Worried I am concerned

I was diagnosed 5 months ago with type 1. Never had any fluctuations since dx. My a1c was 5.7 a couple of weeks ago. I was all good until today. I have a dexcom sensor on me. I started using it last week. Today was my day to change it 7 days. I decided to restart and extend it. I added some skin tac around the tape. I went for 6 hours without eating a meal 12pm to 6pm. Just ate some sugar free cookies and a low carb bar. My blood sugar has dropped to 54 after extending sensor. I drank a 8 oz pop and it brought it back up to 140. I ate some chicken strips with a small salad. Now after an hour an half sugar is back down to 60s. I dont take any rapid insulin just levemir 5 units once a day. Can anyone help me understand what is going on?

Are you double checking your Dexcom with a finger stick? They get weird when they’re settling in.

Yes finger stick is reading low too.

It sounds like you need less insulin. Maybe try talking with your doc or just lowering your levemir dose by one unit. Were you more active than usual when you went low? 6 hours may be too long to go without a meal on that basal dose with a certain amount of activity. The problem with long acting insulin is it’s in your body and can’t be adjusted if it becomes a bit too much or too little. It’s not uncommon to go through periods even day to day when you need less insulin sometimes it’s seasonal and a lot of people need less insulin in the warmer weather. My dexcom is frequently off by a huge margin unfortunately- it usually gets the trends right.

I usually workout every day either lifing weights or running. But i did not work out at all yesterday. Before the lows started I was outside watching my daughter’s soccer game. It was cloudy 70 degrees here in Chicago, but the sun did come out and gave me a good dose of vitamin D for at least a half hour I was out there. I have been taking 5 units of levemir for 5 months once in the morning. Never had this happen to me without any type of running involved Usually when i run i might get low some times. But i drink some gatorade amd i am back to a stable blood sugar within minutes. I am currently typing this and my BG is a stable 100 now. Thank God. Just trying to figure out why it happened so i can try to be more prepared or avoid it altogether.

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Thats good you’re stable now. I guess it could have been anything that caused it like the things you mentioned… sometimes a change in activity from less to more more to less can do it too. It can be very confusing to figure out for sure- I hope you get it figured out :relaxed: It’s amazing to me how much of a difference just a small amount of dose change and other things can make on what happens. Just always keep your gatorade and glucose/snacks on hand just in case.

While LADA is considered by most of us as T1 it actually is often slow onset. And many people have a honeymoon which may last for years. And your natural insulin production doesn’t just turn off or just constantly degrade. It can go up and down in fits and starts. Which means that if you are taking insulin you may at times find that your dose is too much or too little. Usually your natural basal insulin will adjust to things but mealtimes are different. Mealtimes may be difficult. If you still have marked natural insulin production left your body may respond in a sluggish manner. This can result in what is called reactive hypoglycemia. In this case but you ate cookies and low carb bar (remember sugar free is not carb free) and your body may have had a delayed insulin response and you just overshot. You just need to be prepared for this. If it is a continued problem you can follow a lower carb routine eating more frequently avoiding meals/snacks that have a spike. And although it may not work you could start taking a unit of insulin with your meal which may suppress the reactive hypoglycemia. And as a final strategy you can watch your CGM and take a small amount of glucose an hour after your meal if you see down arrows suggesting an impending low. I like small tubes of smarties, each little tab is 0.6 g carb.

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Great info. I lowered my levemir this morning to 4 instead of 5 units. I ate turkey bacon egg whites and to low carb toast with butter at 5am. BG started around 88. Then jumped to 113 and now as i post this my dexcom reads 65. What do you mean take a unit of insulin? 1 unit of rapid insulin or basal insulin with meals. I dont even have rapid insulin. Just have a bunch of pens of levemir.

A normal insulin response releases an immediate surge (called Phase I) of stored insulin (from the islet cels) in response to a meal. If this insulin is insufficient to handle the meal then a Phase II response occurs where the beta cells are ramped up to start producing insulin. This is slower and once it get’s going it may keep going well after blood sugar is normalized. This means that you may go low with reactive hypoglycemia.

As your natural insulin production wanes, you may find that your Phase I response dissappears, you just can’t produce enough insulin to store it up in the islets. The result is that you handle the meal with just a Phase II response. A small bolus at mealtime can mimic the Phase I response thereby reducing your dependence on the Phase II response and reducing the reactive hypoglycemia effect. The issue is that if you are very insulin sensitive, one unit at mealtime may just be too much.

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Thank you for the detailed response. I will keep an eye on this. If it continues to happen i will contact my endo. This just began yesterday night. Didn’t have this issue for the past 5 months.

you don’t take levimir for meals, Take it as directed, you may need to see your Dr for approval on your adjustments. I would ring if you are still going low with 4U. he will probably suggest 3U

@Brian_BSC OP said he doesn’t have bolus insulin. just the levemir

Thats what inwas thinking. I will go down to 3 tomorrow and see whats happening. Just ate some chicken and vegetables and its at 72 bg

I would do an overnight and Miss a meal Basal test, write it all down and show your Dr. meals shouldn’t be a factor in your basal levels. have a good protein and fats supper tonight, perhaps even set the alarm for a 3am check.
If it was me and you are T2, I would drop to 2U for a few days and then build up, with your Dr advice.

I am actually type 1. Came up positive for antibodies.

it sounds like you are going into a honeymoon period, a last fling from your pancreas :slight_smile:
I would still do the basal test
I would ask your dr if he thinks a referral to an endo or diabetic team would be better. you could be on both long acting/basal and short acting/bolus insulin.

I would ask to do a course. this may help a bit for background info
A workbook (the certificate ran out but the site is safe)

You exercise hard all day you reduce insulin in half and eat more. There’s a dynamic to it concerning days off. The exercise effect on metabolism you will pay attention to. Its hard to eat when you don’t want to and not eat when you do want to but that may help. Food is medicine. Food consumption is a medical operation and should only be attempted by trained and certified medical professionals. You are one of a kind. So no one knows what you should eat yet. But you may develop some intuition.