Strange hypoglycemic episode after injecting Lantus

Last night, my daughter had a severe low, dropping from 150 to 40 very quickly, about 15 minutes after injecting her long-acting, Lantus. She had no Humalog on board and it had been 5 hours since she ate dinner. It took 100 grams of carbs (juice) to stop the fall and I almost reached for the glucagon. Her Dexcom was reading 50 double down and a finger poke said she was 40. This was such a frightening experience, especially since she is heading to college soon! She was diagnosed 4 years ago and we’ve never had this happen before. Has anyone experienced such a thing? Thank you…

Have I ever dropped from 150 to zero fast? Yes. Sometimes after exercise my liver decides to “recharge” and it takes 100 or more grams to recover. Cheers and good luck :four_leaf_clover:

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Anytime I drop that quickly it’s usually due to exercise, hormones, stress, or sickness. Or forgetting to eat all of the food I took insulin for. I’ve never connected those sudden drops to lantus. Also, I’m pretty sure that it takes some time (1.5-2 hours) for Lantus to get into your system and start working. It’s not a rapid acting insulin so it shouldn’t pull your blood sugar down that quickly. Maybe the sudden drop was connected to something else?
Any double arrows, down or up, are scary :frowning:

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Cathleen @cminer, yes, I’ve had situations like this, the worst were in 1974, 22 years before arrival of “Rapid-Acting” insulin and in those days I rarely used the fast-acting along with my usual NPH long-acting. It got so bad, so often at work that my boss put a case of coca-cola beside my desk and screwed a bottle opener to the side of my desk so there wouldn’t be any delay in me getting carbohydrate into me. I hope your daughter’s event was / is her only time this happens - it is frightening.

The “bad & good” for me was after a couple of weeks with a few of these sudden drops that I checked into The Joslin [diabetes] Clinic for a week of close, observed, measured analysis and was clinically diagnosed “brittle diabetic”, so that forced me to be very observant of my body, recognize impending lows and, tak remedial action. Another positive was that The Joslin Scientists were investigating glycosylated hemoglobin and I was there for MANY blood draws every day [still 10 years before reasonably accurate Digital BG Meters]; “Glycosylated Hemoglobin” is now abbreviated to its chemistry name: HbA1c with which we have all become familiar.

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Yes, we have been brainstorming what might have happened. Just a typical day and strange sudden drop with no other factors than the Lantus she just took. Thank you for the ideas!

Dennis, wow you have been through so much. We are spoiled with such amazing technology now. I hope my daughter, like you, will learn to tune in closely to her body’s signals to take quick action when needed!

I’m new to T1, but have seen some strange BG drops, however they were not due to Lantus injection. I’ve taken short 1mile slow walks and have seen my BG drop by 100-130 in 20min. Last night at 8:45pm I was at 168 and at 10:20pm I dropped to 45 (finger test, sensor read 56). Had 10g of juice and 4g of peanut m&m’s and by 11:30pm was at 170 so I took my Lantus and went to bed.

I’ve found many times of unexplained BG weirdness, however low impact exercise has a significant impact to BG drops. A more intense workout (playing racquetball for 1.5hrs) causes a far smaller BG drop for me but with the benefit that the following day my BGs are consistently in the 80-120 range. Wondering if a low impact exercise may have helped cause your daughters hypoglycemic drop.

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Cathleen @cminer, I suggest that you remind your daughter that there are many, many unexplained events experienced when living with diabetes. Yes, she could take notes when something very unusual happens and “only” become concerned when a particular weirdness repeats.

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Thank you! My daughter is very exercise sensitive as well.

Thank you, Dennis, this is reassuring. After talking with her endo, we are going to monitor, be more cautious in the evening, and hope it will be something that doesn’t recur. She thankfully caught the low, but I was there for support. Soon she will be at college and I hope she will be able to keep safe on her own!

What is your experience w/ brittle T1D, in terms of what the swings are like? How often? Does it make you (as far as you can tell) more sensitive to insulin than other T1D’s? Just curious. I guess I’m still trying to get a handle on my own situation. I don’t think I’m brittle, but sometimes I wonder why just a smidgen of Humalog 5 hours after eating causes a large bs drop. Could be I’m just insulin-sensitive, or maybe the carbs outran the insulin at the end, but then the insulin I injected initially eventually caught up, making later-injected Humalog too much… Also hormones (for ex., when no Humalog on board)…

Becke, use of the terms “brittle diabetes” or “brittle diabetic” have been discouraged because of too many providers and patients used these terms as excuse instead of looking for actual causes of sudden BS change; such as, “Forget about this, you’re just brittle diabetic” or “it’s NOT my fault, I’m a brittle diabetic”. A hospital documented event of my extreme BS drop, referred to above, went like this:
This was on about my third day at Joslin In-House Teaching Unit where all meals are measured and all insulin injected by staff, and before MDI protocol where predominant management was by a single daily NPH dose, or like me, a split NPH dose. My usual day, after Grand Rounds, walked the couple of hundred yards to the next building and participated in the morning lecture class; around 11:30 a flock of white-coat vampires, an affectionate term, descended on the lecture theater and drew a pipette of blood from each patient’s ear; this was still in the days when the quickest BS took hours. After the lecture, i walked back to the dining hall where I was served my principal meal of the day, about 70 gm carb, and without any meal insulin. So I wouldn’t drift off into a dose during afternoon lecture, I went for a mile or two walk. When I arrived back to grab my notebook for the lecture, one of the other patients grabbed hold of me asking me if I was feeling well - I guess my response didn’t make sense - he sat me down and called for a nurse. The nurse looked at me and called for the “crash-cart”. Next morning during “Grand Rounds” I was interrogated by a bevy of doctors with questions, including who had given me additional insulin. There wasn’t any insulin given to me. Numbers: my 11:30 BS was 368 mg/dl [I somehow remember that number], I ate more than 70 grams of carbs, my 2:30 emergency BS couldn’t be determined because it was “too low”. So it was estimated that my BGL dropped 350 md/dl in less than 3 hours.

Insulin sensitivity occurs in a couple of diabetes “Classifications”, more prominent in Class II. You can, and should determine, your sensitivity for different times of day; do this when your BGL is at least 150, and for at least 4 hours you haven’t taken any insulin and been living at a moderate level. Inject exactly 1 unit of insulin and check and record BGL when injected and hourly following for 5 hours - six readings. Graph and analyse.

How long does Humalog last in YOUR body? The only way, other than your observation, find out is through testing blood to see if insulin is present - while determining if the insulin found is injected/infused of naturally produced; this is lab work and equipment, nothing most of us could do at home. Lilly says “average or mean”, I forget which, is about four hours. I suspect my duration is closer to 5 hours, and apparently FDA believes 5 hours is what we should use for safety when using iAID systems.

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Out of curiosity, what did your daughter have for dinner that night? Did she have anything unusual? I often have spikes and drops in the evening at seemingly strange times and I’m pretty sure it has to do with the glycemic index and how quickly my body is digesting the various foods that I ate for dinner.

Also, is your daughter using a blood glucose meter or a CGM? I made it through college by setting a higher blood glucose target for myself right before bed. I knew that my blood sugar tended to drop overnight, so that was how I coped. 200 before bed meant 120 when I woke up. Now that I have a CGM, I’ve set my low alarm to go off at 85. Forewarned is forearmed, as the saying goes. If the arrow’s pointing down, I have a snack. If the arrow’s straight or pointing up, I might ignore it for a bit and wait to see what happens. It can be annoying sometimes, say if my blood sugar’s hovering between 80 and 90 all night and the alarm keeps going off. But I prefer seeing a low coming over treating it as it’s happening.

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Thank you for the info and suggestions, and for sharing. As another member said, I’m very thankful to live in a time w/ improved management systems!

I tried googling insulin sensitivity classifications, but only got results regarding the class of T1 vs the class of T2. Is there a link you can give with info regarding the classifications you mentioned? No worries if not–just wanted to look into a little more.

Anyway, thanks again!! -Becky

Beck @BKN480, I was not referring to classification of “insulin sensitivities”, but rather to Classification of the many types of diabetes. The American Diabetes Association [the ADA] in its Standards of Care for diabetes [SoC] guide for professionals has gathered the many diabetes types into four Classifications to assist doctors in first identifying the condition with which a patient is living, and methods for management.

I don’t know if this is helpful, but exercise can still drop or affect your blood sugar for an amount of time after exercise, I don’t know the exact amount of time but it heavily depends on the kind of exercise, her adrenaline, her heart rate, and if it was weight training and/or if she drops or lowers after cardio or weights. I’ve heard that it could affect you maybe a day later? I don’t know for certain (I’m only a few month into this myself) but I only know that even an endo will tell you that for a lot of things that it depends on the person, or features such as if their lean, how reactive to exercise they are, or anything like that. Since she is four years in I have no idea the cause, but in any case good luck and happy hunting.

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Thank you, yes she is very exercise sensitive and slender, possibly contributed to the situation, but still an unusual drop at a strange time.

Dinner was salmon, a cup of pasta with cheese and broccoli at 7:30pm. The fast dropping low happened at midnight with no Humalog on board by then, I’m assuming….
I’m really looking into the Lantus injection she took right before the drop. I have found precautions in Lantus and Basaglar instructions to avoid injecting into muscle or a vein (I’m guessing that would be via IV in a hospital), that it can cause severe hypoglycemia. I had never heard of this until I looked into it after this episode.
Thank you for your college tips, very helpful, and yes she has a Dexcom set to 85 for her low alarm.

I’ve never heard of that either, but it makes sense. Would Lantus cause such a severe low so quickly if you had accidentally injected into a muscle? A vein doesn’t seem likely since you haven’t mentioned lots of bleeding right after the shot. It seems more like it would be prolonged or recurring lows with Lantus? I’m not discrediting you, just wondering/ trying to think with you. Lantus is definitely a possible devil in this situation.
We’ll never be 100% sure, unfortunately, what causes our weird highs and lows (don’t you wish we could interrogate our pancreases/blood sugar and demand reasonable explanations for these things?). I hope this never happens again!

Thank you for thinking with me! What I read is that Lantus and basaglar need to be injected into fat to work properly and release slowly. It’s very possible my slender daughter injected into muscle. Her very experienced endo, though, has not heard of this effect so this makes me wonder.

She also had fallen asleep from 9-midnight and went low when she got up, so I wonder if getting moving made her drop. We probably will never know or understand, but I felt compelled to figure it out to see if we need to change long-acting insulin. We’re taking precautions like having her take Lantus earlier and being awake for at least an hour and injecting into the fattiest tissue she can find.