FUDiabetes

Crazy Extraordinarily Stubborn Lows

Has anyone had this (its happened to me twice; once last year, and then again last night) ?

i start going low, so i correct with carbs. very briefly my BG comes up, but then it goes down again. so i treat with some more carbs. my BG goes back into target. But then, within minutes, i crash again.

this goes on all night. i continue feeding the crashes, trying desperately to stay in target or at least as close to it as i can get. afraid to fall asleep when my BG is under 60. but eventually, i am so exhausted, i basically pass out.

well at 2:30, my overnight alarm goes off, so i get out of bed to do a finger stick. my BG is now 300!!! i did an IM shot of 3 units, and went back to bed.but at 6:30, i woke up again and did another finger stick; my BG was 219, so i did another IM correction. eventually, my BG got back into range. but this was a real roller coaster, and i am whipped.

has this happened to any of you? and if so, how have you handled the situation? i dont know why it happened. i didnt do anything out of the ordinary. the only thing i can think of is that the antibiotic that i am taking is having this effect on my BG. other than that, ???

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I’m not sure what good this’ll do you, @daisymae, but yes. I’d like to say Ive had it happen once, but it’s happened way more than once. I won’t bore you with all the details, but I can tell you that fear is definitely part of the equation that leads to that rebound, and confidence has been part of the solution that has helped prevent them. Sometimes i just get hit with a low that continues despite my expectations. It rattles me a little (sometimes a lot), and I hit back hard. Rarely did it turn out I genuinely needed 140g of carbs or whatever I ended up with. But sometimes, maybe because of that profound deficit, it just takes a while to climb back out. So I look a couple of times, see a good number, and let down my guard. Look again later, and… 300.

I’m learning, and this is a fine line, too, to do the insulin when I’ve found myself treating like that. I’ve hit 300 so many time (and 4 and 500 in the crazy careless days) that I have a good idea it’s coming. I’ve also send myself plummeting because of too much insulin too soon. So if I find myself treating like that, I might do a conservative half unit right away. If I see a little bit of a rise but nothing crazy, I’ll do another half. If I see a big jump, even if it’s only to an 85, I might do a bigger bolus. I can still see a spike, but it usually is a more manageable one… as is another crash if that’s what I have coming. With all those carbs and a healthy dose of insulin battling each other, the outcome usually is a little more mild than if I’m giving one a big advantage.

And if it happens over night… I guess I’d rather over-treat a low then over-correct a potential rebound. So if I found I’ve done a huge amount of carbs, I wouldn’t think twice about bolusing, but maybe I’d keep it to a unit and fix the leftover once I was up. I really dislike waking up with an ugly high but not nearly as much as I do waking to a crazy low.

I say as I polish off my bag of skittles… :roll_eyes:

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At times when I am taking a lot more carbs than what seems reasonable for a low, I know what’s going to happen a few hours later. A big spike.

So I will either take insulin a little later, ahead of the spike. Or increase basal, or do an extended bolus ahead of the spike.

If you are eating some crazy amount for which you didn’t take insulin, I think you can just expect a spike a bit later. Get ahead of it.

It takes guts to take insulin after you’ve been low for an hour, have eaten a ton, and are still low. I know that. But eventually you can trust that the spike will happen. I’ve seen it enough times.

It sounds like I’m on the same page with @Nickyghaleb on this one.

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Seriously?!

:star_struck:

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I have certainly experienced recurring persistent lows. As for the “why” - I don’t have any logical scientific answers, but I can certainly attest to infections influencing illogical highs and lows, so antibiotic influence in that mix is certainly in the realm of possibilities.

As far as treatment for the recurring persistent lows, I have found that pairing protein with my carbs does the trick. Decades ago when I started, and the only options were MDI’s of N and R, I was taught that protein was key to keeping balance with long acting insulin. While BS balance is much easier now that I am using a pump, if I have 2 unexplained lows, I still revert back to adding protein with my carbs to balance out the lows.

At night, I typically don’t even wait for 2 lows. 1 low and I am adding protein. Peanut butter is my favorite go to - carbs and protein all in 1 spoonful! There’s a jar of peanut butter and spoons right in my night stand.

I also find that if I over indulge in eating protein, the highs are still lower, and build up slower, than if I over indulge in just carbs.

As a side note, I use Sugarmate as a glucose alert system. It works with dexcom, and as I understand it, also with anything compatible with Nightscout. Sugarmate alarms are very customizable, and most importantly for me, it can call my phone for lows. I am very prone to be woken by my phone ringing, much more so than anything else.

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About once a week I have a night where I just keep going low. Eat a few glucose tabs, go up a bit, drop, repeat, repeat, repeat. I don’t know why this happens; there’s no pattern I can see related to meals, dosing, timings, stress, whatever.

If the first couple of treatments don’t keep me up in range, I’ll eat extra. Cookies and milk. A Cadbury Crème egg. Crackers with peanut butter. (Not all together!) And bolus for it. <-- That was a revelation to me, after decades of overtreating and then being high for hours. It’s weird to be shaky-low and injecting at the same time, but it works! (I probably wouldn’t do this with Afrezza, though. It might start working before the carbs really get going.)

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this is great to hear. i am a fresh peanut butter addict. grind it meyself and make about 1/2lb per week. i will certainly remember this for next time.

last night was another hell for me. but i susoended my pump for 40 min and lowered my basal for a couple of hours. the highest i went overnight was 154. still way out of my target range, but after all the lows, i was content to be high. i felt safe enough to go to sleep after it remained high for a couple of hours.

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i guess when i am in my low 40s, bolusing just doesnt seem like an option. how on earth do you do this? it sounds like it takes guts and a bit of crazy. :crazy_face: can you elaborate on this?

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HAHAHAHA :rofl:

what i had tried: glucose tablets, fresh coconut water, chocolate (of course), maple syrup on a challah role, apple juice…

you’d think that would send my BGs through the roof, but i continued to get into target, only to crash again. and then BAM, 2am BG 300. as if it were a delayed reaction to all of the carbs at once.

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I know this. I know how this feels. I assume most, of not all, of us do. You know you’ve had plenty, but it’s like there’s a fresh level of urgency. So I have no idea if any of this is real (it is, but it could probably be better communicated in a more scientific explanation), but I’ve begun thinking of my treatments and corrections in terms of distances… and bridges. And I already know I’m going to lose some people with this explanation. But i’m allowed—I was an English teacher.

So… I have a falling blood sugar and have been pretty active (or have a bunch of insulin on board). I am thinking of this treatment in two parts. I need something that’s going to help me cover the not too distant future, but I’ll also need a bridge. So maybe something like half a sandwich (which gives me a slow climb but a reliable one) and 6 skittles. The skittles are for now, and the sandwich will be picking up about the time the skittles are wearing off. A now and later. :grin: I like that better than bridges.

Anyway, I do the same with my insulin corrections. If I’ve had something that’s going to be a slow climb, but I’m a little high now, I’ll do a now and later… which…I have just realized is an extended bolus. :rofl::rofl::rofl: EXCEPT I don’t do it with my pump, I do it with injections. I hate to mention IV (but Afrezza users would have the same choices, too), I can do a small “bridge” IV and a pump bolus at the same time. By the time one fades, the other is kicking in.

I didn’t mean to mention this in terms of insulin action but just to exemplify my strategy. I really do think in terms of bridges all day long. If I don’t use bridges, I’m chasing a lot. Soooooo, and now I’m trying to remember the point of your comment, IF I’m dropping like that with all of those things, I can depend on the fact there is going to be a rise, but I can supplement it with something to get me there. Skittles. I can also start getting a little insulin on board to subdue it, knowing I’ve got padding for a while.

I feel foolish attempting to explain to you a diabetes management technique since it really feels you should be schooling me. :thinking:

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HAHAHAHA. i really do need schooling though. very badly. BUT, i am seeing my Endo this week on Friday, and i know we’ll be able to come up with a plan (or at least attempt to).

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Before we had Basal-IQ, this was my approach for a low overnight.
I would give about 12 fast carbs (OJ is our carb of choice overnight) AND ALSO do a temp basal 30 minute suspend.

Most of the time, it is a one and done. BG comes up. Check 20 minutes later and BG in range and does not go low again.

On occasion, the BG does NOT come up. The issue is no way to know in advance if this is going to be an easy “One and Done” or if it is going to be a persistent low. So, the basal suspension comes really helpful if the BG does not come up. If 20 minutes later the BG is still too low then we already have a 20 minute basal suspend behind us. Give another 12 carbs and reset the basal suspend for another 30 minutes.

Now with Basal-IQ, the basal suspension happens automatically as well as the basal resume so I do not have to do it manually.

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Assuming you’ve already treated for the low, just pretend you’re not low and bolus as normal for what you’re eating.

Even after I started doing this I thought it was asking for trouble. A couple of times I bolused half what I normally would. And still went high. So learned my lesson.

A lower temp basal never really works for me when I’m stubbornly low. Because the “treat/have extra/bolus” routine usually levels me out in range, the effect of the bolus drop two hours later just sends me high. (However, if I’m low at bedtime and not treating, a lower temp will bring me up later on but not make me high. A suspended basal is way too drastic for me.)

I’ll second @Dc53705’s recommendation to have protein/fat with your treatment. If you’re just having fast-acting sugars, the insulin will still be hanging around after the sugar is all absorbed. So include peanut butter, or cheese, or even milk. This isn’t new thinking. When I went to diabetic summer camp in the early 1970s, for lows they used to hang jugs of corn syrup from tree branches along with peanut butter sandwiches. The corn syrup was for bringing you up fast, and the pb and bread were for keeping you up.

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Yup. I’ve had this happen. A fair bit, actually. Except in my case, I often don’t spike. Sometimes I do, and often if I know I’m going to spike I take insulin for it as soon as I’ve come back up. But I’ve had hours-long lows that don’t spike. Last night I was low for eight hours straight. Now, part of that was because I slept through the low, but I did try suspending my pump twice and eating glucose tablets. I did spike this morning, and have stayed high into the afternoon. But I’m not entirely sure that’s related to a low if it happens eight hours after the start of that low. I think it’s more related to being a bit conservative about how much insulin I’m taking today…

As to cause, I truly have no idea. No idea whatsoever. I did nothing unusual yesterday and in fact lazed around the house all day. My stomach was somewhat upset, but it’s been somewhat upset many days for the past…years. I have raised my basal insulin a lot over the past few weeks due to hormones, but I’ve had no signs of going low until that persistent low last night.

So, no idea. Just one of those mysteries of diabetes.

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this is one of my favorite combos. who would have believed that it was healthy for a D :grin:

This is such a funny mental image to me. :+1:

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I was diagnosed with type 1 in 2002 and This used to happen to me every night before the insulin pump. Also, it is prone to happen to me when I had more physical activity or exercise the prior day.
Now I just reduced my basal at night and at 05:00 it doubles. Try some protein when treating lows. Protein helps the glucose stay up. Be sure to give it 15 min. to come up. Over treating can make the glucose spike as well as the dawn phenomenon. Hope things get better for you.

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i tried this yesterday with peanut butter and it worked very well. so thank you for that. it was extremely helpful info!!! :grin:

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Hello everybody I’ve been a diabetic for 48 years and I’ve gone through just about everything everybody’s talked about at this point I just want you guys to realize that one thing you have to consider is physical exercise stress stress from your job stress from just being a diabetic exhaustion lack of sleep family problems money problems everyday stress of Life all factors into how your diabetes reacts. Exercise plays a big part of how my diabetes stays in good condition and if I overexert myself with too much exercise even if the exercise was two days ago I can run into this low situation that you’re all talking about. You can do everything right you can count carbs you can do the very best you can every day and you can stay in your range day after day and nobody can factor in the stress of everyday life and believe me every little thing will factor into how your diabetes fairs at some point your body is just going to not be as strong as it was the day before and you’re going to have Low’s and it might last one or two days even. I have had situations where I have not had to take my medication for a whole day almost and I remained in my zone just because of what has happened in my life or my body was exhausted . Same with mental exhaustion if you’re mentally burnt out that’ll throw your diabetes way off also. Believe me this is a big reason why lows come out of the blue for no reason and we’re all different it’ll all affect us in different ways but it will happen to you keep on doing your thing that’s all we can do good luck guys.

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