Type 1 high readings

[grahamrb]

I am keeping records of everything and last dozen or so readings are high 12 to 18 there’s no correlation between readings, carbs , insulin or food eaten
When readings are low just take suga etc and all ok
What do you do when bg readings are high?
Extra insulin does not seem to make any difference

 

[sleepster]

Hi @grahamrb, if you're high you can become insulin-resistant and you may need extra insulin in addition to your normal correction dose. Sometimes I can need twice as much insulin.
Do you know what your insulin sensitivity factor is?
Alternatively (or in addition) you can go for a walk or do some other exercise, or have a big drink of water. I tend to use an exercise bike and a couple of minutes of cycling helps to bring me down.
Some people find exercise, particularly intense exercise, can raise their BG so if you're unsure it's probably best to try something fairly gentle and see what happens.

 

[sleepster]

P.s are you unwell? That can cause high BGs and add to insulin resistance.
Do you have a way of checking for ketones? If you have ketones you shouldn't exercise.
If you're worried or in doubt call 111.

 

[In Response]

Personally, I would avoid exercise when high.
Exercising when I have too much sugar in my blood causes areas to my body and raises my levels further.
So, I would use this technique with extreme care .@grahamrb you say your insulin is not working. Have you tried changing your own/cartridge? It may be faulty if it is not working (although I agree with @sleepster about this nsulin resistance when high)

 

[grahamrb]

Dear sleepster and response
Thank you for your replies
I have joined the forum on behalf of my wife who is 78 and was diagnosed with type 1 in May this year so I am still learning.
Please advise what the insulin sensitivity factor is?
She is not unwell and ketone reading is0.1
I have discovered in the last few months that the diabetic team seem reluctant to tell us everything, I have learnt more from the forum in the last couple of weeks than in the 6 months with the hospital and I have to say it is a very steep learning curve.
Do you know if there is such a thing as Type 1 1/2?

 

[sleepster]

I have joined the forum on behalf of my wife who is 78 and was diagnosed with type 1 in May this year so I am still learning.
Please advise what the insulin sensitivity factor is?
She is not unwell and ketone reading is0.1
I have discovered in the last few months that the diabetic team seem reluctant to tell us everything, I have learnt more from the forum in the last couple of weeks than in the 6 months with the hospital and I have to say it is a very steep learning curve.
Do you know if there is such a thing as Type 1 1/2?

Hello again @grahamrb,
Is your wife on a mixed insulin or is she on basal/bolus and able to take correction doses when she is high?
If she is on a mixed insulin (or fixed doses) then the following may just confuse matters.
Insulin sensitivity factor is also known as correction factor and it's the number by which your BG will fall if given 1 unit of insulin. So if you're high it helps to work out how much correction dose is needed.
So for example mine is 2.5, so if my BG is 12 and I took 2 units it would (in theory) take my BG to 7.
Hopefully your wife will have been given this information, as your correction factor can be worked out using your total daily insulin but if not, you could work it out or you could ask her diabetes nurse for guidance.
Could it be that your wife's doses need adjusting if she's not unwell? Has she been sleeping ok? Or is she stressed about anything?
Type 1.5 is also known as LADA and there's a few members on here who have it. I must admit I didn't know it was a thing until I joined the forum.
I'm still learning and I've been diagnosed nearly 24 years

 

[KK123]

I have joined the forum on behalf of my wife who is 78 and was diagnosed with type 1 in May this year so I am still learning

Hi Graham, if you don't mind me asking, how did they come to diagnose your 78yr old wife in the first instance, we get so many older people misdiagnosed as type 2 that it's refreshing to see a scenario where they have done all the tests for a type 1 diagnosis. Also, can you give us a typical days numbers and food, the higher readings may have little to do with her bolus (food insulin) and everything to do with her basal (background insulin) dependent on what type of regime she is on as mentioned by sleepster above. The more information you can give us, the more we can wrack our brains for any possible solutions.

 

[grahamrb]

Dear KK123
They did in fact misdiagnoe her as Type 2 first, she was supposed to have a test to see if it was type 1, the laboratory messed it up, the 2nd time she went for a test the lab said that she did not have a Dr's note, the 3rd time the lab said that it wasnt worth it.

This started in November last year and went on until the spring this year.

I asked for an explanation and was told that because of cost constraints the lab decided to ignore the Dr's instruction. Can you believe it?!!

Our dr's speciality is Diabetes! He was livid.

In May this year the hospital had a conflab and decided that it was Type1 ! so we had to start all over again. that's all we need at our age.
we are pretty sure that the Lantus long acting is OK, the nurse said to have 12 units every morning we have upped that to 14 units of insulin every morning. We are due to see the doctor on Wednesday, 1st time since May 2021.

I am preparing a list of questions which I will send her in advance together with a scan of our records, so that she can answer them when we see her.
One of the questions will be "Why am I not allowed to do the Bertie course till next May?. ther looks to be a lot of good stuff in there.
We have kept records of everything, the proble is knowing what to do with them.
I worked out our ratio as about 6 to 1, the dietition worked it out at 16 to 1 using some mythical figures plucked out of the air, She suggested using 10 to 1, if I use those then the BG goes up.
Anyway lets see what Wednesaday brings.
i think that i have sid before elsewher that i have learnt far more fro the forum thamn the professionals, I dont think that they are used to proactive patients.

 

[KK123]

Hi @grahamrb, your wife is a very lucky woman to have someone like you totally involved (along with her) in the management of what must be a massive change to your everyday life. You are doing a great job! x

 

[Hopeful34]

Great that you've worked the ratio as about 6 to 1. Just be aware that often people's ratio is different at different times of the day. Some people are quite insulin resistant in the morning, so need more insulin for 10g of carb, than later in the day.

If your wife's blood test is within normal range before breakfast, but is high before lunch, and your basal insulin is correct, this suggest she needs more insulin per 10g carbs for breakfast. If you want to, you could ask the nurse something along the lines of "does the high blood sugar before lunch mean my wife needs more insulin per 10g of carb for breakfast. If so, what ratio should we be using?"

Do hope you get some help on Wednesday. I agree with KK123. that you're doing a great job. It's a steep learning curve, but it will soon start to get easier, although we all continue to learn. Diabetes isn't an exact science and likes throwing a curve ball in to keep us on our toes!!

 

[EllieM]

One of the questions will be "Why am I not allowed to do the Bertie course till next May?. ther looks to be a lot of good stuff in there.

I can think of a couple of possible reasons for this. The most likely (in my opinion) is that new adult T1s often have a honeymoon period, where their pancreases produce a bit of insulin for a while. They may be hoping that after a year your wife's insulin needs will have stabilised more, as it's common for insulin needs to change in the first year. Maybe they are afraid that if you do the course too early it'll be too hard to calculate your wife's ratios because they are still changing?

In any case, you seem to have made a lot of progress. Getting the right basal and calculating an insulin to carb ratio are both important steps, even if you have to tweak your figures.

As for your current issues, there's a whole list of things that can make insulin needs go up, including
1) illness (eg a urinary tract infection can be symptom free but still push your levels up)
2) problems with a faulty insulin pen or insulin
3) problems with injection sites (long term T1s sometimes build up fatty deposits that don't absorb insulin well)
4) change in insulin needs due to honeymoon period
5) reduced exercise
6) stress

There may be others as well, that's just the things that occur to me off the top of my head. And sometimes things like the weather can change people's needs as well.

Good luck for the appointment next week.

 

[grahamrb]

readings today 14.5, 13.5, 14.5, 14.9, 17.9 everyone far too high.

nurse said range should be morning 6 to 8, before lunch 5 to 10, before dinner 6-12 and evening 8 to 12

If the ratio is 6 to 1 and the normal breakfast dose is 8 units and i know that i am going to have 40k of carbs for breakfast;

do I dvide the 40 by 6 and get about 7 and then that to my normal dose of 8 making 15 and take 15 units of insulin, or have i got confused, I have not tried this yet.

I am worried about long term damage elsewhere in the body of bg is always too high

my wife is completely fed up with talking about it

 

[EllieM]

do I dvide the 40 by 6 and get about 7 and then that to my normal dose of 8 making 15 and take 15 units of insulin, or have i got confused, I have not tried this yet.

I think you've got confused. The 7 units would cover your breakfast carbs if that ratio is correct, but you might need to add a little to bring the starting level of 14 down.

Is the 8 the amount of insulin you normally have for breakfast? Or is the 8 a separate basal dose? (I can't remember when you take the basal.)

 

[EllieM]

I am worried about long term damage elsewhere in the body of bg is always too high

Relax, as a long term T1 (51 years) I have had occasional readings like that for many years of my diabetic life with no obvious diabetic complications. In your position I'd worry about the short term (hypos and DKAs), damage occurs over years of persistently high levels and it's normal for new T1s to run some weird blood sugar levels on occasions.

 

[grahamrb]

The 8 is the suggested normal rapid before breakfast
It’s a number suggested by the nurse/dietitian
The way I worked my ratio was by using actual carbs with the insulin dosage
The basal of 14 units is taken every morning first thing
Now I am confused
What you are saying is that the normal 8 should cover breakfast which clearly it doesn’t
We have increased the insulin but to no avail
The nurse said that I should start my ratio as 1 to10 which if I have understood you means I should divide 40 by 10 and then have only 4 dosage before breakfast is the reasoning correct

hypos are now few only about 2 or 3 a week and are easily treated with coke or jelly babies

 

[EllieM]

The nurse said that I should start my ratio as 1 to10 which if I have understood you means I should divide 40 by 10 and then have only 4 dosage before breakfast is the reasoning correct

Yes, if that was the correct ratio. But it's pretty standard to start with that ratio for new diabetics. People's actual ratios can be 1 unit for 1g of carbs or 1 unit for 20g, so that's only a starting point.

The issue here is that you are too high before the meal so you need to add in an additional correction dose to bring that before meal number down...

 

[grahamrb]

We have tried increasing the dosage but to no avail.

 

[Circuspony]

We have tried increasing the dosage but to no avail.

what fast acting insulin is your wife using?

What is she having for breakfast? Some foods spike blood sugar levels much faster than others and its really hard to inject for them. How long after she has eaten are you taking another reading? Going for a walk can really help bring those levels down.

 

[grahamrb]

What are trophy points? I seemed to have earned 1!!

 

[searley]

I am keeping records of everything and last dozen or so readings are high 12 to 18 there’s no correlation between readings, carbs , insulin or food eaten
When readings are low just take suga etc and all ok
What do you do when bg readings are high?
Extra insulin does not seem to make any difference

a lot of things can explain higher levels

from being a little ill you may not even notice

mood.. stress.. weather..

as stated above I find when I'm a little high I need extra insulin to treat the high than I'd normally need

with insulin the goal posts are always moving and I find I'm always adjusting my doses to suite

sometimes if I'm constantly high/low it's my basal I adjust.. if it's post meal then it's the basal