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Blood sugars out of control

S

slayer

Well-Known Member
Messages
132
Type of diabetes
Type 1
Treatment type
Insulin
I am 42 and female. I have been diabetic since 13 years of age. My Hbac1 used to be 50 but now is 77. In the last couple of months I have had to increase my evening basal to 3 units per hour. I am on metaformin and fiasp via Omnipod pump. I have had to increase carb ratio from one and a half units for 10g of carbs to three units for 10g of carbs. However, my blood sugars go up to 20 in the evening no matter what I eat. The nerves in my feet feel exposed and hurt when I walk, therefore I think I have developed neuropathy. Please help as I am at my wits end and my diabetes team are not helpful.
 
slayer said:
I am 42 and female.
Click to expand...
Starting menopause?
Changing hormones can affect insulin needs strongly, as we know from all desperate parents trying to manage their teenagers diabetes.

Are you using a CGM?
Are you seeing higher numbers all the time or going low as well?

It might be worth doing some basal testing if you haven't already. Do you use the same basal rate all day or is it varied depending on time of day?
 
I use the libre sensor and am finding the highs are 6pm until 12am. I don’t know how to basal test. I vary the basal rate. What worked for me before was looking at my bar chart and adjusting basal accordingly, but my device does not let me put in more than 3 units an hour and I am on 56 units of basal which is a lot.
 
I don't use a pump so I have no idea on that.
But the amount of insulin we need is highly personal and you need what you need. I'm on pens and currently my basal is around 60, but for years I've used 100-120 units of basal, which didn't bother me or my endo. Your insulin needs are determined by your blood glucose, there is no maximum dose of insulin.

Can you link those highs starting at 6 pm to anything specific? Activity, food?
If this happens every day it looks like a clear pattern telling you you need more insulin during this time. Have you asked your diabetes team to help you adjust the settings of your pump based on those patterns?

I don't know which Omnipod you use, but I found a user manual of the Omnipod 5 and you can adjust the maximum basal rate on that one up to 30 units an hour. So you might want to look or let your diabetes nurse/educator/endo look at your pump settings.
https://www.omnipod.com/sites/default/files/Omnipod-5_User-guide.pdf
Settings for max basal and basal programs start at page 80.

Here's an article on basal testing but there are different approaches to this. They all come down to finding patterns when no food is involved: https://www.mysugr.com/en/blog/basal-rate-testing
 
Agree with Antje - perimenopause can cause insulin resistance, so being female it has a direct impact on our t1d, I am peri and on HRT which has helped massively, it's given me a level playing field, best to have a chat with your GP if you think it could be this.

Also agree to basal testing, it's the foundation to control and will indicate what is really going on, but best to break it down into 3 time frames and repeat to get best results, shout on here if you need any help with this ?

Have you spoken to your DSN about this ? Could be worth reviewing insulin and seeing if a different insulin could offer better results, also trying to pre-bolus too is another option, sometimes the insulin efficacy can diminish so trying a different approach is food for thought.

When my levels run high and need correcting I combine with exercise to help bring them down, as well as drinking lots of water - getting active can help speed things up just watch out for the lows though.
 
Literally terrified of the word menopause or any similar word. I was supposed to start IVF, but have to put that on hold until the blood sugars are sorted. I will try to watch Youtube to find a video on basal rate testing. I am on Fiasp and they have said it is the best insulin for me but I will speak with them again. My weight has crept up even though I am eating less - must be the large amounts of insulin. I am considering asking for Monjauro injections. When I asked for a different injection in the past, I was fobbed off.
 
Tbh the menopause isn't something to be afraid of - I embraced HRT and it's been brilliant for my control, prior to that I was out of control for 1 week each month going from insulin resistant to hypoland, it was tiring to deal with and it wasn't great for my mental health either.

Start with the basal fasting tests - we should be doing this from time to time as part of our management to ensure our basal is set at the right ratio, it's vital to get this right, track your results and get your team to review them, I send mine via Glooko: https://glooko.com/ and my DSN can review readings prior to a discussion - you need your team to have a look and see if they can pick any areas to work on, they may also detect how your quick acting is performing too.

Try and get on email convo with your team too - my DSN is great and I can email her at 8pm with a reply the next morning - building a solid relationship there is vital.
 
I have tried to do my three day basal average for the morning whilst fasting. My blood sugars are usually better at this time:

7am: 5.5
8am: 6.4
9am: 7.7
10am: 7.5

Do I need to adjust my basal rate based on these readings?
 
I found with the Omnipod Dash - the cannula wasn't long enough for my 'thick skin' - its 6mm deep and inserts at 45 degrees.

Worked great for 1-2 days then I got insulin resistance - swapped to another pump with a 9mm cannula and no problems.

Might be worth a thought, but might be unrelated (just me)

Also worth trying to swap sites to somewhere you don't usually wear it, in case you're becoming resistant in your usual places (I found it to be especially bad with ultrafast - Fiasp and Lyumjev)
 
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