Lows in the afternoon?

Just curious if anyone stays fairly 'normal' most of the day, and then bottoms out in the afternoon? I just had my lowest BG reading since I've been checking.. it was at 68. I felt fine, but decided to take two glucose tabs because my BG had dropped from 93 to 68 in the span of a couple hours..

An hour and a half later, it was back down to 85 which is fine.

I think I may back off on my daytime Lantus from 5u to 4u... and keep the night time amount the same.

But my 3am readings are never low. I guess I am backwards. :/

We all have different patterns of when our basal needs dip or rise; that's why the pump is so useful. I myself have different basal rates in 9 different time periods! It is quite a bit harder to accomodate these normal variations with MDI.

You say you see these dips frequently in the afternoon, so my question is at what time? And more importantly, what relationship to your mealtimes. If it's say 2 or even up to 4 hours after lunch (depending on your type of insulin, and the protein, carb and fat content of what you eat) it might be more related to your lunchtime bolus and you might want to back down a tad on your lunch I:C. I can't recall if you yet have different rates for your meals, but most of us do and it takes awhile from the time you start on insulin until you tweak it right.

If, on the other hand, your lows are significantly after lunch (perhaps closer to time for dinner), then you are using the right approach to back off your daytime Lantus. Lantus peaks about 5 hours after you take it, so you might also want to wiggle the time a bit. For example if you are taking it in the morning say at 10, it will have its peak around 3 which might be the exact time you're talking about. It's hard to get things exact with long acting insulin so play with the amounts and times, and hopefully you will even it out a bit. 68 is not a very low number, so hopefully a little change will get you up to the 70s or 80s.

I use to have that problem with Lantus, its the over night dosage. I changed the over night to less units and stopped having that problem...

Thank you, Zoe. I really should get on a pump at some point, I would love the opportunity to change the rates for different times of day. I hate that once I've given Lantus, I'm stuck with it.

I am taking my Lantus at 7am and at 8:00pm. I see the dips usually between 3 and 5pm.

I had been doing a 1:10 ratio for every meal because that's about what it took to get somewhat reasonable numbers. I was 134 when I got up; and 230 2 hours post breakfast. So I think that ratio needs to be more like 1:8.

By lunch time, it dropped to 93. And because my numbers were so much lower... I did a 1:15 ratio for lunch. Two hours post was 95! So I feel almost as though I should have done a 1:18 or even a 1:20 for lunch so I'd be high enough afterwards that my afternoon drop wouldn't be quite so dramatic..

So it's either change daytime Lantus, or just back off at lunch. Maybe I'll try one more day of 5u Lantus in the morning and change the lunch variable to see what happens. Does that seem sensible?

Weirdly, late afternoon (ahem, DRIVE TIME) is a critical time for me. I live in a huge metro area and unforseen traffic jams (I mean 8-10 or overnight) are not uncommen. I keep a lot of supplies in my car!!

I really lower my basals, and work a schedule where I come in at 6:30am and leave at 3:15 pm with no lunch. Hard, but I have a great place..... But I miss a LOT of problems with that schedule.

I wish I were to the point I could set my own schedule. I was scared of having a hypoglycemic episode in front of the clients we were seeing at the time, so I know I over-reacted. I haven't really experienced a hypo yet and I'm terrified of it.

I'm wondering if my pancreas is wanting to honeymoon, too...

I should write a letter to it... Dear Pancreas, make up your freakin' mind. :)

Oh, as far as times... I ate breakfast at 7:30AM. Lunch was at 11:30AM. Then the 68 came around 3:00PM and I didn't give it time to drop further.

Yes, many of us have more problems with carbs at breakfast. My own ratios are 1:5, 1:10 AND 1:21 I don't know how many carbs you eat at breakfast, but you might want to look at reducing it if you get highs like that a lot. Also, I know you are very recently diagnosed, but in time you will get in the habit of doing corrections if you wake up high or adding them into your bolus. That's what I do if I start out at 134, but still that's a hundred points jump! Even with a 1:5 ratio if I ate say cereal, fruit and milk I'd inevitably jump that high. I haven't eaten cereal in a long time!

Actually, technically starting at 93 before lunch and ending at 95 is as close to perfect as you get! The goal is to have as little rise from meals as possible. But I understand you are anticipating a big drop from that 95.

John Walsh says to make sure your basal is right before modifying your bolus and I agree. I personally would go down to 4 on the Lantus in the morning and see how that works for a few days. But whichever way you go, what's important is to only change one variable at a time and then sit with the results for awhile before you change something else. Otherwise you don't know what caused what and you can be on a rollercoaster.

If you tweak and continue to have a problem you might want to talk with your doctor about switching to Levemir. For many of us it has a smoother action.

Normally only 30 at breakfast, about the same at lunch. :/

I feel like my other option is to just know that after lunch, around 3pm, I should probably go ahead and have a snack. I like how my numbers have been today otherwise. I feel good, too.

I'll think about it some more, see how everything goes with dinner, and then hopefully make up my indecisive mind.

Hopefully I can get set up with a pump before I need to ask the doctor to switch and have to start over again. Blah!

I had a daily low at 630pm every day when on Lantus. It's common for people's insulin demands to fluctuate on a daily cycle based on the body's diurnal rhythms. It's fairly common for the afternoon to be a time when people need less insulin and morning ot be a time when you need more.

For me the disparity between the two caused either overnight highs or afternoon lows when I was on Lantus. Splitting the dose didnt help. Ultimately, the pump helps with this. A solution for some on MDI is to use something with a shorter action like Levemir, and have 2 injections a day. one ofr night and one for day.

The good thing about a pattern like you are seeing is you can be prepared for it and test/eat to compensate. It IS a good idea to test before you get into the car, especially since you know you likely be low for the afternoon commute.

It may not be your basal insulin that's causing your low BG in the afternoon. Your breakfast and lunch are only 4 hours apart so you could have some active insulin when you bolus for lunch.

Skip lunch and see what your BG does...

Have been thinking about testing before getting into the car ever since you first mentioned it.. sometimes I do, sometimes I don't. Definitely have been in the afternoon and will continue to do so, thanks for the suggestion.

Neglected to consider that.. I'll be armed with lots of snacks today in case it goes lower again, and I'll try to skip lunch to see what happens.

Went to bed at 122 last night, it dropped to 110 at 3am and back up to 113 by 6am. So it seems like my night time basal is set right, though I guess the numbers themselves could be lower? Have read that as long as it doesn't vary more than 30 points overnight, it's probably set right.

Have thought about taking 6 at night and 4 in the morning... but will give the original plan the rest of today to see how it goes....

Thanks everyone, really appreciate the input. :)

Just tagging on John's post, palamino. If you eat close together be sure you take into account the Insulin on Board (IOB) when you bolus. First determine your duration of action which can vary from 3-5 hours depending on type of insulin. Then do the math and subtract for any insulin on board.

Wound up not skipping lunch, but waited 5.5 hours before eating lunch today and also adjusted the I:C ratio. Everything went a lot better than yesterday- so I think I did indeed stack insulin and had it all screwed up.

Thanks again..

Glad it's going better! Computing the IOB is vital, but eating a bit less close together also helps with the problem! I use Apidra which has the least tail, so I compute only 3 hours for duration. I only need to consider IOB when I've corrected after a meal, but of course I now have a pump that does the math for me! I'm pretty good at math, but it's nice to be lazy! (Not that I always listen to the pump wizard!)

Haha. So you can use Humalog, Novalog, or Apidra in the pumps as well?

Yes, that's what you use in the pump, just fast acting insulin. The pump supplies your background insulin needs by giving you regular small doses of fast acting, rather than the once or twice daily dose of long-acting on MDIs.

I knew someone on another message board who used R in hers. You had to wait a couple of hours but, once it was going, it was going just fine.

Just didn't realize it was the same ones; hadn't thought much about it.. With the Apidra, since it has a shorter tail, do you have more risk of going into DKA sooner than with the other two? Just wondering if something comes detached and you don't realize it..