Hi All:
My 8 year old son was diagnosed in March. He is currently in the “honeymoon” phase and I am just trying to understand low BG in people with type 1. I am just wondering if the lows are due to an issue in the glucagon/insulin feedback loop that keeps the BG of people without DM regulated or if it is due to having too much long acting insulin on board? I hope that makes sense. At this point he is only on 1 unit of Lantus at night and, depending on what he is eating, gets a total of 1/2-2units of Humalog throughout the day (his carb ratio is 1:60 and he is still having some lows. He clearly still needs the insulin since sometimes he will pop up to the 180s/200s if we leave carbs uncovered at dinner for when he has baseball in the evening but I am just trying to get an understanding of the physiology.
Thank you!
It’s the insulin.
Glucagon raises BG, insulin lowers it. The body only releases glucagon when it senses a low happening; in a properly functioning endocrine system, self-imposed lows happen seldom or never. In T1 or LADA, the fundamental problem is that endogenous insulin is erratic and unreliable, or absent altogether. So the diabetes leads to highs. Overdosing on insulin, which is really easy to do when the endogenous production is unpredictable, can often cause lows.
It does get much better with time and experience, but even those of us who’ve lived with it for a long time and accumulated lots of hard-won experience have to be careful. Every diabetic eventually learns to keep emergency glucose handy for those inevitable times when things just don’t seem to follow the known curve.
Hi, @JsMom1.
I’m sorry about your son’s diagnosis. My son, Caleb was diagnosed when he was three, he is currently 14.
Caleb’s dosing was very low shortly after diagnosis - less than 2 total units a day. The simple answer is lows are a result of too much insulin. A more specific reply to why your son is having lows when he is, is much more complex. Caleb had a very strong honeymoon and it went on for a long period of time. It was hard at times to manage his bg with a pancreas that was still doing some work, but doing so in an unpredictable way.
Even without having to manage a honeymoon period (which also has its benefits), getting dosing right considering carbs consumed, the impact of protein and fat, growth, variable activity - it’s very difficult to manage without experiencing out-of-range blood sugars one way or the other.
Is that your question though, or are you asking something much more scientific that I may not be qualified to answer?
Well, both. In T1D, insulin-secreting beta cells are gradually destroyed in an auto-immune process, and endogenous insulin production capability decays over time. Although glucagon-secreting alpha cells are not destroyed, in T1D glucagon secretion function is also adversely affected in concert with decaying beta cells, although (as far as I know) these mechanisms are not completely understood. In particular, in the presence of externally injected insulin, the messed-up glucagon response is what makes people with T1D even more susceptible to hypoglycemia as our defenses against low bg are compromised. From a management point of view, excess insulin, short-acting or long-acting, is what leads to hypoglycemia. Wish you best luck!
Unfortunately I would say that most well-controlled t1s have to deal with hypoglycemia, and sports and exercise are very tricky. Insulin pumps help because you can lower your basal rate before playing sports and then raise it back afterward - lots of t1 athletes use them including NHL player Max Domi and a couple pitchers who have played for my home team, the Jays (Brandon Morrow and Dustin McGowan I believe). Sports after eating is difficult because the large meal dose will be active for 3-5 hours and will be absorbed very quickly during exercise. The best strategies are a lower meal dose than usual before sports, eating hours earlier or eating after instead of before.
It’s also worth noting that exercise affects the metabolism for 24 hours. So if your son is having inexplicable lows on non-sports days, this could be related.
I once heard it said that when you are bringing outside insulin on board, sometimes it seems your BG will jump or drop 50 points because you held your tongue wrong against the roof of your mouth (read: no logical reason whatsoever). I don’t want to speak for others, but I can certainly attest to the truth of that statement.
I love it! So true.
And what’s all this talk about a honeymoon period? I never got a honeymoon period. 
Where do I apply?
I think you are also supposed to throw one unit over your shoulder for each 15 units you inject. Repels the diabetes demons, or something like that.
Really? You missed out! It was the best (well, best would be not having stupid diabetes), for 2-3 years I could bolus, eat almost anything, and almost always expect blood sugars between 4-7 after. I figured that was just how the pump works! Then I started seeing all these 12s, 13s, 15, 17s doing that, and the super fun times were over forever…
Welcome to the site. Sorry to hear of your son’s diagnosis, but I’m glad you’ve found TuD. I was diagnosed at age nine, but my honeymoon (over 25 years ago) wasn’t that strong. The lowest my TDD got was eight units a day, and I still had readings up to 200-300 mg/dl at least once almost daily. Still, during the three or so months the honeymoon lasted, my control was very good, much better than anything else I was able to achieve afterwards, given the insulin regimens in use at the time.
My understanding of lows with Type 1 is that it’s a combination of too much insulin at a particular time and the fact that the alpha cells that release glucagon stop responding to hypoglycemia. I have read studies where they have used insulin to induce lows in people with Type 1 diabetes and people without diabetes, and even with the excess insulin, people without diabetes have a glucagon response while people with Type 1 do not (one example study is here). So, not only is there too much insulin driving blood sugar down, but the usual safety mechanisms that the body uses to restore normal glucose levels don’t kick in.