ROUTINE SUDDEN DROP IN BLOOD SUGARS

[DJDI]

I AM A TYPE 1 DIABETIC FOR 36 YEARS(SINCE AGE14) I HAVE BEEN ON AN INSULIN PUMP FOR THE PAST 9 YEARS. MY BS CONTROL HAS ALWAYS BEEN VERY ERRATIC NO MATTER WHAT I DO. HOWEVER, I AM HAVING SEVERE PROBLEMS WITH THE LOWS. MY BLOOD SUGAR WILL SUDDENLY DROP FROM THE 80'S OR 90'S TO THE 40' OR EVEN 30'S. AS A MATTER OF FACT A FEW DAYS AGO I WAS TAKEN BY AMBULANCE TO THE HOSPITAL BECAUSE I HAD A SEVERE HYPO EPISIDE. IT TOOK A LONG TIME FOR THE NURSES, DOCTORS,... TO GET MY BLOOD SUGAR TO NORMAL.

I KNOW THAT I HAVE A VERY HIGH METABOLISM, BUT I DO NOT HAVE A THYROID PROBLEM. ALSO, AT TIMES WHEN MY BS DROPS IN THE LOW 50'S OR 40'S I FEEL AS THOUGH I AM HAVING SOME KIND OF WEIRD OUT OF BODY EXPERIENCE - I DON'T KNOW WHERE I AM, I SIT AND STARE AND FEEL LIKE I'M GOING CRAZY.

DOES ANYONE ELSE EVERY HAVE THIS PROBLEM?

[jake4224]

Hi
I hope someone can shed some light on a problem we're having. Out 11yo daughter (dx T1 17mth) has a Veo pump (Revel in US?) and Enlite CGMS for which we are very grateful. However, the CGM tells us that most nights she has very sudden, severe hypos followed by what we presume to be liver dumps resulting in his BGs come morning. Without the CGM we would most likely not be aware of these as she is hypo-unaware though the higher morning readings would suggest something is up at night.
She could be on a glucose level of 10mmol/l (180mg/dl) and within 10-15 minutes her CGM shows <2.2 mmol/l (38mg/dl) followed by an equally quick rise to perhaps 11mmol/l (198mg/dl) or more. We've tried everything we can think of.
We've given her a supper of full fat milk & occasionally some cheese, sometimes with very low bolus to cover. We've dropped her basal from 10pm until 3am by more than 60% of that leading up to 10pm. We've monitored exercise to see if it was being caused by PEL (post-exercise late onset hypo) but it happens even when she's had no exercise for days.
Usually it happens between 12:30 and perhaps 2am but more recently it's happened at 11:30 or 4:30. We've on occasion by luck 'caught' it by BG but the number we get is likely later than the actual event given the CGM is 10-15 behind so the BG shows something like 7.0. However, this continues to rise (Symogyi effect) as we prove with later BG tests.
From my reading I'm beginning to think it might be thyroid related though her last bloods were clear. She does have celiacs already. Any help much appreciated - perhaps it 'fits' with your own experience?
Thanks,
J

[JDRF-VOL-RL]

Wow, I'm glad you finally found out the cause of your daughter's erratic scores.  That has to be a relief, hopefully her situation is better now!

[JDRF-VOL-RL]

Hello.  I'm not a medical professional, just the parent of a kid with diabetes.  The out of body feeling you have is a common symptom of lows.  I'm curious about your pump settings.  Have you ever done basal rate testing?  That would show whether or not you have the right basal rates for different times of the day.  You can test overnight rates or rates across any meal or any part of the day.  You basically start blood sugar testing 4 hours after last eating in order to make sure that your food is digested and through your system, and your fast acting insulin has completed it's work to cover that food.  You test about every 3-4 hours to make sure you're not high or low, and don't eat or drink anything until your test period is over.  For example, if you are testing overnight basals, and you are done eating supper by 7, don't eat anything else and start blood sugar testing at 11.  At breakfast time, your blood sugar should still be within 20 points of where you started at 11 the night before.

The reason I'm asking is because I'd guess that your basal rates are off, so that under a normal day you wind up getting too much insulin.  It could also be that your carb ratios are incorrect, so that you don't get enough insulin, then you correct later and you get too much.  Also understand what your insulin duration setting is.  Insulin duration is the time that insulin is effective in your body.  Normal duration for fast acting insulins is 4 hours, after that the effectiveness is almost nothing.  If you have it set to longer than that, it's possible that your pump thinks you have more insulin on board than you really do, so it doesn't dose you enough.  Then if your correction factors are wrong, you get dosed the wrong amounts of insulin, and you go low.  All these could be a factor in your erratic scores.  You really have to dig into your pump settings and understand what each is for and how to tweak things.  A caution, though:  don't tweak more than one setting at a time.  If you tweak too many, you may wind up causing other problems, and you won't know what setting changed caused the problem or fixed the problem.

Another possibility is that you are not getting good insulin absortion some of the sites you choose.  If you don't get good absorbtion you will have erratic scores.

Yet another possibility is that your estimates for carb counting are off.  Have you considered getting a digital scale to better estimate portions?  Accurate carb countings, along with understanding which foods affect you in which ways, as well as understanding how to subtact off for fibers and portions of sugar alcohols.  I'd suggest working with your endo and a dietician that specializes in diabetes if you're interested in this information.

Good luck and let us know if there are any other questions you have.

[DJDI]

THANK YOU ALL FOR YOUR INPUT. IT HAS BEEN VERY HELPFUL. ALSO, I FORGOT TO MENTION THAT I HAVE GASTROPARESIS, WHICH I KNOW AFFECTS MY INSULIN ABSORPTION AT TIMES. BUT I CAN'T TAKE REGLAN BECAUSE IT MAKES ME SEVERELY DEPRESSED. I HAVE ASKED THE DOCTORS IF THEY KNOW OF ANY OTHER MEDS THAT CAN HELP, BUT THEY DON'T SEEM TO KNOW OF ANY.

MY SISTER ; WHO IS A PHYSICIAN, ORDERED A MED FROM CANADA(CAN'T THINK OF THE NAME RIGHT NOW), BUT IT IS NOT APPROVED BY THE FDA AND HAS BEEN KNOW TO CAUSE PROBLEMS WITH STROKES AND HEART ATTACKS, SO I AM A LITTLE RELUCTANT TO TAKE IT FOR MY GASTROPARESIS.

ANY THOUGHTS?

THANK YOU.

[kraysmom]

My daughter is 16 years old and has had diabetes since she was 11.  We have had a terrible time getting her blood sugars under control.  She is on the pump for the second time and we are on our 5th specialist.  She has been having the same problems with her blood sugars and no matter what we did, it wouldn't come up.  We recently found out, after being hospitalized for 4 days, that she has a Pituitary Suppression.  They said that it was not functioning properly.  When her sugar drops below 50, she has to take a shot of a steroid to bring it back up.  This has been the problem all along but it took our doctor in Nashville, TN to know what blood tests to run to find out the cause.  Ask your doctor to run a cortisol stimulating test when your sugar is low and if it is normal or low, then this could be whats going on with  you as well.  It should read elevated at the time of low blood sugars.  Her pediatrician thought it was normal but it took her specialists expertise to tell her different.  Get checked out because it is controllable. I hope this helps you.