Hello! Random question and a little back story. First off, I’ve been type 1 for just over 16 years so I’m well out of my honey moon period. I went through a weight loss transformation last year and ever since I’ve had so many more lows. I’ve done all the things including basal and IC tests, but all of it seems pretty spot on. I used to go low maybe 1-4 times a month if that, and now I go low probably once a day. The majority of these lows are minor we’re talking high 60s and easy to correct, but frustrating nonetheless. I’ve worked with multiple people including my endo to figure it out but everyone is so stuck on the idea that my A1C is 5.9 (down from the low 7s the 16 other years I’ve had it) that I feel like they’re overlooking the annoyance of daily lows. I’ve tried tweaking for activity, looking at my correction factor, making sure I have a good and healthy blend of fat/protein etc, measuring food with a scale and making sure my carb counting is spot on and sometimes it works but I’m still sick of going low. There’s not necessarily a pattern where I can tweak a certain basal time of the day or anything either. The only time of month I get a break is if it’s my time of the month when I develop insulin resistance. It sounds weird but I kind of like that week because I know I can be more active and do more stuff without constantly crashing but then on the flip side that’s the one time a month where I climb over 200 easily which is also frustrating. So my question is this- those with A1cs in the 6s and TIR of 70-80%, how often do you go low? Is once a day actually pretty average or does it seem like there’s something I still need to figure out?
A great A1C is important, but I believe it is just as important to factor in quality of life - specifically, do my numbers allow me to do the things I want to do and not put myself in danger.
When tight control first “became a thing” there were stories of people going to the ER with lows that had not been an issue before (thankfully you’re able to correct yours). Needless to say, that’s not good either (Captain Obvious has spoken). Even with CIQ I lneed to leave myself a cushion: my basals are fine overall, but sometimes I have to pick up and go unexpectedly, without time to activate exercise mode in advance. So I choose to keep my numbers a bit higher than some people might, to allow for a cushion. All of which is to say (finally): I’m not suggesting you be irresponsible and ignore the importance of the ranges - but in all likelihood your doctor is not living with diabetes and so is only looking at the data. That 5.9 is impressive, but they don’t have to worry about needing to stop and treat a low so you can safely drive, exercise, work, attend class or whatever the case may be. So my goal is to aim for numbers that are healthy and allow a cushion for those spontaneous things that pop up, and adjust my basals accordingly. That’s just me.
I was diagnosed July 2020. I was so afraid of and frustrated with highs in the beginning that I was going low a lot, probably once a day or every other day. Rarely it would go into the 40s (a few times), often it was 50s and 60s. I have slowly over time learned to be more ok with short-lasting highs (I mean I try to avoid them but they happen, of course), and as far as how I feel physically, I feel so much better when I avoid lows. Even going into the 70s makes me feel crappy, because I almost always have even just a little insulin on board, which means whatever low I hit, I’m almost always trending lower over time. Now I go low about once every other week, and that’s almost always 60s, and I trend low (and have to buffer to prevent actually going low) several times a week. Even this I find highly annoying, because it plays on my mind, it makes me worry about what I’m going to have to do, it often happens before eating dinner, which makes my enjoyment of eating dinner go down, etc. My tolerance for lows is just getting less and less. So, I’m still trying to learn how to get better at avoiding them, even if it means I’m hitting higher numbers than I like to, more frequently. Frankly that’s just a trade-off I personally prefer. I can mostly stay under 200, sometimes I go between 200-250, and of course I correct them asap, while factoring in possible insulin on board, in order to avoid going low later. It’s really tricky, but yeah, I asked your same question a while ago and maybe others are just more comfortable going low more frequently, not me.
All you can do is try using less insulin. If you’re trending low too much, that’s really the answer. Try reducing basal a bit and carb ratios a bit, just a little at a time. That’s what I’ve been doing and am getting better and feeling better. It could also be a timing issue - like if you exercise, you need to let your blood sugar go up a bit before taking insulin you’d normally take, etc. Anyway you’ve had much more experience with me on this given how long we’ve each been dealing w/ this disease, so I’m probably not saying anything too enlightening! But given I have struggled with this as well I wanted to share my input. 
I had too many lows until I started using an insulin pump and a CGM (Continuous Glucose Monitor). Adjustments of insulin deliveries can be made with the pump, and you would have your glucose numbers available on the CGM all day and night.
I am type 1, but there many type 2 diabetics also using a CGM, and some are also using a pump.
I have an A1C of 5.7 for the last 6 months, but was 6.0-6.3 all of last year. I rarely have lows below 6.5 now.
I set my Dexcom for alert at 75, so, if I pay attention, I just grab a Payday and keep on truckin. If I am out walking dogs, or paddling, there are paydays in my pocket, the peanuts keep the bar from melting to the wrapper.
Thanks all! So it sounds like lows in general are fairly common but maybe I should tweak basals a little again too. I’m meeting with my endo for my quarterly check in tomorrow and she’s actually a new one so maybe she’ll be awesome to work with!
Hello, I am proud of you for perservering through the honeymoon stage. I can only imagine how hard it is by being a mother of a daughter with type 1 diabetes. The insulin pump is what is saving her right now. It is linked to her phone via an app and it keeps a constant reading and adjust the insulin output so that she does not drop or go too high. Being low is worse than being high. Please speak to your endocrinologist and request an insulin pump.
Hi Taylor,
I had an endo years ago who advised me that there are two different kinds of low blood sugars; those you can treat yourself and those where you need someone else’s help. The latter being the one to be more concerned about.
For example, if your blood sugar is at 70 mg/dl or above before a meal, this is simply your body saying it needs more fuel. This is normal! However, if a couple of hours after eating, or during the night, your sugar drops to a point that someone has to call an ambulance to administer glucose, this is not normal and needs to be addressed. Basically, if the “lows” you are experiencing are not disruptive to your daily routine, you don’t need to be overly concerned. You can eat a piece of candy, or drink some juice and keep going. If this is happening too frequently, you may need to make some slight adjustments by either changing your insulin dose, or the amount of/types of carbs you are consuming, or the timing of your insulin to your meal times.
There are so many things that could be the cause, as I’m sure you are aware, that I can;t list them all here. The best advice I can give is talk to your doctor/NP/diabetes educator about your concerns and see what they suggest.
Pam K.
T1D 57.5 years and counting!