Low, after low after low

I don't know what is happening but I'm having lows after every meal now, when I was high. I can see on my CGM and it looks like my insulin is hitting before my food. I was 40 the other day, 60 1 hour after lunch, now 58 1.5 hours after eating dinner and dropping so I've downed glucose..and will probably spike. I'm getting very concerned. I'm taking too much insulin. Is this a sign of gastrioparitis (?) when insulin hits before food. I'm eating and bolusing. I switched back to novolog from humalog on friday too. I start my omnipod on monday and we're only going to start with basal and I'll do MDI with food/correction until I can get this right. Any advice would be helpful, seems like any movement at all with any bolus on board and I'm dropping, dropping. thanks!

Is your basal correct? If you are consistently low before you eat, I would suspect basal and do some testing to determine if the current rates are correct. The pump will give you a chance to really fine tune that.

Could your carb/insulin ratios be morphing? My ratios will change sometimes when the seasons (and activity levels) change.

I would check basals first. Then I would check bolus---eat something you know your body reacts well to and see if you still drop. Then keep an eye on what happens between meals. If you are going and staying low, your C/I may be incorrect. If you are going low, adding glucose, then spiking, it might be gastro.

I dunno if there's enough info to dx gastropariesis however it seems as if perhaps you've had some of what I sometimes thk of as dosage creep.

I try to react quickly when my BG is up and sometimes will get carried away and turn everything up enough, at the same time, that the opposite effect will happen and I see more lows.

I have found it relatively easy to figure out when this is going on with the pump and the CGM, due to the way the reports and data are organized by the Medtronic Carelink software. I am not 100% sure what the Omnipod provides but I'm sure they'd have something similar? Based on what you are describing, I would turn some of the basals down today (although maybe it's too late for that?) and just adjust your bolus ratio down a couple of clicks.

It's not really practical to do anything drastic for one day but your description sounds uncomfortably low so I'd lower the dosages across the board. Starting a pump is like starting from scratch, I think they cut the basal b/c it works more effectively so you may do ok but, if the calculation is based on too much, it will be apparent pretty quickly.

thanks. yeah, even .5 unit correction is dropping me 50 points. now, there's no having to prebolus, no bolusing for (protein) or anything other then straight carbs...i'm taking too much I:CR and think maybe my basal is now right and my I:CR has been way off because my stupid basal was wrong. or both...my 1:8 I think is more like a 1:15 like everyone keeps telling me considering my small size and amount of basal I use. IDK. dial back on everything I guess. instead of having any type of ppl spike i'm dropping now every meal. i mean, we're supposed to rise at least some and not drop, correct?

Did you switch insulin? Some think that Novolog is not as potent as Humalog or Apridra. Also, if you are running high, that may cause insulin resistance and normalizing your blood sugars can result in a change in your ratios.

i was on novolog, tried humalog, switched back to novolog on friday and am finding it wicked strong. i'm like honeymoon sensitive right now. gonna call my doc tomorrow, don't know what to do, take..don't even want to bolus now..ugh!

Eating less carbs can sometimes help figure out ratios with lower risk. I always do better during the week and don't make a lot of changes based on what I do on the weekends when I eat more and eat worse.

Yes, if you've made significant changes in your basal, than your I:C ratios could be affected. My suggestion is to do things lowly. If you are always going low after a meal at 1:8, then try going to 1:10 for a few days and see how that goes. Don't just jump from 1:8 to 1:15!And as you see how that 1:10 goes for a couple days be aware that you may have different I:C ratios that work for each meal. (Mine are 1:6, 1:11 and 1:15) And like I mentioned before, you might want to drop the protein issue for now, especially if you are not eating very low carb.Just bolus for your carbs. Keep it simple!!

Sarah, I can share my experience..it does sound like GP. I was dxed last year, all of my symptoms were the same as you described but to be sure your medical team will have to test. My GP was discovered during an Endoscopic I had last year. A few years before that I had the test I call the swallow test, where you're injected with a nuclear med and given a sandwich and you lay and a machine follows the sandwich...I know sounds strange but that's my description. At that time they said I didn't have GP but I must have been on my way because I had all the symptoms.

Hey Sarah, If I'm constantly running low, I will run temp basals at decreased rates until I find a rate that works for me, then I will set new basal rates. Just a thought.

Good luck with your OmniPod start! I've been on OmniPod for just over a year now and the best advice I can give you is just to be patient - it may take you some time to find the sites that work best for you and the "routine" that works for you, but once you get it, it will be worth the effort. The OmniPod users group here is full of information to help. They helped me so much more than my medical team with the transition. :)

Personally, I wouldn't start my pump until I had my I:C ratios stable. Those, unlike the basal, don't change much. Whether you don't carb count accurately, or you just haven't tuned in your ratios appropriately there are numerous skill sets such as carb counting, correcting and including I:C, and ISF figures that need to be learned. Switching to a pump is a learning curve enough without having been stable on MDI's when you start. That's just my opinion. You're already overwhelmed, I would do one thing at a time.

Thank you so much. We're actually now not going to start it until Friday, only start with basal on POD and I'm gonna continue to do my bolus/corrections with MDI's until I can figure this out, then move to pod for full insulin delivery. Do you have the newer smaller pods? Do you like using the pods? Curious, what insulin are you pumping with?

also, one more question please...do you guys check 2 hours after you start eating (your first bite) or 2 hours after you finish eating (last bite)...i have conflicting suggestions here from Endo vs. Pump nurse.


I actually end up testing two hours after I bolus as if I forget what time I ate, I can check it on my pump. I was originally taught two hours after you start eating. But since our spike points vary, I don't think it's really that important to be exact to the minute.

Me? I don't use an Omnipod; I use a Ping. I use Apidra.

Sarah actually to test an hour after eating is more accurate, I've been doing it for years. My CDE said that's when bs is at it's highest point.

It actually varies for people. Some are closer to one hour but I think more are closer to two. The key is to find when your own personal spike comes by doing a bunch of testing. Mine is between 1 and 3/4 and 2 so I just use 2.

OK, thanks for your replies. So, i saw my Endo this morning, he spent an hour with me...nice guy, i kinda got upset, he said, "I want you to know I care about you and this and we'll get it worked out." thought that was nice. :) He doesn't want me correcting, unless really high or low, only before meals and not before bed so we can figure out basal, etc.. Nurse told me to try this test, which i just did. First, I've never have bolused 4 units (most has been 3 units at once). I've been eating low carb, mostly protein and veggies (don't know why, think I'm too much influenced by this site sometimes..ha!). As my endo said, fast analogs work best with CARBS and if I continue to eat low, low carb, I will need to probably bolus for protein. I actually probably need to put some weight on too.

So, I ate a Lean Cuisine 35 carbs, did 1:9 bolused 4 units:
Started 88 (tested 1 hour after first bite)
1 hour 198
2 hour 129
3 hour 97
4 hour 86

So, because I had NO activity I probably would have gone low. don't like that 1 hour spike either and probably need to adjust my basal a bit as I don't want to be fasting in the 80's. Thoughts?
I'll do test again tomorrow for lunch while I'm just sitting and working. Kinda tasted good to eat some carbs.


Usually to test for a right basal you do fasting: skip breakfast and see if you bg is steady. The day after skip lunch and look for the same. So for dinner.
I think your basal is too high.
It could even be that your eating low carb is misleading you in dosing your basal. Perhaps you are "counting" fat and proteins bg rise in your basal. A lower basal and double wave boluses could be more fit to your habits.

yeah, my fasting was before lunch 88, no breakfast and only levemir on board.