Type 1 High BGL and getting it down

[gavin86]

Saw the team yesterday. We all decided things seemed to have settled into a honeymoon phase as I've been taking 5-6 units bolus instead of 10-12 for a couple weeks. (Diagnosed a month ago). We set up a carb ratio based on the week's diary, a correction factor too. We considered dropping my lantus by a unit or two as I had a couple nights in the past few days where I dropped by 1-2mmol/L... we left it as is.
Then this morning I start at BGL of 8. Use the ratio with my same measured breakfast... go up to 15.
Lunch, same lunch as always + correction.
BGL: 18, 20 by dinner time.
Carb dose + correction +2.
Eat a measured meal. Only carbs I had were the same packaged sliced bread I always have.
25. Ketones 0.3.
Now it's the middle of the night, gonna be up at least a few more hours to try and correct again... didn't sleep well last night, or the night before...

Aaaaaaaaarrrgghhhhh!!!!

Frustration tempts me to dose higher, but I can't because I don't want to all of a sudden crash, particularly if there's a risk of falling asleep...

I'm not sick, my pens haven't been exposed to undue temperature/sunlight, they're only a week old. I wasn't stressed, until now.. am sleep deprived.

Any suggestions?

 

[TorqPenderloin]

You ultimately have to decide what is best, but with a bgl of 25 you have an extremely long way to go before you hypo. That's also not to mention that you're at levels that most of us consider to be unsafe (even in the short-term).

My observation is that you're over analyzing your basal rate and under-analyzing your bolus needs. Dropping your Lantus by 1-2 units isn't going to have a profound effect on your levels. You might wake up 1-2 mmol/l higher or lower than when you went to sleep, but that's nothing in comparison to starting the day at 8 and ending at 25.

 

[Deleted Account]

A couple of things I have noticed
- when I have a high BG (higher than 14, typically), I need more insulin for correction. Usually 1.5x as much as usual
- my body struggles to absorb more than 10u insulin in one go. When I have a large carby meal (or normal meal plus correction), I need to split my dose over at least 30 minutes.

Not sure if this is what has happened to you.

In theory, I agree with @mahola.
However, it is not always practical - I may be hungry (high BG often makes me hungry) or have a busy schedule (including considering going to bed at least 2 hours after eating).

I hope you your levels under control soon. Just try not to stress too much. Yeah, easier said than done.

 

[gavin86]

Regarding over/under analysing... the bolus had been working correctly, the basal has been close enough to flat that it wasn't a big deal. Seemed like the right thing to continue on.

With splitting correction and bolus - does that make a difference? It's still the same amount of insulin which I thought would have the same effect. Also was advised against overlapping doses, just because it gets messy/complicated. That said, I'm perfectly confident I could manage it, if it's worth doing .

I'm just ****** off that things changed a day after thinking I was finally getting some sense of predictability.
Also somewhat wary to dose big in case I switch again to needing less, like what happened two weeks ago, when the needing less insulin started abruptly. Had my first worrying hypo that night that took me beyond the milder "I feel a bit different" ones.

Anyway... went with 3u, will see what happens. Just have to stay up all night I suppose.. siiigh. Will be happy if I'm under 20. Otherwise will have to pickup the batphone.. or.. endophone... or whatever.

 

[azure]

Don't forget you can try carefully moving your breakfast bolus more in advance too @gavin86 That can give excellent results.

I second the advice to,wait until your BS is in range before you eat. It's a pain but can stop a prolonged high.

 

[gavin86]

Interesting.. I will try tomorrow morning, thanks. Is shifting breakfast just for in the case of high pre-breakfast BGL? Or a general thing to keep you from going high in the first place?

 

[azure]

Interesting.. I will try tomorrow morning, thanks. Is shifting breakfast just for in the case of high pre-breakfast BGL? Or a general thing to keep you from going high in the first place?

A general thing to stop you spiking too high. Bolusing more in advance can stop the spike. Eg with a normal BS and using Humalog and bolusing just before eating, I could spike to 11 or 12 but by bolusing in advance I only spike to the 5s or 6s.

 

[noblehead]

With splitting correction and bolus - does that make a difference? It's still the same amount of insulin which I thought would have the same effect. Also was advised against overlapping doses, just because it gets messy/complicated. That said, I'm perfectly confident I could manage it, if it's worth doing .

Many of us find when our bg is high we can become very insulin resistant, for example where usually 1u may lower bg levels by 3mmol/l it may only lower it by 1-2mmol/l (when bg levels are in double figures), it's certainly my own experience anyway and we have discussed this many times on forum over the years.

As Azure says pre-bolusing can prevent you from getting high bg levels in the first place.

 

[gavin86]

That may well be the case noble head...

Made it down to 16 at least

 

[noblehead]

That may well be the case noble head...

Made it down to 16 at least

Persevere buddy, once your out of your HP things will all settle down

 

[gavin86]

Thanks.. it's just a pain in the bum. I guess the long term effects of having a chronic disease are becoming clearer now.

I didn't really mind when I got diagnosed, besides my fear of needles... I'm probably a lot more caring about my health now which is a good thing.
I wouldn't say it was denial... just a lack of awareness about how it could be harder than it sounds!

 

[azure]

Thanks.. it's just a pain in the bum. I guess the long term effects of having a chronic disease are becoming clearer now.

I didn't really mind when I got diagnosed, besides my fear of needles... I'm probably a lot more caring about my health now which is a good thing.
I wouldn't say it was denial... just a lack of awareness about how it could be harder than it sounds!

That's the first thing that got me too @gavin86 I knew a couple of people with Type 1 befire imwas diagnosed and so I thought I understood it. However, it's far harder than I'd thought then! Take comfort in the fact that other Type 1s know how hard it can be and what a daily grind it all is.

 

[Kyambala]

Saw the team yesterday. We all decided things seemed to have settled into a honeymoon phase as I've been taking 5-6 units bolus instead of 10-12 for a couple weeks. (Diagnosed a month ago). We set up a carb ratio based on the week's diary, a correction factor too. We considered dropping my lantus by a unit or two as I had a couple nights in the past few days where I dropped by 1-2mmol/L... we left it as is.
Then this morning I start at BGL of 8. Use the ratio with my same measured breakfast... go up to 15.
Lunch, same lunch as always + correction.
BGL: 18, 20 by dinner time.
Carb dose + correction +2.
Eat a measured meal. Only carbs I had were the same packaged sliced bread I always have.
25. Ketones 0.3.
Now it's the middle of the night, gonna be up at least a few more hours to try and correct again... didn't sleep well last night, or the night before...

Aaaaaaaaarrrgghhhhh!!!!

Frustration tempts me to dose higher, but I can't because I don't want to all of a sudden crash, particularly if there's a risk of falling asleep...

I'm not sick, my pens haven't been exposed to undue temperature/sunlight, they're only a week old. I wasn't stressed, until now.. am sleep deprived.

Any suggestions?

Good afternoon Gavin. Are you on the Low Carb High Fat diet? It is the carbs which force your BS higher.

 

[azure]

Good afternoon Gavin. Are you on the Low Carb High Fat diet? It is the carbs which force your BS higher.

The OP is Type 1 on insulin. Type 1s can eat carbs if they bolus correctly.

 

[Kyambala]

The OP is Type 1 on insulin. Type 1s can eat carbs if they bolus correctly.

Good afternoon Azure. I accept that, but yourself and others had already given good advice on bolus - but there seems to be a problem over correct bolus - reducing carbs might help to stablise BS readings so that Gavin can stop worrying and get some sleep - stress also increases BS readings. Just simply increasing medication is not always the best way. Diet might be part of the problem.

 

[azure]

Good afternoon Azure. I accept that, but yourself and others had already given good advice on bolus - but there seems to be a problem over correct bolus - reducing carbs might help to stablise BS readings so that Gavin can stop worrying and get some sleep - stress also increases BS readings. Just simply increasing medication is not always the best way. Diet might be part of the problem.

I think lots of the problems are due to the honeymoon period of Type 1 That causes erratic sugars.

I also guess that doses and ratios are still being adjusted gradually, as is basal. It takes a while to get to grips with Type 1 and Gavin has made a great start

 

[Kyambala]

I think lots of the problems are due to the honeymoon period of Type 1 That causes erratic sugars.

I also guess that doses and ratios are still being adjusted gradually, as is basal. It takes a while to get to grips with Type 1 and Gavin has made a great start

Hello again Azure. I agree - that why I sent him a HUG after his first post. I am a Type 2 of 20 years duration and on Insulin and still have erratic BS readings - but since I started the LCHF diet my readings are much better. Thank you for encouraging him.