FUDiabetes

Request for help understanding a hypoglycemic event

Nah, there’s some old timers here who’ve had D for many years and have yet to go through 100 lancets. :joy: Lifetime supply = one box! Hahahaha! They last for a lot of pokes.

I kinda want to frame that and hang it up. Because it’s super true. And moving on is really the key. @Eric once said to me “don’t worry, if it didn’t work this time EH can try again tomorrow. He’ll still have diabetes then too.” Which is actually reassuring.

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Every day will be full of surprises, it seems.

I’m really astonished by this.

Last night, despite that I tried to push Juno up a bit before he slept at 9.45pm, within about 45 minutes he was back down in the range of 108-120 and I watched this apprehensively until I couldn’t stay up any longer, probably at around 2.30am. He was in this range, with none of his usual elevations, for around 5hrs. I’m anticipating the coming low — based from his past readings — at 5am, thinking that because he’s now at 110, the low will be very low this time.

Usually I can go all night and not need sleep, but last night I was so exhausted I went to lay down next to Juno and wait for the Spike app alarms to trigger, hoping — between now and the arrival of the Bluetooth speaker I’ll use at night to amplify them — that I will hear them.

I wake at 6.15am and Juno is putting his clothes on. I go to look at his graph, and no lows. He’s 86 when I wake up

Basically, 8hrs within a range of 80-120.

I make him breakfast (two egg omelette in flat bread, plus Nutrifit muesli bar and banana milk and apple slices) and bolus 1 unit. The muesli bar always elevates him. It’s what I used yesterday when I was testing to discern his ratios. Alone, it adds 60 mg/dl over one hour.

Off to school, but even with all that food onboard, the 1 unit is pulling him down as he goes to class at a rate of -10 mg/dl from a reading of 89.

So, from a high of 160 to 89 within 30 minutes, all from 1 unit pre-bolused at 7am when he was 69.

He gets another muesli bar.

I start to wonder if we need to bolus Juno at all.

p.s., The low on this chart was purposive, as described in a post above.

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A very practical approach that saves a lot of mental wear-and-tear!

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You may absolutely have times where your son needs no bolus insulin because his pancreas still has enough production to cover your meals. We had a couple approx 4 day periods where we only used basal insulin, but then his immune system would get back to work, and in short order he needed bolus insulin again. It looks like you might be at one of those periods. With that said, we have lows like this almost every day, so you should probably start to think of those as normal.

In short, there is nothing in your quite normal looking graph that is concerning to me. We often have highs with much steeper down slopes that resolve themselves just fine with a few carbs. I would keep an eye on the 3:00 am - 5:00 am period and if you consistently have a downward trend for 3 straight days, you might want to adjust you basal insulin slightly.

edit: made a mistake in the bolus basal insulin categorization, fixed the issue.

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Just a quick note to confirm what @Chris wrote. We have had exactly the same experience.

I remember the first time we hit a low, or a high of 200, after DKA. These felt worrisome at the time. But they quickly become par for the course.

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Thank you, Chris.

Following Eric’s instructions on Filling your own pens, I made a cartridge with Apidra and put into the HumaPen Luxura HD, so I can give 1/2 units.

You can see on the following the blue spot where Juno took half a unit before eating a fairly big bowl of pasta. And hour later, he had another bowl without any further bolus. I’m amazed by how flat his line is.

Started 108, down to 86 at the lowest point, and back up to 109 as I type this. A period of around 3.5hrs.

I don’t want to put strain on his pancreas, if anything remains of its function, but the ability to half dose is clearly better for him. At least right now, and that may change, as you say.

Cautious about curious about what will happen tonight.

p.s., the previous high was Juno at school eating 5 skittles and a juice instead of the two I asked him to.

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I know that this is frustrating, but be careful about scolding here. It is his body, and he will need to learn how to handle it, eventually he will take control and do the right thing, but right now he is in a period of mourning and adjustment. You have clearly done a fantastic job of learning how to control this disease, and that is amazing and an awesome testament to your learning ability. One of the less told truths is that the mental health aspects of this disease take a worrisome toll on many.

I remember vividly the week that my son had finished his initial learning, and about a month had passed, and he finally said the words that I was sort of dreading, “This is forever isn’t it dad?” This led to a 2+ month period of pretty severe depression and was only improved by his attendance at a diabetes camp where he got to meet his many T1 friends and find out he wasn’t alone.

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This exactly.

I had a similar experience. The biggest question Juno has voiced in his life, in fact. I was laid down holding him, to put him to sleep, and he said: “I will always have this, right baba?”

Words collapse.

I will do the best I can. The mental part of this, in fact, is what I’m maybe better prepared for, and I’ll certainly aim to be attentive to. Of course, I know I will fail. Just like every other parent in history. We’ll have our fights ahead, doubtless. I’ll make mistakes.

I will put faith in the embrace. It sounds facile, but I do believe that love helps us endure. Love, solidarity and hard work.

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I don’t now how you answer that question, “I will always have this?". But one thing you can tell him with all honesty, is that no matter how long he has it, every year he has it, the disease will get smaller and smaller. And eventually it becomes so small it no longer matters.

In everything I do in my life, diabetes is always way down on my list of things to think about. It becomes automatic, no longer anything to be conscience about. Just like you don’t have to remind yourself to blink or breath or tell your heart to beat. If you work it right, it just becomes automatic.

Right now it’s formulas and calculations. And that is all you can do as a parent at this stage.

But eventually for him, it can become instinctive. And that is a much easier way to live. When he is ready, lead him in that direction.
:heart:

I think that’s a good thing to tell him, no matter how long he has the disease.

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I think I’ll send myself off to sleep with this tonight. :heart:

It’s what I’m learning to do now. @ianrobertdouglas, it’s the difference between being diabetic and having diabetes. One is the essence of you whereas the other is only one small part.

I’ve never met anyone who is less diabetic than Eric. Where I was fighting to make it my focus, he has been trying to teach me that it shouldn’t be. Forever is a long time, but it loses its power when we’re not afraid. I’ve been many kinds of diabetic since being diagnosed, and the type I am now is the kind I want to always be. I’m not afraid, and I’m not burdened. I’m not worried about whether or not I will have diabetes forever. I’m too busy enjoying today. Juno will get there, too. As will you and your family. Maybe you tell Juno you can’t answer that because you can’t. None of us know, and then you get him thinking about today.

I want to make you feel better. Juno will probably feel about it the way you do. Life is good. It really is. You guys will get there, and then you’ll be arguing about way more complicated things like why he can’t take the car.

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:laughing: :heart:

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I want you all to know how much this thread is really helping me. I’m pretty much a one-man show out here, in some distant slipstream. I know it’s early days. Doubtless time will bring with it the ease of experience. Until then, I’m trying to intuit and feel amid what inevitably feels like a high stakes game. Because if it were me, no problem. But it’s my son. So I appreciate the collective kindness and patience.

When Juno was newly diagnosed, his basal dose (he’s on Lantus) was set at 18 units a day. But about two weeks in, an endo we saw briefly suggested to drop this to 17 units.

Math is not my strong suit. My brain is resistant to logic when it comes to correlations among numbers. But I want to double check, triple check, and ultimately understand everything, including how to arrive to determine a basal dosage.

Of course in lieu of catching up on my reading here, is it a matter of certain correlations? How does one arrive to a suggested dosage?

Thinking ahead, and if — and it remains a big if — I can get a supply of Omnipods back to Egypt, I don’t know anything about how basal rates for Lantus are converted to Apidra or any other fast-acting insulin, which I understand is what is normally used in any pump. I have a new friend here whose daughter is on Omnipod, so I would have practical support, as well as our endo, and I suppose pumps are all more or less the same, in terms of the fundamentals. Nonetheless, I’d like to get started in my basic understanding. If others know of resources that are especially useful, I’d love to know.

Bolus doses, I get, in principle. You look at rates of absorption. Figure how much 1g of carbs pushes BG. You try to match two inputs (food and insulin).

But basal — a kind of reserve and always present insulin — I don’t understand the big picture and what determines dosages.

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Love those things. I love the idea of it becoming automatic.

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I think that many people here on FUD felt that way too. I know I’ve read many accounts of folks that had never met anyone with T1 in real life before becoming involved in the diabetic online community (DOC) and that it can be an incredibly lonesome experience. I’m glad you found this early in your family’s process.

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It is not a perfect translation, but the closest you can think of it is how many units per hour you are using. So if your daily basal now is 18 units, it is about 0.75U/h, so that is, theoretically, what it would translate to on a pump. Most endos, though, would want you to take it down 10% to start, ie to about 0.65, or even lower, to make sure you don’t run low, because you can never know the translation for sure.

I am not sure if that made sense to you?

[EDIT] Just thought if something else you may not get: how you tuned basal. Essentially, basal is properly tuned when you are flat, whether it is as 80,100, or 200. The concept between basal and bolus is that basal is what keeps you flat of well tuned, and bolus is what makes you go down.

So, for example, if you are flat at 200 your basal is OK but you need bolus. If you are steadily going up and are right now at 100, you basal is too low. However, you cannot base your basal changes on how your instant trend is. You have to look at a stretch of time where there is no IOB and outside conditions are stable. Typically, you look at a whole day’s worth of data and check if your basal is likely OK.

The discussion on how to actually do basal testing is another one. The discussion above is primarily conceptual.

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Here, mabey this link will help.

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I’m not adding anything important to the discussion here, but I just want to say that in the above dialogue there’s so many well-written perspectives from a caring parent, unburdened individuals with diabetes, loved ones here to support and help cope… just thank you for all being so honest and humble. I’m crying now because it’s really touching to me to view this disease through all these lenses

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image

Actually you can cry. I’ve done it a ton here at FUD! I just never have a chance to use that Bitmoji*, and I love it. :smile:

*if you are unfamiliar with Groucho Marx, he was a comedian. There was a set of novelty glasses made up to mimic him and function as a disguise. That is why my Bitmoji is wearing a pair of glasses and a small mustache.

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Just an update, in case anyone was wondering.

For the second night, Juno was very steady all night long. We skipped the half-unit bolus at 7pm for his light snack/supper. He was going down from 130 when I put him to sleep. Hit 85 and then rose to 110, where he stayed more or less all night. His lowest point was 75 at 5am, which to me is great.

I’m putting this down to the reduction of bolus insulin. Earlier, when he was on 4-7 units, we were both feeding the insulin, but also seeing high elevations and steep falls.

Now, everything is calmer, and much more predictable.

Hoping this repeats tonight, and onward.

It’s beautiful to watch a straight line with minor +1/-1 variations more or less throughout the night.

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Here’s the big picture. The body always needs a bit of glucose in the bloodstream to power the processes of staying alive: thinking, breathing, heartbeat. Supplying this background energy is the job of the liver, and it supplies however much it thinks we need. That’s not a constant amount, it can vary depending on lots of things like time of day, stress or illness, and so on. Now to move this background supply of glucose from the bloodstream into the muscles takes insulin. That’s automatically handled by the pancreas in a non-diabetic, whereas in a diabetic we need to supply that “background insulin” to use the background glucose. That’s what basal insulin is.

The basic idea of setting a basal insulin dose is to adjust it so that the blood glucose tends to stay level: it doesn’t seem to rise all by itself or fall all by itself. That can be a little hard to see, since BG rises and falls for so many different reasons (the biggest one is eating carbs, but also stress, illness, hormones, and exercise among others.)

With an insulin pump using fast insulin, we can adjust the basal to be different amounts at different times of day if there are routine patterns in the BG. In my case, for instance, I need much more basal insulin at night than I need in the daytime — about 3 times as much. But this varies for everyone and for some people it is the complete opposite, where they need much less at night. You just have to see how much your individual body needs, or Juno’s in this case.

With injections of slow “basal insulin” such as lantus we have to pick one hourly amount of basal insulin, (or maybe a “day dose” vs a “night dose” if we use levimir which doesn’t last as long). So aim to get an amount that doesn’t let your BG go way high or especially doesn’t let it go low overnight. That’s just a matter of making small changes and seeing whether there’s a tendency of the BG to rise all by itself, or fall all by itself. For example, in the CGM picture you show at https://discourse-cloud-file-uploads.s3.dualstack.us-west-2.amazonaws.com/standard14/uploads/fudiabetes/original/2X/d/d1b38f4a8953230d1db5ead9d8e03f8eb39a706f.png
it looks to me like the overnight shape is a gently rounded hump, with the high point around 1am, and then from there it falls until about 6am. In that area from 1am to 6am the BG is “falling all by itself” approximately from 120 down to 75. On a pump, if I saw that pattern for 2 or 3 days I might decrease the basal rate a tiny amount, like a decrease of 0.025 units per hour, and watch what happens over the next few days. Does that make it better? Do I need to reduce it a tiny bit more, or leave it where it is, or go back a bit higher?

With once per day basal you have to focus mostly on avoiding overnight lows, and second on avoiding overnight highs, because maybe nobody is awake to deal with it, whereas in the daytime we can do corrections with glucose or insulin.

Analyzing this can get as detailed and complicated as you like, but when you need to cut through the confusion just remember “if your BG is too high, you need more insulin” because that goes back to the basics.

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