Hi! I'm still fairly new diagnosed and have been having reaally low sugars, all the time! Even after meals. My insulin to carb ratio is super low, and lately (last 3 days) I haven't taken any insulin, short acting OR long acting, because of all the lows. I check my sugars 8-10 times a day, and haven't peaked over 130 this last week. The lowest I've had was 60, but I feel like I can't bring up my sugar levels enough before they just slip back down. So frustrating!
I'm guessing this is the crafty work of the Honeymoon phase I've heard so much about, but did anyone else experience as many lows? I've gone through two 50-count glucose tablets and three 8-packs of juices in the last week lol. Nuts!
Does missing insulin shots affect anything else other than blood sugar levels? Maybe metabolism?
What do you mean you haven't taken any insulin? For how long? Your lows could be attributable to short and/or long acting insulin. That is, the problem could be your bolus and/or basal rates. Are you eating low-glycemic meals? How soon before meals are you injecting? Are you exercising? When you correct for lows, are you only consuming glucose tablets (or high glycemic foods) or are you following this treatment with fats and proteins? How often are you eating meals? What are you eating? Etc, etc, etc.
In addition to asking fellow T1s on this site, you should contact your doctor as s/he already knows your history and is in a better position to recognize what your problem areas are.
I have to agree with Elie... I would definitely contact your doctor ASAP even if you are in your honeymoon phase you still need insulin to prevent you from going into Diabetic Ketoacidosis which is very serious. You can also have normal blood sugars and be in DKA. Let us know what happens!
I have an appointment with my endocrinologist next week! I've been writing down all my questions for him too, haha.
My ratio has been changing just so I can see what works best for me, but it's usually around 17g of carbs to 1 unit of insulin. All I eat lately is chicken, veggies, peanut butter, and cheese sticks haha. I know these are pretty low on carbs, and I do exercise a lot PLUS I'm a manager at a restaurant, so even when I'm not working out I'm working really hard.
I usually test and inject 15-20mins before meals and then check my sugars 2 or 3 hours after or if (or more likely when) I feel shaky. I eat 3 times a day plus lootttts of snacks - but again, most all the food I eat is low-average in carbs and calories, high in protein.
That's super scary about going into DKA even with normal blood sugars, definitely didn't know that. Can't I test for that with those test strips for urine or something?
Good to hear you're seeing your doctor soon. He will probably lower your rates, or at least one of them (again, I'm not in a great position to determine which one). I also (highly) suggest discussing with your doctor the relationship between diabetes and exercise. Exercise, while great in oh so many ways, complicates everything a lot, for example, by causing fluctuations in insulin sensitivity and thus the amount of insulin your body needs for x grams of carbs. This is just one example, though. Generally speaking, if you exercise, it is easier to manage your diabetes with a pump. During workouts, you can temporarily lower your basal rate or maybe even disconnect entirely. You can also set different basal rates throughout the day. With multiple injections, on the other hand, you inject your basal once and are then stuck with it for the rest of that day. I'm not saying it's impossible to maintain healthy blood sugars with multiple injections, just much, much more difficult.
Also, you're eating very low-glycemic foods. You may find that you need to inject significantly less for a 10-grams-of-carbs serving of peanut butter than for a 10-grams-of-carbs serving of saltines. Similarly, you may find that you need to inject 5-10 minutes before eating peanut butter but 15-20 minutes before eating, idk, a bagel. Also, make sure to subtract fiber from your carbs calculations.
Oh, one more thing: I go to http://nutritiondata.self.com/ all the time. This is a great way of figuring out the macronutrient profile AND the glycemic load of your food and will help you figure out how much to inject.
Elie and Gina are right on. I'll add a couple things:
- Until you meet with your doctor increase your target blood sugar. Not sure what you're aiming for now, but when dosing insulin try to aim for maybe 125-130 at all times. It will give you a little protection against lows.
- Until you meet with your doctor increase your carb ratio slightly. Then test 2 hours after eating and if you are still low then increase your carb ratio a little more. There's really no carb ratio that's too big or small. Little kids have carb ratios of 1u for every 100g of carb they eat!
- You may try taking insulin after you eat. Your body sounds sensitive to insulin. Mine is too and if I shoot up 15 minutes in advance of a meal it will cause a low.
- With shots, exercise usually requires you to eat extra carbs. That can mean having a snack before working out, testing and drinking some gatorade halfway through (if needed), and then having a few extra carbs and undosing the insulin for your next meal. Exercise can lower your blood sugar for 12 - 20 hours after you work out too, so be conservative with your insulin until you see how the workouts impact your blood sugar.
Let us know what changes your doctor recommends. These ongoing lows can be prevented, so just see it as a temporary problem.
Your diet sounds awesome! I'm eating chicken, nuts, veggies and lots of healthy fats and I have had diabetes for 2 years and I'm still not using insulin...keep the good work up! You cannot go into DKA without high blood sugars. You can get ketones doing low carb, but without high blood sugar that is NOT possible!!!!!!
I double checked about the DKA with normal blood sugars with Gary Scheiner CDE and he had this to say: "Not common, but it can happen if you become dehydrated and are insulin deficient due to infection or anything else that causes extreme insulin resistance."
Hey, Gina, thanks for the clarification/information. I just did a quick google search. I guess it's called Euglycaemic Diabetic Ketoacidosis? Interesting stuff! onlinelibrary.wiley.com/.../abstract
Thank you guys for all the help! I've been reading about pumps and the CGMs and I can see how they make life easier, or at least more normal. I'm sure I'll try it! And you're all probably right about how I'm only eating low glycemic foods and then exercising/working a lot. It makes sense now.
I was paranoid all day about if I was in DKA.. or euglycaemic dka really, again even with normal sugars now, but the only symptom I had was that I was really thirsty - but I drink 2-3 gallons of water everyday anyways, even before my diagnosis or DKA, so I think thats just normal for me. Just to be safe I'm going to pick up some of those ketostix, fingers crossed. Really interesting article, or preface to the article at least haha. Mildly alarming though.
Jenna - I tried what you said about smaller insulin ratios and injecting after meals and I didn't go as low! So that's awesome. Oh and p.s. - I definitely bought all 3 books you recommended to me a few weeks ago! I'm half way though Think like a Pancreas. Thanks for that too! haha
Sounds like you're doing really good. Bet you never knew thinking like a pancreas could be so much fun. =]
You're not in DKA. I have been a few times and it makes you so sick you can't stop vomiting and go in and out of consciousness, eventually into a coma (I was in a DKA coma for a week once during college).
Eating low carb causes small to moderate keytones, but it's not a health risk as long as you drink lots of water so they're flushed from the body.
Keytones can be a warning sign of trouble, that's why doctors make a big deal of them. Realistically, the only time you personally need to worry about keytones is if you have a stomach illness or food poisoning that keeps you from drinking for extended periods (making you dehydrated) or if you're not able to take enough insulin and have super high blood sugars for extended amount of time. Pretty rare situations.
If either ever happen, call your doctor and they'll give you an IV to get your fluids back to normal levels and may give you medicine to stop vomiting. Usually within a short time and you feel much better.
Hey Aeriel, i know we talk on the phone a lot but i figured i would just post this here. After reading everyone's responses i think there is tremendous amounts of great advice in there. One thing that i think is very important (which i overlooked when talking to you before) is the dietary fiber counts in the carbs you eat as Elie brought up. I know that after i was stabilized, my body craved nutrients from the D.K.A. debacle. Because of this, certain fiber may be used very quickly (especially soluble fiber, which usually helps to hold your blood sugar steady by slowing the absorption of sugars into cells) by your body and could cause your calculations to be a bit screwy. Coupled with the honeymoon period, this could be a contributing factor in your constant lows.