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Crazy blood sugars - need some insight

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craig0ss

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Hi there

I'm new to the forum although i've browsed for years, i'm a type 1 and have been for almost 20 years. I have a problem more recently that i'm unable to make sense of my blood sugars and in turn how to control them. I'm ending up in a pendulum type effect which is starting to take its toll.

So here goes

Firstly my specialist i see every 6 months is useless and isnt providing any information i havnt heard before, same for the diabetic nurse staff who refer me to said specialist. Enough said about that.

The issue im having is my blood sugars are going up far to high (from a start of say 7 up to 16+ then crashing back down to normal levels or staying high) unless i administer an excessive amount of insulin - which can be dangerous.

Im on Levimir twice a day - morning and before bed at the recommendation of my specialist which did work for a couple of weeks to my advantage.
Im also on novorapid which is taken with every meal as expected.

Take this morning as an example without going into massive detail and having a huge wall of text for people to read. Firstly i do believe the GI of food is having an effect which i can measure but the problem im having is in conjuction with this effect - ive had to remove breads from my diet completely!

This morning i got out of bed and tested my blood - it was 7.5. I had 1.5 units of novorapid at this time also. (as i know its going to rocket)
Cooked breaky and headed to work, an hour had passed - i retested and it was 9.5
I ate (scrambled egg, 2 sauages and 2 pieces of bacon - so very low carbs, probably around 5g if that). I had no insulin for this meal due to the low carbs and the insulin i had when i got up.
One hour later i retested - its now 11.2 - i had 2 units of novorapid
1 Hours later its still 11.5
Now i have the issue of overlapping insluin.
Previously i have left it go high to see what happens over a 6 hour period so a single injection of novorapid has been spent. Sometimes it drops a bit in the last hour, sometimes it crashes, sometimes it correct. Again some of this is to do with me being sensitive to certain types of foods with GI/GL which im currently trying to get a handle on. This is however removed when i have almost 0 carbs or a meal and still get a high rise in BG.

Can anyone see what the issue is here as i'm at a loss - ive tried:

Eating very low or no carbs the night before - to try and reduce the morning phenomenon - no effect.
My bloods can double or tripple from waking up to 2 hours later without any food.
Adding food can really mess things up - i use carb counting as my way of working out how much insulin i should take - seems to work out correct, except in the above circumstance. With high GI food after 5 hours or so (the active time of novorapid) my bloods do return to normal levels after peaking high which is im told the symptom of eating foods with a high GI.

The morning thing at the moment is unmanageable though - the increase in blood varies so i cant administer insulin safely. Once its around 11 i have really trouble getting it below to acceptable levels without administering too much insulin

So in the above i have had say 5g of carbs (from the sausage) which equals 1/2 unit novarapid. My bloods have increased by 5 points and ive had 3.5 untis of fast acting insulin.

Any one got any thoughts? :D

I have tried a lot in the past few weeks to try and get this sorted - appointments with the specialist, dietician, nurses etc etc, all have a blank look when i explain what's going on. I read a lot on this forum, especially about the glycemic index of foods (which i was only made aware of 6 months ago after being a diabetic for 20 years!) - this did help but the issue is now the morning rise - it has a knock on effect for most of the day, returning to normal levels in the evening, my waking bloods are good - its just the day is now out of control. I dont thinks it purely this morning phenomenon issue, something else is happening i think.

Thanks in advance.
 
Hiya Craig,

I also eat low carb but i've found I still need to inject norvorapid for a meal I would consider to be only a few grams of carbs, for example this morning I ate an omelette made with protein powder and chicken, yet I still take 3 units of QA. The reason for this is that our bodies will convert carbs to sugar so essentially - there is no free meal with diabetes.

I also find my body is less insulin resistant in the morning so my ratio of quick acting is higher first thing than at night - so I take 1.5 units to 10g of carb.

I would recommend injecting for breakfast which will prevent you running high. That's my personal advice, would also save you nose diving later on ;)
 
I'm going to agree. Protein is also converted to glucose in the body (albeit at a lower rate than carbs) and particularly in the absence of carbs, this will show up in blood glucose. I usually take insulin for low carb meals - today, for example, I ate two eggs for breakfast - no carbs, but around 12g protein. For something like this, I assume that protein is about 50% as effective, so I would take insulin as if for 6g carbs.
 
A couple of topics for you to read:

http://www.diabetes.co.uk/forum/threads/how-does-protein-affect-blood-glucose.75156/

and

http://www.diabetes.co.uk/forum/threads/insulin-load-index-most-ketogenic-foods.75704/

There are essentially two processes going on. The first, that you have already identified, occurs immediately after eating, when your body believes it needs to release insulin to aid the absorption of Amino acids and glucagon to counter the blood sugar reducing effects of insulin. As you have no insulin, you just see the bg level rise.

There is also the second effect of high protein, which is Gluconeogenesis. This is the process that the body uses to allow the liver to convert protein to glucose. In a non-diabetic, insulin regulates this process, but with subcutaneous injections, more of the insulin goes to peripheral organs so it is less controlled. This results in a slower conversion of excess protein (not being used for muscle repair) to glucose.

Basal rates (whether pump or MDI) are typically designed to cover the function of the liver in a steady, fasted state. In the link to the second topic above, I discuss some of the approaches that you can take to dealing with this effect when on MDI.

Various foods generate different responses. I think the key to this is the fat content of the foods, in line with Marty's paper in my first link. In my experience, Whey protein shakes lead to an almost instant bg increase, eggs are nearly as big a spike followed by chicken breasts and pork and beef (dependent on leanness) in terms of the rate of bg increase. This also affects the timing of insulin you might take with these foods.

Typically when you discuss this with medical professionals, especially DSNs, very few of them understand it. In Dr Bernstein's Diabetes solution, he recommends injecting your Insulin:Carb ratio for half the weight of protein and Marty's discussion recommends 0.54 x the weight of protein.

Ultimately what I find is that for a high protein meal (e.g. 80g protein in a single meal) I need to inject 4u of insulin ahead of the meal and then 1.5-2u at 1.5 hourly intervals to maintain control for the next three hours. On a pump this is obviously easier.
 
Hi Craig,

You mentioned you are on levemir but have not stated what amounts you take and when.

If you are seeing a consistent rise even when you don't have breakfast that would have me thinking that my morning Levemir was not enough. Is the rise throughout the day fairly linear? What I mean is that if you skip lunch do you see a similar rise between 12 and 6pm as you see from waking up to 12?

One thing that I notice when I have a day off or on a weekend is that if I do not do my morning levemir shot by 7am then I will see a rise and which then comes back down without correcting at lunch.

I strongly suggest that you should have a good hard look at your basal insulin since this does feel to me more like your basal rates have changed.

What do your sugars do overnight? Are they fairly flat?
Basal rates are not completely uncommon. Mine seem to change a few times a year, over summer my morning basal was quite a bit higher than my night time one but now they have switched back.

/A
 
Hi

Thank you all for you're replies, i will digest them as best as possible over the next few days!

AndyS - 11 units when i get up, 10 units before bed. This has recently changed so i am also leaning toward my issues being related to my basal as well as other things. I think i need to increase my before bed slighty. I do see my sugars in the evening needing less care :) usually the 1 unit FA per 10g carbs works. My before bed levels are usually about 8-9 dropping to about 7 when i wake. I may need to reduce my morning basal and increase my morning, it seems the morning and after noon (7am - 4pm) is the time range in which im having issues - before bed insulin? Also im going to try your example of missing lunch to see if i see a similar rise compared to the breakfast.

tim2000s - that is some information i'm going to have to digest in more depth, but thank you. I do have a question however, say if i have a meal of say 30g of carbs, which also contains 50g of protein, for this i would usually just bosal for the carbs, would i maybe have to take into account the 50g protein as well or does this only really matter when having a low carb/high protein meal?

misswhiplash, juicyj - i think i may need to pay more attention to the protein intake and also take the morning in isolation in regards to the insulin amount administered compared to other times in the day.

Again thank you all i think for now im going to lower my carb intake somewhat in the troubled areas, breakfast and lunch and pay closer attention to the protein intake. I think i also need to do a fast to make sure my basal rate is correct. At least i have a few things to try out in the short term. My diabetes was well controlled for around 4 months earlier this year but that soon evolved into my current situation and im not sure why.

Thanks,
 
@craig0ss, you need to bolus for very low-carb meals like the one you ate this morning, start off with a lowish dose then adjust your dose from there, it really is trial & error when you bolus for such meals but by recording your results you will get there in the end.
 
Hi. I guess it's always possible you have one of the more problematic variants of diabetes that cause large variations in blood sugar. Perhaps someone else can suggest some of these such as MODY if I remember plus RH.
 
craig0ss said:
Firstly my specialist i see every 6 months is useless

I have tried a lot in the past few weeks to try and get this sorted - appointments with the specialist, dietician, nurses etc etc, all have a blank look when i explain what's going on.
Click to expand...
Hi and welcome. Looks like you have some good suggestions above and things to try. If you continue to have issues and are still getting nowhere with your specialist, is there another specialist you could see? It's possible they might not have any more idea about it than your current one, but it might be worth a try? If you live in or near a large city, there might be a number different teams available and members can make recommendations about who is known to be helpful with complex cases.

If there isn't anyone else you can see, then at least there is some knowledge here at the forum. Phew.
 
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