Hypo one day high the next day after similar meal - Delayed Activity impact / new pen?

Strange BG readings - an unexpected Hypo 22/11/12 @ 19:56 and the second day with similar evening meal unexpected high ! It seems that we are always getting readings we do not understand. Does not add up.

Could it be :

1. change of pen ? switched from NovoPen 3 Demi to NovoPen Echo as from lunch time on 22/11/2012. Only difference I noticed is that the Echo continues to release insulin at end of dose whilst end is pressed. Similar to what Solostar does for Lantus. The leaflet says count to 6 seconds - but maybe this is a new factor to take into account. The NovoPen 3 Demi hardly released any. Almost none.

2. Delayed effect of activity causing the hypo. An hour travel for eye check in the afternoon.?

3. A glass of red wine with meal? Hypo was one hour after meal so quite quick. The wine bottle was opened a few days earlier. Does this change how red wine behave? I have had red wine before with no significant impact to BG.

4. A thought: Is it possible that QA:CP ratios should be different depending on BG level? For the 2 evening meals pre meal BGs were 6.0 and 10.1. The accuracy of the Accu-Chek Expert is probably about 1 mmol as a repeated test for the 2nd day gave BG 9.3 (variation 9.3-10.1 for same time). Maybe ratios should be lower if BG below 7.0 and higher if above 8.0? Just a thought that it is not as simple as just having +/- QA corrections

Any views?

PS Also Beans were implicated in high BG reading on 21st November. Nuts and Beans always get implicated for me and perhaps should be counted - partially?.

Simon

I think you have basically covered all the bases, well done, now all you need to do is find out what the explanation is..........

I personally don't think a change of pen would give such a noticeable effect.......

the activity in the afternoon is definitely a good one!! Where you walking a lot?

We all know alcohol inhibits the liver, but I don't think one glass would do that much, however everyone is different. If it doesn't normally do this then its unlikely to be the wine......

It is known that insulin resistance does increase the higher your blood sugar is, but an easier way to deal with this, with manageable dose adjustment in mind for the future, is to give yourself more correction the higher you go........

If I am over 17mmol/l I need 1 unit of QA for every 1 mmol/l, as opposed to the normal correction of 1 unit for every 2.5mmol when I am below 10.....

changing ratios depending on BG would make the DAFNE approach impossible......

If you have seen an effect with beans then they should definitely be considered. Do a test to confirm the effect if any

Thanks James for looking into this.

I am not active and activity such as walking to the station, travelling on the underground etc does lead to significant drop in BG. For travelling from West London to UCLH and back for appointments I normally reduce QA dose by 30% for the meal before the travel and that has worked fine. On this day it was only a trip to Acton but the walking was the same so 30% reduction for QA at lunch time. I was back 3 hours before evening meal. May be there is a delayed effect on BG.

With regards to corrections I will review my corrections and see if there is evidence of needing higher correction doses for BGs of 15+ mmol/l.

I am also finding the QA and BI peak times is a factor (despite what people say, Lantus effect does peak for me after 7 hours) so I am trying to make sure QA + 3 hours does not coincide with BI + 7 hours and that was the reason for choosing 11am and 11pm for the BI doses. The hypo was 4 hours after end of the activity, 1 hour after the QA and 9 hours after the BI,

Simon