Odd Low Blood Sugar Situation

Hey guys, just looking for some input into an incident I had last night. First off, I'm a type 1 diabetic of 7 years or so, almost 31 years old. I'm 5'9 and 145lbs and a pretty sensitive insulin user. I am always tinkering with my units. Anyway, last night I go to the gym and get home at roughly 9:45pm. I check my sugar and it is 10.4 mmol/l or so. I take 4 units of my lantus 24 hour insulin because it's time for it, and I take a unit of insulin to try and bring it down. I check it half an hour later and it is roughyl 6.8 mmol/l. I see at this point it is dropping quickly and I act by eating 2 nutrition bars (25g carbs each or so) and chugging a glass of oj, roughly 35g carbs. I check 5-10 mins later and it is still dropping, 5.7 mmol/l or so. I chug 2 more glass of orange juice and pop 4-8 dextrose tabs. check 5 mins later, still dropping, 4.3 mmol/l now. I start to really panic, as this is 45 mins into a 4 hour fast acting insulin. I'm shaking at this point, chattering and can't stand still. So I start chugging more orange juice and eating all the dextrose I can find. Finally it starts to increase a little. I see it go to 6.4, then 8.7 and stop around there. A sweet sigh of relief. Oddly though, it stops at around 13.2 mmol/l even after I had consumed probably 200g of sugars or more. I go to bed and wake up a half hour later, and find it is dropping again! 5.8mmol/l when I wake, eat some sugar, check 5 mins later and it is still dropping, now to 5.4 mmo/l and the shakes set back in. I head to bathroom and tell my fiance she might need to call an ambulance, as I'm so full from all of the oranje juice I can't even think of putting a dextrose tab in mouth. Then I throw up, all of the orange juice comes up. More panic sets in, as I think maybe I just threw up all of the sugar I'd already consumed. So I get a nother big glass of orange juice and more dextrose in me. Finally, after a half hour or so, the levels start to increase. This time it goes back up to 13.8 mmol/l or so. Luckily this was the last of it, as I stayed up until the 4 hours were up, monitoring it like every ten minutes. Still, I wake up this morning and my sugar is at 10.4 mmol/l now. This isn't very high for someone who probably ate 400g of sugar just 7 hours ago. I am pretty much scared to take my insulin now. I guess after all that what I'm looking for here is, has anyone ever had experiences similar to this? Any and all info would be greatly appreciated.

Appreciate the response, but definitely never switched them. I actaully checked after to make sure, because my novorapid pen is the new one which tells you what the last dosage was. Either way, I won't be injecting any insulin after the gym any more haha!

That's was the exercise!! I NEVER use fast acting insulin after a workout.

I'll give you a example: yesterday was my cardio day. I run 3 miles around 6pm. I ate one foot long at subway without Humalog. 2 hours later I was at 102.

All depend of how intense was the exercise

Agreed. Sometimes exercise drops me low super fast, other times it sends me soaring high. I think it has to do with the length of the activity, and how vigorous I'm going at it.

I've been known to "cheat" after a hard workout, just because I knew I wouldn't need the extra bolus to cover it. :)

I have had this happen myself. I can be 160, exercise and then drop. I spoke with my diabetes educator and physician regarding this. What I learned is exercise can impact your blood glucose level up to 24 hours after exercise. If I eat a 15g carb before exercise and then 15g carb after exercise, I do not experience this.

I have had some lows like that that don't respond for a long time to lots of sugar, but not to the extremes of sugar that you took. I was almost always constipated at the time and when I go to the bathroom then the sugar starts to work finally. On one occasion I started to get very nauseous also and thought I would vomit too, but I didn't. I almost always spike to 200 and above after but not always. I'm assuming I have some form of gastroparesis maybe. I also had a low of 29 in the middle of dinner a couple of weeks ago. I don't think I made any errors.. I took the same amount of insulin as the night before for a similar dinner, with a similar amount of activity level before dinner. I waited a little longer after my bolus but no more than 5-10 minutes to eat. I had been constipated all day so I think the food wasn't getting into me and maybe I had some insulin production too. I had shoveled some snow, but not much before the 29, and had shopped for two hours the night before with no low.

Some of my faster dropping lows were after a correction and a walk. I had one yesterday where I just ate with no insulin and took 4 ounce oj because I could tell I was crashing. I started to come up finally and decided not to bolus at 122 so I ended up at 220 later. I didn't even eat very many carbs either.. just the oj, 2 eggs, a slice of toast, butter and tea. But at least I avoided a bad low.

It might be the "always tinkering with [your] units". I did that until 2008 (I started working out regularly in 2005, a lot in 2007...) and knew nothing about carb counting or bolus basal, calculating dosages, etc, just fired away "hmm, burrito, hmm, maybe 10 units? Hmmm it was high last time, let's try 12...".

Nutrition bars are not the best thing to have when you're low as the carbs tend to be somewhat slow. I guess there's more than one kind however many of the "granola" type of bars have slower carbs, are useful for providing concentrated energy for hiking, etc. 5-10 minutes isn't long enough to wait for the sugar, even really nimble OJ to deploy either, although the dropping dropping dropping you describe might lead you to think that it is. The 5.8 to 5.4 drop is within the margin of error of many meters and I think the timing of the testing, 5 minutes later, is also too quick to measure a significant change. 5.8 by itself is a pretty good number. After treating lows, I find that, in many cases, waiting more rather than less, I will do 20-30 minutes, to give the sugar a chance to deploy more completely, can help avoid the ups and downs so much.

There's not quite enough info in the story to say for sure where the annoyingly persistent low came from. I will see a tailing effect on BG that might be that your basal is a bit more than it needs to be. If you are taking 4U at night, is that the only basal? Maybe there's not much to cut out. When had you last had insulin before you worked out? Did you eat dinner and then head to the gym or something like that? I like to get bolus insulin out or mostly out before I work out.

I appreciate the thoughts, but I don't think my tinkering and yours are the same. I tinker because I am so sensitive to insulin. I do carb count but when you are at the point where you are taking 0.5 unit of novorapid for anywhere from 35g-50g carbs, it;s tough to get it right, especially when your'e active. To be honest, I am think I am going some crazy sort of honeymoon, almost 7 years after diagnosis! Since my incident reported above, I haven't taken any novorapid, just 4 units of lantus at night, and the night before last night I woke up at 4.4mmol/l and had to eat something to stay from going low. I dropped to 2 units of lantus last night. Woke up today at 8.8mmol/l, ate a carb free breakfast, and 2 hours later I'm down to 4.7mmol/l! Going to see my endo next week, but won't be taking any novorapid until then. It's not worth the danger of lows while my sugars are so steady at normal numbers.

It sounds like high stress could have caused the weird duration of the episode. I've noticed that my blood sugar drops when I'm panicked, probably due to the fight-or-flight instinct utilizing a lot of glucose. Since you had a flat-out panic attack, that could have prevented your blood sugar from completely skyrocketing. Also, never eat a nutrition bar to treat a low, because of their higher protein/fat content; this can significantly slow the absorption of glucose.

I had this problem before. What was discovered is I was not eating enough carbohydrates daily so my liver was releasing stored glycogen to keep my glucose elevated. Then out of know where I would crash. I would drink 2 regular bottles of Coke and still not bounce back until a few hours later. I finally started eating enough carbohydrates daily and bolusing for them and boom, no more crazy unexplained lows.