Lowering BS quickly vs slowly?

What’s your take on this? Say you have a BS of 300 or over. Whatever way you fix it (be it that you need to go to the hospital for a DKA workup, or its something as simple as you didn’t do enough insulin for a meal and need to correct,) I have had different doctors say that it’s better to lower the sugar slowly. Others have said as quickly as possible. What has everyone else heard about this, and what is your opinion? Does lowering it slower vs quickly make you feel different? I know for me if it lowers too quickly I get horribly nauseated, but then again I get nauseated just from the high sugar itself. The nausea just tends to get a little worse.

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I do 2/3’s up front and then square last 1/3 over half hour if it is a big dose.

I’ve heard this claim too, that rapid change itself can be damaging. I don’t know if it’s true.

When my blood sugar level is dropping quickly I sometimes get hypo symptoms well before my blood sugar gets below 4.0 mmol/l

It’s been my habit to lower it as quickly as possible. I will use a combination of an intra-muscular injection and Afrezza. I’ve done this successfully many times but I’m unsure of any possible hidden disadvantages. I rarely see the 300 (16.7) level these days, maybe once or twice per year, so I don’t have continuing repeated experience. Your diabetes, of course, may vary.

I’m not sure what to make of doctors’ advice on these kinds of things. I’m always trying to see if their advice is based on science or simply arises out of their ultra-conservatism with all things insulin.

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What is your reason for lowering it this way?

I get that too! It’s something I’ve just recently noticed, especially when coming down from a very high level.

If I lower it too quickly, I feel some low symptoms, so it depends on the circumstance. If feeling a bit low won’t be a problem, I try to smack it down fast (and most of the time, that’s still not as fast as I’d like, which is part of why I’m considering trying Afrezza). I would say that’s my usual strategy, since I’d rather feel a little off in order to minimize the amount of exposure to high blood sugars. However, if I need to perform well at something during that time and low symptoms would be too disruptive, I’ll maybe do an MDI equivalent to what @JC14 said, like 2/3 of the dose immediately, and the rest a bit later.

I’m not well versed on the effects of lowering bgs quickly v slowly. I vaguely remember a discussion about this at Joslin’s family camp years ago, but I remember it in the context of bgs constantly changing from high to in range and back again. That left an impression with me that is different from lowering an isolated bg back into range. Because of this context, I’ve always interpreted the danger or damaging effects to be related to a constantly swinging bg level. That’s just my interpretation though, and likely influenced by irrational emotions that high bgs elicit in me.

We’re usually pretty aggressive about higher bgs, invoking super bolus methods to get back into range sooner rather than later. They are fairly infrequent though, and using Loop technology, we have become a little less aggressive bc the risk of sustaining that high if it gets there is lower than without the help of Loop.

Solely for comfort as large bolus hurts taken all at once, lol.

There are really two different cases here. Research shows that a sudden lowering of average blood sugar levels temporarily worsens diabetic complications, but the effect stabilizes and the benefits become evident only after a period of sustained improvement. But I wonder what if the patient’s basic case of diabetes has an intrinsic instability, with many reductions in the average level followed by many rises? Shouldn’t that cause the worsenings simply to accumulate, since the blood sugar decrease could not be sustained?

The other case is whether blood sugar level should be reduced quickly on an everyday level if it is suddenly found to be too high. A problem is that a sudden reduction can only be achieved by a large dose, and that will likely overshoot the mark later on.

Haha then that’s a valid reason!

I can’t wait to get on the loop system for this very reason, along with the fact that I’m a VERY brittle diabetic. The sun shines on me wrong and my count goes out of whack! I never thought of it in relation to the long term effects of bouncing blood sugars, but I wonder if there is a long term factor from lowering them quickly/slowly. It makes sense to me too that lowering them quickly might have long term affects the same as constantly bouncing sugars.

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Hmmm interesting… By overshooting the mark I assume you mean causing hypoglycemia later on, thus having to correct for that and making the sugars bounce around?

That makes a lot of sense to do. Wha is Afrezza? I’ve never even heard of it. Is it like Actos? I know a long, long time ago a doctor (who was a total Ahole) tried to get me on Actos. I think later on there was a lawsuit against the company because it caused some severe side effects.

It’s inhaled insulin, nothing like Actos. It works much faster than any injected insulins, but it’s not widely used yet. If you search for it on here, you will find some threads on it.

Hi, I am Hanz…

Type 2 but a great pharmacist health nut diabetes educator stressed to us exercise is the fastest way to lower BG.

Walking does that. Now intense exercise might raise it. That is all I know.

It’s up to you, but I drop it from 300 ASAP. That takes me around 4 hours. I wont feel great, but I’ll feel better faster. I also tend to overtreat and rollercoaster after a high.

If you have a CGM then it makes it a bit easier to intentionally overtreat the high to get it down and then plan to catch it before it bottoms out like maybe around 100 and have a small number of carbs to see if you can get a soft landing rather than a hard bounce.

@McChesney - Agreed. Even like 15 or 20 mins of moderate exercise seems to give the insulin a jump-start and it definitely seems to react faster. We have not the rise from exercise but perhaps it takes a more intense workout then we would do. Also I have heard some others say that it is specifically intense weight lifting (as opposed to bicycle or walking) that could cause the rise. We see the drop from moderate exercise but probably are not involved in the activities that may cause the rise.

This is so true, especially if you walk when a high glucose insulin correction dose is peaking.

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Trampolining is very effective. Just sayin’. :rofl:

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