How often in a week do you go low?

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?

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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. :slight_smile:

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.

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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.

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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!

I’ve learned that people with diabetes and those who provide care for us put too much emphasis on carbohydrates and insulin, as if we’re car engines and only require fuel and air. Get the ratio right and that engine will run perfectly.

But we are not simple fuel consuming engines. We’re more like a modern car that has multiple computers and dozens of sensors that all have to work right for the engine to behave the way that we want it to. That makes it a lot harder to troubleshoot the cause of a problem when something isn’t working properly but it’s still possible.

I used to believe that my blood sugars were fairly predictable. When checked with finger sticks before meals at bed my level slowly drifted up and down from day to day, and my A1Cs were consistent and reasonable.

I was stable for years. About 2 years ago that changed. a routine that had worked well for me was now producing nocturnal hypoglycemia.

When I started wearing a CGM I became hyper focused on what was happening immediately after eating until my blood sugar dropped from its peak…
What I was doing was watching the speedometer and the fuel gage of my vehicle. I’d fill it up with food and time the acceleration and top speed.

It took about a month for that hyper attention to pass and return to looking at what happened over many hours not one,.
Then could look at everything I ate, not just the number of grams of carbohydrates I eat at one meal but what kinds - and what happened during the preceding days as I had before.

My diet is well established and very standardized. We use meal menus that change very slowly over years. We rarely eat out. I know the number of carbs I’m going to be eating in every meal and it’s always approximately 40. That made it much easier to see patterns and find what my variables were.

If I’m in the same overall condition not just my same blood sugar before I eat one of these standard meals I’ll always get the same response. It will vary depending upon what fats and proteins are in the meal. If it’s ham, rice, beans and salad it will go up not exceed my target range, peak and becoming back down from that peak within 20 to 25 minutes. If I replace the rice with a hot potato and swiss cheese side dish my wife makes, the rise is half as much and lasts twice as long.

One day the latter meal made my blood sugar rise, stay there and not come down until I forced it down with a series of corrections.!?!

Obviously something besides that meal was responsible. It wasn’t activity. It wasn’t stress. My BP , temperature and pulse were normal.

The only thing that could make my blood glucose be unpredictable were the rate of digestion and metabolism

My activity level is near constant without bursts of intense activity so I did not have to be concerned with short-term changes in my metabolic rate.

It turned out that I had a restriction in my fuel line. It was constipated.

Even though an estimated 1/3 of all people would type 1 diabetes have them, Cchronic constipation and irregular digestion are seldom discussed as a complication - of diabetes management…

These can be caused by quality of diet and/or diabetic autonomic neuropathy caused gastroparesis.

These can change blood sugar.response after a meal similar to starving a gasoline engine then flooding it with fuel.

Delayed digestion and varying constipation affect how quickly the food moves through the intestine and how pre digested it is at each point. If accompanied by dehydration the processes that move glucose from the gut into the bloodstream and through the tissues are affected. If you wear a CGM and pay attention you will note that when you are dehydrated your blood sugar will reach a high peak level slower and stay there for a longer period of time.

When constipated food has a longer time to be pre-digested by stomach fluids. When that food moves into the intestine it is more easily absorbed. When those carbs are embedded in a mass of fiber and fat and protein digestion is delayed.

When I recognize what’s happening and take osmotic laxative, within a few minutes after a bowel movement I’ll see a fairly rapid change in my blood sugar usually a drop, and within 6 hours my postprandial blood glucose levels return to being predictable.

Until the next time.

If I were a rapidly growing child or adolescent or a woman it would have been a lot harder for me to figure out what my personal complication was, but I would have if I had kept good records and analyzed everything not just carbs, units and levels.