Help !

[PG1759]

Really struggling today. My bloods have been high since I woke and they will not come down for love or money !
I've had a virus of some kind for about 3 weeks now (cough and cold type thing) and for some reason I ended up with a fever over the weekend on and off so there is obviously something in my system still.
I am fine today and have been in work as usual.

I've got no keytone strips and I've been between 10 and 15 (18 at highest) all day. I've only consumed 70 carbs all day and injected a total 20 units of fast acting the latest batch being tonight and it still won't come down !? It's almost like my body is resistant to it.
I am aware that you can become resistant to insulin during periods of illness but I feel ok in myself.

Should I be concerned ? Is there anything I can do ?

 

[PG1759]

Further to the above.... Is it worth increasing my basal tomorrow ?

 

[donnellysdogs]

If you go above 12 you will more tham likely need more insulin to bring down your levels than a normal correction dose. My pump manual for corrections says any level above 14 may need double the correction factor. I always double mine if my levels go that high. Must emphasise tjough... This is only the correction bolus, nothing else.

Prob coming down with something...

 

[Daibell]

Hi. When I'm ill I increase my Basal and gradually bring it back down as meter readings show I'm returning to normal. As long as you are not into the 20s you should avoid DKA.

 

[jack412]

have a read of the sick day rules too, it may help

Sick day rules
http://www.diabetes-support.org.uk/info/?page_id=141
http://www.diabetes-healthnet.ac.uk...flet_-_Sick_Day_Rules_for_Type_1_-_Nov_13.pdf

Sick day rules flowchart
http://www.leicestershirediabetes.org.uk/uploads//documents/Type1 Sick_day_rules_InsulinV3.pdf

 

[noblehead]

I am aware that you can become resistant to insulin during periods of illness but I feel ok in myself.

Yes you can become resistant, you should follow the DAFNE Sick Day Rules when ill following the links that Jack has provided above, also you need to keep a supply of ketone testing strips handy for occasions like this, the blood ketone monitors are the best and the Glucomen LX is a good meter for this purpose, if your gp won't prescribe them (due to cost) then you should ask for some Ketostix to be added to your repeat prescription.

 

[dtennant9]

I would agree with above that you may need to up your correction factor when higher. I never really noticed it much when on MDI but since I have started on my pump I have noticed that at times when high you need a higher correction. I have no doubt that was the case when I was on MDI, I just didn't pay enough attention to what was happening.

 

[novorapidboi26]

I have found that I needed a higher correction factor on MDI but not on the pump...........my theory would be that on MDI I may have had an insulin surplus/deficit due to basal inaccuracies which resulted in similarly inaccurate corrections.........

I worked out a system though........

5.5 - 10mmol = 2.5u/mmol

10 - 13mmol = 2.0u/mmol

13 - 17mmol = 1.5u/mmol

17mmol + = 1.0u/mmol

it was quite complicated at times..............

 

[-Artemis-]

Only a post to empathize.... I have a stinking cold and am needing much higher insulin to carb doses than normal - it's like I've suddenly become insulin resistant. I don't know why the body does this (I think actually it's something to do with the liver chucking out more than usual 'helpful' amounts of glucose - can't remember specifically why!), and it does freak me out when it does (I think I'm gonna be like it forever... ;-) but being on my third cold / flu bug this winter, the insulin sensitivity does come back as soon as the bug clears... Rest up and be well soon.

 

[PG1759]

Yes you can become resistant, you should follow the DAFNE Sick Day Rules when ill following the links that Jack has provided above, also you need to keep a supply of ketone testing strips handy for occasions like this, the blood ketone monitors are the best and the Glucomen LX is a good meter for this purpose, if your gp won't prescribe them (due to cost) then you should ask for some Ketostix to be added to your repeat prescription.

Thanks noblehead I appreciate the advice as always.

This is a genuine question rather than a challenge to what you've said- why do we need to check keytones ? I know all the health risks etc etc but what I mean is (correct me if im wrong) I can't actually do anything specifically about the keytones can I ? All I can do is try and get my blood sugar down, which in turn is what I'm trying to do any way. What I'm trying to say is why do I need to know how high my keytones are ?

 

[Lucyturner]

Your keytones will always come down before your blood sugar, so if you know how high they are then you can incorporate this in to your insulin dose and give yourself enough to bring down the keytones and your blood sugar. If you don't know how high your keytones are then your blood sugar will stay high.

 

[PG1759]

Your keytones will always come down before your blood sugar, so if you know how high they are then you can incorporate this in to your insulin dose and give yourself enough to bring down the keytones and your blood sugar. If you don't know how high your keytones are then your blood sugar will stay high.

Hi Lucy,
Thanks for your comment - again this isn't meant to be argumentative but I don't agree. Your insulin serves one purpose and that's to bring your blood sugar down. All calculations regarding this relate to bringing your blood sugar down which in turn will bring your keytones down.
Knowing how high my keytones are will not effect my blood sugar control. That will be dependent on insulin levels and other factors.
I have since read an article which has made me realise the importance of KTA which Has made me realise of monitoring your keytones now.

 

[Lucyturner]

I get where you are coming from. I never understood this either I have only found this out since I started having problems with my keytones getting high and I found that by blood sugars didn't come down until I brought my keytones down I found it was a case of trial and error. I only ever check my keytones if my blood I'd above 16.0 or if I am unwell as anything less then that shouldn't cause any health problems as people go on diets that rely on them having keytones and I also discussed this with my DSN. I would say that only you know your body and how insulin works for you so I suggest a bit of trial and error for you and you will work out what doses you need and when.

 

[PG1759]

I get where you are coming from. I never understood this either I have only found this out since I started having problems with my keytones getting high and I found that by blood sugars didn't come down until I brought my keytones down I found it was a case of trial and error. I only ever check my keytones if my blood I'd above 16.0 or if I am unwell as anything less then that shouldn't cause any health problems as people go on diets that rely on them having keytones and I also discussed this with my DSN. I would say that only you know your body and how insulin works for you so I suggest a bit of trial and error for you and you will work out what doses you need and when.

Thanks Lucy. When you say "my blood sugars didn't come down until I brought my keytones down" what do you mean ? In other words am I missing something about keytones. How do you specifically bring your keytones down ?

 

[Lucyturner]

Insulin brings your keytones down, if my keytones are above 0.6 then I need to bring them down as they can then start making you ill if your blood sugars are high as well. I had to play around a bit until I found out how much insulin I needed to bring them down. Keytones are a sign that there is not enough insulin in your system and so I tend to take an extra dose of insulin for my keytones and then when I eat take my normal dose that way you know you are getting the insulin you need plus the extra that your body is telling you it needs by creating the keytones

Sent from the Diabetes Forum App

 

[-Artemis-]

... Lots of water helps flush out ketones too...

 

[donnellysdogs]

T1 for 30 yrs.. And never tested for ketones ever...yes, I've had some highs, but never ended up in dka or hospital from not testing them.

Luck of the draw I guess, not saying this is ok to do.. But I prefer to see my blood results coming down from calculated corrections within 5 hours if under 15 and 10 hours if over 15.

This is exceptionally rare and only happens now due to a pump fault of some description. As my levels normally do not exceed 7.0 then anything above gets corrected. If I go above 10, and I know its mot due to me underestimating my carbs then I will add some extra insulin to my correction dose. If I go up seeiously quickly, I do a complete change of everything and then do a double dose of correction.

I got a ketone meter recently, but only used it once in 30 years and that was to check if Hubby was in ketosis from low carbing...

Please don't do this at home folks. I know my body very well and my pump etc...

 

[tim2000s]

As it happens, insulin is responsible for regulating blood glucose levels and also controls the production of fatty acids that lead to ketones, so if you are high and displaying them, the insulin dose will bring both down.

 

[jack412]

I 'think' read here before that someone with ketones had to eat so they could take more insulin to get rid of ketones...or was I dreaming?

 

[noblehead]

Thanks noblehead I appreciate the advice as always.

This is a genuine question rather than a challenge to what you've said- why do we need to check keytones ? I know all the health risks etc etc but what I mean is (correct me if im wrong) I can't actually do anything specifically about the keytones can I ? All I can do is try and get my blood sugar down, which in turn is what I'm trying to do any way. What I'm trying to say is why do I need to know how high my keytones are ?

Because ketones can build up to dangerous levels where the blood becomes acidic which in turn leads to DKA, this can take place within 24 hours and can be potentially life threatening, so it needs to be nipped in the bud before it happens.

Only by monitoring them can you take the appropriate action, if your bg remained high and your ketone levels increased then you would seek urgent medical advice, hope that answers your question.