That was not cool. I am only 1 month into being diagnosed type 1. I am taking Humalog before each meal. 10 at breakfast, 9 at lunch, and 8 before dinner. And 12 units of Lantus before bed. I have been having lows in the 50 range before lunch for the last week. Had one 45 after dinner one night. I do not like this at all. And am kinda starting to freak out. I thought I was having a gosh dang heart attack 30 minutes ago. Is this part of the honeymoon period? Could use any advise at this point.
It sounds like you might be having too much insulin for breakfast if you are having lows before lunch. I would advise you to contact your Doctor’s office and explain your situation. Are you counting carbs? What is your basal (background) insulin? Do you test your blood glucose before each meal and two hours after each meal? That is what I was taught to do. A low of 38 is not (in my opinion) part of the honeymoon period. Someone else might disagree with me though.
I had that problem to right off. I agree with Mayumi that it may be your basal insulin, which will need to be decreased if you have a significant honeymoon phase. The way to test this is to skip breakfast for 2 days in a row, take your basal normally but no short acting. This will give you an idea if you need to adjust your insulin:carb ratio, basal insulin amount or both. I have hypoglycaemic unawareness so I don’t feel low until about 35-40 depending on the rate of fall. Feel fortunate that you do feel low. Have some glucose tablets handy and don’t freak out when you do go low. Have a plan ahead of time about how you respond to glucose (how much they raise your BG) and write it down in your meter holder. I did this and it saved me having to think when my brain wasn’t working correctly and helped me from overtreating the low.
I’m 26 and was diagnosed T1 last May so I know what you’re going through. It takes awhile to figure it out and sometimes when you do everything correctly it will still go low or high depending on how you honeymoon is acting that day, hour or minute. Keep trying and you will do great.
Those amounts of insulin are HUGE for someone just diagnosed… my thoughts are you could probably safely cut your meal doses in half, and maybe scale back the Lantus a bit as well.
Talk to your doctor if you are unsure… I had lows in the 30’s the first week I was on insulin, because they put me on NPH and somehow missed stressing how important it was to have snacks at certain times, so the insulin was “peaking” and I wasn’t eating, however on MDI with Lantus and Humalog you shouldn’t be having lows that severe unless you’re taking way too much insulin.
It could very well be your honeymoon period. You may still have insulin production & it comes in spurts that cause lows. It takes a lot of constant tweaking to get doses correct. Humalog needs to be dosed according to carbs. If your meals are 4-5 hours apart insulin from the previous meal should be gone before the next meal, but this varies according to individual chemistry. Most people are most active in the afternoon & most insulin sensitive at this time.
Lantus has peaks that resulted in lows for me. Doctors will quote the pharm literature saying it’s level & stable, but it’s not.
What is happening to you isn’t part of the “honeymoon”. It sounds more like part of the learning curve and I recommend faxing your blood sugar readings to your endo or CDE every three days so that they can help you make initial adjustments.
Are the prelunch lows more than 3 hours after eating breakfast? If that is the case, you may need to cut back on your basal. If the lows are coming within 3 hours of a meal then your mealtime basal is the more likely culprit.
It sounds like you are on fixed doses of insulin for ech meal. That isn’t a good long term strategy but is certainly ok when you start out. I didn’t count carbs for about 6 months after diagnosis. But just because you aren’t counting carbs it doesn’t mean that you don’t have to match your carbs with insulin. If you are taking 10 units for breakfast every day, then you should be eating approximately the same number of carbs at breakfast every day. If you usually do OK with rice and vegetables for dinner, you can’t take the same 8 units if you are having just a piece of broiled fish and a salad.
If your endo or CDE won’t help you set your dose one month in you probably need a new endo and CDE. But even if they don’t help, there is no reason for you to have so many lows. If you have an unexplained low within 3 hours of a meal, cut back on that mealtime dose by a unit and then try the new dose on for 3 days. If you’re still going low, cut back again.
It takes a while to get the hang of it but it does get easier once you do.
I highly suggest you not only inform your endocrinologist, but lower every dosage! Have plnty of juice available - apple juice, orange juice, even a half can of soda. But you need to lower your insulin dosages. When you get that low, have some juice, even a glass of milk, with some carbohydrate, like peanut butter crackers. You should eat at least 20 minutes after juicing. Beware to not over do it! God Bless and Keep You Safe!
Holy Moley that is a lot of mealtime Insulin. When I was first diagnosed I took 1 unit per 20 grams of carb. So yeah, maybe back off on the Humalog until you can talk to your doctor.
Usually basal (Lantus) vs bolus (Humalog) is somewhere around a 50/50 split. Now you are getting 27 units of Humalog and only 12 units of Lantus. Unlesss you are eating a huge amount of carbohydrate I would venture to guess you are getting way too much Humalog. If it were me* I migh try something more like 5 or 6 of Humalog per meal and I would likely find that still too much if my true Lantus dose was only 12 units. Not sure if you are Carbohydrate counting or not but you might find that eating a consistent amount, at least until you find the right dose for you, might make the trial and error a little easier. If you do not feel comfortable with messing with these doses on your own you should call whoever prescribed these doses to you and let them know about your significant lows.
What is the 10, 9, 8? Are you giving us your insulin to carb ratio and not the number of units, correct? You are probably honeymooning, but either way this is a lot of meal insulin. How accurate is your carb counting?
I see endo’s prescribing insulin like this frequently thus I assumed it meant that this was the number of Units not I:C ratio.
Wow, that is a lot of meal time insulin. Personally (and we are all different) I don’t like to take 5 or more units with any meal because strange things happen, like the lows you describe. I limit my carbs a bit, but will often check again and take another dose rather than loading up all at once. My Lantus is higher though, about 20 units (well at least it was last week, this week I don’t seem to need insulin anymore – quite strange). T1 at 43 a year ago.
Since you are having problems mostly at lunch time, I would suggest a snack in the middle of the morning, or reducing the breakfast and lunchtime injections, and not so much of the Lantus at night (and a snack before bed!) I know that quite often the amounts that people have been told to take of any of the insulins is not what is really needed and you need to experiment for a week or so by reducing the insulins. Lantus I know about because I used to be on it and it was way too strong for me. I reduced it as I was guaranteed a hypo every single night and it is not funny when I live alone!
Test often and try reducing the boluses and make a note of results and how much you are injecting. I wish you well. It does take time to get it right for you and remember your body has not been used to the insulin since you have not been producing it, it probably it is in a bit of a shock and reacts to a sudden increase.
If what the OP describes is units of Humalog per meal vs I:C ratio, I think (if it is units) that lantus is not the one to blame but the Humalog.
The other thing about the larger doses is that shots > 7U don’t act as regularly as shots <7U so the 38 could also be perhaps influenced by “leftovers” from breakfast? Although it may just be a swingin’ honeymoon going on and the Lantus may benefit from being turned down as well?
If you don’t know your carb ratio, and you can’t get immediate feedback from your doctor, I would figure it out (by counting the carbs of a meal and dividing by the amt of insulin) and then lowering it maybe 2G/U? So if the 10U shot is covering 100 carbs, try 9U. There’s a significant amount of “firepower” in a unit so it may very well sproinggg your numbers back the other way but a little bit less may fit very smoothly? The other thing to consider might be to scale back the carbs to until you get the ratio calculated accurately. I am not as “low-carb” as many people who have achieved success with it but the large shot variability issue makes it much easier for me to run smooth numbers when I eat less. Good luck and good job tracking this site down! It took me 25 years to figure a lot of this stuff out so you will be waaaay ahead of me in no time!
My Endo initially overestimated my insulin needs as well. I had to do a lot of snacking to keep up with it!
Well, those hypos can be scary and they can really leave you just feeling sick. I know all this is new to you, but it is very likely that you are having these lows because you are taking “fixed” doses of insulin at meals. Those doses of insulin are strong enough to properly control your blood sugar when you eat a meal that contains a “chunk” of carbs. That chunk may well have been assumed to be quite a bit, a couple slices of pizza. If you don’t eat those carbs, then you will have a low, possibly a harsh low. And the fact that you are newly diagnosed introductes more variability.
Eventually, you will need to count the carbs in your meal and dose your insulin to match the carbs. This is the way that most of us deal with meal insulin (the rapid insulin called bolus at meals (Humalog)). If you are taking insulin at all three meals, then you are ready to learn to carb count. One way is to just take a class at a local diabetes center, have your doctor refer you. There are a number of them in Wichita. Typically a Certified Diabetes Educator (CDE) will teach the class and show you how to estimate the carbs in a meal and then figure out how much insulin to use. I learned what I know mostly from books. I bought “Using Insulin” by Walsh and “Think Like a Pancreas” by Scheiner.
ps. And I agree with others, your meal time insulin seems high. A general rule of thumb with a diet where you get 45-65% of calories from carbs is that your total insulin during the day should be split 50/50 between basal and bolus. Yours is split 12 U Lantus/ (10+9+8) Humalog = 10/27.
It’s RIDICULOUS in this time and age to have you on a fixed-rate insulin regimen. What the heck?! See your endo and insist you want to dose your insulin according to carb counting. That way you don’t have to eat to feed your insulin - you can give insulin based on what you eat.
I am sure your doctor would like to hear about those numbers. I agree with those who have said that sounds like an awful lot of meal time insulin. I was diagnosed with Type 1 almost 3 years ago. They had me start with a 1:15 insulin to carb ratio, which was just too much insulin and resulted in a lot of lows. I am still at 1:20 or 25, depending on what I am eating, use a pump, and can count on one hand the number of times I have bolused 3 units for a meal. Everyone is different, but if you are experiencing those types of lows, your boluses are likely too high for the amount of carbs you are eating. Please don’t feel bad about calling your doctor’s office or CDE.
Thanks everyone for all the great information. For those who asked if the 10 9 8 was my units or carb ratio… YES they are the number of UNITS at each meal. I talked with a nutritionist today and she said I should try a 13g or carbs for each 1u of Humalog. Shed said I was taking way to much for what I told her I had been eating. I take 12 units of Lantus at night and don’t seem to have any problems while asleep. I wake up with a fasting of 140 to 170. Then after breakfast…my meter reads anywhere from 80 to 190. But before lunch …at least for the last week…I get my butt kicked. Meter has read 38 to 55. Then I don’t even want to eat dinner. I need to get my stuff together…cause I feel like I’m gonna freaking die when I got low. My heart races and I feel like I could just fall over deader than a door nail.
What are some of your carb/insulin ratios? I am going to try the 13 to 1 starting at breakfast.