Low, HIGHS lows again. Just done


#1

Woke up low. 59. Corrected with 15 carbs. Sensor change. Was 259 at calibration. Corrected. Waited. Next finger stick, 301. Oh, ketones also. Used FS and pump bolus calculations until BG was normal, about 5:00. Stressful.
At 8pm reading 59 and FS at 39.
Have had dinner, 30 carbs of juice and still going lower. Current CGM at 8:10 is 49.
Out of ideas and positive actions.


#2

We are on Basal-IQ now with automatic basal suspends for predicted low BG.

But prior to that, I had modified our approach for low corrections. This would be for dealing with lows under 50 or lows a bit higher but with steep cgm drop or with large IOB still to go.

(For us, I don’t even consider something in the 60s a real low unless the cgm indicates down still with IOB present. But just a 65 with steady cgm and no IOB at least for us would easily be bumped higher with maybe 8 fast carbs.)

I would do a 30 minute basal suspend at the same time as treat the low with fast carbs.

Reason is some lows turned persistent and I had no way of knowing in advance which would be persistent and which would not.

If the low responded in 15 or 20 minutes then cancel the suspend and things move on normal.

If the low doesn’t respond and it turns out that this is going to be a persistent one then I am already ahead of the game a bit by having the suspend already in place for a bit. (And then give more fast carbs.)

Immediately adding the basal suspend at the same time as treating the low with carbs seemed to often times be helpful.


#3

Ive been doing this for weeks. I know I have bad sensors. I know it. Should have known sooner because of ultra crazy erratic data. See how it jumps from normal to off the charts in a moments notice? I thought I was getting sensor error from rapid changes in BG. But, no. Thats not it. The data is nonsensical.


#4

You might want to try the afrezza to correct highs. Its out in 90 minutes and very predictable once you know how a 4u, 8u and 12u impact your BG level.

You can buy direct from manufacturer here www.insulinsavings.com

You will probably want the variety box to start so you can try different sizes. The 12u can always be manually split into three 4u but don’t equate it to current insulin you are taking. Try it and see what it does and how much a 4u, 8u, 12u reduce your BG.


#5

I’ve been double checking with finger sticks. All pretty accurate. Not a sensor error.


#6

Darn it. Thought maybe there was a bad lot because so many people have been bringing it up at the same time.


#7

Is this just today or has it been going on for a while? I had a day like that last week but went back to normal the next day.


#8

I have had very serious retinopathy and have been warned that fast recovery from high BG can be dangerous for me.


#9

It went from high from noon to six, normal a few hours, then crashed all night. Juice would bring it up a small bit, but then it would crash again. Finally about 4 am, juice got it out of the red zone just barely. Now at 9am, it’s in the red zone again after breakfast and some additional juice.


#10

T1Forever - I found that advice to be interesting so I spent some time researching the subject. I could not find any study with some level of confidence associating fast BG reduction with retinopathy complications.

I would be interested in learning more about the advice.

The time action profile of afrezza is near identical to intravenous insulin. I included those studies in my search. While the overall Trina Health approach has significant short comings the basic treatment is IV insulin administration.

They did a study “The Microburst Insulin Infusion Study” which is summarized here but they said they saw improvement in retinopathy. https://www.businesswire.com/news/home/20170726005326/en/Newly-Published-Study-Validates-Trina-Health-Artificial

There was also a 200 PWD afrezza pilot recently completed by VDEX and in their paper they discuss concerns being raised that immediate BG reduction would create problems. They say their finding were just the opposite. https://static1.squarespace.com/static/5a37ff648fd4d234be3cea06/t/5c2ea96170a6ad1b09ad6f9a/1546561892258/vdex-whitepaper2-092618.pdf


#11

Thanks. My source was Bernstein related. Appreciate our discussion. I’ll check some more.


#12

T1 - thanks for the info. I know Dr. Bernstein and Al Mann use to have healthy disagreements from time to time.

I am not sure what “tools” Dr. Bernstein would have when compared to Al Mann’s afrezza. Let me do some follow-up and I will probably reach out to him directly to get his experience. It would have had to have been in hospital situations during IV insulin.

The one “concern” I think he might have is after long periods of high BG the body may re-adjust so you start experiencing a hypo at a more raised BG level, lets say 100mg/dl. This still would not be an issue taking you from a roller-coaster high of 300 to lets say 150mg over a couple of hours.


#14

@T1Forever, there is no rhyme or reason when it comes to this horrible disease.

What I can offer is that since I have been using the t:slim with Basal IQ (basal suspend) my lows have almost disappeared. And the lows I do have are less severe, rarely requiring me to eat additional food.

If you can, definitely look into getting this amazing technology. It is life changing. And I do not say that lightly.


#15

I’ve seen a somewhat similar problem with my blood glucose meter. It occasionally starts the setup procedure procedure unexpectedly. If I don’t complete enough of the setup procedure, It gives number around four times the expected numbers.


#16

I can say that MY eye complications worsened just after switching from single injection Lente to “MDI” with NPH + REG, and was told this was common. A1C dropped from teens to 9s. I was told by medical team that it was common (after the fact). I believe there was some reference to this in the follow-up DCCT studies.