Why the lows?

This may sound like a stupid question, but why do we go low? I assume it is because we eat then bolus and then we may have bloused a little too much. Is that it or are there other reasons why we go hypo. It just seems that some people go really low, so there has got to be more to it. If it was just because of bolusing then we would just bolus a little less. I must be missing something. Please help me under stand, I I know carb counting isn’t exact.

I think that it's easy to underestimate how wickedly strong insulin is. Since I've had my pump I'm always surprised to see that relatively minute adjustments, e.g. +/- .025U/ hour or .1G Carb/U, can make a big difference in my results. I'm always skeptical but, when I see numbers run off repeatedly, I make changes and they often fall into line, or at least move the way I should. I don't think that syringes can really handle accurate delivery the way a pump can. At least for me but, when I read other peoples tactical notes about various adventures we have, it makes me think that tighter dosing control would be very helpful.

I agree, I use a pump also and make small adjustments as needed. I get lows but nothing severely low, only down in the 60’s. With my pump and dexcom I can normally keep myself between 70 and 180. I just read a lot of stories on the forum of people going severely low and I want to learn some more so I don’t have that problem.

There are a couple of pieces to this puzzle. All of which need to be bang on most of the time to achieve the tight control we all want.

Basal rates vary from hour to hour and day to day as our activity levels change- work day to weekend to vacation to sports day to workout day to couch potato day to sick day. Not to mention hormones up vs hormones down, vs hormones going sideways!

Insulin to carb ratios varie with time of day. What works in the evenings may not for breakfast. The kinds of carbs you can do change from hour to hour not to mention the amounts of carbs vs meal times will vary dramatically for each of us. And that assumes that you are a perfect carb counter and never have to deal with the hidden carbs that are sprinkled like fairy dust some days! High carb, moderate carbs, low carbs, extremely low carbs what you eat and when will effect the amount of insulin on board and how much your damaged pancreas can still help to cover some of it.

Correction factors also change with time of day and for some the phases of the moon.

Duration of insulin activity (DIA) is very personal and will make a big difference in how you dose.

And then there is physical activity. The more active you are the more insulin sensitive you are. Not to mention the more active insulin on board while you are active the faster your BG will drop.

Learning how to juggle all of these balls takes time, and then just when you think you have it down, and are on top of things the season/mood/phase of moon/karma/weather/D God's smile or frown and your back at square one.

The only constant is that things will change. Learning to ride the flux and go with the flow are the most important lessons you can learn on your journey. If you can not learn how to adapt on the fly and make changes to your routine and have to rely on your Endo/CDE to make changes for you at set time points/office visits then you will not be able to stay on top.

Scary at first but as you learn to take charge, you will realize you can make positive changes to how you deal from day to day. And by taking charge you will effect your day to day as well as your long term quality of life.

Thanks for the great explanation. That makes a lot of sense. I’m still in my honeymoon phase and feel like I got things fairly controlled for the most part. I’m sure the rug will be pulled out from under me in the future.

Dehydration, vomiting and delayed eating will cause me lows as well as moderate prolonged exercise. Heavy exercise causes my glucose to increase. With regards to food, some types of carbs cause me to jet up and others do not. Learning our bodies is a constant education.

I agree with all that's been written already in answer to your question. The most important factor in the whole equation of good BG control is the variability of each of our body's metabolic systems.

Just consider our insulin sensitivity. That's the amount that BG will drop given a 1 unit insulin correction. Insulin sensitivity is also a part of our insulin to carb ratios, I:C. While many of us have tested to arrive at that factor, do you really think that insulin sensitivity stays the same, throughout each and every day, month after month, year after year?

All the various factors that we use are valuable for good control but they are simply an idealized average. One day they work as advertised and the next, not so much. If diabetes is anything, it is imprecise.

Your experience, John, with avoiding severe lows, may be related to your remaining endogenous insulin production. That implies that you take fewer units of exogenous insulin overall. Less external insulin means milder dosing mistakes. It's part of Bernstein's law of small numbers.

If our metabolic systems operated in a static fashion then controlling BGs would be much easier for we PWDs. As it is, we must contend with hitting the moving target as often as possible. It requires an enormous investment of time and our attention as our systems flux from moment to moment and day to day. People who do not live with this can't really appreciate what we do.

Good luck with your continued BG success!

I know this is not a high-tech answer, but I think it accounts for many of my lows: checking BG with what i guess was a speck of dirt on my finger (a sweet speck, that is), then over-bolusing and going low. I try to remind myself that if my BG measures unexpectedly high, wash hands and test again.

When I was first Dx I was 34 and very sick but when I started using a little insulin and stopped putting 3 tablespoons of sugar in my 8 cups of coffee every day my BG dropped and it seemed at the time to be quit simple for me to control my BG and I bragged to my doctor saying what's so hard about this. He always smiled and said your in your honey moon phase...just wait it will get much harder to control later...He was correct on all counts.

I suspect that we...LADA's have a little bit of counter regulatory response left in the beginning, and this triggers a sugar dump when we get low or have a little to much IOB. I survived hundreds of night time lows that where fallowed by High BG rebounds in my early years but now after many decades my body has zero response to Hypoglycemia and I have no rebounds left, I suspect that I just used them all up....YMMV

I have an Organic Farm and most people don't realized all Carbs digest at different levels. White flour digests Quickly yet Corn flour is slower and less complete. The break down of Food values is not accurate in my opinion. They put food in a Blender and then test the food values, our intestines don't work like a blender so how accurate could it be. The older I get the faster my Blood Sugar can drop also. Things like Blueberries keep the body from taking in Carbs so I try to pay attention to what foods cause my Lows most.

John, others have provided a lot of detail as to why, but the simple explanation is this: Insulin response is a very complex metabolic process with many variables, so there isn't a simple, linear relationship between carbs and insulin, or BG lowering ability.

Carb counting and correction factors are crude approximations, leaving out many other factors that affect insulin action. Much of the time, these factors can be ignored, but not always -- like when you're sick, or taken steroids for some reason, or stressed, or... There are gazillions.

Were only that it were as simple as IC ratios and Correction Factors. Then BG control would be a piece of cake!