FUDiabetes

What do you do when this happens? Lots of lows in a row

hypos

#1

Well, with our quickly growing teen the normal for us is surging hormone highs multiple times a day. They usually occur in the late afternoon, and between 1-3 in the morning. Then every 10 days or so we get one of these. When we recognize them, we reduce the basal for 4 hours, but we still often get patterns like this that are hard to break out of. Just as a data point, at 10:00 pm my son ate 1 cup of ice cream with his friends after a band concert. Normally this would send us to 250. Other than more agressively reducing his basal when we see the pattern is there anything else we can do?

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#2

What’re you treating the lows with? Maybe just consider snacking on something with a little more staying power than ultra simple glucose, eg some peanut butter on crackers


#3

He has nuts with him for longer carbs, I need to ask if he is eating them. That is a really good point. Thanks.


#4

If I have one bad low, the odds of subsequent ones tends to increase, I think because I suspect I do still have alpha cell function, so my liver dumps glucose for the initial low, resulting in less glucose production afterward, decreasing immediately subsequent basal need and increasing the odds of another low (and one that is more stubborn). I’m not a pumper, so I don’t have this option, but I wonder if a temp basal that’s reduced a bit (after the initial bad low? early in the pattern? more aggressively?) following a bad low might be the solution?


#5

@Chris, we don’t get exactly the same pattern, but our pattern is more one of an unbroken low for 3-4 hours, barely hitting 100 before going back down. The difference, I am sure, is that we don’t up the average correction fast enough.

Be that as it may, one thing we have found out is that, in order to get a basal change to take effect faster, we always help it with additional support. When we have a high that we attribute to a basal issue, we will change the basal AND bolus. When we have a low pattern where we recognize a basal issue, we will typically do a full 30-minute suspend before changing the basal (in addition to a carb dose of course). In fact, we have sometimes done 2 30-minute suspends that are 1/2 hour apart. We keep two successive suspend actions apart at least 1/2 hour because we have found out that anything much above 30 minutes of suspension at one go is almost sure to create havoc later.

With our frequent basal changes right now, we have figured that, for us, a new basal will get into play significantly faster if accompanied by one of the two types of adjunct actions that I described above.


#6

@cardamom and @Michel Thanks for responding. We will try to more agressively tweak the basal, as well as eat some long carbs. I hadn’t thought of suspending all basal for 30 minutes, that might be worth a try. Hopefully we will remember, since I am sure the unrelenting highs are just around the corner.


#7

For what it’s worth, I’ve tried it, and I’d go sky high a few hours later (do correction, repeat problem). I find reducing the basal by 50% or so carries less risk of a rebound high, but even then, I don’t find the outcomes consistent. Better to leave the pump out of it and deal with the low the traditional way. If it’s one of those cycles where a couple of glucose tabs sends me up a bit but 30 minutes later I’m low again, I’ll have cookies and milk, or crackers and cheese, even if it’s 3 in the morning.


#8

I agree, in general food is a better solution to lows. There are circumstances when basal adjustments are useful, but most of the time eating is the best bet for a low.

My general rule, I use basal to prevent a low or high, but food or insulin to treat a low or high.


#9

My understanding based on the BG curve is that @Chris is trying to prevent the upcoming 4+ hours of lows.


#10

Just got this same recommendation at the CDE visit on Monday. “Don’t be afraid to suspend temporarily if you’re having a drifting, untreatable low.”

For us, it was a basal issue (still new, still figuring it out), although not always. EH has post-exercise drifting lows over night.

Is suspending or tweaking basal always the right answer? No, probably not. But it does seem like it might be worth trying once if it means not losing a handful of nights of sleep every month.