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High sugars - insulin not working?

Discussion in 'Type 1 Diabetes' started by passittotheleft, Jan 2, 2017.

  1. passittotheleft

    passittotheleft Type 1 · Member

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    I'm having the same problem as the user who posted this blog.

    2 nights ago, for dinner I only had a salad with chicken and a few chocolates thereafter (Christmas...). My blood sugars were 20 which I was really shocked by. I corrected etc and went to bed later. I woke up feeling really really sick, blood sugars were 22. I was worried n confused n knew I was going to vomit as a result but took insulin first to try and prevent this. I vomited quite violently and felt better. 4 hours later, Blood sugars were still 20 so I changed my insulin(from the fridge) and blood sugars went back down.

    However, same thing is happening this morning. Blood sugars 20,took insulin, 45 mins later they're at 19! Is my kidney failing? Is there something really wrong with me? I'm not ill.
     
  2. azure

    azure Type 1 · Expert

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    Hi @passittotheleft If you're sure you're not ill or coming down with something, then the first thing to do is change your insulins just in case the pens/vials you're using have become ineffective. You say you've done this - have you changed both basal and bolus insulins?

    If your BS is 20, you'll need a higher correction dose. Also bear in mind that it could take three hours until you start to see them come down properly, so keep testing but don't inject more insulin because you don't want to stack doses and then go hypo.

    Have you tested for ketones?

    What's your BS now?
     
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  3. passittotheleft

    passittotheleft Type 1 · Member

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    Thanks for getting back to me. Would my basal insulin have such an impact? There have been times when I've forgotten to take it and my BS increased by only 2-3 units.

    It's weird that I changed my vial yesterday and it began working but then became ineffective today (??). I changed vials again today and it went down a little bit to 17. I just checked a d my BS is 6.4 but this happened yesterday too.

    I've just got 2 new vials from the chemist.

    Just to add - i keep my pen on me at all times (outside of the fridge) and I've had no problems apart from 3x in 13 years. Just seems odd that it works initially and then stops.

    Thanks for your advice, think I'll change the basal too. Thanks!
     
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  4. azure

    azure Type 1 · Expert

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    Always worth changing the insulins as a precaution :)

    Another cause may be stress (even good stress like Christmas), a change of routine, or the colder/darker weather (many of us have to increase our basal slightly in Winter).

    You could also try changing your injection sites in case it's an absorption issue.

    Once you're back to your normal routine, it might also be worth doing a basal test, and then also checking your mealtime ratios are ok. It's always surprising how much our insulin doses can need tweaking.

    Let us know how things go :)
     
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  5. passittotheleft

    passittotheleft Type 1 · Member

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    Thank you so much for all your suggestions, you've been more useful than the NHS! ✌.

    You're definitely right, worth changing insulins. I think it's my basal but if it is, it's acting weird (over riding my bolus).

    How do I do a basal test? I've never done one before.

    Thanks again for your help, you've been fantastic!
     
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  6. azure

    azure Type 1 · Expert

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    A basal test is basically testing various segments of the day to make sure your basal dose is keeping your blood sugar steady (in the absence of food).

    There are various sites explaining how to do a test, but here's a good one:

    https://mysugr.com/basal-rate-testing/

    It can take a while as you do each segment, but will show you if your basal is keeping you steady day and night by the time you've finished.

    Lots of the basal test sites use US units, so here's a handy converter if you need one:

    http://www.diabetes.co.uk/blood-sugar-converter.html

    :)
     
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  7. passittotheleft

    passittotheleft Type 1 · Member

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    It's happened again. In the late afternoon, I checked my blood sugars before a snack and my BS was 12.9, so I took my insulin+a correctional dose. 2 hours later I sat down to have a roast and my BS before were 12.6, so I took my insulin beforehand (carbs=potatoes+yorkshire pudding, not much insulin needed). 2 hours later it was 15. I know i shouldn't take insulin but i took my correctional to see if it had any impact.Another hour later it was 15 and just now (midnight) it was again, 15.

    I'm convinced it must be my basal. I've called 111 for some advice as I don't want my BS at 20 again and to be sick.

    This is so frustrating.
     
    #7 passittotheleft, Jan 3, 2017 at 12:12 AM
    Last edited: Jan 3, 2017
  8. steve_p6

    steve_p6 Type 1 · Well-Known Member

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    Hi @passittotheleft. For your correction dose, assuming the basal insulin is under performing, you could add an additional correction to counter the expected BG rise over the next 4 hours due to the basal insulin deficiency. Eg in this situation, for my ratios, I would take an additional 3-4 u and aim to come down to about 7-8 as a safe target with little hypo risk from too much bolus.
     
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  9. tigger

    tigger Type 1 · Well-Known Member

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    Lots of good advice above.

    I'd also add 3 other things to consider.

    1. Did you have a hypo at any point before the first really high blood sugar? If you did and depending on when you managed to stop it your liver may have produced glycogen which then sends you really high later.

    2. I find that my normal correction factor has to be massively increased if I'm up in levels like that. Also drink lots if you're that high. Not only will you feel the need to but it moves the sugar through your system faster and dilates the blood cells which reduces your blood sugar faster. Insulins also work at different rates and you have to factor in that the bs reading on a meter is already 15 mins old so your levels may be increasing more since then.

    3, How much in advance are you bolusing? Particularly if you have to reduce an already high pre-meal level you should consider doing it earlier. I don't know what insulin you are on but as an experiment you can try moving each bolus 5 mins earlier than you would have done until you hit on the right time to eat when your curve is going down but not too late so you hypo. Bear in mind that food with higher fat content will be released into your blood stream differently and roasts and yorkshire pudding may well be higher in fat than what you normally eat. Fat can delay the absorption of carbs so that may be why you're seeing a continual level.

    Good luck in solving this. It's rotten feeling high.
     
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  10. passittotheleft

    passittotheleft Type 1 · Member

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    Hi guys,

    I appreciate all of the suggestions and tips.

    I changed my basal vial last night to a fresh one, hoping that maybe it was the previous day's lantus that had gone off.
    This morning, I took 1 unit of novo rapid/bolus insulin to test it to see if it would reduce my BS and it dropped to 14.3, so I was hopeful that this whole episode was over. However, I had 2 slices of toast and took a rather large dose of 14 units (slightly more correctional, like you mentioned) before I'd even started eating it and 2 hours later....my BS has increased to 15.6!

    I'm really annoyed now, nothing appears to be working and I've run out of theories. I've tried to contact my diabetes specialist but as usual, it goes straight to answer machine :( My GP just said "call your diabetes specialist", uh huh.

    I get that fatty foods could slow down the breakdown process but it only dips a bit in the morning (false hope) before sticking to 15-20 for the whole day for 3 days now! I'm considering going to A&E or the less serious version (wouldn't want to waste tax payers money, bla bla).

    Thanks for your support.
     
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  11. tigger

    tigger Type 1 · Well-Known Member

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    @passittotheleft are you always eating when you're high? If so that might be part of the problem. Looking at the information you've given above you post meal rises are low (1.3-3 mmol). You should expect to have that increase when you're eating. The issue is that you're not going down again. I'd recommend that before you eat next time, test, bolus and then test again before you actually eat. Then test 2 hours later. That won't get your basal right but might give you an idea of your post meal rises. The other thing to remember is that when you end up at a certain level for a while the body often assumes that's your normal and it's hard to move off it.

    Other good but very boring advice is stick to identical food for the same meal for a couple of days to make sure your carb ratio is right. Also are you weighing your bread and using the correct carb/g rate for the type of bread? I know it's really basic but it's shocked me how much portions have increased over the years since I started strict carb counting again. As an example a standard slice of bread in the 80s when I was diagnosed was 10g for wholemeal and 15g for white. It's now easily 15g for wholemeal and only if really quite small.

    And do basal test if you can. It's a complete pain (10 hours no food min) but gives such good information.

    I wouldn't recommend going to A&E or calling 111. They are unlikely to have people who can give you anything more than general advice. You'll just sit there getting stressed and that's not great for levels either.

    Good luck. I know it's a complete pain but you can get there.
     
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  12. GrantGam

    GrantGam Type 1 · Well-Known Member

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    A couple of things to bear in mind (if you're anything like me):

    -Carb intake - during the festivities, I consume a LOT more carbs than normal. As in nearly double what I would usually. For such a dramatic dietary change, I have to make a substantial increase in my twice daily basal insulin dose. If you know your usual TDD, and what percentage of that is basal - then it's fairly easy to change your basal dose to suit your festive TDD.

    -Activity levels - virtually non existant. I spent a week over Christmas on the couch watching TV and playing with our new pup, I did no exercise at all apart from taking the bins out. Lack of exercise makes you more insulin resistant. And this is turn will have quite a substantial impact on the effectiveness of both bolus and basal insulin. It's amazing how much more we can need when we're not as active.

    All of what I've mentioned above may be of little use to you. Other than carb intake and activity levels, I'd second the advice given by @azure wrt basal rate testing.

    Good luck!
     
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  13. tim2000s

    tim2000s Type 1 · Expert
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    Hi @passittotheleft - you really need to do the basal test that was mentioned earlier. If your basal is out, for whatever reason, it can completely stuff up everything else. Try that first, before looking at I:C ratios, calling the specialist, etc. It's a key part of fixing many problems.
     
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  14. catapillar

    catapillar Type 1 · Well-Known Member

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    If your insulin doesn't completely stop 2 slices of toast from raising your blood sugar, that doesn't mean your insulin isn't working.

    If pre meal you were 14.3, you bloused 14 units and then immediately ate around 30g of carbs a rise to 15.6 isn't anything unusual suggesting the bolus isn't working/has gone off. In fact a rise of only 1.3 at 2 hours after eating would suggest your insulin is working just fine.

    If it were me, I would have bolused for the food and done a correction for the 14.3 reading and then waited until my blood sugar had actually corrected and was at least under 7 before eating.

    If you think you're sugars are inclined towards rising basal testing and adjustments to your basal dosage is the way to go.[/QUOTE]
     
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    #14 catapillar, Jan 3, 2017 at 1:49 PM
    Last edited by a moderator: Jan 3, 2017
  15. CathP

    CathP Type 1 · Well-Known Member

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    Hi, it looks like you've already had some great advice. I'm no expert, I'm only a year in to t1 with my daughter, but if I was experiencing this with her, I'd be giving a correction dose with her meal time bolus, and waiting until she was back in range i.e. about 5mmol before eating. Once you're high, it's really hard to get back into range, even with a correction if you've got food on board. We always prebolus and tend not to eat until in range. Best of luck.
     
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  16. passittotheleft

    passittotheleft Type 1 · Member

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    Hi guys,

    Thank you ever so much for your input. I think I've just had a very weird 3 days. At around 2pm, my BS came down to 9.4 and an hour later they were 8.1, which is a million times better than before. I really do think it was my basal that was playing up because I was taking bolus+correctional, checking and then another correctional without my BS coming down at all.

    Last night I changed my basal and today it's started to go back to normal. Apologies if it seems like I haven't taken your advice but it's just been a little perplexing and unprecedented.

    Again, thanks for all of your pieces of advice, the support on here is unreal compared to what I get from the NHS. A breath of fresh air
     
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  17. passittotheleft

    passittotheleft Type 1 · Member

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    I took the basal vial from my rucksack which is risky, so I'm pretty sure that was the problem. When you're at 20 BS and you take 8 units to just bring it down and it remains at 20, you're then vomiting and it's still at 20!! you know something is awry. 9/10 everyone here is bang on the money. It was as if I had a virus, the way my BS weren't going down. Last night's basal was taken from the fridge and things are cool now.

    The ppl at my diabetes clinic were really defensive and pretty clueless about their hospital. Im just going to chat to ppl on here next time, the type1 admin was super, as were you all.
     
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  18. azure

    azure Type 1 · Expert

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  19. fletchweb

    fletchweb Prefer not to say · Well-Known Member

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    There's been times where my BGs have shot up to the 20s - I usually know before hand because of the way one feels but test just to make sure. Over Christmas I hit a 22 because I started munching on something that I should not have been munching on. When this happens I usually do two things - give an extra shot of insulin - when I hit the 20s I find for me personally 10 additional units of humalog gets me right down to normal again within 2 - 3 hours - the other thing - I will fast after giving the shot until my BGs are at a better level. Only problem you got to test yourself often in the event that you over compensated. I found about 90% of the time it's because I ate something that had more calories than I anticipated (restaurant food is really bad for that). The irony - because of this kind of experience - I have an easier time getting my BGs to a normal level than I do keeping them there - As well, I'd suggest you do the Basal fasting thing - Many type 1s take this approach and it's assisted me in giving the correct dosage of Basil Insulin. When I first switched to Lantus my Doctor told me to take the same dosage as my previous Basil insulin - fortunately for me after fasting etc I realized I was taking way too much Basil and after a week of fine tuning ended up giving myself 12 units less - quite significant.

    I'm relating this information because it helped me but we're all different - I'd recommend doing the Basil Fasting method -it's so important to give the correct dosage of Basil.
     
  20. Hussein 2

    Hussein 2 Type 1 · Newbie

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    Hello, i m also having high blood sugar despite taking hight doses of novomix and nobody rapid,before breakfast novomix 48 units, lunch novorapid 20 units, dinner novomix 44 units my blood sugar stays high between 11 and 17, what can be the problem
     
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