hasn’t been mentioned is that the reading of 290 was off—if you get a really weird/unexpected reading, sometimes it’s worth it to test again (and make sure hands are clean and dry and everything).

Also, I’ve recommended it on here before, but if you’re concerned about taking your Tresiba twice by accident, I highly recommend Timesulin pen caps which show how much time has elapsed since your last injection. You can find them on Amazon for about $7 (you only need one and it lasts for ages).

Because my fasting blood sugar was 290! Chart said 5 units with 30 carbs so I should have done 4 units I think thanks

Sorry, when I first responded to you I lost sight of the fact that your breakfast dose was combined with a correction. I’ve heard Dr. Stephen Ponder, a T1D, referring to some highs as “hollow,” meaning it doesn’t take much to correct them. I’d highly recommend reading his book, Sugar Surfing.

He’s a pediatric endocrinologist with a sense of humor. His thesis is that diabetes is a dynamic condition. Applying static formulas and hoping for the best is not ideal with diabetes. Our metabolisms vary from day to day and hour to hour. Of course, his methods, work better if you use a CGM.

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Great description of diabetes! OK Will order Sugar Surfing form my library. Not only dynamic, with such a sluggish metabolism, prone to water retention and weight gain, feeling pregnant when I have not been pregnant for 18 years!! Now my doctor is ordering a diuretic. Wonder if this helps people? Just did yoga and feel so much better. Something with the steam and sweating it out helps reduce the swelling!

Hopefully tomorrow is a better day. I am going shopping for vegetables and meats and a bunch of new foods.

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I’ve been a T1 for 30 years (starting with gestational), after many scares of “did i take my morning or lunch or dinner dose”, I use a small plastic tray from (ironically) cookies! There are 7 sections. I put 4 syringes in each section, which is my normal number of injections per day. 1 syringe for my daily Lantus in the a.m., 1 each for breakfast, lunch and dinner. If one is missing I know I took it! It works for me and has given me a lot of peace of mind. When I travel I put 4 syringes in as many snack size zip lock bags with the day/date written on each.

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