Lilli,
It might be that when you rest your pancreas by either taking over the background need with a long acting or the rapid response to food needs with a bolus/rapid insulin, that it can recover for a while. I have had the occasional out of the blue abrupt drop out in insulin requirements. Have never gone to none, but have had to chop my basal and bolus rates in half on more than one occasion. For me my needs do eventually come back up, usually after a few couch potatoes days. But it is interesting on my side to see that when I take ibuprofen on a regular basis for a bad hip, that my insulin sensitivity goes up big time and my basal bolus requirements drop. With my pump I can adjust by doing temp basal rates for my changing sensitivity.
No John, I didn’t know if that really happens, that’s why I asked you experienced people for input:) So the bruise indicates that’s probably what happened? After only 2 weeks of injecting insulin it was unexpected, frightening, and not a great way to begin this journey.
Yes, I’m not going to bolus and see how it goes for a couple days hobbit. My insulin needs are still low, I only need mealtime. I know I’m lucky I still have my own background insulin, my hope with starting bolus was to be able to eat more normal meals (not low carb) gain some weight back, stop the progression of neuroathy in my feet, get back some energy, and of course retain the functioning beta cells I still have. The first 2 weeks were good, no lows and for some meals I was going to try upping my bolus because 2u only brought me down to 180 and I’d like to be below 140.
Oh boy, I am so not a lab geek! My husband is a chemist and biologist though so if it comes to that he will be able to help me. My endo left to run a lab at Baylor though so I’m working with my PCP right now, they may not be up for doing this.
Thank you for this niccolo, I guess you can tell I’m feeling whimpy right now and when I think about what many of you have had to put up with for years, well then I really feel whimpy! I was just so happy the day b4 this happened because the first 2 weeks had gone so well, I finally had hope that I was going to get my health back on track after a couple of difficult years of rollercoaster BG, doctor appts, trying different orals…I do need to chill and maybe it is time to meditate regularly. I used to do it some but got away from it, I’ll look up Jon Kabat-Zinn. Thanks again and thx to everyone here, who else can we talk to about these issues?
The bruise doesn't guarantee that's what happened but it's certainly consistent with, and suggestive of, that happening. But you can easily create a bruise without also happening to inject insulin into a blood vessel, which is what happened most of the time you see a bruise.
Making the dilution does not require a lot just the ability to take 5 cc out of a vial and placing in back in a different vial.
Hard part was getting endo office to contact NovoNordisk for the paperwork to order. Need to pick up stock from MD office as they will not ship to patient. Th shelf life in fridge is the same for novolog- as in two years so not need to order dilluent that often if you get it. I did have to tell office what to order syringe and needles wise so I could make the U50, but once it was in record has not been a problem for refills. Have way more in the closet than I will use.
Once you do the math for your I:C ratio and CF it does not change so you are not redoing it every time.
If you want help with this just let me know.
Yeah, being a lab geek, 2hobbit (bless his heart) makes it sound far more complicated than it is.
Two vials, two syringes. Remove half the contents of each vial with a syringe. Inject each syringe into the OTHER vial. Done.
Far easier than most cooking recipes!
Agreed, this community is pretty fantastic. I just discovered it as I was starting a pump a few weeks ago, and I'm psyched to be part of it now.
And we're all wimpy sometimes! Don't beat yourself up for it, honor that feeling, but then work with it and don't let it cripple you. There will be good times and bad times, and both need to be kept in perspective!
It could be what happened but it is only a possibility and to be honest I don't know how common it really is to have that happen. A bruise doesn't guarantee it and isn't by any means firm evidence of that. I've had numerous bruises after injecting and I've never dropped to the 20's after and had a resistant low afterwards.
I think you need to consider all the other possibilities and discuss them with your doctor. I also would use this and your lack of awareness of your lows until they are really bad as a reason to get a dexcom, it's not perfect, but it can hopefully warn you about any lows you may have before they get to this point.I actually find doing all that stuff pretty confusing- figuring out the doses and then huge air bubbles in the syringe etc. .. that just happened to me yesterday with doing a cartridge fill, had a huge air bubble which just wouldn't go away and it messed up the whole dosing twice.
I would also suggest couple of things. Not sure if they have been already mentioned.
1. Try to measure the correction factor. It is how much blood sugar drop will 1 unit of insulin cause. For example, lets say after 2 hours of meals your BG is 180, you inject 1 unit and within 60-90 minutes your bg becomes 100. So correction factor is 80.
2.Based on this you can use sliding scale approach. So basically you are only correcting rather than proactively taking insulin before meals. You can do the carb counting approach after some time when the body is more accustomed to external insulin.
3. Please don't combine another drug with insulin. You mentioned prandin. As it causes your own pancreas to secrete insulin. Best thing will be to stop it for a while.
Dr. Cox out of U.VA. did work with B.G.A.T. (Blood Glucose Awareness Training) you will want to explore meaningfully.
It is rarely that we do "not get them", but that we do not PERCEIVE the fact we are instead. Its interesting work.
Last I heard, if you let your numbers be higher (sic. much higher?) for a 72 hour period, many get a "reset" of symptoms. The trick (one anyway) is fighting the urge to correct our numbers. But, last I heard if we do not try and force ourselves to hover too low for that 3 day period, (ie higher than normal, leave it alone, don't touch) things can return...
Counter intuitive.
I stopped the prandin because of side effects, just using Novolog right now:)
Correction factor is important, but should be measured based on when insulin stops pushing your BG down, e.g. around 4:30-6:30 hours for Novolog/Humalog, not at the 60-90 minute peak action point (when more than half the insulin action still remains). Otherwise you're setting yourself up for some very serious lows.
I got my awareness back briefly once, this was pre-insulin by trying hard to avoid the reactive hypo lows. It didn’t stick even though I didnt think I was having them as often after going low carb. If I get a Dexcom I’ll have a better understanding of my cycles, especially at night. Staying high is difficult for me as lows follow the highs, my BG is more of a roller-coaster ride, one of the unusual things about my BG issues. I will look at Dr. Cox and his research see if I can learn some other signs, thanks. I felt fine the other day until I suddenly felt weird, like if someone hit me in the head but without the hit if that makes sense?
As other people say, the bruise doesn't indicate that happened; bruising happens all the time (sad to say). I was just making a false inference of what you were thinking from your post.
My experience suggests that my feelings of low blood sugar are actually feelings of rapidly descending blood sugar. These days when I get that feeling I do a test.
On the other hand if my blood sugar goes below about 60 in the night I wake up, and do a test... If it happens during the day these days I also do a test, but I think it is a learning exercise; I spent a significant number of years of my life targeting a bg around 50 because of a misunderstanding of the translation between mMol and mg/dl when I moved to the States. That was a very fine learning experience because the effects of going below 50 are more acute than those of going below 80.
I’ve been giving myself b-12 shots for years and will sometimes get a small faint bruise. This one is the size of a quarter and deep purple so that’s why I wondered if I could have hit a blood vessel. I guess I have to accept I may not know and just “get back on the horse” so to speak.
Hi Lilli,
I have bruising sometimes( kind of like what you mentioned but not that dark maybe, I tend to bruise easily but not like some people do) and I also sometimes have a little blood come out right after injecting, that happened last night, but I have never had any reaction like that after either of these. I sometimes wonder if when blood comes out that some of the insulin comes out too so I often place my finger over the site and hold it there for a bit. I don't think I've gone suspiciously high after that though, not that I recall, maybe once or twice but I'm really not sure if it was even insulin not getting in.
I have never had a major fast/bad low like that after bruising or blood so imo I don't think that is what happened to you. Also the needles are so short, do you use pens? I don't think there is any way to hit a major vein in the places we usually inject, you would see that probably, and the smaller vessels probably wouldn't cause that unless something else weird is going on, but I could be wrong. Just my thoughts.
Sometimes what I do notice is if I inject on the outside of my thighs where I have less fat I do seem to sort of hit the muscle and then I pull back or sometimes find somewhere else, but even that never seemed to cause any lows.
I think that it's more likely some of the other issues maybe? Like stacking insulin/your sensitivity/fat slowing things down. The insulin can stay active for a lot longer than the package info in my experience, so I leave long periods between my meals and boluses and I keep careful track of corrections and when I take meal boluses etc. I would definitely ask about diluting insulin like others have mentioned. I'm considering that for my pump now also although I don't think I'm quite as sensitive as you.
Don't worry, you will get your confidence back. It's good to always have caution when you use insulin. Just discuss this with your doc first and see what he/she says about it. I would try that course mentioned by Stuart I think also. Anything you can do to make yourself more aware is good. I often find if I'm concentrating a lot or I ignore one symptom, if I notice it, I can all of a sudden be much lower than I would like.
Sometimes Dex misses it but I feel it first. It feels to me like dropping on an elevator going down a bit and sometimes I can catch them at 120 or higher too. Then I know to treat if I feel bad or to keep an eye on things.
When you start out again once you've got a plan and maybe dilute the insulin or not, not sure what you're planning to do, I would take much lower doses too and see how you do with that.