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Finally edit: See below - problem solved! Edit to my tale. After my low of 34 at 5AM this morning, I of course took too many glucose tablets to treat because I wanted to go back to sleep, and this morning woke up at 209. But then I kept corrected and only have gone up. I've been in the 300s since lunch. I corrected and came down a bit (249) but then went right back up and now am 327 at 10:45 at night. I'm nervous to treat because of last night, but I'm not going to go to bed in the 300s. I've had some questionable sets, and changed twice, but nothing obviously wrong. Is this a normal reaction to a bad low - though one in which I didn't lose consciousness?

If so, I'll treat a bit longer, as I stay up pretty late, see if I can at least get into the 200s. Hopefully it will be better tomorrow? I've never had this experience. Thanks any nightbirds who respond!

Hi all

I had one extreme hypo when I first started using insulin where I went unconscious and my liver kicked in, but it was because neither I nor my doctor knew what we were doing and I was on way too high a dose. In the three years since I haven't had any lows I couldn't easily manage. So I think I might have gotten too cavalier an attitude towards hypos. (Maybe, maybe not and I'm just nervous this morning).

I only treat hypos under 60. I realize some people treat under 70 and some under 60, and I'm not planning to change my treatment level. But I do have a habit of "letting a low ride" for example when it's close to mealtime and I'm say in the 50s. I really prefer not to eat glucose tablets when not necessary (I'm a bit fanatic about weight gain and about consuming sugar. I haven't eaten sugar in 17 years. I do allow glucose tabs as "medicine" but still don't like it) So in a case like that I'll just go ahead and eat and then monitor my bloodsugar for when it comes up into a safe range to bolus I also bolus my full carb amount (as the Ping wizard suggests) as I find if I don't I go high.

I also correct promptly, and fully but usually don't exceed the amount taking into account the IOB. (only do when I'm having trouble getting down)

At bedtime I'm a bit more conservative as I live alone. If I'm in the 60s or lower I will treat and then wait to make sure I come back up before going to sleep. If I'm in the 70s, I'll take a couple glucose tabs and then go to sleep, having ascertained that will normally raise me up into a safe area. Some people talk about going low, treating and then going low again and needing to eat something to sustain. I've never had that problem, as long as there is no IOB I come up and stay up. Recently, though I've noticed that I've had a few instances where I had to stay up for hours because I would go low, treat with the dose I have always known to work and still not come up. I have gained 10 pounds over the weight I was at after losing at diagnosis but that was over a period of a couple years so I don't think that is significant in changing the dose needed to raise.

Anyway....last night I was 73 at bedtime (1AM -five hours after my last Apidra bolus and my basal doses have seemed very accurate for awhile). So I took 2 glucose tabs to be safe and went to sleep. I really hate staying up when I'm sleepy but would have done so if it was lower.

I woke up around 5AM, with my nose running and reached for a tissue. I have allergies and often do this in the middle of the night, so I keep tissue boxes everywhere. Unfortunately (actually fortunately!) the tissue box was empty so I got up to get a new one from the cabinet. My house is strange - it's round and with a very narrow area where the cabinets are.I've only lived here a few months and I've actually gotten disoriented walking around in the dark before-but not like this. I stopped at one cabinet and remembered it was in another further along. Then I was suddenly confused because I was past the cabinet area altogether. All I remember feeling is: annoyed at the runny nose and no tissues and really really cold. It was in the 20s out and I keep my heat low at night as I sleep under a down comforter. I only had on the light thermals I sleep in and my feet were bare. I was so cold as I groped, touching things to find my way and it seemed to take a very long time. Gradually it hit me, I am really not thinking straight and I must be quite low! I finally made it back to my bed and immediately ate some glucose from the night table, then I tested and was 34. It was hard to do this because my cat was really demanding attention and getting in my way. Where were you, Lula 15 minutes ago?? After testing I got the brilliant idea to turn on the lights, got tissues and worked on getting warm. I stayed up for awhile till I came up enough to go back to sleep.

Ok, too cavalier or just a freak occurrence?

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Yeah, who knows with Lula, just when I think we're communicating well, she changes things up to keep me on my toes. When I catch her for her meds I tell her, Hah! You're faster, but I'm smarter! But I secretly know that isn't true!

I don't believe I had any IOB. I don't snack at all, and I ate dinner at 8 so by 1AM when I went to bed at 73 and took two glucose tabs there shouldn't have been any left let alone by 5AM when I woke up and was 34! It's a mystery to me what dragged me down. (I use Apidra which has the least tail and generally calculate it as 3 hours , 3 1/2 on the outside)

I do think that many of us are too cavalier about lows, but I'm not quite sure what the solution is. When I analyze my Type 1, I often think that the thing I'm most lacking is "equilibrium". There is only a very small range that is not "too high" or "too low". If I don't want to be high, then chances are I'm going to go low. If I want to avoid all lows, then of course I'm going to be high. Our tools are not precise enough to be perfect. Each one of us has to set goals that work for us and we have to learn to live with the risks of those goals. Lows can be dangerous in the short-run, but highs are risky for the long-term.

I have to remind myself that there is no virtue in living in the 60's and 70's. Yes, those numbers reduce my A1c, but they shouldn't be my targets. I do correct numbers in the 60's and usually in the 70's. I am very insulin sensitive and insulin stays active for a very long time for me. So if I'm in the 60's, it's usually on its way to the 50's or 40's. My endo only scolds me for numbers that get to the 40's. Usually super low numbers come from battling highs. So avoiding highs can help reduce lows. It's that continual search for balance.

The more you read Type 1 message boards, the easier it is to start accepting all these lows as good numbers. Obviously none of us want to face amputations, kidney disease, etc. But the million dollar question is: At what number do the risks of lows outweigh the dangers of being high?

I agree that equilibrium is definitely the preferred goal for me too. I've been all over the place for a couple of weeks, adjusting food here and insulin there, trying to keep weight "stable" while I'm sort of hitting "the next level" lifting weights and running hard, etc. I think I got back to where I want to be maybe yesterday and today although I went for a longish run yesterday so perhaps I also cheated?

I am not "scared" of the 70s but I've had a few times, particularly when I'm yutzing around with rates and ratios where I'll hit "oops, it's 11:30, I'm tired, I'm at 65 *and* have have 3.3U on board and there's no more ice cream because I ate it all 2 hours ago...". I would prefer the 80s but will take 70s over 120s if I have a choice as 70s are more fun to fix.

No, I don't think you are cavalier with lows. I treat the same as you, below 60 I eat glucose to bring it up to 80 or 90, in the 60s it depends how I feel, if I feel slightly low I will correct if not I just leave it. It also depends what I am about to do if I am off out into the garden I will correct & have a couple of plain gluten free crackers to cover the gardening.

In the last 10 years or so I can only remember a couple of lows where I was so confused that my husband had to feed me glucose tablets, once with me throwing them around the room! In 51 years of T1 I have never had to go to the emergency room or take glucagon because of a low, & I do frequently go down to the 40s, but I recognize it & test. Something wakes me at night, & I get up & test & correct up or down as needed, like you my nightime target is higher, 100 rather than 80-90 during the day.

10 years or so ago I used to wake up during the night covered in sweat when I was low (it made it very difficult when I was having hot flushes), now I just wake up often with wild & vivid dreams.

I am working on cutting back the lows, but this works for me.

Thanks everyone, yes it does seem that it's all about balance and some of us tip it one way and some the other, and we all change our balance sheet now and then. I guess last night just was one of those moments which made me consider not a panicked 180, but just a bit of tweaking. All of your inputs are helping me look at the variables.

I laughed at your throwing glucose tablets around, Annabella. I actually think that barring unconsciousness and the inability to treat myself (which I don't expect), I do better on my own. I think I detect lows better without other people and things for distractions and I think in a moderately serious low like I had last night I would find another person telling me things distracting as well. Even 7 pounds of feline was making it harder to focus. I still at age 63 have a bit of the rebellious teenager in me...No, I won't do what you're telling me! (Or is that a toddler with a tantrum?)

I don't let lows scare me either, I guess because I have been doing this for 20 years, it doesn't phase me. I remember getting off the school bus one time, extremely low, hoping I would make it down my 1000 foot driveway without passing out. My mom asked me how I did it, and I told her I had to or I was passing out in the driveway!

It sure was nice though that the Nurse CDE I saw today read my last doctors note "Uncontrolled diabetes, lots of lows" It makes me so mad because my lows are 60-65 and at the end of the session, she really didn't have much for me to work on that I didn't know already. That's why I would rather analyze my own data, she scrutinized my data looking for something!

You sound pretty confident, Kelly. I think I've developed good instincts in just 3 years on insulin but I do have a tendency to be over-confident at times.

How annoying about the CDE. Dumb question: Why do you bother going to see her, since it doesn't sound like you get much out of it.

That is annoying! Not just "looking for something" but someone who, despite years of study and treating patients w/ diabetes, feels the obligation to add something clueless. I haven't gotten there yet but I always feel like I'm inches away from getting my diagnosis revised if something freaky happens? I agree w/ Zoe and would probably consider "firing" the medical group and shopping around for a new diagnosis. Or maybe shop first and fire later?

Been ther done that
Butt? For nitetime? Going to bed with a 70
And Taking a Bsal bedtime shot?

2 Tabs Isn't enough for me
It has to be the 15/15 rule.. I take 15 carbs and wait the 15-20 min and test to make sure they're comming up.. Esepcailly if I have Some Bolus Insulin still in my system.. It last about 3 hrs for me..

I have to be min 100 -120 at bedtime

Drinking OJ drink- Little Bottles have 13 carbs in them and a glucose tab chaser..
Get and Drink Fruit Juice - Find the Little Bottles with 10-20 carbs in them

I also have a 2nd Meter on my NiteTable.. and extra Carbs.. Tabs and Those Choc. Mini Bars ( have 10 carbs each )

and Add some Nitelights-- I have a Low wattage Light On a Timer for the Kitchen it's On all nite..

And another Nitelight with a 7 watt bulb, not 4 w., in it for the Hallway..

another issue with running Hypo over nite? Notice how you have lower or no Bowel Movents in the AM?

High At Bedtime?
-If I am Upto 175, I will take a Full Correction Bolus and call it a nite
-If I am Above 175? I take a Full CB, but set my alarm for 3 hrs and Test again.
-Takes less than 1 min to wake up, lean over, test and Take a Bolus is Needed..
And I keep a Hand Written Chart-Index Card I made up as to How Many Units to take per what the BG # is..So I don't have to think at time of nite waking up and make a Serious mistake.

-I found , when High At Bedtime? My usual CB is not effective enough vs during daytime
I figure that is due to sleeping and not being physically activie during the daytime and if above 175 at bedtime, I will normally Need a 2nd CB 3 hrs later..

I edited my post to add my latest problem! This just isn't my day!!

Hello Zoe, I have some remarks:

a) I think lows should be treated with the same respect and care as the highs. We should not accept that a low is the price to pay for good control. Lows are suspected to cause complications too: memory loss, higher cardiological risks due to increased stress levels, risk to develop chronic anxiety, dead-in-bed syndrome due to sudden seizure (although I think the number 1:20 of the JDRF is exaggerated), negative even lasting impact on performance of nerves, risk of high fluctuations in blood glucose, in addition: risk of having a deadly traffic accident, risk of high costs due to need of ambulance. This is why we should identify the driver behind the development of the low. Not that I am in any way perfect with that but it should be our goal to minimize lows and highs equally. Mentally we should set 200 on the same level as 60 mg/dl = no good control.

b) The I:C factor is supposed to keep our blood glucose at the same level. Our bolus has always to components: the carb component and the correction component.

Target level (110): carb component without correction
Higher level (200): carb component + correction to get back to target level
Lower level (60): carb component - correction to get back to target level

Situation: you have 60 and you eat something and cover it with normal I:C. Even if you give the carbs a head start you are still supposed to keep the 60. The I:C is always neutral to your levels.

The negative correction could work by reducing the dosage. This can be done by calculating the neutral carbs you can eat to get your level up to the target. For this you need to know how much one gramm of carbs will increase your blood glucose. This is normally something around 3 mg/dl (0.16 mmol/l) per gramm. If you like to eat 30 gramm of carbs you can substract 16 gramm [= (110 - 60) / 3]. This means you will bolus for 30-16 = 14 gramm. Our Glucosurfer will support this kind of calculation. The problem with covering the low with your meal is that the carbs in your meal are too slow. This means your low would prolong longer than necessary and I do not think this is recommendable. I do not want to get used to low numbers to keep my awareness.

Because of that I always treat the lows with additional carbs like glucose tabs. I can then use the normal I:C factor without any correction. I will inject the insulin after or in the middle of the meal.

c) over the years you will experience many lows. But some will be very different from the normal and easy ones. They can be so scary that they can even haunt you for some time. From these I collected a hand full in the last 24 years. If things get really rough on the low side I try to recall those: it will get over soon, just stay calm.

Thanks for your response, Holger. It's pretty late here so I think I need to consider it tomorrow to see what I feel applies to me. But I definitely appreciate your words of calm.

Right now, as I added above, I'm dealing with prolonged highs (bouncing from the high 200s into the 300s which is very rare for me). I just now got my first 216; I'm hoping it's finally coming down as I'm reluctant to bolus more so close to bedtime. In your experience have you seen radical highs for this long (20 hours) after a low of 34 (without losing consciousness)? I've also changed my site a couple times but haven't rotated my area. That's the next thing I'll try if it doesn't stabilize soon.




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