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Any ideas what may have caused this?

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Hi all another post, just wondering of any ideas what may have caused this, sugars are horrendous, basically I am on 18 levimir in morning and at night with varying nova rapid, it's like iam playing the lottery everytime I have a jab, yesterday dinner sugars was high again had 3 units of Nova rapid and possibly 30/40 grams of carbs normally I'd have a correctional dose to bring it down, but decided to leave it see what it does, I had more carbs to insulin, and it came down alot, needless to say I didnt know when it was going to stop so I ate a lot drank lucqzode etc even though it wasn't a hypo, I prob did panic then thought if I was In normal range or out and about and this happens don't fill me with much confidence. Then had a lot of correctional doses through the evening and night to try and bring it down. Not come down alot. Total exhausted again sitting with sugars in the 20s now trying to decide if it's going to come down on its own again or have some extra units to bring it down. No clue feeling rubbish as per usual any ideas. Another eye op again this month and need laser in other eye this month two, but there is hope a may be able to see a consultant but probably not this side of the century, and clues what's happening feeling ill by the day now
 
Any help please what's happening
 

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Hi. I find that once my BS goes too high it takes a long time to bring it back down i.e. hours and I have to use much more Novo than usual. I therefore always try to get it as near the right ratio as possible to avoid the runaway state. I split my Levemir but have very different doses am and pm. I find the Libre 2 very helpful in getting my pm dose right for that night and I vary it each time. I would use Dextrose tablets rather than Lucozade as you have better control over the amount of glucose you are taking in.
 
It was drinking lucozade when your blood sugars were still above 9 mmol/l that caused your blood sugars to go high. You should only have hypo treatments when your blood sugars are below 3.5 mmol/l otherwise try eating a small apple or other piece of fruit (DAFNE course advice).
 
Hi yep understand that, treating a hypo when it's not isn't helping. But yesterday think my sugars was around 18 so in theory I would of thought most people would have just 3 units with no carbs just as a correctional dose, I thought if I had extra units on top of the 30 grams of carbs I ate probably would of brought it down too low, I've been on this regime around 6 months or more now, at night although high it is stable and stays around the same all night, but as for taking the nova rapid it's like sometimes it works sometimes it doesn't iam just lost, thought I can get it where I can say I've had that amount of carbs IL take this amount of extra insulin then it should bring it down to around this level. As it's so unpredictable iam finding IAM more cautious to what correctional doses etc I should do. IAM doing a injection now and waiting around 3 hours thinking whatever it decides to do today after a few hours it isn't alot. I would do a background test to see if that's correct, but in the last year or so I don't think I've had one bg test in the normal range single figure etc. So I am not sure as is says to do a background test it needs to be in normal range. Just being told a consultants are hard to get hold of, not sure what the criteria is to see one, ie hba1c over 100 losing a lot of vision in one eye needing laser now in the good eye and injections protein in urine only 41 think some people would of seen a consultant or had extra help by now, spose some of us get it some don't, that's why on this forum for any help at all
 
You should have a DN as part of your diabetes team that you can email? I suggest you email your food diary, CHO ratio, dosing, timings and your data in for comments.
 
Hi yep seeing a diabetes specialist sometime twice a month, just being told to try this and that, asked about a pump etc waiting list and need to meet criteria, just finding really hit and miss as too what it's doing, borderline house bound now rotting away, it's crazy was thinking about going back to humilin M3 twice a day again as with this iam trying all sorts and feeling totally I'll all the time, having up to 10 jabs a day, now just attending appointments or operations there seems to be no consistency with the way injections and food interact. Just not sure, been like this for a while now don't eat much these days either as I am constantly trying to lower sugars lost alot of weight, 2 o'clock in the afternoon and already waiting for bed, been trying to get the right help but seem to be getting no where. see why people get diabetic burn out. Nothing seems to be working really fed up now.
 
Keep emailing your DN and keep asking for comments on your data until your next appointment. I find the DN more practical day to day blood sugar management. There should be a dietitian you should access to also.
 
My apologies if I've asked this before but what are your injection sites like? If yo have hyperlipotrophy then it can affect the insulin absorption?
Lipohypertrophy - Injections and Lumpy Skin (diabetes.co.uk)
But honestly, I too suspect that you are treating the hypos too soon.
DannyH said:
I would of thought most people would have just 3 units with no carbs just as a correctional dose
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Do you have an official correction ratio calculated by your team? It can vary massively between people eg I am moderately insulin resistant and if I were at 18 with not much bolus my system I'd need more than 3 units to bring me down...
 
I've read a lot of your posts @DannyH & I feel for you in a big way.

I'm a T2 on no meds so can't relate but I'll be blunt about what I read.
You seem overly scared of of going hypo, sucking Lucozade when you see a hard line down.
Your fear of going low seems to outweigh the damage that high BG is doing to your body & your eyes.
I think you need to grasp the nettle, risk those single figures, rely on your CGM & alarm.
I really believe a pump loop system is a must for you.

I'm pulling for you
 
Hi @DannyH

As ert said above using lucozade is fine if you're going hypo but when levels hit 3.9mmol/l - however in your case as you're accustomed to running your levels higher, then in your shoes I would treat if going below 5 mmol/l - I can imagine you were feeling panicky and anxious at 9 because your not used to running in single figures, but this is where you need to start taking more control. So control over how you treat a hypo, control in managing your insulin doses and corrections. Taking glucose at 9 will send you sky rocket, so you need to trust yourself more that you can bring your levels down and run in single figures.

I know you think a pump is a magic wand but unless you can start getting to grips with managing your insulin/carb intake then it may not ever happen, the NHS can be very firm about this, so it is even more incentive to really start to grasp your doses/carb intake to show them the effort you are putting in that would warrant their support with funding for a pump.
 
Just to add a pragmatic element to this managing your levels with a Pump is more difficult* than managing them with injections. Adding an extra layer of difficulty, might not be the best course of action for you right now.

*In the sense, there's a lot more going on that you have to be aware of.
 
Hi all again, injection sites are ok I think, do the injections in bum, stomach legs, rotate as much as I can, Iam carb counting etc, the diabetic woman at the hospital thinks the drops etc I take for eye etc I've steroids etc may have some impact along the way, iam unsure about ratios etc, all I know for myself is in the morning and evening iam less sensitive than in the middle of the afternoon. But as before my sugars was around 18 I had a sandwich etc so around 35 grams of carbs and decided to have just 3 units of rapid and it brought it down, but this doesn't happen everyday sometimes it doesn't bring it down. In the evening I can have a few units at night and it not really touch it through the night. But agree treating as if I am having an hypo when it's not isn't. Helping so need to stop that, think over panic as live on my own, and right eye seems on way out vison rubbish and seeing flashes etc sending me dizzy etc and think don't want a bad hypo on top so treat it way to early which needs to stop. As before not been shown how to set background insulin so unsure. At night if I have a correction dose whatever it comes down to sometimes it will come down to 14/15 etc which I know is too high still but it will stay around that untill around 6 in the morning then think the dawn phenomenon thing kicks in pushes me up over 20 then I am battling to bring them down all day. I have around 20/30 grams of carbs per meal etc, not sure if people inject for proteins etc. Unsure if ratios need changing if background insulin needs adjusting. Just a shame iam trying everything don't drink, smoke eat junk food my snacks these days are more like a tin a tuna, but just not getting a break, being fully aware of the unseen damage having awful sugars like this and the toll it's having on my body, I know they say diabetes shouldn't stop you doing anything but it has me absolutely everything, holidays going out socialising going to watch my young lad play football that he keeps asking. All the things people take for granted just a dream for me. Roll on 7 so I can go to bed again
 
I know you're struggling Danny, but you can turn this around and get better control, we all have our struggles with our t1 but we can generally can keep ourselves well enough to manage day to day life, I have a few pointers which I hope you will read and take on board.

Firstly eating carbs when your already out of range is just going to push you higher despite your carb bolus, when your above 9 can you look at a low carb alternative, like bacon/eggs/mushrooms ? Eating carbs on a high just makes it harder to get levels down again, then take a correction for the high ?

Do you know what your correction dose is ? As a rule follow this guide: Calculating your insulin sensitivity factor You need to calculate your insulin sensitivity factor to work out your correction doses. To do this you need to know how much insulin you usually take a day. 1. Calculate your average Total Daily Dose (TDD) of insulin over about 4 days 2. Divide 100 by your TDD 3. This is the amount 1 unit of insulin will lower your blood glucose level. This is your insulin sensitivity factor.

However a correction dose cannot fix your overnight highs - you need to adjust your background dose until this comes down, I cannot guide you on how much insulin to increase by as I am not a medical expert, I can only guide you from my experience, if you don't feel confident doing this then contact you team and ask for guidance, but trust me life does become alot easier when your background dosage is working at the right rate, so getting this right is key to improving your control.

Ultimately these decisions are yours to make, so taking control and getting on top of this is within your power, just try not to feel defeated and take on board the advice and support you get as we do want to try and help you.
 
As @ert says the key to support is a good DN team, not just the consultant. This should be in place for you and if not it is something you must push for. Whenever I have had my consultant appointment he always asks if I have the DN teams phone numbers/emails and must not hesitate to contact if I have any issues.
 
Would this formula actually work in Danny’s case? Isn’t the logic behind this formula that TDD is keeping you in range, which Danny’s clearly isn’t, like at all.
 
StewM said:
Would this formula actually work in Danny’s case? Isn’t the logic behind this formula that TDD is keeping you in range, which Danny’s clearly isn’t, like at all.
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Good point.
I also personally think that the formula is a bit like the 1 unit per 10g rule often used for starting out insulin dosing, it's a guess that then gets modified by experience. eg Although my clinic also uses that formula, for me it would suggest that 1 unit of insulin brings my levels down by about 2.5 mmol/L, and for me it's more like 1.25mmol/L . (Logically, given that the amount of carbs you eat greatly affects your daily insulin dose, the calculation is going to be drastically affected by how many carbs you eat in a day.)
 
Hi @StewM - yeah I completely agree but on the basis Danny doesn't have great control it's a generic guide to help, otherwise it's just a potluck guess, until he starts seeing single numbers on a regular basis then any help/support is worth a go and this is the guide given to t1 children so better than none.
 
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Hi, I think re your original post you over treated your 'hypo'. Overtreating hypos (panicking and taking too many carbs) is very common and we all do it.

If your blood sugars do average in the 20s then you will be getting the horrible physical symptoms at 10 or 12 (though luckily not the mental stress of a genuine hypo where you have the actual additional real fear of losing consiciousness if you hit the 2s).

So treating your 'hypos' if they're at 10 or 12 is fine I think for now. They don't feel good and you don't want to lose motivation. But just practice not to over treat them. As mentioned at 10 or 12 you're already high, so you will rocket back up. You only need a surprisingly small amount of quick acting glucose. Then wait 15-20 minutes and see what your reading is / how you are feeling. And in your case you actually have the huge reassuring buffer all the way down to 3 b/s or so where you would encounter genuine physical danger from the hypo.

Similarly when you're high and you eat even a regular meal, things get hard to control as the glucose already has such a headstart. My range is 4-10, but I don't eat if above 7. If towards top end of range for whatever reason i'll correct first and wait to get below 7.

How about just focusing on two very simple rules everyday, that you can steadily work to improve each month.

So...
Month 1 - I will not eat if my b/s is above 16 and I will only treat 'hypos' below 12
Month 2 - I will not eat if my b/s is above 14 and I will only treat 'hypos' below 10
Month 3 - I will not eat if my b/s is above 12 and I will only treat 'hypos' below 8
Month 4 - I will not eat if my b/s is above 10 and I will only treat 'hypos' below 6
Month 5 - I will not eat if my b/s is above 8 and I will only treat hypos below 4

So you don't eat until you've corrected. This may mean a couple of hours of mild hunger now and then while you wait to come into 'eating range'. That's just tough i'm afraid! Only you can decide whether feeling a bit hungry sometimes is a price / effort worth paying versus long term protecting your eyes and your overall health.
 
Draco can you explain a bit more about where you got this approach from? The reason I ask is, if Danny treats 12 and below as a Hypo, even treating it modestly will likely send him above 16. You’re also suggesting to him not eating if his blood sugar is above 16, but your first piece of advice would largely keep him above 16, so you’re essentially suggesting he stop eating anything but Hypo Treatments which seems extremely dangerous.
 
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