It's like my body is finding ways to make managing diabetes as difficult as possible. Lately I've been having so many different kinds of problems (pump rejection, uncontrollable high blood sugars, scar tissue, and so on), but now it's added a new weapon to its arsenal and it's even scarier than anything that's come before it.
I won't go into detail about the previous problems since they aren't as pressing as this last one (and I'm seeing the endo yet again in a few days to continue trying to fix them), but this latest one is more of a "right now" problem and I can't wait until Friday for an answer.
So here's the thing: In a nutshell my numbers have been absurdly low for the last two days. It started Saturday night when I bolused for dinner (I'm MDI again until the endo can figure out why I'm rejecting the pump) and one hour later my numbers started dropping rapidly. I corrected, tested, waited, and the dropped again, and again, and again, until I had consumed an entire 2-Liter of Pepsi and 10 glucose tablets in a period of two-and-a-half hours. Finally it stabilized long enough for me to go to bed feeling somewhat confident I'd wake up the next morning. The next day was fine until dinner again. I bolused, ate, and two hours later dropped low again. That's when the all night marathon started. From 12:00 am to 5:30 am I consumed 850 grams of carbs in various forms just to keep my blood sugar barely above 50 (keep in mind that my ratio is 8 grams to 50 mg/dl so in other words I raised my blood sugar by a cumulative 5312 mg/dl over five-and-a-half hours without going over 56 mg/dl once all night). Finally, around 5:30 I "spiked" up to 97, then 114, then 129 in a half hour so tired and beaten I went to bed.
I woke up at 10 am with a bg of 193. By noon it was 87 without any correction on my part. I ate lunch without taking any insulin and at 3 pm I was 53. I corrected, jumped to a perfect 100 within an hour and then dropped again to 60, 30 minutes later. Corrected again, jumped again to 102, and then kept climbing until I hit 336 (keep in mind I had not taken any insulin for my lunch, and the only insulin in my body was my decreased shot of Lantus the night before (normally I take 25 units at bedtime, but I took only 12 due to my numbers). So at dinner I decided to bolus since I was so high and wouldn't you know it an hour later I was in the gutter again with an mg/dl of 41 (this was only a few hours ago by now).
So right now I'm sitting here typing this after 32 oz of apple juice and another 40 grams of carbs worth of bread and my bg is 80.
Here are my thoughts:
1st I'm thinking it's the Lantus. The night this all started I had just started a new Solostar Pen and so I'm thinking it's a bad (super-potent?) batch. The problem with that theory is that the problems started before I took my first shot from that pen. It was the same night, but first came the massive low and then came the shot of Lantus a few hours later.
2nd I thought about Celiac Disease. If I'm not digesting all those carbs immediately that could explain the low numbers immediately after bolusing. But there are two problems there. First, I was just tested for that and many other complications as part of a normal routine with my endo, and I was negative on all counts.Second, the low I had today after lunch wasn't even caused by a shot of Humalog because I didn't take my shot. And besides, all those carbs I ate last night would have eventually come back to bite me if it was Celiac even if it was hours later.
3rd (my wife's theory) is the Pepto Bismol I started taking a few days ago for some stomach discomfort. I've never had problems of any kind with Pepto, but my wife thinks that perhaps it's somehow increasing my sensitivity to insulin. But then why am I having the same trouble today even though I haven't had any Pepto since last night?
4th the universe is a cruel kid with a magnifying glass and right now I'm in her cross-hairs . . . wouldn't that be a nice, simple answer . . .
So I come to you good people once more looking for help. I need help! If it weren't for my wife and kids I'd check myself into the hospital and stay there until Friday when the endo will see me, but I can't, so I won't, so now I need to try and figure this before I have one-too-many all-nighters or before the BG goes too low before I have a chance to do something about it.
I don't have much to add to what's already been suggested but I really just wanted to wish you the best and to say hang in there. The staggering lows frighten me. I was having similar things happen but for different reasons, mostly female hormone related. I was eating everything I had in the kitchen and about to bust only to keep dropping. Staying up all night to fight the battle.
I ended up cutting way back on my Lantus (I take one shot at night) and changed my I:C ratios at the meals where it was happening closest to. I also made sure that I didn't correct at all within 4 hours after a previous bolus of short acting insulin (I use Humalog). I hope your endo helps you find relief quickly. Make sure to keep a glucagon kit with you during this time.
First off I'd like to thank you all for your input.
The update is that last night I used a new Solostar Pen (Lantus) and I didn't have any dramatic lows. However, I do seem to be following the patter for gastroparesis. Just a few hours ago for example I tested before dinner at 329. I bolused for correction and food and an hour later I was 84 and dropping (though very slowly). Same thing happened for lunch today, though I wasn't high pre-meal but I did drop quickly post meal and then had that spike pre-dinner (that I already mentioned). I do find it strange, however, that this would happen so suddenly. Shouldn't there be a gradual build up to this? Can you really go from not having it one day to having it that same day, only later in the evening? I mean this all started Saturday night and up until that dinner I had not had a single indication or even an inkling of such a thing.
Besides, whatever happened the other night isn't (or can't be) a problem with digesting food. Like I said, those 850 carbs (spread over some time of course) had to show up at some point even if it was hours later. But they didn't. All I was able to do was keep my BG from going under 50.
I guess what's really bothering me is that when I was a "bad diabetic" I never had anything to worry about. I never tested, never counted carbs, never adjusted dosage based on anything, never corrected a high (because I never tested to know I was high), never did anything other than take 3 shots each day and occasionally eat some chocolate to correct a low (I know, I know . . . chocolate and lows . . . bad mix . . . but back then I didn't care). I spent a little over a decade living like that and many people in my life didn't even know I was diabetic because it was never an issue for me. But then my daughter was born three years ago and I got super serious about my health. I got a pump, I learned about carbs and ratios, I tested a minimum of 8 times a day, and I generally took a very micromanaging role with regards to my numbers and my overall management of diabetes. Now? The harder I try, the more problems I get and the worse things seem to be each time. Unfortunately, as much as I'd love to go back to being a "bad diabetic" I can't. I mean, I can't even be thirsty now without checking my BG to see if it's related.
Hate to be the bearer of bad news. Gastroparesis occurs over time & it can worsen somewhat suddenly. If that's what you've got, you may have had a mild case before. Delayed digestion is also dependent on what you eat. Perhaps you'e eating more high fiber/high fat/high protein lately?
850 carbs is certainly a boatload. Perhaps that was the Lantus. Can't say that I've ever eaten that many carbs, but I had lows that were difficut to level out when using Lantus. Only other time I had stubborn lows was while on an antibiotic. I ate without any bolus.
Gastroparesis is a neuropathy caused by high BG, like other neuropathies. Yea, putting your head back in the "bad diabetic" mode won't help, of course. You're paying close attention now & that's great, even if it is frustrating right now.
Sad for us that damage is cumulative over years. Problems now could be from the past.
To me something doesn't add up. When you said you drank a 2 liter of Pepsi and that kept you from going low, you would need a lot of insulin on board to cover the carbs (41 Carbs per 12oz) in that 2 liter of Pepsi. Do you know how much insulin you had on board Saturday Night? Granted GP can impact the digestion of liquids, but typically they digest much faster than food. If you were having problems with liquids it seems like you would also be having some dehydration issues as well.
Anyway, I am hoping for you that it is something other than GP that is going on.
It's not GP or Celiac's (sp?) or anything else apparently because after my last visit to the endo I received the best medical advise I have ever heard in my life: "Bummer." Those were her exact words when I told her about my problems with the pump. I asked her to try and think of anything that could possibly be causing this and she said "all I can think to tell you tight now is bummer."
Now what do I do? My A1C has jumped from 6.6 (on pump) to 7.8 since I've been off it.
I think you have to restart from this:
- your insulin sensitivity has changed
- your stomach has something (you took Pepto)
So adjust your basal (lantus): try to start with a good bg in the evening, skip breakfast and don't eat till lunch. Find the right dose to do this without hypo.
Lower you CHO/U ratio at meals: keep it safe till you have found your lantus dosage, than eat simple meals and calc your ratio.
Go to a doctor for your stomach: perhaps a gastroscopy would be usefull.
As to split lantus or switch to levemir, first try to fix the big numbers.
As to micro: was your "no delivery" real, did you get ketones and high BG ?
If so, the only thing is to try many different sets until you find yours: keep trying.
Try to use sites never used before, for example behind your arms to see if it works.