unexplained lows...what to do?

[dqmomof3]

Today is a frustrating D day...Jayden woke up with a bg of 66 this morning - help me out from here.

Wake up - 66 - at 8:25am...no idea why the low. Go to bed number last night was 109, so I had her eat 15g of carb and then go to bed. I don't know what the final number there was.

She ate grapes for breakfast, and she bolused for the grapes. Pump target bg is set for 80-120, so I thought we'd be OK.

9:47am - number is 111. Looks good to me, an hour after the grapes.
10:43am - 41!~!! Where did that come from? Gave glucose tabs to raise her to 195, then ate a PB&J to try to keep bg stable. She did bolus 1 unit for the PB&J (ratio is 1:17, and the sandwich was 40).
11:59 - 145. We'll take this...
12:42 - 121. Still good, we'll keep this one
2:08 - 43!!!!!!!!!!!! Again - where did that come from? We're currently in process of a little soda, followed by a South Beach bar. Three hours of gymnastics are coming up at 4pm.

AHHHHHHHHHH! What in the world happened here? Yesterday every single reading was between 80 and 100, which hasn't ever happened to us before...we usually have at least one or two oddballs. It's like yesterday she was trending lower, and today she's just diving. Summer activity? Heat making insulin work better (it's in the 90s here!)?

[twodoor2]

Today is a frustrating D day...Jayden woke up with a bg of 66 this morning - help me out from here.

Wake up - 66 - at 8:25am...no idea why the low. Go to bed number last night was 109, so I had her eat 15g of carb and then go to bed. I don't know what the final number there was.

She ate grapes for breakfast, and she bolused for the grapes. Pump target bg is set for 80-120, so I thought we'd be OK.

9:47am - number is 111. Looks good to me, an hour after the grapes.
10:43am - 41!~!! Where did that come from? Gave glucose tabs to raise her to 195, then ate a PB&J to try to keep bg stable. She did bolus 1 unit for the PB&J (ratio is 1:17, and the sandwich was 40).
11:59 - 145. We'll take this...
12:42 - 121. Still good, we'll keep this one
2:08 - 43!!!!!!!!!!!! Again - where did that come from? We're currently in process of a little soda, followed by a South Beach bar. Three hours of gymnastics are coming up at 4pm.

AHHHHHHHHHH! What in the world happened here? Yesterday every single reading was between 80 and 100, which hasn't ever happened to us before...we usually have at least one or two oddballs. It's like yesterday she was trending lower, and today she's just diving. Summer activity? Heat making insulin work better (it's in the 90s here!)?

If you're at low to mid target range one hour after a bolus, that may indicate that a low is coming up. I suspect that since you are on such a tight range 80 - 120, you may need to work on the ISF's and/or I:C ratios a bit, and/or lower the basal.

[Mary Lou]

Hi Jennifer,

We're going through exactly the same thing here. The boys are popping out lows as if they were running marathons, which they are not.

Hubby and I do suspet that they boys are dropping out of a growth spurt and/or just the warm weather inspiring more outdoor games and activities (which seems to happen every year when winter breaks).

I tend to not get too crazy over the "why's" and focus more on the solution. When you stop to think about it, it doesn't really matter WHY they are trending one way or another, what's important is that you recognize the trend and adapt your insulin regime to match it.

If she was trending low yesterday and has hit two lows today, I'd cut back on basal for the am reading and the meal ratios, too. Did you treat the 66 or did she just eat the grapes and then bolus as if she was 70? If you treated, then ate (no protein with the grapes after a low?), and then dropped right back down, I'd say your meal ratio was too much.

Which midday meal # was her pre-lunch #? If she ate at 145, then dropped to 43 within 3 hours, I'd say that meal ratio needs to be turned up (less insulin), too.

If there was no unusual activity the day before and if meals were typical meals, no illness, I'd be dialing that insulin down for tomorrow without waiting for a trend to appear.

Trust your instincts and know that this is a very "normal" way for insulin needs to change.

Good luck at the gym and pack some gatorade/vitamin water whatever liquid sugar works for her. I know I got a couple of bottles for us for today's workout.

[Kaylee's Mommy]

my guess is the summer time activity, her body may have been trying to recover from a previous low, so it went low again.. the hour after grapes and only being 111, Kaylee would definitely end up low... 3 hours of gymnastics coming up, I'd get her plenty of protien and carbs.. back off the basal and ratios to see what all that activity is going to do to her.. of course, it could be the moon is blue and the wind blew east instead of west:rolleyes::cwds:

[jcanolson]

.. of course, it could be the moon is blue and the wind blew east instead of west:rolleyes::cwds:

lol - I'll have to remember that one!

[saxmaniac]

When you say 80-120, does your pump target the 80 or the 120? I ask because on the pod we are set to 120/150 during the day. Note I don't write 120-150, it means it will try to correct to 120, but when above 150. The 120 is the target, midway between 80-180 (his Rx range).

[dqmomof3]

As I understand it, my pump corrects lows to reach 80, and highs to reach 120. I used to have a single target set, 120, but that was a disaster - way too many highs! Maybe Marsha knows...I'm not sure if it aims to the number in between (100) or not.

Anyone?

[twodoor2]

As I understand it, my pump corrects lows to reach 80, and highs to reach 120. I used to have a single target set, 120, but that was a disaster - way too many highs! Maybe Marsha knows...I'm not sure if it aims to the number in between (100) or not.

Anyone?

Whenever you are in the target range, no correction will be done at all. I hope that answers your question. It will only perform a straight food dose for the MM522. I'm not sure about other pumps, but from what I hear, I think this is their calculation as well.

This is why even though you are in the target range and you see a low BG relative to your Active Insulin, ALWAYS ALWAYS account for that. Give extra carbs, or subtract some insulin if you're bolusing for something else. If I see a 100, and there's 1.2 units of active insulin left, that's a red flag to give more carbs. 100 is still in Elizabeth's pump range, but with that much IOB left (1.2 units), it's a sure thing she'll go hypo.

[Lee]

This is why even though you are in the target range and you see a low BG relative to your Active Insulin, ALWAYS ALWAYS account for that. Give extra carbs, or subtract some insulin if you're bolusing for something else. If I see a 100, and there's 1.2 units of active insulin left, that's a red flag to give more carbs. 100 is still in Elizabeth's pump range, but with that much IOB left (1.2 units), it's a sure thing she'll go hypo.

I used to do that - but then food would kick in and she would be high - I use it more as a -retest in 30minutes warning sign! But, my daughter is 10 - so not as sensitive...

[twodoor2]

I used to do that - but then food would kick in and she would be high - I use it more as a -retest in 30minutes warning sign! But, my daughter is 10 - so not as sensitive...

Hi Becky!!
She never goes high from correcting with carbs because I use the Active Insulin amount to gage exactly how many carbs to give. If I ever overshoot the Active Insulin (IOB) amount, she will definitely go high. That's why I'm a stickler for curvilinear IOB since it's a much more accurate reflection of how insulin decays. :)