Feeling unwell

[Danaemac]

Hey guys needing some advice again !!

Been feeling pretty rough since finishing my first block of night shift in my new job did seem to have a kind of cold / bug on Tuesday and Wednesday but all week numbers have been either through the roof between 16-20 or through the floor at 2-3 no rhyme or reasoning to it have tried various temp Basals + 10 % right up to + 80% on Tuesday afternoon the 80% still remained at 16 until I had tea then crashed during the night when temp basal was reduced
Today I kept basal on normal as at 3.7 when wakened at 6 am no food just water up to 16 by 10 put 10% temp on and correction remained high at 16 all afternoon with correction again at 2pm put to + 20% to then drop to 2.7 before tea had mince and a few potatoes for t and back to 16 I'm beat don't know what to do I don't feel particularly ill just a bit hot but this could also be through high bs any suggestions ? I'm normally not bad at getting things sorted but this just isn't stabilising

 

[jack412]

if it's regular, you are going to need to work out your basal rates with your Dr/nurse
http://www.mylife-diabetescare.com/mylife-diabetes-knowledge-lowering-raising-basal-rate.html

 

[Danaemac]

It's not it's just been since Tuesday rates and Basals were checked last month and were all sitting pretty stable. Was sitting on a 6.8 30 day average but this week has just been 1 big roller coaster can't decide if the body clock has been thrown by the night shifts I suffer with DP quite badly or whether there is something more to it can't get a basal check done as I'm either 2 high and need to correct or 2 low and need to eat that's before I even start a basal check

 

[jack412]

were you on night shift before and it was ok, you might just be coming down with something this week

 

[Danaemac]

It seemed ok though the week of nights a little higher as that was my choice just to play safe as I do almost double the basal rate at points overnight and didn't want hypo at work so temp -20% worked well giving an 8 average for the week I really feel not to bad I actually think the high bs is now causing more symptoms than the actual bug but can't get them down without crashing

 

[Spiker]

Sounds like a bug and if you can't get it down without crashing you are by definition over correcting. I would suggest don't both correct and also run + basal %. Do one or the other but not both.

What I would do is use corrections alone to figure out how much extra insulin you need at the moment to be stable.

Eg if you would ordinarily correct from 12 mmol to 6 mmol with 3 units over 4 hours but instead it takes you 5 units over 8 hours (take 3u, wait 4 hrs, test, BG high, take 2u, wait 4 hrs, test, BG ok) then you are needing an extra 2u/8 hrs = 0.25u/hr. So add that to your pump basal (just an example).

So basically use a series of corrections without a raised temp basal, then use the amount you had to over correct by, to raise your basal.

I would NOT use a % increase. Edit your basal profile to increase the dose, or better (if your pump allows this) copy your basal profile to a "Sick Day" profile and edit that copy.

Sorry that is probably not the clearest explanation. I have been grappling with this myself last 2 months due to having frequent infection.

 

[Danaemac]

Thanks @Spiker think it makes sense it's at 8.3 just now with a +20% basal think I will leave that on overnight as I will waken high if I don't I have upped daytime basal by 0.35 for tomorrow from analysing the past week on the good old diasend so will see how that goes thanks as always for the advice

 

[donnellysdogs]

Do some basal testing... Working different job, different hours will affect you. (As well as a possible illness).

Do not rely on temporary basal rates, as they are not going to head off a high when you are already high.. You would be much better giving yourself an increased correction if your levels go over 12 and if you are unsure what the reason is. I was always told if over 12.0bg you need to increase your correction bolus that your machine tells you to have.

Like this morn, I have woken up with a bad set and levels at 14.7. Changed set and machine told me to give 3 units. I manually over rode this after I did set change to 4.5 units. 2 hours later I am still 11.3, but coming down slowly. This is despite giving extra 50%. I then will see what I am at 5 hours before doing anymore corrections. As I know i want to be 6.0. If I was 6.0 at 2 hours I would crash by 3 hours.

Personally, I would if changing job etc see it as a time to basal test... I think this is necessary as will probably be the cause of your higher levels....it also is likely that your correction doses will change too.

 

[Spiker]

^^^ Everything DD said.

 

[Danaemac]

I cant get basals done as I am running too high and having to check blood and try and correct every 4 hours to bring a +20 result down I have just phoned my DSN shes going to look at things for me in the morning I am not convinced the hot flushng etc is not down to high bs rather than anything underlying just seems an awfully drastic change from levels that were relatively stable to through the roof overnight

 

[jack412]

a T1 should be along soon, @Spiker
I've read here they suggest to change your cannula and tube, new insulin

do you have pump sick day rules?
do you have ketone strips?
http://www.uclh.nhs.uk/PandV/PIL/Patient information leaflets/Sick day rules - insulin pump therapy.pdf

you would know the MDI ones
Sick day ruleshttp://www.diabetes-healthnet.ac.uk...flet_-_Sick_Day_Rules_for_Type_1_-_Nov_13.pdf
Sick day rules flowcharthttp://www.leicestershirediabetes.org.uk/uploads//documents/Type1 Sick_day_rules_InsulinV3.pdf

 

[Danaemac]

I have been checking ketones they are at 0.1 tried pen corrections changed sets etc etc nothing is taking it down today when it does drop it crashes

 

[jack412]

new insulin?







I pulled this out of the pump sick days it might be easier

this is for over 14 and under 1.5 ketones, I would ring A&E if you start getting confused with the high reading

Program pump calculator with BG and give correction bolus.
Recheck blood glucose after 1 hour.
If BG has not improved:

1. Calculate correction dose and give as pen injection
2. Change infusion set
3. Set increased temporary basal for 4 hours (200 or +100%)

Give clear sugar free fluids.
Recheck blood glucose and ketones after 2 hours. If no improvement, calculate correction dose and give as pen injection.
If remains unchanged after 4 hours, seek urgent medical advice/ go to A&E

 

[Danaemac]

Jack I don't have ketones I have done all these steps over and over the past week nothing works then on the 1 attempt out of many it crashes down to 3.7 in a couple of hours I have been taking up to 20% TDD every time its above 16 this should actually be 10% as no ketones this brings it to around 12 but 4hrs later its back up I have phoned DSN who is going to have a look at readings I have phoned GP no appts until tomorrow I do not have ketones so no urgency as not at risk of DKA I just feel **** but reckon this is down to the high bs

 

[donnellysdogs]

So why don't you just up your basal rates?

 

[Danaemac]

I have now added almost 50% to my tdd with no effect my tdd is now at 75 units it was previously between 50 and 55 really don't want to do much more due to poor hypo awareness normally at 2 b4 I notice scared to do much more I have spoken to dsn she is looking at it in the morning

 

[Danaemac]

I am also eating very little a yoghurt this morning and nothing since

 

[donnellysdogs]

How much insulin were you on pre pump?

It doesn't matter how much insulin you use... Everyone is different.

Incidentally have you tried using a different area and a different batch number of sets?

 

[Danaemac]

I was on tdd average 68 on mdi my concern wit uping things rapidly is poor hypo awareness I've had pump since May and basals have steadily being reduced to tighten control and achieve target range along with better eating habits I have tried different areas with set and I'm pretty sure that the sets were out a different box since last Thursday and still nothing I must b getting insulin as I don't have ketones I think I'm right in saying that but I am now starting to query a kidney infection as my back has over the last hr become very sore although this could also be due to a bit of exertion at work and a pulled muscle I'm also going hot cold and feverish off and on which I had been putting down to the high bs I'm phoning Dr in morning

 

[Spiker]

Get antibiotics from Dr and be prepared for BG levels to start to dive a few hours after you take them. Just an educated guess but when you have swapped out *everything* and you have correction-resisting rebounding persistent high BG it is usually an infection. For me there is no better diagnostic sign of an infection than persistent resistant high BG.