Unexplained lows

I have been having a very frustrating and scary few days. I can’t seem to keep my blood sugar up. I can eat whatever (seriously… I tried it with a candy bar) and bolus 1/2 of my usual amount and within a few hours my blood sugar goes low. I did try not blousing at all and I went high, corrected and then went low again. When I don’t eat anything my blood sugar stays in normal range. I’m on tresiba and apidra. I don’t know what to do! Nothing has changed and I’m not pregnant. Any ideas?

How long have you been a Type 1? Some people can have an extended period of time where the pancreas still produces a lot of insulin. I didn’t need mealtime insulin until about a year and a half into being a Type 1.

I’ve have type one for 11 years now. Thanks for the thought!

We had something that sounds similar a few weeks back. It was odd. Ending up cutting all the insulin (basal/bolus) maybe in half with lots more carbs and was still riding the low train. Lasted about a week. Joked about the Pancreas coming back to life. Week ended. BG went up. Insulin went back to previous levels. Carbs back down to normal. BG now back in its wobbly more or less regular pattern.

I’m sorry. That is frustrating. It is coincident with opening a new vial of insulin? Could it be a prelude to illness? I know Caleb might be coming down with something when I see lows I can’t otherwise explain.

When this happens to me, the first thing that I do is weight myself. Sometime I loose 20 lbs and don’t notice because it happens slowly over a couple months. Just to be sure, you aren’t part of the pump infusion set recall, are you? See link: Medtronic Insulin Pump Infusion Sets recalled!

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LOL that was my first thought! I was like “I am cured!!” weird though…

Well come to think of it, I did just get over a cold but usually my blood sugars go higher during sickness.

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Thats a good thought! I will weigh myself and see if anything has changed. Nope I am not part of the recall, I am on MDI!

Thanks everyone for all your ideas, hopefully one of them explains what is going on :slight_smile:

Insulin requirements in type 1 diabetes can vary for no discernible reason. With the same diet, consumed at the same time every day, and the same activity level, I have required 15 units of Humalog per meal in June, and now in September I need only 2 units per meal (all my meals are weighed and exactly the same). So what explains it? It must be the shifting of some variable that eludes measurement.

Actually, Seydilitz, the variable is likely insulin production. Recent research has found that about half of all T1’s still produce some (wildly variable) amount of insulin. So, Katiecat - it’s very possible that your pancreatic endocrine beta cells have “splashed” some insulin into your bloodstream - much like the “honeymoon” phase that most of us experienced shortly after dx’s. Here’s an article:


@Seydlitz I guess I have just never experienced such a rapid change, it has completely thrown me off!

@T1Wayne wow! That article is really interesting… I didn’t know that. It’s kind of scary though!

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The short answer is “because it is diabetes”. For me, when this sort of thing happens I have to look at all the possibilities. That is if I can find them all.

All of the replies give you good possibilities to look at. There is something you said that I have found a similar issue with which has not been mentioned. That is the insulins you are using.

I began my insulin usage with Lantus and Apidra. After using Humalog during a shortage of Apidra I found that it worked much better. Apidra was working too quickly for me and causing lows. I switched to Humalog and it helped immensely.

Then early this year my doctor switched me to Tresiba from Lantus. Shortly after that I found that I needed to use less Humalog than I had previously been using by about one unit across the board. I have not heard anyone else say that Tresiba has increased their insulin sensitivity, but it definitely has for me.

What you are describing sounds to me like there is just too much insulin activity going on for what you are eating and doing. It may be the combination of the two or it may be your basal dose. I have noticed and others have stated that Tresiba has a sweet spot. One or two units either side of that can create a significant response either way.

Different insulins work differently and some are not suitable depending on your diet and lifestyle. I would seriously take a look at this with your doctor and maybe change the Apidra to something that is not as fast acting. That change made a big difference for me and it might for you.

While there is some residual beta cell output in type 1 diabetics, it declines over time and quickly becomes insignificant, so the huge fluctuations I experience all the time after more than half a century with the disease are unlikely to be due to residual insulin output.

Consider the likely influence of background residual insulin output in type 1 diabetics on meals. In the normal adult, the average c-peptide level (which measures insulin output) two hours after a meal is 1.5318 nmol/L. But in a type 1 diabetic, the background c-peptide level is 0.187 nmol/L at diagnosis, declining to 0.096 nmol/L after ten years, and 0.029 nmol/L after fifteen years. While c-peptide itself may well have some retardant effects on the development of complications, it doesn’t seem as if the residual insulin output which it measures would make much difference.

See: T. Lee, et al., “The Clinical Measures Associated with C-Peptide Decline in Patients with Type 1 Diabetes,” Journal of Korean Medicine, 28 (9) 1340-1344 (2013).

It’s possible that your basal insulin needs have gone down, perhaps temporarily. If you take too much basal insulin, then the basal insulin starts to assume some of the bolus or meal work. I know we like to think that there’s an ideal dose of insulin but I’m a believer in the idea that diabetes is, if anything, a dynamic disease. It’s nice when we can predict insulin dosing outcomes well but when diabetes does its dynamic dance, we need to adjust. Just an idea.

I am in a dynamic phase right now. I would like to throw a :bomb: on my diabetes right now. It’s only fair. Type 1 is like a never-ending game of Spy vs. Spy!

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@Timbeak48 – Sometimes you just need to go along for the dreary ride, but try to learn something that may help you with the next time you face this circumstance. Diabetes has a way of showing you similar, maybe not the same, symptoms and learning can help. Stealing from a clever quote, diabetes, like history, doesn’t repeat itself but it does rhyme.