Super highs urgent!

[icylilies]

Hello,
I'm a very stressed type one right now! My blood sugar levels are at an average of around the 20mmol mark, often reaching past a measurement that my monitor can read (so above 34mmol)
It's making me feel very ill, however my ketones are practically non-existent. so I don't really have much worry of going into DKA besides my levels have been like this for over three weeks. I haven't been to any lessons for around 2weeks and have missed a week of exams, so not only do I have to catch up with lessons I have now to catch up with 2hour exams.
I take all my insulin, test regularly and correct. I stopped injecting into my stomach as it has become lumpy. now I have lost quite a bit of weight and barely have any fat to put a 6mm needle without excruciating pain and bruises, sometimes bleeding. so my legs are my back are my only choices! But how can I keep injecting with chronic pain.
I'm really worried, I don't want complications with diabetes and I don't want to stay behind a year!
My nurses and doctors just tell me write a food diary which I have done repeatedly.
Currently on 20units of levemir night and morning and 110units of rapid a day.
Any help or advice would be greatly appreciated!

 

[ivinghoe]

Are you sure you have no ketones as any above 1.5mmol in your blood should mean you contact your clinic ASAP. Any ketones over 3.0mmol and you should go straight to A and E
If you can I would try get in contact by phone with your hospital first thing in the morning and ask to be put straight through to your dsn's and explain the situation with them.
Its impossible to give medical advice really but looking at the amounts of levemir and especially rapid it would appear you are not getting enough insulin. This could be due to poor absorption due to scarring etc. I would also ask about the possiblity of having a pump as it would certainly make life a lot easier for you imho.
If you dont like the idea of going for a pump you can have a diaport fitted for help with your injections.
Also are you carb counting as this will most definitely help your control? .... ask your dsn's for help with this if you are not currently counting.

Alan

 

[icylilies]

Hi,
I have spoken regularly to my team and they don't seem to have anything constructed in any meeting I have with them. They keep telling me to keep putting it up and up and then my control is awful! It is of the belief that your insulin should be equal or no more than your weight in kg's as a rule of thumb. as I'm 63kg,s 150units is way over the mark!
As for carb counting, I recently went over this with my team as we'll as increasing insulin ratios. However not even a slight lower reading in sight.
Thanks Pip

 

[iHs]

How are you adjusting your bolus insulin to deal with the high bg levels? Do you use the 100 rule to work out a correction factor and if so, have you doubled the correction factor to try and get your levels to come down?

Bolus/basal regimes often work better for diabetics who test bg levels every 2hrs and then by looking at the results and writing down the amounts of carb that is eaten, start to adjust the bolus upwards or downwards and then by keep testing bg levels are then able to see the effect that the changes make to bg and keep on with the adjustments until a desirable bg level is achieved which will then be the correct ratio that they use. Are you doing this already?

With a bg level as high as yours, you should really be in hospital I think so phone for an ambulance and explain your situation ...... definitely drink a glass of water every 45mins or so in order to make yourself going to the loo even though keytones are not showing as your urine will be a dark yellow colour and should be paler....

 

[Ambersilva]

In my opinion you should present yourself at A&E to get yourself sorted out.

 

[donnellysdogs]

If you are over 12bg you should consider doubling your correction bolus that you would normally give.... But you must if doubling up check your bloods every hour for 5 hours...

 

[donnellysdogs]

I too in your situation would go to A&E.. Make sure you take your medicines with you.

If not, try changing to different cartridges of insulin now.
Drink as iHs says.
I would be doubling correction insulin and also giving an extra small shot of basal if you are on basal / bolus regime.

You need help, your best option may be A&E, WITH your meds...

 

[hale710]

I agree with all of the above. Get a good correction dose in you, test lots and get over to the hospital. Please!

 

[dmcx3x]

I have been in your situation with very high sugars bit no ketons however they were not lowering themself so i presented my self at a&e gpt put on a slidingscale and then the next day got to see a diabetic doc who fixed all my inculien for me i would advise you to go to the hospital or phone your diabetic team first thing in the morning ps you can get
4mm needles x

Sent from the Diabetes Forum App

 

[noblehead]

Stress can do this to bg levels unfortunately, you really do need to speak urgently with your diabetes team about increasing your insulin to compensate.

 

[mariposa84]

I'm not sure how old you are so forgive me if this doesn't apply but it might possibly be puberty hormones in addition to stress with your exams etc. or you may have an infection that you're unaware of which might be causing this. I don't know as I'm not medically qualified...
BUT
I was v. unwell with a virus a few yrs ago that caused my blood sugars to drop very suddenly and I struggled to bring them up again as my throat was so swollen I could barely swallow liquids....I made decision to go to A+E and was so relieved when the Doctors and nurses took over my bg control on sliding scale as it meant I could concentrate what little energy I had on fighting virus.

I echo what the others have said .... please go to A&E with all your meds and let them help you and try and find out why this is happening. This situation is what A&E is there for.

Take care of yourself.

Wishing you all the best

Sent from the Diabetes Forum App

 

[icylilies]

Thanks for the replies!
I am on a 1:1 ratio anyway for correction. So where I take 35units about 28 is correction.
My diabetes team don't think I should change my carb ratios, but I'll change that to 1 unit for 2g. Hopefully it'll do something!
Normally I'm a low girl and I don't particularly detect hypos all that we'll so I am a little wary of injecting large sums of insulin. Baring in mind I used to take very little insulin beforehand
Thank you
Oh and as for a&e I'm trying to hold off with it, I never been hospitalised with diabetes besides when I was diagnosed and if I can fix my insulin without going there it will be much better

 

[iHs]

Is it no wonder that u r getting high bg levels using a carb ratio of 1u to 10g carb. You need to alter the ratio to 1u to 5g first and then if u are still going really high you could alter to 1u to 3g but it might pay to adjust the basal up a bit to see if that helps a bit more instead of using a lot of bolus. Everybody is different though so some will need more bolus in the ratio for breakfast and then less bolus in the ratio at lunch and so on for eve meal. Its all about balancing up the bolus with the effect of the basal against the carb being eaten. Until you get yr ratios correct, try keeping to eating about 20g carb for every meal and then if u make a mistake over the ratio being correct or not, yr bg levels are not going to go through the roof.

Sent from the Diabetes Forum App

 

[icylilies]

You must have misread,
I'm on 1unit to 4g now and i'm reducing to 1unit 2g.

 

[SamJB]

Firstly, you need to get your basal correct, without this correct you will never get your bolus ratios right. Tonight can you do a test? Try not to eat or inject at least 4 hours before bed. Post back on here your before bed, before breakfast readings and how much bolus you took. Don't forget to wash your hands first. If you are really high (i.e. > 15 mmol/l), that will need treating so give yourself some bolus, but post how much bolus you took too.

Oh and assume that because your don't have ketones you are not at risk of DKA. Ketones are a symptom of DKA not a risk factor.

 

[iHs]

Hi Again

From looking at yr first msg in this thread Ive just realised that you are using Levemir just once per day????? Levemir's action is not really designed to last 24hrs so that is what your problem is.... You've not got enough basal and instead you are needing to use loads of bolus to control yr bg levels. What time of the day do you inject the Levemir? Most people usually inject it roughly 12hrs apart although I got by fairly well injecting it about 10pm and then again at 7.30am. So you could have a go at doing the same and try a 50/50 split to start off with and then do as SamJB has suggested, don't eat any carb for about 4 - 5 hrs and then test yr bg levels every 2hrs and just see what effect the basal alone has on controlling yr bg and then if need be you can increase it slightly by 1u at a time. Ideally, you need to be about 6-7mmol every 2hrs and then that will also help to avoid any hypos.

For bolus/basal insulin pen users although basal testing can be done, its not the same as basal testing in a pump. Basal testing pump style allows for the basal insulin to be altered every 1-2hrs (according to time slots available on pump that is) whereas basal like Levemir and Lantus, its hard to get the same bg level all day long and some go as far as injecting it at odd times according to how their body changes direction in its need for insulin.

A good book for you to read about bolus/basal regimes is Think Like A Pancreas which explains about using the modern analogue insulins like a 'poor mans pump'

 

[SamJB]

Well done iHS, that sounds like the problem!

 

[hale710]

Well spotted iHS!

 

[icylilies]

Hi again,
I do take my levemir once in the morning and once in the evening.
Sorry this is very confusing for people, I keep leaving things out everywhere! (blames the highs)
So yeah, I take it between 7am-8am and 7pm-8pm everyday

 

[iHs]

Something is not right here so
1 Are you taking drugs or meds that could cause you to get high bg levels
2 Is there a chance that yr insulin has gone off due to not being stored correctly?
3 Are you eating loads of carbs in order to make yr bg levels go up high in order to avoid the hypo feeling
4 If its none of these, then something else is wrong and u need to see yr doctor fairly quickly and have tests done to see whats going on with yr endocrine system as you might not be able to tolerate analogue insulins



Sent from the Diabetes Forum App