Sorry this is long...
Had been doing really well until Thanksgiving. It is not high blood glucose causing the problems, but devastatingly lows ones and I have no idea why! Ideas? Here is what happened:
1. Thursday morning I woke at 72. Did some cooking for the big meal and made us buttermilk pancakes for a late breakfast (10 am). I calculated the carbs for each pancake (11) and took insulin for 22 carbs, but ate three pancakes with APPLE BUTTER for pete's sake. On the way to the dinner, I started feeling low (husband is driving) and I tested at 45. Had the completely disorienting kind of low where I actually seized a bit. Treated with Skittles, but it took a long while for it to go up.
2. Fast forward to the trip home. Please note: I ate reasonably well, had some pie, etc. Figured I would eat about 70 carbs and bolused for 50, square wave as it was a two hour meal. On the way home I was having a lot of trouble looking at the road; long story but I thought the problem was related to my slight double vision. Husband was driving again and thought I was sleeping. Got home and I tried to get out of the car, fell down in the front yard (neighbors probably think I was drunk. THE JOY OF BEING DIABETIC!) Tested at 41. Got into the house and my husband starts pouring juice into me. About two minutes after I drank the first juice, I got horribly ill. Eventually, he had to treat me with gel.
3. Woke up 209 on Friday, of course. Treated the high blood glucose level and got it under control by 10 am. I hovered around 100 all day. Dinner was leftover chili and I again under bolused. Woke up this morning at 40. I tested at 1 am and was still at 100. Took about two hours (ate breakfast, had some juice) to get it up to 60.
Basals have been refined lately and have been nearly perfect the last few weeks. Not sick or getting sick. No other bug changes.
All of these lows have been the very disorienting type. I get jerky, ornery, and am not the best to be around. Husband is hovering, looking at me with puppy dog eyes--he worries so. And I feel awful from all the lows.
Anybody have any thoughts on why this might be happening? Usually I would just say too much insulin, but I am pretty sure my carb counts were pretty accurate and I under bolused so much, that just does not make sense.
I do not see or missed what the meal boluses or basils doses you are running and I assume you are pumping.
Some other thoughts:
a) make sure you do not have giardia/amoeba in your gut, they steal sugar like bandits and can drive you nuts.
b) you have to watch out falling asleep before meal is digetsed or the gut shuts down and glucose production shuts off and if insulin still live in blood; you will get nasty low.
c) watch out you are not using insulin with huge time to live like 70/30 or 75/25 as well as large basil doses that can creep up on you.
d)maybe pancreas working wobbly and kicking into full production doubling up on the external doses.
I am not expert but just some thoughts.
Here's my take and a couple of questions. Questions first, was there any alcohol involved with dinner? Were you running on the low side the day before/any unusual activity?
I think you probably counted correctly, but still had the the insulin arriving before the glucose.
The first clue is the buttermilk pancakes. For me, I find that buttermilk and sourdough products take FOREVER to impact my blood sugar, frequently in the 3 - 5 hour range. So if I bolus, even square wave, I am routinely fighting lows. My current solution is to mostly avoid these products; when I do indulge, I bolus very conservatively around 30% of what I would normally take and then test frequently until I see the BG rising, then square wave the other 70% over 2 hours.
For the dinner, I think you had a similar delayed digestion. Again for me, meals with a lot of protein and/or fat really slow the carbs from getting into the bloodstream. Lots of post meal testing required.
Finally, I really feel like yelling when I read these posts of treating with skittles or juice, etc. When you are that low, always treat with glucose tabs or gel first - speed is critically important. It doesn't matter if they don't taste good or are chalky or anything else! Skittles and juice take longer to treat your lows.
One glass of wine with the meal. Had been running a little low--80-90 all morning.
I use buttermilk all the time in cooking and actually like to drink it ocassionally. I have not had any problems like this before after eating it.
The hostess of the Thanksgiving meal is vegetarian and everything is organic. There was a turkey that had been cooked on the grill, but I only ate 5-6 small bites. As far as the fat part, the meal was exceptionally healthy--even most of the desserts were gluten free--but not all. I had a bite of my husbands pumpkin pie, and one rugelah (because I made them.) Veggies were all roasted.
I only had skittles available in the car, which is why I used them. And, as I said earlier, juice works really fast for me, and I have had 50 years as a diabetic to try everything. I know what works, as Zoe said above, we are all different. Paramedics are trained to treat lows with OJ, usually with sugar added, if the patient is able to drink it.
A vegetarian host who served Turkey? Wouldn't happen in this vegetarian's house!! But that is neither here nor there. So my question is...how are things going now?
Yes. She is a vegetarian, but her husband is not. As a result, he can eat meat, as long as it is not cooked in the house. However, meat of any kind is not the norm in the household.
Better. I tried some of the suggestions provided (THANKS!)and backed the basal rates down a bit. I was still 54 at noon today, however, so will back off a bit more, at least on the 7am to 12pm basal rate. Still running a little low, but it takes a while to make effective changes.
Thanks for asking!
Good, I'm glad it is coming into line, whatever the cause!
Yes, we are all different, but some things are universal in terms of standards of care/best practices.
Just because the paramedics use OJ doesn't mean it's right! OJ has a glycemic index of around 52, table sugar is 60, while dextrose (found in glucose tabs) is 100. FWIW, Skittles are 70. I have glucose tabs everywhere and get a bit panicky when I get down to my last container of 50. For me, when I get that wonky, low feeling coupled with an idea that I might be going lower ... give me the speed!
Sorry for ranting ...
Another quirk with my diabetes (YDMV, of course) comes on big event days like Thanksgiving/Xmas/Performance reviews/Job Interviews, etc. Sometimes the little adrenaline push that typically raises my BG will do the opposite and push it down dramatically. I know I have had a few interviews that I must have sounded nearly incoherent while fighting a low, even though I was a bit high going in - ugh!
Choked on too many of those dried, chalk gigantic horse pills... never been a fan.
IMHV if its texture can cause issues, much batter methods need to be used...
Given you've been stomped several times CUT BACK on the insulin, period. Does not matter whether you've got the carbs correctly counted, you are getting crushed again and again. Does the origin matter per se, or just preventing it?
Sounds like you could have a potential pattern with the dinner/late afternoon coverage. Cut back your background first. Then look at your dosing for lunch/mid afternoon. Consider cutting that back too.
NEVER EVER cover with skittles. severe problems there. Always, soda, or gels. Anything you have to count, or can miss putting in your mouth, ie little candies, a BAAAAAAAD idea. Anything with chocolate on it cuts down the breakdown/absorption rate. You want straight sugar in the most rapid form possible
Great shot - I love it.
Been there , done that too.
Have a great day!
OK UPDATE If you want to shout...
I have reduced all basals and I/C ratios by 20%. Additionally, I am under reporting my carb count when estimating a bolus; I input a carb count of 30 when I figure it is more like 50. Oh, and after all the reductions, I was 43 at dinner. I had eaten (I will not say what I ate. Am feeling a little bullied..)about 3:30 when I tested at 48.
I know everyone thinks I am taking too much insulin, but this is all VERY new. Before last Thursday, I was tightly controlled, not not really low this consistently. I am beginning to think that after 50 years as a Type 1, my pancreas is rearing its ugly head. Correction foods aside, this is really scary. I have lowered all ratios considerably from 1 week ago, am not stressed (EXCEPT FOR THIS!!!) am not getting sick, have not changed my life patterns.
Overwhelming, while trying to maintain normal family patterns. Husband is aware of the problem, but I am trying hard not to create a lot of drama around it. Refer to puppy dog eyes in my first post.
Am actually considering suspending basals and just living on bolus for a while....