New to basal, scary BG drop and over I really behaved like an idiot

Hi all,

I m starting to feel like a bit of an idiot because I ve been consulting this forum for so many BG issues lately, constantly asking you all to hold my 34year old hand; I wish I d have more courage to figure out some of this stuff myself, but I guess I just need a few more experiences to go on. So for now, I would like to ask once more for some much needed advice:

I have been on a low dose of basal (3 units Lantus before bed) for a few days now, my BG patterns have drastically changed since I caught the flu a week ago, so nothing works anymore like before.
Today I had dinner and bolused 2 units, which has been whats needed since my cold. I was in bed for a week, so have had NO exercise at all, but today after dinner I had to go out.
I bolused, measured an hour later and had only gone up to 112, (from 99 before food) still having almost my whole 2 units on board. I left the house and walked for about 10 minutes to the bus stop, measured again and had dropped rapidly to 70 mg/dl.
Since my diagnosis I only really had 2 lows, so you ll have to forgive me for what happened next. I saw the 70 on my metre and...panicked. Which led me to accidently drop my metre into my VERY unorganised, huge handbag. The bus came, I got in and rummaged through the bag like a crazy bag lady while at the same time feeding myself with 3 (!) glucose tabs, each one consisting of 10 g of carbs. (I know!)
But because I was dropping so fast and started feeling shaky and couldnt find my metre I thought I d rather over-than under treat.
Which is why after I had finished with the glucose and still couldnt find my metre I topped it off with a muesli bar (15g carbs). ( I KNOW!)
When I got to my stop I jumped out the bus, I sat on the ice cold floor and tipped out my bag, while swearing. (Once again, I know...)

FINALLY I found the metre, measured and was 90, then 120, and half an hour later 210. Well done.

So I over-reacted, I know that. But I am just still so completely unexperienced to how a low will behave itself, and that fast drop from only walking 10 mins really threw me off.

Why did I drop so fast? Did this have something to do with having been so inactive the weeks before? How much lower could I ve dropped? How do I know if I need 1, 2, or 4 glucose tabs, and if I should also have additional longer acting carbs like a muesli bar? Aaarrggh, I m so overwhelmed by all this right now!!
Your handholding would be VERY much appreciated ;)

julez - You’re doing just fine. You are very new to all this and you need to learn some of this stuff first hand. A good startinig rule of thumb for treating low BGs is to treat with 15 grams of carbohydrates and wait 15 minutes and test again. If you’re still low, repeat the 15g/15 minute drill again. I know you temporarily lost your meter, so it makes sense that you erred on the side of caution with the additional carbs. If you have a lot of active insulin on board then you need to be extra cautious about relapsing into a low.

It’s great that you’re being so vigilant. That’s a good thing. Better to be safe than sorry. Looking back at what you did, you could have just treated with 1 1/2 glucose tabs and you probably did not need the muesli bar. In the future, if you feel you’ve over treated a low, just add some insulin to cover it. Don’t do this analysis when you’re low! Low BGs can reduce most of us to an incoherent puddle. It’s just the nature of it. You’re not alone!

Draw the right lessons and just move on. Good luck to you.

Rapid acting meal insulin has an action curve that peaks at 1-2 hours roughly. Look at the package insert for its action curve (onset, peak, duration).

Generaly, if you exercise when your insulin is peaking you are subject to fast BG drops. This will vary from person to person and even in the same person from time to time. Even a 10 minute walk can amplify the effects of the insulin. Walking is my main exercise and I’m always reminded at how effectively it lowers my BG.

'an incoherent puddle' ... yep, that's me.

I agree with Terry's advice about 15/15. I know that when I'm low, there's this absolute need to shove more and more into my mouth. I do my best to remember to stop and give the glucose a chance to work but man, it's a challenge.

I can't say why you went low so quickly. Illness has a way of funking up our bodies, I've learned. Can you tell us what you ate?

Yes, shoving anything eatable I could find in my bag into my mouth was exactly my impulse. I think I would not have cared if it was a three week old sandwich (which could quite possibly be found in my bag sometimes) ;)
To answer your question: I had a big bowl of leek-potato soup with two low carb toast breads (4g carbs each) for dinner. I bolused 2 units of Novorapid 15 mins prior to eating, since that dose for that exact meal had worked well the days before)

AHA! that is very good to know – and quite logical really. I will try to count that fact into my dose next time I m planning to walk soon after eating and bolusing. It seems one unit of Novorapid would have been quite enough. Thank you so much for your very helpful reply, Terry!

I agree with Terry, don't apologize. I can still remember all the questions I asked on here when I started insulin. We are here to help each other!

I know it's harder when something like that happens when you're out and about, because just dealing with your blood sugar can be enough without trying to function in the world as well!

Just to give you some perspective. I'd say we are about evenly divided with some people treating lows under 70 and some treating under 60. I'm in the latter camp so I would have done nothing if I were 70 (just watch it). Second of all most glucose tabs are 4 grams, not 10. The way to know how many to take is by personal experience. For many of us that standard rule of "take 15 grams and wait 15 minutes is not appropriate. 15 grams (4 tabs) would be a lot for me. I've learned that two glucose tablets work if I'm in the 50s, three if I'm lower. I also don't retest until 1/2 hour because it seems to take that long to have full effect for me.

I never have to "follow up with food" and would go high if I did. Depending on whether I have IOB I will treat once or twice and then be up in range and stay there. Some people do find they will drop more if they don't eat something. Whenever you treat a low for awhile, write down what you did and the results. That way you will get to know the correct dose and timing for you. The good news is that with time you will learn it and most of the time it will lead to the results you want.

My "hand holding" consists of saying "don't beat up on yourself"! You won't be the first person who panicked at a low and over-treated. It's a learning experience as the saying goes.

I also have another bit of advice I can't always adhere to myself, but I always try. There is a lot you can learn about managing your D - and learn it you will! And every experience is a learning experience giving you information to tweak your treatment or approach. But the nature of the condition we have as Type 1's is full of variables. So many variables it's sometimes impossible to sort them out. And there are variables we don't even know about (some of us choose to call those D gremlins). You can't always explain everything. Sometimes things happen that don't make sense. I've banged myself against the wall of "why" way too many times. Often what's most important is to just deal with the problem at hand. Later you can analyze it to see what it has to tell you. But as you come out of your honeymoon you will have some WTF's - times when you have no idea why something happened. Fortunately that is not the rule. But when it happens, don't let it drive you crazy. I like to understand and control things, we all do, but it's not always possible. Type 1 often has a mind of its own.

I used to totally do the "munchies" thing for hypos. Once, I got the ice cream into my head but it was over frozen. I contemplated, at hypo-speed, the "inside out" nature of the microwave and put it in the broiler to thaw it out properly. Then the phone rang (more distractions...) and I set the ice cream carton on fire. Ooops, fortunately I was able to extinguish it without burning down the house.

I had a BD Ultra Smart meter and, a few times, it registered numbers like 7, 12, 23, etc. and I was still conscious, although zonked out of my gourd. For some reason Guitar Hero really seemed to push me down, although I haven't actually played it since I started exercising more.

I wouldn't consider a 10 minute walk to a bus stop to be "exercise" but I walk the dog a lot if I drift up after dinner. If the 1U or 2U questions are hard to deal with, can you find a delivery system that will deliver finer gradations? I think a lot of the ok results I've had are from respecting how fine adjustments to basal rates and bolus ratios are very useful.

I also totally agree with don't worry about posting! I like these kind of threads as thinking through other peoples' issues helps me think about my own!

I agree that the 15/15 rule is just a place to start when treating low BGs. These days I usually just use one or two glucose tabs, 4 or 8 grams of carbs, to treat lows. I’ll be more aggressive if my IOB number is high.

Yes, as much I like to solve my metabolic puzzles, sometimes you just have to chalk it up to the D gremlins.

ah, it's OK, i still over treat sometimes...I wouldn't suggest treating at a 60 low blood sugar....I treat for anything close to 70 as I drop quickly too, especially if my bolus is still active. I too use about 1 or 2 glucose tabs - mine are 4 grams, depending when I last bolused and what i'm doing in terms of exercise. I hate over treating then having to go through the same thing all over again, correcting again..ugh! Jelly Beans are great too, keep a bag full, they're 1 gram a piece and just take a handful. if you've been inactive and started a basal regime then, yes...even walking with a bolus on board can cause a low. walking can cause me to go low a lot.

julez, you are doing your best! we are so quick to criticize ourselves, but this is scary and overwhelming and no one understands what it is really like. you will take stock of what happened this time and next time you have a low, you will be better to evaluate the circumstances of THAT low. no one is going to be perfect all the time. when my honeymoon was ending a couple of months ago i was on here asking basically the same question 8 different ways and there was some great hand holding going on. ;)
i think the big drop in bg was from the iob. you only had an hour between the 99 and the food and the 112 bg, so maybe do you thin you may have miscalculated the carbs? pancreas working a bit better today? spitting out a bit more insulin?
for treating the low, again, a myriad of factors come into play. if i were at 70 and still had lots of iob then i would eat some slowish carby thing, a slice of toast with something fatty on it, like butter or cheese, to slow things down a bit.
tomorrow will be better.

I keep myself from overtreating by using juice boxes ONLY. Gerber makes juice bottles made of hard plastic that can sit in the bottom of a backpack squashed by books for FOREVER (yay!) and still not burst. They are, however, impossible to open when you're low, so I actually keep a juice box sealed in a soap dish, which keeps it from bursting and still grants me easy access.

Don't beat yourself up over it, though. It happens, especially when you're new to things. It took me forever to learn not to treat a 54 with a protein bar (yes, I really did that!) And, of course, I believe I followed that up with animal crackers and maybe a granola bar, too. We all figure it out eventually--don't beat yourself up over it.

Low blood glucose also causes a "hungry" effect--you want to eat MORE. Additionally, if you are feeling low and unstable, the fear will make you over treat.

I agree with all the comments. You are really new to this, a little unsure of it all and it will take some time to learn.

And we are willing to "hold your 34 year old hand," as that is what Tu is about.