Hope you are all feeling well....I have been having low blood sugar issues and just looking for some insight. Since being dx in April I have been on Lantus 10 units at night and I started on Humalog 1u/10 carbs which changed to 1u/15 carbs because of post meal lows. I was doing pretty well, an occasional weird low here and there that made no sense but since last week I have been dealing with more and more lows and none of it makes much sense (I guess this is normal and the nature of the beast so to speak) for instance last night for dinner we had spaghetti and meatballs, I measured my pasta, also had a piece of bread and dosed accordingly and post meal I was at 52, drank some choco milk (that's my go to corrector if possible because I love choco milk lol) so ok fine before bed I was at 120. I woke up with a fasting of 70, I have never had a fasting that low before, typically it is 90-110. I ate breakfast...2 pieces of toast with a little jelly, a yogurt, coffee dosed as usual and post meal was at 50 and feeling shakey and "off"...I again drank a little cup of choco milk and now I am at 91. I am just not sure what the deal is, it has been uber hot here, does heat effect levels? or is this just part of dealing with being a new diabetic and part of the honeymoon phase do you think? it almost seems at times like my pancreas is working fairly normally but I have a feeling at some point it will just crap out and then I will be here complaining about unexplained highs lol. I have considered dropping my Lantus to 8units at bedtime and maybe changing to 1u/20carbs ratio for the Humalog, I seem to be very insulin sensitive or something. My endo is great and is very much supportive of me adjusting on my own, thoughts? worth a try? should I just try adjusting one or the other at first? I just hate the lows, they make me so funny in the head and blah! and I worry a lot about going low over night, I am looking into getting a CGM soon I think that will help ease my fears.
Any thoughts appreciated, I could of course call my endo but I feel like you fine folks who are living it probably have equally good if not better advice. Thanks!
i am also a honeymooner and i was started on 12 units of lantus and a sliding scale type thing for bolusing. thank god for tudiabetes and a friend of mine who got type 1 2 years before me. anyway, when i first started i was low after breakfast every day and had some of those horribly terrifying night hypos, waking up wondering why there wasnt a snickers bar in my hand...
i lowered my basal by two units every couple of nights and was finally good at 2 units!
ive been honeymooning about seven months and have had to change my bolus I:C ratio four times, up and down in the last 3 or 4 months. i would say raising it 5 carbs and testing afterwards to see what your body is doing sounds reasonable.
i did the first changes more 0r less at the same time because i was having lows all the time, night and day. it would probably be more sensible to change one at a time, but was hating the way i was feeling so didnt wait...
enjoy the honeymoon while it lasts, i know i am!
If you were waking up at a good number and only going low after meals, that would typically indicate that it's your I:C ratio that needs adjusting. However, since you're waking up on the low side, you may want to first start by nudging your basal down slightly. Try 9 units of Lantus tonight and see what happens.
Also, be aware that Lantus does have some peak activity for some people, usually about 5 or 6 hours after you inject. I took Lantus for years as one nightime injection without a problem then began having significant drops at night. I was having hormone issues as well and recently switched to a pump so I could set different rates for different times of day. Some people break their Lantus injections into 2 shots twelve hours apart to avoid nightime lows. But I think the first step for you to try is to reduce your Lantus by one unit at a time.
The thing to remember is small changes then give it 2 or 3 days to see what happens, then change again if needed. It sounds like you're dealing with this really well though so good for you! Hang in there, it gets easier as you go along. :)
Remember to test, test, test and write it all down so you can look for patterns.
If the lows you are experiencing are primarily after meals there would be no reason to change your Lantus, but yes, you might want to change your I:C ratio. I personally don't advise making such gross changes such as from 1:15 to 1:20. Rather, if you are going consistently low (not just one or two times) from a particular meal, you might want to go from 1:15 to 1:17.
Also, the meals you are eating are very high carb and higher carb meals, especially if they are also high fat are very hard to bolus for. You might consider cutting carbs a bit and see if you get more consistent results.
You don't mention how much ahead of time you are bolusing, but you might try reducing that gap if you are going low soon after eating.
Finally, you are getting those lows at, I assume the 2 hour mark. You might try testing later and see if you go high. If this is a frequent pattern, you might want to be tested for gastroparesis (sp?).
thanks for the thoughts...I bolus right before a meal, like literally I count up the carbs, take the shot and then eat right away. I test 2 hrs post meal unless I feel funky then sooner but I also test a lot so plenty of tests in between and all around. I haven't had a spike over 170 in a long while and that has only happened a couple times since starting insulin. most of the time when I spike up it's in the 150 range, and even that isn't that often. My post meal spikes seem to be in the 130 range for the most part. So I am not going super high (surely I just jinxed myself ;)) As for the carby meals they aren't constant either but I do eat a higher carb diet than probably a lot of diabetics, mostly because I am skinny. When I discussed this with my endo she said not to low carb and I don't typically eat spaghetti/pasta (overly high carb meals) regularly but I do have little kids and that is one of their favs so if I make it I also eat and account with my insulin dose but typically we don't eat carb loaded meals, just average if that makes sense. And I never eat sugary desserts or anything like that. When I had GD when preggo I was put on a strict low carb diet to control, not only did it not control my blood sugars (probably because I was LADA then too) but I had such a hard time gaining weight with either pregnancy, I barely gained 20lbs both times around and had 8lb kids and about 15lbs of fluid leaving me weighing less post birth then when I started, most people get excited with that sort of thing but having always been the "skinny kid" I don't much like it haha, anyway I am rambling now....gastroparesis is a thought, I have a GI and we have discussed it but without getting the later spikes I am not sure? I have always had GI issues, since childhood I am actually considering getting checked for celiac now, always something!....thanks for your thoughts, I think I will start by lowering lantus by a unit and see what happens....sometimes I think "am I really a diabetic?" because it doesn't always seem like I am, like I am an intermittent diabetic or something, I know that's silly but honestly somedays nothing adds up!! blah! I am due for an A1C this month it will be interesting to see what it is....my starting one was 8.2.
Sounds like you're doing great, Kimmiejo, for how recently you were diagnosed. I was misdiagnosed type 2 so I was on oral meds for 15 months, which meant I missed those early days of really low insulin needs or needs that varied. Don't let the highs or lows get to you, just look for patterns and make small changes, then sit with them for a couple days. I agree with smileandnod that you might want to split your Lantus at some point to get more even coverage (or switch to Levemir which many people find works more smoothly).
thanks, it's a learning process for sure...honestly I probably would have been misdiagnosed for a while too, my family dr was very aggressive in her thought that I was type 2 due to my age, take metformin, see you in 3 months. Had it not been for the fact that metformin made me horribly ill I probably would have been on board with that too for a while but if I am being honest I thought from the first time I got dx with gestational diabetes 5 yrs ago that something more was going on, it just didn't make sense and I have so many type 1s in my family! so once the metformin illness kicked in I was determined to figure it out because that med kicked my arse lol. I felt like I had morning sickness 24/7 with no baby on board ;)...so glad I found this board! great advice from all of you!
I think that it helps to think of the "ratios" pretty closely? If think you are 10G/U and should maybe be 15, if you have say 40G of spaghetti, that's like (*does math*) an extra 1.4ish units of insulin which at 35 mm/dl/U is nearly 60 points off, BG wise? It doesn't take a lot to get pretty whacked out. I sort of cheat as it's very easy to change ratios with a pump which will then compile data intelligibly. When I find my numbers being off regularly, I'll turn the ratio up or down a couple of G/U and that often seems to fix it. If it's the basal/ fasting numbers, I'll adjust thouse a shade, which is harder to do with MDI but can be done too?
Hi Kimmiejo: First, lows make us feel awful! Good if you consult with your endo to tweak things a bit to avoid lows wherever possible. Here are my thoughts, for the 2 cents they are worth: you are newly diagnosed and have gotten diabetes largely under control. You have some remnant beta cells that are happy to have the assistance from exogenous insulin, so they are doing better and helping you out in your honeymoon. This is incredibly positive! The longer you keep the honeymoon going, and if you maintain good control you can keep it going a LONG time, the better off you are in the long term. When I was in my honeymoon, my ratio was 1:30.