Severely decreased basal rates

Brand new to this site so apologies if im doing this wrong. Since starting college late august, I began a low carb (< 30g/day) and lowish calorie (~1500/day) diet in attempts to lose weight (overweight at ~220 last I checked, don’t have access to a scale at school) and regulate blood sugar. My problem is while I’ve succeeded in regulating my BG, I have decreased my basal from 24u/day to 8u/day, and still I can not get above 90 on a regular basis, instead I hover around 75, which is too low for me to feel comfortable. On top of that, I’m rarely taking any bolus insulin because every time I eat the few carbs in my meal has to go towards bringing up my BG. Even cutting my basal so much has yet to help, as I’m still often going down into the high 60’s. Despite this, I feel much better than I did before starting this diet and would not like to change it, if at all possible. I am reaching out here rather than to my endo (at this point, if it gets worse that is my next step) to find personal experiences similar to mine and how the problems were fixed.

My questions are: Is this typical of starting a low carb diet? Is my basal rate getting concerningly low? (Diagnosed october 2016 if relevant) Do I need to just give up and get more carbs in my diet? (I really hope not) In addition, if you have any advise, it would be very very appreciated.

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First - Hopefully you are discussing this with your Endo.

Diagnosis of October this past year does seem relevant. Quite possibly you are still on your “honeymoon” which means your pancreas may be producing insulin still. Low carb plus losing weight would make sense that your insulin needs would decrease. During honeymoon phase insulin needs can certainly be confusing and variable.

We adjust the insulin up or down as needed. I don’t care how much or how little insulin. If the BG is low, we use less insulin. I don’t care how much less. If the BG is high, we use more. I kinda care how much more as we don’t want to have a bad low so are cautious when increasing to check BG and be prepared with fast acting carbs in case of a sudden and unexpected low.

So my thought for you is if you have decreased from 24u/day to 8u/day then you clearly are comfortable with decreasing the insulin on your own. Is there a reason you have stopped at 8u/day if you feel that your BG is still too low?


Hi, @Melissa37!

Welcome to TuDiabetes! You are doing everything right!! :wink:

I don’t have the specific experience you are looking for, but I know others here do and will give you good advice. My son has been living w T1D for almost 11 years and never eaten particularly low carb. My suggestion would be to continue to lower basal insulin. But that seems like too simplistic an answer, so I’ll leave it to the better versed in this area.

I just wanted to say, welcome and thanks for joining our community. :slight_smile:

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Didnt stop at 8u/day, thats just the last I changed it-about an hour ago. I’m just unsettled by such a big change -TDD dropped nearly 80%- in the span of barely a week.

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Are you on MDI (multiple daily injections) ? Which insulins do you use?

Do you have a CGM or strictly fingersticks?

Medtronic (630?) pump with humalog, and Ive got a dexcom, so the lows aren’t necessarily dangerous just concerning due to how many I have in a day and that I struggle getting them up.

When you have the lows, have you confirmed them with a fingerstick or are you going entirely from the Dexcom?

With the Dexcom, are you doing the twice per day calibration? When you calibrate the Dexcom, how close is the fingerstick calibration to the current Dexcom reading?

Also do you feel the physical symptoms of a low?

I’ll confirm with a fingerstick if I have my meter on me, which is most of the time, and typically calibrate 2-4 times a day, depending on how off dexcom is. Typically, it is very accurate when I;m in range, but if it says I’m low, its usually 5-10 lower than actual, which I know isnt too bad. I’ll sometimes feel slight symptoms, generally if I’m below 65, but otherwise I feel pretty normal.

Your Dexcom experience sounds typical but when you say it is accurate, what would typical difference be between Dexcom and calibration? (Different people have different ideas of what is accurate.)

Our experience seems similar that we consider 65 to be where the low feelings start kicking in.

I consider accurate anywhere under like 15 off, i guess that I care more when I’m low because it gives me alerts, and thats when I want it to be the closest. If its a new sensor, i’ll feel fine if its within 20, so the first 2-3 days of a sensor I don’t trust very much. I’m at least 5 days in with this sensor, and its doing great, so I’m not concerned about it.

I just ask as like I said - different people are different. The Dexcom is (apparently) not so accurate with everybody.

It works great for us immediately from day one as soon as the 2 hr warm-up is over. Sounds like it works really good for you also although perhaps the accuracy needs a bit more time to settle down (ie - you say day 5 is better than day 1 in terms of accuracy but still good accuracy overall)

Anyway - So you have a Dexcom cgm and it is (by all accounts) accurate, you feel your lows and you often times confirm the Dexcom reported low with a fingerstick.

I am agreeing with @Lorraine. Perhaps in this case the simple answer is the correct answer.

But I would still put a call in to your Endo and discuss this with them. As you say, it is a very big drop. One thing with T1 diabetes that is important to remember is that everything is not about diabetes. lol. Maybe something entirely different is going on? Perhaps you have something that is temporarily causing a problem digesting carbs or who knows? I would want to at least run it by a Doc and make sure that nothing is being overlooked due to following what would appear to be the obvious path?
In the meantime though, you don’t want to keep having lows so decreasing the insulin while you wait to hear back from the Doc certainly seems the reasonable path to go.

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Sounds good. Thanks for the help!

Thats a big jump. I weigh 170 lbs. and I’m taking around 30 u basal/day. I also only decrease my basal by one unit at a time (per day). I don’t like this. Call endo ASAP.

When I adopted a lower carb way of eating five years ago, my insulin needs dropped by about 50% but it did not happen as quickly as you report. I cut my basal rates and made my insulin to carb ratio less aggressive.

It would be smart to keep your doctor involved with this. If it were me, I’d keep good records, emergency glucose close at hand and just keep backing off the insulin delivery. One thing I’ve seen is that cutting back on insulin delivery, just by itself, leads to cutting back insulin delivery even more. It’s counterintuitive and that counter-trend doesn’t last a long time but it can concern you if you haven’t seen it before.

I don’t count carbs consumed treating a low blood sugar within any of my goals or targets. When you need that emergency glucose, you need it. Ideally you would never need to treat hypoglycemia but life is not always ideal.

Doing what you’re doing wth a CGM helps a lot with your personal safety.

I’ve been eating lowish carbs for five years and it’s wonderful for blood glucose management. In addition to cutting my total daily dose of insulin, I also lost about 14% of my body weight, about 25 pounds. I regained about 10 of those pounds and recently dropped 5 of those.

In answer to your question, is this typical of starting a low carb diet, I will say this. It’s very typical in terms of insulin reductions but your reductions are more drastic than what I’ve experienced and what I’ve read others report. But I wouldn’t be unduly alarmed about that. As long as you remain vigilant about your glucose levels, especially with a CGM, I think you’ll be OK.

You should check with your doctor but be aware that many doctors do not understand or like restricted carb diets. Once my doctors can see a good solid history of CGM data with few lows, lower averages, and reduced BG variability, they seem to back off the low carb criticism.

Good luck and keep us posted.

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I went from about 62 u/day to about 22 u/day within a week when I switched from MDI to a pump. About the same % drop as yours but with MDI I didn’t have a real basal “rate”. Thought I was going to wear out my meter from testing those first weeks. It also resulted in about 50% less carbs in meal planning since with a pump I had to be more accurate and realized what a sorry job I had been doing on that. I felt increasingly better over the next few months. My endo didn’t say a thing about the big drop. Would love to hear what your Endo thinks about it.

Others have already made many great points. Keep checking in here. You will learn something or pick up tips from everyone’s thoughts and experience. If you are on campus, your health clinic or nurse’s office might have a scale you could use. Sounds like to low carb is working for you. After reading multiple success stories here I’ve been inspired to get my carbs down. Like everyone said, keep watching your readings. The “right” amount of insulin is whatever works for YOU.

I am so curious to hear how this all ended up for the OP. I actually just entered this situation into google and found this entry! I, too, just lost a pretty significant amount of weight while participating in a pretty low-carb eating regimen. My basal rate is now 8u, as well, and I am a little gob smacked right now! Do you have any updates? TIA! :slight_smile:

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