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Running high for over a week now..

Juicyj

Juicyj

Expert
Retired Moderator
Messages
9,290
Location
Worcestershire
Type of diabetes
Type 1
Treatment type
Pump
Dislikes
Hypos, rude people, ignorance and grey days.
Hi folks,

I have been struggling for over a week now and have gone through the list in regards to checking on the reasons why, but I still cannot get within my range :banghead:.

Typical example, last Friday I woke at 12.3, ate low carb breakfast and took correction dose, tested at 10am and was at 13.6, had salad for lunch, took QA and came down nicely to 6.6 mid afternoon, then started rising to high teens by the evening, this is a typical daily pattern. I was so down on Friday that I drank 2-3 large glasses of red wine, which obviously didn't help but tried to regain control at the weekend and did a 20km bike ride on Saturday which bought me back down to 6.8 but as soon as i ate dinner I started spiralling upwards again and even with a correction before bed I still woke at 13.7 yesterday morning.

I have changed insulin cartridges, checked sites and to be honest where I am injecting there are red spots but don't know if this means anything. I am not due on, just under a bit of stress at work but who isn't, I generally feel ok just feeling the effects of running high which is blurred eyes and feeling tired but apart from taking more correction doses and going out on the bike which is hard as I work and am a mum. I eat low carb so don't know what else I can do.

If anything has any ideas please let me know..
 
Assume you basal/bolus? you say you've change insulin cartridges - for both types? (Has your insulin been stored correctly? could the whole batch be 'bad')

Have you tested during the night? I wonder if you're going low at night and then your levels are bouncing around during the day. (or missing lows during the day?) - try not doing a correction dose for a day or two.

Try injecting in a different site.

All the best.
 
Hey slip - thanks for your reply.

I changed to Tresiba about 4 months ago as was on Levemir and had become resistant so was taking over 36 units a day and still running high, I subsequently put on over a stone in weight from QA correction doses and consultation switched me over to Tresiba, which up until a few weeks ago was working fine, I take about 16 units of basal a day, store insulin in the bottom of the fridge so it's in the coldest part, I inject basal in my bum, sites are rotated daily, QA goes in my tum which has a few sore red spots but no lumps, have changed cartridges to rule out bad insulin. I have thought about possibility of running low in the night, but normally I wake and know immediately to take glucose, also my meter does my correction doses so feel this shouldn't be the case, however oddly enough last night I did wake at 3.18am which is when I am at my lowest but didn't feel low. I haven't had a hypo in about a month which on one hand is fab but on the other hand its telling me i'm not getting in my range. I generally try to eat dinner early in the evening so when I test again my meter can calculate the right correction doses I need to try and get down, but even doing this I am still taking above 12 each morning.
 
you seem pretty in tune with it all so stepping back and doing some basal testing should be no problem for you........

I have had no experience with Tresiba but its a 24 hours insulin is it........?

going by your comments about going out on the bike would suggest your active which means that a split dose of basal would suit you better.....

when the basal is pinned down you can start looking into your insulin/carb ratios.........

what are they at the moment...?

how many mmol are you assuming 1 unit drops also?
 
Thanks Boi.

Tresiba has a long flat profile and lasts up to 42 hours so don't need to split, although i've been trying to reduce my basal to help lost weight which is where the bike came in.

I take an increased ratio of QA in the morning of 1.5 to 10g carb up until about 2pm when I reduce back to 1:1. generally if I take a correction I expect 1 unit to reduce me by 3mmol/l, but even taking corrections isn't pulling me down..

Thanks for running through this with me, listening to my own opinion is repetitive and it helps to cross check it with someone else, i've tried contacting my DSN but haven't been getting anywhere with her and she keeps dangling the pump carrot which may or may not happen and that's just frustrating to hear. I am getting down with taking corrections and not getting anywhere and exercise only having a temporary effect, I have booked in to see an 'advanced nurse of sorts' at the local practice this afternoon to see if they can help shed any light - but any other ideas in the meantime would be of great help - thanks.
 
slip said:
Any chance the coldest part of the fridge is too cold?
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We have a monitor on the fridge which tells us what the temperature is - I will stick my thermometer in it later on when I get home to check as it may be faulty but it doesn't freeze so shouldn't be an issue.
 
I'd second the bottom of the fridge comment. I was always told to keep my insulin in the door of the fridge so it didnt get too cold. Or, if there was no room there, on the front of the top shelf. Worth a try.

The other suggestion I have is to try injecting in a different place eg your thigh. I used to use my tummy all the time for my pump cannulas with no problems then suddenly over a few days my blood sugar went high. My tummy no longer worked. You wouldn't know that by looking at it - no lumps, no bumps - but it just doesn't work for me any more. You could try using your thigh and see if that helps.

The pattern of waking up high and what you've described above is a pattern I see when I put my pump site in an area of poor absorption, hence my suggestion of injecting in a different place.
 
Thanks Azure, will try a different injection site, although I don't have any fat on my thighs, I first started there but it got too painful, what other sites do you think would work ?
Oddly enough it feels like i've become insulin resistant again, am going to also try metformin SR, I was put on metformin but my tummy was in bits - have heard the SR version is much kinder on tums, it's got to be something to do with either my sites or my insulin, unless i'm an alien from out of space..
 
Juicyj said:
Thanks Boi.

Tresiba has a long flat profile and lasts up to 42 hours so don't need to split, although i've been trying to reduce my basal to help lost weight which is where the bike came in.

I take an increased ratio of QA in the morning of 1.5 to 10g carb up until about 2pm when I reduce back to 1:1. generally if I take a correction I expect 1 unit to reduce me by 3mmol/l, but even taking corrections isn't pulling me down..

Thanks for running through this with me, listening to my own opinion is repetitive and it helps to cross check it with someone else, i've tried contacting my DSN but haven't been getting anywhere with her and she keeps dangling the pump carrot which may or may not happen and that's just frustrating to hear. I am getting down with taking corrections and not getting anywhere and exercise only having a temporary effect, I have booked in to see an 'advanced nurse of sorts' at the local practice this afternoon to see if they can help shed any light - but any other ideas in the meantime would be of great help - thanks.
Click to expand...


I realize that Tresiba may last that long but the problem with a single dose is that that flat fixed dose has to cater for a non flat varying output of glucose from the liver, but also during times of exercise or activity its good to be able to make a reduction in dose through the basal, but its sound as though you may have had issues with certain insulin in the past but its definitely something to think about..................even a pump as your basal is catered for with Novorapid/Humalog.

When I was injecting I had an insulin/carb ratio of 3 to 10g in the morning... so you could still go for more potentially, also being more resistant in the morning and at varying levels throughout the day a correction bringing you down 3 may not be happening, in fact I was taught in DAFNE that 1 unit, at least in the beginning, should bring you down between 2 - 3, so 2.5mmol.........you should maybe try that........

I currently use a sensitivity setting on the pump that assumes 1 unit drops 2mmol, and that's for the whole day........so again, some minor things to think about tweaking......

do you find exercise upsets your blood sugars either during or after.......?
 
I like to think my thighs aren't particularly fat either ;) When I use my back up insulin pen, I inject there in the top half of the thigh, either the top or on the outer side. I pinch up some of the flesh.

You coukd try your arms. If you don't have anyone to help you and usually pinch up, you'll have to kind of squash your arm against the back of a chair, etc, so that you can inject. I've done injections in my arm before, roughly in the same place as you'd have a jab at the surgery - ie upper arm outer area opposite the bicep.

Another place I was able to use was the outer bit of my waist, where people can have 'love handles'. That used to work well.
 
novorapidboi26 said:
I realize that Tresiba may last that long but the problem with a single dose is that that flat fixed dose has to cater for a non flat varying output of glucose from the liver, but also during times of exercise or activity its good to be able to make a reduction in dose through the basal, but its sound as though you may have had issues with certain insulin in the past but its definitely something to think about..................even a pump as your basal is catered for with Novorapid/Humalog.

When I was injecting I had an insulin/carb ratio of 3 to 10g in the morning... so you could still go for more potentially, also being more resistant in the morning and at varying levels throughout the day a correction bringing you down 3 may not be happening, in fact I was taught in DAFNE that 1 unit, at least in the beginning, should bring you down between 2 - 3, so 2.5mmol.........you should maybe try that........

I currently use a sensitivity setting on the pump that assumes 1 unit drops 2mmol, and that's for the whole day........so again, some minor things to think about tweaking......

do you find exercise upsets your blood sugars either during or after.......?
Click to expand...

Thanks Boi, I think the advantage of Tresiba is that its more a flat profile so in comparison to Lantus which peaks after x hours and starts to run out, Tresiba gives more flexibility with lasting longer and if you forget to inject then you take it when you can, so no need to split. I may need to review my QA ratios and check if i need to increase so try a 2 units to 10g of carb.

In regards to exercise i've found that if I just do an hour on the bike that it brings me down to my range and I remain stable then until meal time, have done a few 2.5 hour rides and will dip about 1-2 hours later but only by a max of around 2 mmol/l as my glutes use more glucose, but otherwise exercise has a very positive effect.

I am still rather perplexed by the high levels i'm achieving regardless, it still feels like my body is not utilising the insulin correctly or not getting enough..
 
normally most folk would need to take out some insulin whether it be basal or bolus if going out on a bike for an hour.......

if your not then it may be the case that the basal isn't right and in fact too much.....

basal tests will confirm though....

splitting a basal is basically all about catering for the different insulin requirement from the AM to PM as well of course to accommodate for the varying times it lasts but that certainly not the main advantage of splitting in my opinion.........

if Levemir lasted 24 hours without fail I still would have split it..........;)
 
if Levemir lasted 24 hours without fail I still would have split it.........
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LOL!

As @novorapidboi26 has said I think doing a basal test is a good place to start.

Cut out the carbs etc and QA and see if you stay on an even keel for the day.

How long have you been low carbing?
 
Hi slip - been low carb for over a year now, yes a basal test is a good place to start, just didn't have my head switched on this morning to start it.. Have checked fridge and it's perfect temperature at 2 degrees. Have changed sites for QA injections.

Yesterday, met the 'advanced nurse' who couldn't suggest anything, sent me to my doctor who also couldn't advise me but advised against splitting Tresiba said it would make no difference, found out my DSN only works 3 days a week, so a day later and still no clearer, in the meantime have upped my basal by 3 units after waking at 15.2, and now 4 hours later I am at 14.9, took more QA this morning too just to see what impact this would have.

Am off for a bike ride this afternoon to bring it down as again that's the only thing that seems to work.

Again anyone who has experienced similar please comment..
 
Morning @Juicyj - I won't say 'Good Morning' as 15.2 and 14.9 by anyones standards isn't good :eek: (I was 16.4 this morning but I did eat a large rice dish and messed up my split QA dose last night and hypo'd at around 2AM - I didn't do a correction at breakfast this morning and now at 10.2 - some idiot bought in Holiday Toffees to work and I've had a few of those this morning so 10.2 isn't bad!!)

Would you mind running through this mornings events, what time you got up, when you tested, what you ate, what carbs, what dosages you took and ratios used/corrections, how busy you were etc. Also tea last night too! What is you QA insulin?

Enjoy your ride though!
 
Not surprised your diabetes team have advised against splitting the Tresiba dose @Juicyj, what would have been the benefit from doing this?

I'd definitely concentrate on the basal test and get that right before looking at your I:C ratio's.
 
slip said:
Morning @Juicyj - I won't say 'Good Morning' as 15.2 and 14.9 by anyones standards isn't good :eek: (I was 16.4 this morning but I did eat a large rice dish and messed up my split QA dose last night and hypo'd at around 2AM - I didn't do a correction at breakfast this morning and now at 10.2 - some idiot bought in Holiday Toffees to work and I've had a few of those this morning so 10.2 isn't bad!!)

Would you mind running through this mornings events, what time you got up, when you tested, what you ate, what carbs, what dosages you took and ratios used/corrections, how busy you were etc. Also tea last night too! What is you QA insulin?

Enjoy your ride though!
Click to expand...

Ah thanks Slip you made me feel alot better with that response, although I am also sorry you were high this morning too !

I ate bolognaise sauce and sweet potato fries last night at 7pm and was 14.4, took 4 units of QA for meal and 3 units to correct, tested at 10pm and was 16.8 so took 2 units to correct, then woke at 7am at 15.2, ate greek yoghurt and protein omelette and took 4 units of QA and 3 units to correct - last night no activity.

I think the only thing that sounds feasible is that i'm coming down with something, but apart from feeling the effects of high BG, still not feeling ill so it's a complete puzzle. I know when it comes right again that i'll hopefully of worked out why and it will help educate me for the future but i'm now recording results on Diaconnect so can see history, rather than just looking at my current result on my meter, which is why I feel more compelled to get it right.
 
noblehead said:
Not surprised your diabetes team have advised against splitting the Tresiba dose @Juicyj, what would have been the benefit from doing this?

I'd definitely concentrate on the basal test and get that right before looking at your I:C ratio's.
Click to expand...

Thanks Noble - To be fair I wouldn't of suggested this either due to length of time it remains active and it's flat profile, however when Boi mentioned it I thought I would ask - to be honest I feel like i'm clutching at straws at the moment as correction doses are not bringing me down, it's just exercise which has a positive effect.

Your right tho, a basal test is a good place to start, am going to hit the road later on and try this tomorrow morning.
 
Can understand a spit-dose working with levemir and lantus but with Tresiba it is said to last up to 42 hours so I'd be surprised if anyone had to split-dose this insulin @Juicyj.

Just one comment to make with regards to your reply to slip, if a meal is high in fat this can cause insulin resistant and can effect bg levels for several hours after right up to the next morning, but diabetes can be frustrating especially when your trying to do everything right and keeping the carbs on the low-side, hope you get it sorted soon.
 
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