Extreme hypos

My daughter has been running low a lot. I’ll give an example yesterday she woke up at 7 am in the 300s I gave her 1.5 of r but she went back to sleep and woke up at 11 at 214. I fed her and gave her 1.5 of R . From then on it was 56, 67 40s for hours. No insulin given except at 7 and 11 . She stayed low until 1am. And of course she was high this morning because she I gave her so many sweets to bring her up last night. I gave her candy, a couple gulps of soda, fruit, etc. Over a 7 hr period this was going on of all lows. Shes on 4.5 of tresiba and I didnt give it to her last night. Today she woke up at 305 at 7am I gave her 1.5 units she we went to sleep woke up at 10am in the low 200s I gave her 1 unit and now shes 125 but I’m assuming she will go low. This has been happening so much lately . When she drops over hours I give her foods to bring her up which then in turn makes her high the next morning and it starts all over again. I bring her high down then she goes lower all day without insulin for dinner

Grr. We’ve definitely been there! Sounds like something is out of whack, for sure. Does your endo/CDE have an after-hours number you can call, or an email they monitor? If it’s been like this for a few days now, I’m sure you don’t want to wait until after the holiday to get a call back.

He says reduce basal tonight and just give food until she comes up

Hello ndidi. I’m currently going through the same situation. As a matter of fact as I’m writing this my CGM is going off and I’m 51 just waiting for the sugar to kick in. It has been like this for several days even after lowering basal and bolus dosages. It’s driving my wife crazy. Rest assured it’s something we all go through at times even under the most vigilant care. I’m sure you have heard of the honeymoon phase where T1D’s pancreases start working again and secrete insulin in addition to manual doses by pump or injections so it’s like two different methods not talking to each other and you are fighting hypos for a while. There’s no warning light or alert that says this is happening so the only way we can combat it is by taking less insulin and making her consume sugar to combat the lows. It’s a frustrating roller coaster ride. You are doing the best that can be done in this battle. I know her doctor didn’t offer any drop mic answers but I recommend you follow his advise and tweak dosages to be slightly lower until you feel she’s getting through this issue and if you start getting really concerned about how things look by all means call her doctor again and again until you feel her condition is being addressed. Remember that dietary fixes for hypo’s take time to show up and will cause spikes if it was high in sugar content and we have a tendency to stack snacks causing the eventual hypers. Also, has she been more active or had any routine changes lately? Oh, there is one other thing I forgot to recommend and have run out of myself is Glucerna brand drinks. They come in flavors, my fav is chocolate and the drinks seem to not cause severe BG spikes. Maybe she could use them as a snack before going too low.

Reading this post made me tear up. Its reassurance that my daughter is going through something that every diabetic has gone through at some point. I actually took her to ER because I got super scared she dropped to 36 . I gave her 2 dum dum suckers and 3 high chews and she still would go up then come down . The ER doctor said this was over his head. He tried to contact my daughters endo but no response due to the holiday. He suggested reducing her insulin and when I notice an increase over 200 start insulin again. She finally started being stable there but due to us being there for so long she went down because she hadn’t eaten dinner yet. Thank you for your response . She honeymooned her first year of diagnosis for the entire year no insulin then she needed it but very small dosages. And also yes she has started to ride a bike for the past few weeks and that’s when it started

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I understand where you’re coming from. Issues like your daughter is going through will try even the most protective parents. Y’all are battling an invisible foe and it attacks at every turn constantly. What you said earlier may be a part of the situation because an increase in activity will burn calories naturally, and if excercise is not calculated in bolus decisions her BGL’s can drop rapidly. She may need to take less bolus dosage amounts, postpone a dosage until after biking or eat a moderate snack before biking or do a combination of the three options and be sure to ask her doctor also. Dropping to 36 is scarey and you did the right thing, excellent. If it happens again and she becomes unresponsive call 911 immediately. Also you may want to discuss getting a RX from her doctor for Glucagon an emergency injectable that pulls her bodies sugar stores out of her liver and will bring her into semi responsiveness so you can treat her while waiting for EMS. I still have periods of the honeymoon phase even after 58 years of being T1D so that can still be an element when she has periods of lows for no other reason. Just remember you and your little lady are doing a great job, you’re being protective and doing what every T1D childs mother’s instincts say to do. Job well done.

So sorry to hear about what’s going on with your daughter. As others have said, it happens to most or all of us - even veterans like me with nearly 60 years on insulin. One thing I woyld suggest when treating lows - juices and things of that nature are typically good at bringing the numbers up, but they don’t have “staying power.” Cheese and crackers, or yogurt are a couple that come to mind that will help stabilize the numbers - in fact a mind once recommended yogurt as a good bedtime snack. Check with your team for recommendations. Hang in there!

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Hi again. I’m surprised and concerned the ER doctor was not able to reach someone on call for your endo, even though it was a holiday. Most doctors have only a textbook knowledge about diabetes, and not the finer points - and from there each patient is different, so it’s even more challenging. I live in the DMV, where several hospitals have diabetes treatment centers and access to endos for emergency visits. If there are ones in your area and you have a choice, ask to go there.
It sounds like things worked out as expected following your visit - the later drop would be expected after going so long without eating.

Activity makes a huge difference. When our daughter was on shots, she needed a full unit less of her basal on days she was going to be active, in addition to more snacks (which she didn’t cover for) to keep the lows at bay. Which reminds me: does she have half-unit syringes? A full unit correction in either direction can be way too much, especially in kids….

Hang in there!

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Yes shes used half unit syringes since initial diagnosis 6 years ago. That has been a headache in itself because walgreens was very adamant they didnt supply those so I had to contact the syringe company who gave me the catalog number. Once I gave walgreens that all of a sudden they weren’t arguing with me anymore that the syringes dont exist.i think its definitely activity because her bike riding has escalated since getting out of school

Yeah I’m in the process of trying to find a new endo because that bothered me as well

That makes sense because juice boxes havent lasted when shes low she goes up then comes down. My daughter reminded me that a snack i gave her last year when this happened helped keep her up. They’re the yan yans ( cookie sticks that you dip in cream) 38 carbs or pockys 28 carbs. So I went and bought so many last night

Thank you so much. I’m sorry you’re dealing with lows as well. You’re very encouraging . This forum really helps . I’m her sole parent and I’m trying to do everything I can to make her as comfortable as I can

It’s sounds like your detective senses are kicking in and zeroing in on what is causing her issue. There has been alot of great advise given from others and I think it won’t be long before y’all get a handle on all of this. Thank you for your compassion for my issues. You are her sole care giver but remember we are here to listen and give any advise from personal experinces or to listen to you if you need to vent, so don’t feel that you are all alone. We’re proud of her and you for your determination in making her life as good as possible. Two thumbs up.

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We had that same frustration with the mail-order pharmacy OptumRx. “Yes, half-unit syringes do exist; I’m looking at a box on my shelf right now!” :roll_eyes:

Hopefully a small basal reduction will do the trick, together with correcting lows with the fast-sugar (juice) you’ve been giving her, wait 15 minutes, recheck, and then when she’s in the safe zone again, adding a slower-releasing snack that will hold her BG where it belongs longer. Cheese and crackers, peanut butter toast, yogurt, nuts and raisins, etc. — pretty much any combination of carbs plus some fat and/or protein should help “make it stick,” and help get you guys off the roller coaster.

And for goodness sake, yes, fire that endo! Having no one on call to respond to emergencies? That’s unforgivable.

Keep posting. We’re most definitely all in this together!

@stixxs512 , I can empathize with you and your daughter as she goes through this rollercoaster; the part that bothers me most when I have days like this is because I can’t figure out what I did wrong".

Something to keep in mind that may help you is that we need active insulin in our body 24 hours everyday even when we are not eating. Her Tresiba, a “background insulin” Degludec, which is proven to stay active for up to 42 hours provides this background insulin. When she “skips” her scheduled dose, she is indirectly allowing her BGL to increase for at least a day - my non-professional guess. My other thought concerning her response to the Regular insulin is the heat, high temperatures; for me, during hot weather, Regular Insulin had a double effect anbd would cause hypo events. It got so bad for me when I moved to Florida, that our daughter with many years ER experience who lived with us, kept a couple of ampules of D-50 and IV equipment in the house to manage me in emergency. D-50 is the ER/EMS treatment for those unconscious because of hypoglycemia,

I hope too, that your search for a responsible AND responsive endo is successful.

I’m confused by what you said about the tresiba. What do you mean about skipping a dose? Do you mean skipping tresiba or skipping the R allows for a BGL increase? Or maybe you’re saying regardless of bolus decrease always do the background insulin??
Also with R even when shes indoors she goes down . For example today she woke at 380 I gave her 1 unit of R and she ate breakfast . She went up to 432 2 hrs later . 1 hr later 318. And 30 min later 127. Once I saw that i gave her chips and peanut butter because i got nervous she would drop more like shes been doing. No outdoor activity

I think what Dennis was saying is it’s not recommended to skip or delay her basal Tresiba doses. You can however lower, or postpone or even ommit her bolus R REG doses which is her fast acting but short duration insulin if she is going to be active like riding her bike after dinner however always confirm these decisions with her endo. You can let her ride her bike after you check her BGL and if it’s say 250 maybe do a half bolus dose and if for example she’s 150 postpone her bolus dose until she’s done, then check her BGL again and see if her BGL has lowered or increased and a bolus dose is needed after the strenuous activity has stopped. If her BGL is steady but she wants to eat a snack after excercising a bolus to cover the snack may be needed. Does she use a CGM, or is she pricking her finger? I hope I’ve explained what Dennis said correctly, if I didn’t I’m sure he will explain it more detailed.

@stixxs512 I was talking about Toshiba, the background insulin we need 24 hours every dY. For some people, a very small dose is sufficient, the R is used to cover foods we eat and to correct a high BG

The R you gave her was the right thing to do. Just don’t give her “too much”, or shots too close together or her BG may drop too much. R can stay active in her for 6 hours. Use your best guess.

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Ok I understand now .with the examples i gave of her numbers today all shes had is 1 unit of tresiba last night and 1 unit of R for this mornining