Any ideas what may have caused this?

DannyH said:

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

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Honestly with eye complications, frequent hypos and hba1c and bgs consistently so high I think you definitely need to see a consultant led team (GP should refer you to tier 3 services and I am surprised that hasn't already happened except perhaps you haven't been able to even access basic gp services perhaps?) to get on top of this in a systematic way with a structure to follow. Its hard for us to give you that here but we do get the frustration, exhaustion and confusion part.

• You're very worried about the high blood sugars and seem to be over correcting by stacking up correction doses without giving the previous ones the chance to work. Don't over test or consume too much lucosade 'just in cse'. It is really hard to correct a high bg because the body continues to produce its own glucose for reasons I explain in the next bullet.
• You need help getting the basal right so background sugars aren't creeping up and making you need the correction doses. Even when not eating the type 1 liver chugs out a load of glucose and in normies it would be inhibited by the presence of insulin.
• On the plus side if you can stick to limited carbs (30-40g) and about the same each meal, then I think you can get the bolus ratio right but the trick will be to arrive at a meal time with a normal bg in the first place.

I'd also ask for a referral to a diabetes course just because it will give you a place to get face to face support with clinicians around to answer questions.
Best of luck with the eyes today!

StewM said:

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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?????

Deary me, please read what is written.

He will be having the physical symptoms of a hypo now at much higher levels than a normal well controlled diabetic as his body feels the 20s is normal. It's utterly pointless telling someone running in the 20s, who's clearly scared of running low blood sugars to not treat until they are at 4, when he's feeling awful, shaky, sweaty at 10 as you or I do when we're at 3 or 4. It's actually very dangerous for someone running so high to rapidly drop and aim for perfect numbers straightaway. That's why i'm suggesting a gradual multi month approach as it is both more achievable and safer.

I said (re hypos) "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".

Therefore IF HE DOESN'T OVERTREAT them he shouldn't go above 16. Not overtreating them is a skill to be learnt. A glass half full persective would be he now has a few months to learn ahead of having to deal with genuine hypos at 3-4.

So with practice he won't go above 16. If he does over treat, then after allowing time for the insulin (that prompted the 'hypo'), the meal (that the insulin was taken with) and the correction all work through he can apply a correction if still above 16 ahead of the next meal.

You're also assuming he goes 'hypo' after every meal, which is a false premise.

So no the first piece of advice would not keep him above 16 all the time. What a strange thing to say.

I could't even begin to get my head around what you meant by this "so you’re essentially suggesting he stop eating anything but Hypo Treatments which seems extremely dangerous".

I said don't eat until you're at 16 (or below).

Where did I say don't eat anything until you're at 12 then only ever eat hypo treatments?

Taking Hypo Treatments at 12 or below, as Danny has already stated, will send his Blood Sugars sky-rocketing. So we can reasonably assume until he gets better at treating them they are going to continue to shoot above 16 when he treats them. As such, every time he does a treatment he will be sending his Blood Sugar to a level, where you're telling him not to eat. He has also already stated that his Blood Sugar's are running in the 20s. So that being the case, he will be starting at a Blood Sugar level where you're telling him not to eat. Danny has said when he treats the high Blood Sugar it either stays consistently high or drops quickly. So he wouldn't eat in Scenario 1 because his blood sugar is above the level where you're telling him not to eat, or he'd correct but given what Danny's said there's a likelihood that could send his Blood Sugar quickly below 12. In which case, he'd hypo treat, but because it's highly likely a hypo treatment at that level (and given Danny's current tactics for dealing with them) that Hypo Treatment would then send him above 16 again. This is why this approach seems to have some issues.

It's all very well to say "he must practice not overtreating them" but it seems fairly safe to assume that that skill won't be learned instantaneously, and as such you're going to have to deal with the consequences of those overtreatments occurring in the short term.

All this is to say, I think Danny would be better served following the advice @Nicole1971 gave, as none of us are qualified to be helping out here.

Yes getting advice from his diabetes team would be far better then from me. Or you. But his team don't seem to be there for him.

The man is losing his eyesight, describes himself as rotting away and remains with b/s in the 20s.

Yes practice means "perform (an activity) or exercise (a skill) repeatedly or regularly in order to acquire, improve or maintain proficiency in in it."

So correct he likely won't get it right instantly. Hence the word PRACTICE. It is not as if that will be taking him away from a regime that is currently perfect, is it?

His blood sugar rocketed as he said "he ate lots and drank lucozade". That is not correctly treating a hypo if it sent him into the 20s and he stayed there. Instead he should treat in line with guidelines. PRACTICE. Don't use his 'current tactics'.

Lots of advice is given here re learning new skills and techniques eg you must learn to carb count. Your response to any advice is presumably always "it seems fairly safe to assume that that skill won't be learned instantaneously, and as such you're going to have to deal with the consequences of those overtreatments occurring in the short term."

YES! This is hard and no one gets it right immediately. PRACTISE. In your world we can never try any thing new as we won't get it right straight away?

a) If he is in the mids 20s he corrects until he is ready to eat at 16. Then the initial post meal rise takes him into the low 20s.

b) If he is in the mids 20s and he eats, his post meal rise will take him into the low 30s

Your approach B does NOTHING to reduce his average b/s.

I am telling him to correct before eating! Not to not eat! Please stop wilfully misinterpreting what I am saying.

He needs to learn appropriate corrections for both highs and lows.

He will NOT get it right first time.

He needs LOWER starting points.

Over time that lowers his average b/s, which will lower his false hypo sensations. The 'hypos' he's feeling now are going to be very real and unpleasent.

Maybe I can make it easier by using smaller numbers that you are more familiar with.

My range is 4-10 b/s.

If I start eating at 6 I have an upwards buffer of 4 (upto 10) to allow for rise.
If I start eating at 9, i'm going to stray into the low teens.

That's basically it, unless we're so lucky/brilliant/very low carb that we never have post meal rises.

I do not only eat hypo treatments.

I did not get this all right first time.

For the last 6 years (since i've had CGM) my HbA1C is 33-38 with virtually no hypos.

Danny trying new stuff will come with pros and cons, mistakes and successes.

But his current regime is all the cons and mistakes.

Anyway, can't actually believe i'm having to explain it's better to start eating at 16 rather than 26!

DannyH said:

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

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Hi Danny,

I’ve taken correction doses in the past regarding the odd wayward reading & witnessed a south facing arrow within 1.5 hours.
With the set up I have using a Libre, for me it can start to vary after a while from a south facing icon to a arrow heading south east. Eventually, the arrow will trend east ward for a while so I know the drop has stopped.

Also whilst it’s levelled out at what ever point (2/3 hour mark pending on how high I was originally.) I’ll check with the meter too. There can be in the 5 hour, a little lick in the tail with Novorapid which could drop me further with another southwest arrow? These movements on the graph can have a delayed effect. It’s advisable to check using your meter.

That said & done. I personally wouldn’t recommend using lucozade as a “parachute.” Think of it more as an airbag?


@Draco16 @StewM , if you both wish to discuss the finer points on each other’s posts? By all means use the PM function.

Thanx.

DannyH said:

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

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Hi Dan,
How you are getting on?

I am wondering if your diabetes team have asked you to check for ketones when your readings have stayed high for several hours (without food or Lucozade)?