Before I go into an E.R, was hoping someone has a comforting message.
Yesterday I did a lot of manual labor for 10 hours. Today my glucose levels keep dropping if I simply walk around. I took my normal basal this morning and one dose (4 units fiasp)of fast acting 5 hours ago. But then I dropped to 48. I’ve taken a glucose emergency shot, tons of honey, two cans of Cokes. I was able to get to 180, then did a few house chores but now am dropping fast. Sat down with a bowl of cheerios (41gs) Bouncing up a bit but I should have been up in the 300s with the amount of sugar I had previous. I am physically exhaust from yesterday but would that be the underlying problem?
I have no-one to ask until monday, which then takes a day to hear back and maybe a few days to get in. My only other option is a $2500 trip to the E.R. Thats my cost to walk in with insurance…
Am I just overexhausted? I am 60, and have never had this happen. Any advice or thoughts appreciated.
Sounds like you really depleted your glycogen stores! And probably needed less basal and bolus insulin this morning. I guess the thing to watch out for is a rebound high once your system “catches up”. (That happened to me after a severe low in July.) @Eric, any chance you’re available to advise??
Hi @arnolfo,
Do you know much about glycogen stores?
Glycogen is basically stored glucose. It’s one of the fuel tanks our bodies have.
Glycogen is stored in your liver (about 90-100 grams worth of glucose) and also in your muscles.
The glycogen in your liver is used for immediate energy and for our basal energy (just the stuff to keep you functioning). The glycogen in your liver can raise your blood sugar too.
The glycogen in your muscles is only used for fuel by those particular muscles, and it cannot raise your blood sugar.
A lot of exercise yesterday depleted both your liver and muscle glycogen. As you consume carbs today, your liver glycogen gets replenished, but some of what you are taking in will also replenish your muscle glycogen.
Liver glycogen gets replenished pretty quickly. But muscle glycogen takes a while to replenish. Like 24-48 hours, depending on many factors.
The other thing going on is that exercise increases your insulin sensitivity. So the insulin you have been taking is much stronger than what you might be used to.
All of that 
is just background information. It doesn’t help you right now.
But let’s get to the help…
A few questions.
What basal do you use, and how many times per day?
What is your normal diet? Are you low-carb or normal-carb or what?
I am monitoring this forum. I’m gonna sit down for dinner and then call it a night.
Yes, my numbers began climbing up to 300 about one and half hours ago. At 280 I took 3 units of fiasp.
So now they are falling -hopefully dinner will help.
Thanks for the response. I wasn’t aware of the glycogon stores info… or I did not remember it. But it makes sense with the amount to energy I put out yesterday. I also had a beer. Just one but an Oktoberfest.
I take one morning dose of 16 units Toujeo. Followed by breakfast then 4 units of fiasp. I’m a mid carb diet-no pasta but I do intake manageable carbs 15-30 per meal.
Does that answer you question?
Just finished dinner. Not sure I want to risk taking any insulin. Currently at 103.
Had maybe 25 gm carbs. Maybe I should wait.
Thanks again.
My endo at Joslin Diabetes center in Boston has me manage to minimize lows and accept the occasional highs - so they would agree with you about waiting.
I have a similar, although milder, situation after a day of biking. After eating dinner, I will start heading low later at night - sometimes I have to take one of my “going low” treats to get myself stabilized, Not as extreme as yours, but perhaps also explained by @eric s glycogen story.
Thanks. I’m now at the higher end so I’m gonna take a few units. Still, it’s been a scary day not understanding fully what was going on.
Hoping I normalize by tomorrow…
Sounds like you worked your butt off and had a normal response to it. I feel your pain my friend. But this sounds like a normal part of life with diabetes.
I remember a few years ago texting Eric when I was moving… why is nothing making sense… blood sugar dropping constantly… normal amounts of bolus being way too much.
His answers, and they were so right… because you’re moving, duh (though of course he said it much better, as he does)
@arnolfo,
You are probably over the worst of it by now.
If you took no insulin with dinner, I imagine you might spike tonight.
For big days like you had with a lot of work, consider cutting back on the basal, both on the hard day, and the day after. One thing about basal - you can always add more if you need it, but you can never take it out!
Please let us know how your night was.
@Sam Yup, so I see. I really wore myself down ans still feeling it today. My numbers are back to some form of predictability, so that’s good.
Thanks for helping me to understand what was happening. I was really getting worried.
So, I am very thankful for this community.
My night went ok, with an almost low around 4am. My cgm alarm is set for 92, so I caught it early.
Today I am in a lot of back and hip muscle pain but my glucose levels are back to being somewhat predictable.
Next time I will plan in advance. Less upfront and add more only if I need it.
Thanks again!
Something to consider from “The Athelete’s Guide to Diabetes” by T1D Sheri Colberg, when one has depleted skeletal muscle glucagon from physical activity, a class of chocolate milk is the ticket.
You might pick up the book, It is not just for diabetic athletes.
So glad to hear it!! 