Low/High - Finally normal!

1

Finally edit: See below - problem solved! Edit to my tale. After my low of 34 at 5AM this morning, I of course took too many glucose tablets to treat because I wanted to go back to sleep, and this morning woke up at 209. But then I kept corrected and only have gone up. I've been in the 300s since lunch. I corrected and came down a bit (249) but then went right back up and now am 327 at 10:45 at night. I'm nervous to treat because of last night, but I'm not going to go to bed in the 300s. I've had some questionable sets, and changed twice, but nothing obviously wrong. Is this a normal reaction to a bad low - though one in which I didn't lose consciousness?

If so, I'll treat a bit longer, as I stay up pretty late, see if I can at least get into the 200s. Hopefully it will be better tomorrow? I've never had this experience. Thanks any nightbirds who respond!

Hi all

I had one extreme hypo when I first started using insulin where I went unconscious and my liver kicked in, but it was because neither I nor my doctor knew what we were doing and I was on way too high a dose. In the three years since I haven't had any lows I couldn't easily manage. So I think I might have gotten too cavalier an attitude towards hypos. (Maybe, maybe not and I'm just nervous this morning).

I only treat hypos under 60. I realize some people treat under 70 and some under 60, and I'm not planning to change my treatment level. But I do have a habit of "letting a low ride" for example when it's close to mealtime and I'm say in the 50s. I really prefer not to eat glucose tablets when not necessary (I'm a bit fanatic about weight gain and about consuming sugar. I haven't eaten sugar in 17 years. I do allow glucose tabs as "medicine" but still don't like it) So in a case like that I'll just go ahead and eat and then monitor my bloodsugar for when it comes up into a safe range to bolus I also bolus my full carb amount (as the Ping wizard suggests) as I find if I don't I go high.

I also correct promptly, and fully but usually don't exceed the amount taking into account the IOB. (only do when I'm having trouble getting down)

At bedtime I'm a bit more conservative as I live alone. If I'm in the 60s or lower I will treat and then wait to make sure I come back up before going to sleep. If I'm in the 70s, I'll take a couple glucose tabs and then go to sleep, having ascertained that will normally raise me up into a safe area. Some people talk about going low, treating and then going low again and needing to eat something to sustain. I've never had that problem, as long as there is no IOB I come up and stay up. Recently, though I've noticed that I've had a few instances where I had to stay up for hours because I would go low, treat with the dose I have always known to work and still not come up. I have gained 10 pounds over the weight I was at after losing at diagnosis but that was over a period of a couple years so I don't think that is significant in changing the dose needed to raise.

Anyway....last night I was 73 at bedtime (1AM -five hours after my last Apidra bolus and my basal doses have seemed very accurate for awhile). So I took 2 glucose tabs to be safe and went to sleep. I really hate staying up when I'm sleepy but would have done so if it was lower.

I woke up around 5AM, with my nose running and reached for a tissue. I have allergies and often do this in the middle of the night, so I keep tissue boxes everywhere. Unfortunately (actually fortunately!) the tissue box was empty so I got up to get a new one from the cabinet. My house is strange - it's round and with a very narrow area where the cabinets are.I've only lived here a few months and I've actually gotten disoriented walking around in the dark before-but not like this. I stopped at one cabinet and remembered it was in another further along. Then I was suddenly confused because I was past the cabinet area altogether. All I remember feeling is: annoyed at the runny nose and no tissues and really really cold. It was in the 20s out and I keep my heat low at night as I sleep under a down comforter. I only had on the light thermals I sleep in and my feet were bare. I was so cold as I groped, touching things to find my way and it seemed to take a very long time. Gradually it hit me, I am really not thinking straight and I must be quite low! I finally made it back to my bed and immediately ate some glucose from the night table, then I tested and was 34. It was hard to do this because my cat was really demanding attention and getting in my way. Where were you, Lula 15 minutes ago?? After testing I got the brilliant idea to turn on the lights, got tissues and worked on getting warm. I stayed up for awhile till I came up enough to go back to sleep.

Ok, too cavalier or just a freak occurrence?

2

Well, except for the going to bed in the 70s and trusting the glucose tabs to bring you back up without testing, your aproach is very similar to mine. Im a little more cautious in the 60s then you but just as aggressive.

Interestingly, last night i was in the 170s at bedtime and decided to correct without tracking my bg before hitting tge sack. I woke up in the 40s 3 hours later. Thats a mistake i dont make often. Stresswd me out a bit though which waz probably tge reason why my fasting was 235 this morning. Bgs have been behaving since then.

Glad you are ok.

3

I used to be quite confident in my ability to handle lows. I've been Type 1 for about 25 years now. I've never kept a glucagon kit until this year. This year has marked constant changes in bg stability and frequent unexpected lows and fast drops like I've never seen before in my life. I've also dealt with hypo unawareness for the first time in my life this year.

All this is enough to scare me to the conclusion that nothing about this disease is stable and you can't count on it to remain as you've known it..maybe even for years. I think it's easy to get into a routine that works for you...then BAM the gremlins ambush. Freak occurrence or not, you never know when the next one will hit. I would urge you to be cautious.

4

Thanks, FHS. Glad you're ok too. Yeah, that is another area I didn't mention in my post. When I first started insulin (and after that initial scare) I had a rule in my head to never correct at bedtime. Now I let it ride if it's marginal (like say in the 150 range) but otherwise I do correct, but usually cut the amount a bit from what my ISF recommends. I also recently realized that my ISF is different at night, so probably I could "obey" the wizard now. Do you see a trend here? The desire to test limits? LOL.

When you say "a mistake you don't make often" do you mean normally if you were in the 170s at bedtime you would bolus your full correction but stay up and monitor it or bolus less than your full correction and go to sleep?

5

So glad you caught your low in time before anything serious happened. My dd had a big low last night before bed...she was a 64. I treated with a yogurt drink that usually brings her up fast, but it didn't so I gave her a glucose tab. She came up almost 30 pts so I thought OK she is on her way up let's get her to bed. Oh no...2 hours later I checked her and she was still low...in the mid 80s but that is NOT where I like her to be sleeping for 8hrs. So I woke her up and made her down a 2oz 15g drink. That popped her up to 130...of course by midnight...all those carbs made her BG skyrocket to 200..so I had to correct. Ugh! Tis the life of the yo yo diabetic blood sugars. I have learned...never let DD go to sleep until that number is at the pretty digits you want to see on your meter....including if you have to correct. Again I am glad you were able to safely raise your BG..tell Lula to wake up you sooner next time! (;

6

Thanks, smile. I appreciate your input as someone whose been dealing with this much longer than me. I need to continually remind myself that "things change" and not think I've "arrived" in terms of treatment. My guess is after the responses on this post I'll look at which things in my approaches to low should be tweaked a bit.

7

Thanks, sweet livy loo's mom. I think after you've been doing this awhile you get a little more as I called it cavalier about lows, and can usually find a balance of what works without driving you high. But then you get to a point like I'm at now where you wonder if you've gone too far. I do think it's so different when you're responsible for children though, and that the approach to lows you settle on after awhile will always be more conservative than adults.

Thanks, I will give Lula the message..lol. I was astounded to hear about "diabetes cats" as I always thought cats were way too self-absorbed for that! Lula give lots of love but on her own terms. I'm sure she was just bugging me last night because she was happy I was up and ready to provide attention to her!

8

Thanks Zoe!

I'd set an alarm for an hour later, and probably one more hour after that to make sure. Yup, makes for a bit of a sleepless night. Luckily, something like that won't happen too often.

I'll let my BG ride all the way into the 140s for bedtime.

9

Thanks for the response, FHS. Since I retired my clock alarm has been "broken"...lol. I think I'd rather just bolus less and go to sleep. But yes, for me as well, I more often have a problem with lows or marginal lows than highs at bedtime.

10

Np, and must be nice!

If I'm having BG issues before bedtime, high or low, I have a difficult time getting a good night's sleep anyway. I find managing bedtime BGs so that I can have good fasting BGs to be the most stressful part of diabetes management.

It's wierd. If I set my alarm to wake up, I usually don't actually need my alarm to wake up. The one time I don't, I sleep my way into a low. =/

11

Hi sweet livy loo's mom. I like a yogurt drink for lows also, Dan Active in fact. If I'm too low, I have to add a little glucose to it.

Zoe, what I do about nighttime corrections is forget it up to 150. Higher I correct one half the amount I'd correct in the daytime.

Nothing works perfectly, but those strategies work better than others for me. I've begun to be very cold at night when I go low, which I really really hate.

12

Thanks for the input, Trudy! It was pretty cold in my house last night, but now that I think about it my coldness was more intense so maybe that was the low.

On the topic of temperatures: In November I moved back to where I used to live before I was diagnosed. The cold isn't intense, though it's colder than most people would expect in California. But in summer we often have triple digits (very dry, though, thank god). I've lived in temperate climates since then but went to the hot beaches in Guatemala for a weekend and had an amazing experience of how little insulin I needed there! I'm looking forward to seeing if that's the case.

13

Maybe "demanding attention" is the cat's way of warning you and it thinks you just need to speak cat better? My dog looks at me the same way most of the time but does sort of stare if I'm low? I could be imagining things too.

RE the complacent question, I have been that way for a long time. MrsAcidRock found this cool app, Lose It! for weight loss and I tried using it to track my food and quickly learned that 20-30 jellybeans/ day to correct hypos wasn't unusual. I figured that I was sort of absentmindedly "hitting" the beans to keep thing low and might be able to redo my basals to stop that? It seemed to work and I eventually reached the point where it was not enough and turned the basals back up a notch and maybe ended up a shade lower than I'd been before.

I've gone to sleep in the 70s and it may turn out ok, the other question would be what IOB was floating around? I find that 8-12 snacks seem to deploy more slowly some times and I think they also sort of can contribute to a hypo environment as the stray insulin doesn't quite hit until after you go to sleep and then it clobbers you while you're sleeping.

14

Yeah, who knows with Lula, just when I think we're communicating well, she changes things up to keep me on my toes. When I catch her for her meds I tell her, Hah! You're faster, but I'm smarter! But I secretly know that isn't true!

I don't believe I had any IOB. I don't snack at all, and I ate dinner at 8 so by 1AM when I went to bed at 73 and took two glucose tabs there shouldn't have been any left let alone by 5AM when I woke up and was 34! It's a mystery to me what dragged me down. (I use Apidra which has the least tail and generally calculate it as 3 hours , 3 1/2 on the outside)

15

I do think that many of us are too cavalier about lows, but I’m not quite sure what the solution is. When I analyze my Type 1, I often think that the thing I’m most lacking is “equilibrium”. There is only a very small range that is not “too high” or “too low”. If I don’t want to be high, then chances are I’m going to go low. If I want to avoid all lows, then of course I’m going to be high. Our tools are not precise enough to be perfect. Each one of us has to set goals that work for us and we have to learn to live with the risks of those goals. Lows can be dangerous in the short-run, but highs are risky for the long-term.

I have to remind myself that there is no virtue in living in the 60’s and 70’s. Yes, those numbers reduce my A1c, but they shouldn’t be my targets. I do correct numbers in the 60’s and usually in the 70’s. I am very insulin sensitive and insulin stays active for a very long time for me. So if I’m in the 60’s, it’s usually on its way to the 50’s or 40’s. My endo only scolds me for numbers that get to the 40’s. Usually super low numbers come from battling highs. So avoiding highs can help reduce lows. It’s that continual search for balance.

The more you read Type 1 message boards, the easier it is to start accepting all these lows as good numbers. Obviously none of us want to face amputations, kidney disease, etc. But the million dollar question is: At what number do the risks of lows outweigh the dangers of being high?

16

I agree that equilibrium is definitely the preferred goal for me too. I've been all over the place for a couple of weeks, adjusting food here and insulin there, trying to keep weight "stable" while I'm sort of hitting "the next level" lifting weights and running hard, etc. I think I got back to where I want to be maybe yesterday and today although I went for a longish run yesterday so perhaps I also cheated?

I am not "scared" of the 70s but I've had a few times, particularly when I'm yutzing around with rates and ratios where I'll hit "oops, it's 11:30, I'm tired, I'm at 65 *and* have have 3.3U on board and there's no more ice cream because I ate it all 2 hours ago...". I would prefer the 80s but will take 70s over 120s if I have a choice as 70s are more fun to fix.

17

No, I don't think you are cavalier with lows. I treat the same as you, below 60 I eat glucose to bring it up to 80 or 90, in the 60s it depends how I feel, if I feel slightly low I will correct if not I just leave it. It also depends what I am about to do if I am off out into the garden I will correct & have a couple of plain gluten free crackers to cover the gardening.

In the last 10 years or so I can only remember a couple of lows where I was so confused that my husband had to feed me glucose tablets, once with me throwing them around the room! In 51 years of T1 I have never had to go to the emergency room or take glucagon because of a low, & I do frequently go down to the 40s, but I recognize it & test. Something wakes me at night, & I get up & test & correct up or down as needed, like you my nightime target is higher, 100 rather than 80-90 during the day.

10 years or so ago I used to wake up during the night covered in sweat when I was low (it made it very difficult when I was having hot flushes), now I just wake up often with wild & vivid dreams.

I am working on cutting back the lows, but this works for me.

18

Thanks everyone, yes it does seem that it's all about balance and some of us tip it one way and some the other, and we all change our balance sheet now and then. I guess last night just was one of those moments which made me consider not a panicked 180, but just a bit of tweaking. All of your inputs are helping me look at the variables.

I laughed at your throwing glucose tablets around, Annabella. I actually think that barring unconsciousness and the inability to treat myself (which I don't expect), I do better on my own. I think I detect lows better without other people and things for distractions and I think in a moderately serious low like I had last night I would find another person telling me things distracting as well. Even 7 pounds of feline was making it harder to focus. I still at age 63 have a bit of the rebellious teenager in me...No, I won't do what you're telling me! (Or is that a toddler with a tantrum?)

19

I don't let lows scare me either, I guess because I have been doing this for 20 years, it doesn't phase me. I remember getting off the school bus one time, extremely low, hoping I would make it down my 1000 foot driveway without passing out. My mom asked me how I did it, and I told her I had to or I was passing out in the driveway!

It sure was nice though that the Nurse CDE I saw today read my last doctors note "Uncontrolled diabetes, lots of lows" It makes me so mad because my lows are 60-65 and at the end of the session, she really didn't have much for me to work on that I didn't know already. That's why I would rather analyze my own data, she scrutinized my data looking for something!

20

You sound pretty confident, Kelly. I think I've developed good instincts in just 3 years on insulin but I do have a tendency to be over-confident at times.

How annoying about the CDE. Dumb question: Why do you bother going to see her, since it doesn't sound like you get much out of it.