Can't get bloods in range

[Carron29]

im fed up my daughter has special needs and has type 1 I just can't get her bloods in range she wakes up high and stays high all day or wakes up low and stays high all day doesn't matter how much I change bolous or Basel rate still happens her overall hbA1c is at the moment 53mmol diabetic nurses don't help much she's on a low carb diet with high fat etc just lost at the moment if anyone has an idea I could try please help

 

[Diakat]

If low carb, have you tried bolusing for half the protein too?

 

[paulus1]

have you considered metformin to counter any resistance. any chance she is accessing food that you dont know about.

 

[catapillar]

im fed up my daughter has special needs and has type 1 I just can't get her bloods in range she wakes up high and stays high all day or wakes up low and stays high all day doesn't matter how much I change bolous or Basel rate still happens her overall hbA1c is at the moment 53mmol diabetic nurses don't help much she's on a low carb diet with high fat etc just lost at the moment if anyone has an idea I could try please help

53 isn't a bad hba1c at all. It's an average blood sugar of 8.6, so she must be in range for fairly decent chunks of the time.

What sort or range are you aiming for and what sort of numbers are you seeing? What percentage is your daughter in, under and above the target levels? Remember, no one is 100% in range, it's perfectly possible to have readings that are 30% over target and still have a hba1c under 48.

You say you change basal and bolus. But have you done any analysis to work out what's causing the out of range reading? When are they happening?

 

[mytype1.life]

I'd be really happy with a HbA1c of 53- it's actually my goal so I'd suggest not being too concerned.
I'd also be keen to know what you mean by high all day? It sounds like you are doing everything possible.

 

[Carron29]

have you considered metformin to counter any resistance. any chance she is accessing food that you dont know about.

Don't think she could have this as she's type 1 and that's for type 2 isn't it

 

[Carron29]

I'd be really happy with a HbA1c of 53- it's actually my goal so I'd suggest not being too concerned.
I'd also be keen to know what you mean by high all day? It sounds like you are doing everything possible.

Can't get her bloods in the target 4.0 to 7.9 no matter what I changed our what carbs she eats she is always off

 

[himtoo]

Hi @Carron29
as your daughter is on a pump -- a crucial step in getting basal rates sorted is to do a lot of basal rate testing
here is a link https://mysugr.com/basal-rate-testing/
When I first started on my pump it took 8 weeks of testing and making small adjustments to rates to finally get to the point I was happy with all my settings.

I also can understand that as your daughter has special needs it might make not eating for periods of time more difficult.
in addition perhaps blood testing is an issue due to the pain from the finger pricking.

Have you looked into a freestyle libre -- which would give you a clear picture of what your daughter's bloods are doing 24 hours a day -- and with the additional information could assist in making adjustments ??

I know that many hospital DSN's are able to offer a free trial of the libre -- might be worth asking ?

 

[himtoo]

im fed up my daughter has special needs and has type 1 I just can't get her bloods in range she wakes up high and stays high all day or wakes up low and stays high all day doesn't matter how much I change bolous or Basel rate still happens her overall hbA1c is at the moment 53mmol diabetic nurses don't help much she's on a low carb diet with high fat etc just lost at the moment if anyone has an idea I could try please help

Hi there @Carron29
would you like me to move your thread to the insulin pumping forum ?
this could assist with getting more targeted help from people who are pumping ?
let me know if you wish to move the thread.

all the best !!

 

[Carron29]

Hi there @Carron29
would you like me to move your thread to the insulin pumping forum ?
this could assist with getting more targeted help from people who are pumping ?
let me know if you wish to move the thread.

all the best !!

Yes please

 

[himtoo]

Yes please

that has been actioned for you !!

 

[Carron29]

Done the fasting and results are always good but everyday bloods are a mess no matter what we do I wondering if the insulin works for her or not she's been on novorapid for years now

 

[himtoo]

Done the fasting and results are always good but everyday bloods are a mess no matter what we do I wondering if the insulin works for her or not she's been on novorapid for years now

obviously as none of us are doctors we can't give specific advice .

some of the things I try to see if I can get improvements in post meal blood glucose spike is to adjust the timing of the dose before eating.

also -- another thing that used to help a lot when I was on MDI -- was to eat the same old boring meal for quite a few days in a row -- gather all the BG data -- to see what patterns might be there to assist changes in Insulin to carb ratio.

another thing is ( and I find this frustrating too ) my diabetes never stands completely still meaning that sometiems what works perfect for me 1 day doesn't on another day -- it does feel to me like I am constantly keeping one eye out for my lovely D leopard to change it's spots again.

 

[Carron29]

I'm the same here I could give her the same meal everyday and she's different every time no pattern to her at all tried under carbing for some foods and then she goes high so carb full amount and she hypos can't win they done loads of tests nothing shows up I'm wondering to take her of he pump and see if trying some different insulin would work if they would let me try

 

[Kristin251]

I'm the same here I could give her the same meal everyday and she's different every time no pattern to her at all tried under carbing for some foods and then she goes high so carb full amount and she hypos can't win they done loads of tests nothing shows up I'm wondering to take her of he pump and see if trying some different insulin would work if they would let me try

I am vlc so I do have to bolus for half my protein as if it were a carb. But if she’s eating enough carbs she might not need to do that. And I prebolus 20 min before as I gluconeogenisis quickly

How old is she? Hormones do some crazy things to bg. I’m 53 and post menopausal and I still have high days and low days according to my old cycle.

It is very frustrating for sure.

 

[Juicyj]

Hi @Carron29 I also agree with others your daughters HbA1c is great, mine is 54, I can't get it any lower despite using a Libre, doing careful carb counting and being the best I can be so I think you are already doing an amazing job. Kristin has a good point that if your daughter is of a hormonal age then this could also be causing issues with control, I find one week a month I run high and despite corrections I struggle to get better control. I also don't think your pump or your insulin is an issue, pumps work on user input so providing the settings and ratios are right it should do exactly as prescribed on the tin. Novorapid is an excellent insulin so unless your daughter is allergic to it then this shouldn't be causing a problem either.

Out of interest have you done DAFNE ? I agree with Himtoo about getting a Libre, it's a good way to see how she's responding to food types and seeing how long it takes her Bg levels to spike, how long etc, it would give you a good idea of where patterns are occurring and being more knowledgeable when making insulin adjustments.

 

[Juicyj]

@Carron29 Also just to ask has her cannula sites been checked for lumps or scar tissue, this can cause insulin to pool under the skin and levels tend to run high as a result, get her nurse to have a check over to make sure her sites look ok ?

 

[Carron29]

Does she take any other medication? Some medicines can have an effect on BG levels.

She does take a lot of medication thyroxine for under acting thyroid ferrous sulphate for low on iron naproxen and lansporazole for her scoliosis and pizoitifen for pain plus her insulin poor thing she's 19 and has no speech or awarness of her condition so hypoing is very dangerous on her as shows no signs at all

 

[Carron29]

@Carron29 Also just to ask has her cannula sites been checked for lumps or scar tissue, this can cause insulin to pool under the skin and levels tend to run high as a result, get her nurse to have a check over to make sure her sites look ok ?

I always check her regular for them and change cannula every 3 days unless she pulls it out which she can sometimes the little sod

 

[AmandaD]

well done you're doing a great job. As someone suggested try bolusing for half the protein and using extended boluses (dual and square ) for higher fat meals more often, does she have a cgm?? if not would you be able to get one for her at all?? or even a Libre?? it would help you get a better picture of where she's going high and also alert you to when she's going low.
Her HbA1c is quite good considering everything. I'm type 1 31 years and have been taking Metformin for the last 4 years to deal with insulin resistance so it is something that type 1s can take.