Need Help preventing Lows

I posted this in the Type I forum but as parents, I thought maybe you too would have some valuable suggestions.

I have been diabetic since 1978 and have no complications to date to speak of. I've been on insulin most of my life but started on the Insulin Pump 4 years ago. I took a 2 year break because my body would reject the infusion sets after 24 hours. I went to the doctor 3 weeks ago and my AIC was 7.1 so they decided it was time to go back on the pump to gain better control since I had been experiencing several lows.

The funny thing is I can have a 32 BS and a 442 BS all in a 24 hour period, I am never where I need to be I am either LOW or HIGH but never normal.

I have been on the pump for 2 weeks and I was hoping things would have gotten better but they haven't. My body is not rejecting the sets and I am getting 3-4 days out of them but I am still experiencing the lows and my DH and twin sons age 11 are becoming concerned and getting frustrated. I have changed the basals and that has not seemed to help. My basal from 12 pm - 6 pm is 1.45 and last night and tonight around 5 pm I had a 24 and 32 BS. The last time today I bolused was at 12:10 pm and I did 3.0 to cover lunch and all the Christmas baking I was doing.... Yesterday's bolus was 3.0 at 9:56 am.

Any Suggestions anyone has to stop these incredible lows would be much appreciated by the entire family. Thanks, Jackie

 

If it were my daughter, I would dramatically decrease my insulin until her bs got up to the mid 100's...

How many basal rates do you run?

 

Gastroparesis?

This sounds like it could be gastroparesis, or delayed stomach emptying. Are your lows happening soon after a meal? If this is the case, when you eat and bolus for a meal, your blood sugar drops low because the food is never emptied from your stomach into your intestines and absorbed into your bloodstream. It is as if you bolused for a meal that you never ate. After you have corrected for the low, often hours later, your stomach will unexpectedly empty and cause your blood sugar to soar because you never injected insulin to cover the food. Does this sound like what is happening to you?

 

I run 5 basals -
12 am .95
3 am .5
6:30 am 1.60
12 pm 1.45
10 pm 1.4

Bolus is 1-15 ratio

Yes, nightowl, this does sound like what is happening, any suggestions as to how I correct this issue??? I have also been diagnosed w/ diabetic induced anemia so just finished 5 weeks of iron IV's at the local hospital.

 

It sounds like you already are thinking you should lower the noon basal or maybe start it a couple of hours earlier.

When are the high numbers?

 

Since starting the pump I haven't been having high numbers, I was getting those w/ shots so that is why we started back to the pump.

 

OK - so when are your lows? Are they more random, or after eating, or at bedtime?

I truly hope it isn't gastehowdoyouspellit since that seems truly awful from one parent's experience.

 

Lows are typically in the afternoon anytime from 3-6

 

I would try once again to lower the basals three hours pre-low..by maybe .15 or .25...see if you can run a little higher.

If you aren't having lows after every meal I wouldn't suspect gasteowhatsitcalled.

 

Sorry, forgot to add...most people will lower Basals two or three hours pre low or pre spike.

I have better luck lowering or raising basal right at the climb or the start of the dip. So, I would add another basal at 2 or at 3 that is lower.

 

I agree with Becky, lower that 12noon basal down a bit.. have you had the chance to do any basal testing?

When do you usually eat lunch?

 

Have not had the chance to do basal testing....

Lunch during the work week is ALWAYS SOUP!
Weekends is hard to say, yesterday was fish, today I skipped lunch.

 

What did your blood sugar do with the skipped lunch? Did it still drop around 3?

 

If your lows are mostly 3-6 pm (and I'm assuming 3-6 hours after your lunch bolus) then I agree it's a basal issue that you want to deal with by reducing basals starting at noon and going through 6 pm.

 

I didn't turn the noon basal down but did decrease the 6 pm basal kept 12 at 1.45 and then lowered 6pm at 2 pm to 1.35 - just made this adjustment tonight so it is way too soon to tell if it will work. Have never had lows at this time of night but just checked my blood at 9:30 pm and it was 100 which I thought was OK so decided to treat myself to some ice cream and did not bolus, just checked now expecting a HI and instead got a 39 and keep in mind I did not bolus and in the past 2 weeks have not had any lows... So I don't want to adjust bedtime basal as it until tonight as not been a problem - so glad I didn't bolus but still a 39 is way too low and hubby and kids are out of town. So I'm home alone and scared to death... Am sipping a coke as that typically does more for me than OJ and I wanted it to come up before I go to bed. Am pondering taking the pump off for the night since I will be home alone. Would rather wake up with a 300-400 bs than not wake up at all due to a low... What do you suggest???

 

Skipped lunch didn't cause a problem until 5ish tonight - I took an afternoon nap which should have been my 1st indicator something was not right - anyway when DH went to wake me up to let me know he and kids were leaving for night, it was 28 and he had a hard time waking me up... Lot of OJ and sugar tabs and I snapped out of it but then it stayed in the 30's - 40's for a long time and a I had 2 BIG bowls of chili for supper and they were loaded w/ cheese.

 

I just wanted to say THANK YOU to everyone that has been posting suggestions tonight, I am so thankful that I found this group to help get me and my family through this rough patch... I'm not asking Santa for a present this Christmas under the tree, just normal blood sugars...

 

I think you need to back off all your afternoon basals starting at noon.. remember, you need to change the basal TWO hours BEFORE the problem occurs.. so if you are seeing a problem at 2, you change the 12 basal.. You started having a problem around 5, you'd want to change the 3pm basal, but to keep that problem from happening (since its a big low, doesn't that make sense ) I'd make sure you change the 2pm too.. If I remember correctly, didn't you have a basal change around noon, it was a big jump? I'd lower that one and the next one, so your entire afternoon is lowered. I wouldn't take your pump off tonight but I WOULD do a temp basal, so you are getting some insulin, but with lows like that you want to run yourself a little higher so your body can take back its stores.

 

If you are running that low, I would probably do a 30 or 40 % temp basal if hubby isn't home to wake up and test you. It is odd that you would go so low after ice cream, but ice cream is what I call a long term food - it doesn't affect bs for a few hours since it is so high in fat.

There is somethign very strange going on here. Can you get your insurance to cover a CGMS? Which pump are you using? If you can't get coverage, maybe your endo will loan you one or do a blind study.

You should definitely not be spending so much time in the 30's and 40's and if you are worried about being alone tonight, take off the pump and set hte alarm for 3am to see what you are.

 

Yea, Becky, its gastroparesis, and its just as awful as its spelled!