I'm high and I don't understand why...need help

[Samara1]

Hi,

I was diagnosed in Sept 2019, after going in DKA and 5 horrible days in intensive care, I went back home with a lot of guidelines and a taste of despair. I am 36 and despite the shock, and after the first 2 months trying to understand this conditions, I have been doing quite well until July 2020 (BG around 6 with very few Hypos and Hypers, I was using around 10 units of Levemir a day and 15 units of novorapid a day).

In July, one of my best friends died and right after I had to face a series of medical issues (nothing important, I think that with my friend being gone, the stress of covid added to the immensity of having to deal with diabetes every single day made me psychologically fragile). However, after 2 difficult months, I felt much better in October, BUT my BG is still high and I do not understand why. I do not feel ill, I workout 4 days a week as usual, my diet is the same and I don’t feel stressed, (BG around 12) .

My nurse and Diabetician said that my basal insulin injection at night and day were correct (5 units Levemir AM and 5 units at night) so I’m now focusing on the novorapid dosage. My insulin to carb ratio was 1:10 and my nurse has asked me to try 1 unit for 9 gr of carbs. After few days of trying that, I can’t see many changes to my BG level, I’m still around 11…. I cannot understand why I’m high all the time and because of Covid, I have had only a few phone appointments, but I do understand there are more important things going on in the world … I’m pretty lost! Any ideas? Thanks

No keotones .Both pens look alright.

 

[DCUKMod]

Hi,

I was diagnosed in Sept 2019, after going in DKA and 5 horrible days in intensive care, I went back home with a lot of guidelines and a taste of despair. I am 36 and despite the shock, and after the first 2 months trying to understand this conditions, I have been doing quite well until July 2020 (BG around 6 with very few Hypos and Hypers, I was using around 10 units of Levemir a day and 15 units of novorapid a day).

In July, one of my best friends died and right after I had to face a series of medical issues (nothing important, I think that with my friend being gone, the stress of covid added to the immensity of having to deal with diabetes every single day made me psychologically fragile). However, after 2 difficult months, I felt much better in October, BUT my BG is still high and I do not understand why. I do not feel ill, I workout 4 days a week as usual, my diet is the same and I don’t feel stressed, (BG around 12) .

My nurse and Diabetician said that my basal insulin injection at night and day were correct (5 units Levemir AM and 5 units at night) so I’m now focusing on the novorapid dosage. My insulin to carb ratio was 1:10 and my nurse has asked me to try 1 unit for 9 gr of carbs. After few days of trying that, I can’t see many changes to my BG level, I’m still around 11…. I cannot understand why I’m high all the time and because of Covid, I have had only a few phone appointments, but I do understand there are more important things going on in the world … I’m pretty lost! Any ideas? Thanks

No keotones .Both pens look alright.

Samara - I'm so sorry for your loss. That sort of thing can really knock our lives off balance for quite a while. I feel for you.

Bearing in mind you were diagnosed just over a year ago, it could be your honeymoon period is ebbing a bit. When that happens, many report needing more insulin than before ,and having to revisit carb ratios and so on.

I'm not an insulin user, but in my experience of using a medication where dosages are very individual, it can take a while to get those adjustments worked out and to be back into any sort of comfort zone.

Stay close to your team and when you need to make adjustments, it usually makes sense to make smaller adjustments that we might be inclined to out of frustration.

I think it is also worth saying that all clinics should have psychologists, experienced in working with people with diabetes, if you feel you could do with a bit more support in that area. Whilst they have experience in working with those living with diabetes, it's not the only thing they could help you with.

It's been a very hard year to be getting your head around any form of diagnosis.

Wishing you well.

 

[Jaylee]

Hi,

I was diagnosed in Sept 2019, after going in DKA and 5 horrible days in intensive care, I went back home with a lot of guidelines and a taste of despair. I am 36 and despite the shock, and after the first 2 months trying to understand this conditions, I have been doing quite well until July 2020 (BG around 6 with very few Hypos and Hypers, I was using around 10 units of Levemir a day and 15 units of novorapid a day).

In July, one of my best friends died and right after I had to face a series of medical issues (nothing important, I think that with my friend being gone, the stress of covid added to the immensity of having to deal with diabetes every single day made me psychologically fragile). However, after 2 difficult months, I felt much better in October, BUT my BG is still high and I do not understand why. I do not feel ill, I workout 4 days a week as usual, my diet is the same and I don’t feel stressed, (BG around 12) .

My nurse and Diabetician said that my basal insulin injection at night and day were correct (5 units Levemir AM and 5 units at night) so I’m now focusing on the novorapid dosage. My insulin to carb ratio was 1:10 and my nurse has asked me to try 1 unit for 9 gr of carbs. After few days of trying that, I can’t see many changes to my BG level, I’m still around 11…. I cannot understand why I’m high all the time and because of Covid, I have had only a few phone appointments, but I do understand there are more important things going on in the world … I’m pretty lost! Any ideas? Thanks

No keotones .Both pens look alright.

Hi @Samara1 ,


Welcome to the forum.

You may have had a reasonable "honeymoon period" after initial diagnosis & your requirements insulin wise may now need a tweak??

Start at the beginning. The foundation, ground up. Your Levimir? My first move would be seeing what is actually happening there, prior to changing insulin to carb ratios with the Novorapid. Here is how... https://www.mysugr.com/en/blog/basal-rate-testing/

Best wishes.

 

[Daibell]

Hi. I would check your Basal level. Your BS should remain stable when fasting for a good few hours as it's job is to balance the continuous glucose output from the liver. If you BS goes up then you need to increase the Basal and vice versa. Just do one click and leave it for a couple of days to see what happens and re-check if needed. I need to tweak my Basal if I increase the carbs on holiday for example. Once your Basal is balanced then adjust the Bolus ratio as you learn what works best

 

[Samara1]

Hi,

Thank you for your message. TBH, I think that I did'nt have my honeymoon period as the ratio 1/10 has always worked and I have not decreased my Levemir/ Novorapid dosage since Day 1. But yeah, I read that the honeymoon phase mostly happens shortly after being diagnosed… what do you think about it?

As I was unsure about whether my background insulin needed changing, my dietician asked me to do 2 Levemir tests, 1 at night (eating at 7pm and waking up a 3am to check my BG) and 1 during the day (the fasting test). After seeing my BG levels, she said that my Levemir dosage at night was correct and didn't need any changes, for my Levemir dosage in the morning, she said that it was a bit much but with no much consequences and said I should not inject more.... I did the test at a multiple time and the trend was the same. So now I just don’t know what to do…I don’t really understand.

Thanks

 

[ert]

As you've had your basal tested, I hope you get your fast-acting ratios sorted soon with your DN and ask about corrections. It can be a slow process, as changes are usually small, to safely see what affect they have. I have different CHO ratios for different times of the day, which may be something else to ask about. In the meantime, I recommend https://www.bertieonline.org.uk/

 

[MarkMunday]

Being high all the time usually suggests a basal issue. Bear in mind that your insulin requirement could change over a short period at this stage. 10 units of Levemir is a small dose and you may want to test it again. I would want more rigorous basal tests to be done, one in the morning, one in the afternoon, and one during the night. Ensure that blood glucose is in the target range before starting, skip a meal and then test every hour until the next meal. For overnight testing, set your alarm clock and test at say 2 am. This will give you a good idea of how well you basal dose is covering your background insulin requirement.