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My insulin is not working.

Discussion in 'Type 1 Diabetes' started by Catsymoo, Apr 28, 2018.

  1. Catsymoo

    Catsymoo Type 1 · Well-Known Member

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    Hi all. As I have posted lately my diabetes is out of control. I saw my DSN and she was not concerned about my hypo anxiety and sugars running in the teens constantly. It's getting beyond a joke. Thursday night I ate a salad with NO carbs and some strawberries for dessert. Bolused 5 units. Blood sugar is 19 3 hours later!!? This KEEPS happening and I am already depressed enough because my uncle commited suicide and I have symptoms of GERD.

    Tonight my blood sugar went up to 22 even though I bolused 11 units for a curry and only half the amount of rice my boyfriend had. I took 8 units to correct. It dropped to 21 after an hour. Then I took another 8 units 3 hours later, down to 18. Bolused AGAIN and I'm still at 15.7. What the HELL is happening to me!? I've been crying most of the night because I can't do this any more. My DSN sent me away with nothing but told me to just test more. I'm not even eating enough carbs to be seeing levels like this.

    I am not on any meds that increase BG. Is this really just stress? I've even been working out more lately! This is getting ridiculous. Just 3 months ago I was having problems with hypos all the time and my ratios keep changing! I've tried changing vials and nothing happens.
     
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  2. Catsymoo

    Catsymoo Type 1 · Well-Known Member

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    Update: this morning I've gone from 15 to 7 really quickly and I'm scared all the novo is gonna hit me at once. I can feel it dropping really fast and I'm trying to keep up by chugging soda and eating jaffa cakes. What do I do?
     
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  3. Juicyj

    Juicyj Type 1 · Moderator
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    Hi @Catsymoo Big hug, I know this is causing you anxiety, unfortunately running high compounds those feelings of anxiety, right now just keep testing every 20 minutes until you can see that you have evened out on your novorapid. I don't know the timings of your last novorapid but if you have only come down this morning and your previous injection was longer than 4 hours ago then it should be out your system now ?

    In regards to your DSN, I am unsure if they understood the gravity of your situation, so I would suggest a call back first thing Monday, and as you have done above, explain to them exactly the impact of this in you.

    In regards to running high, you've changed insulin so that's ruled out, however a couple of other things, either your basal needs adjusting, which basal and when do you take it ? Could you be coming down with illness/infection, hormones so are you due on ? How much exercise are you doing and what type ?

    Take a big deep breath, you will work out what's going on, these events will have an explanation.
     
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  4. Catsymoo

    Catsymoo Type 1 · Well-Known Member

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    I'm so sorry for always freaking out. I used to have so much control and chill over diabetes. I called 111 and told them what I told you and they are useless! They said I had high blood sugar and I said no, I'm dropping too fast and I'm worried all the bolus was sitting in my body and hit me at once because I seemed to start dropping a few hours after i took the final correction dose! I said I dropped from 15 to 6 really fast and when i drank 70g sugar it didnt go up, they said "6 isn't hypo". The woman gave me a lecture about calling my GP on Monday and basically told me I was panicking over nothing. I asked her what if it keeps dropping and I can't eat fast enough and she just repeated about getting a routine appointment to adjust my doses.

    While she is right in the long term, that was not the reason for my call!
     
  5. Fairygodmother

    Fairygodmother Type 1 · Well-Known Member

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    Hi Catsymoo, has it stopped dropping yet? Be careful you don’t go into a seesaw situation with it.

    I seem to remember that you work shifts, which can really mess up control. Am I remembering right?

    Hugs, and hope today’s better than yesterday.
     
  6. Catsymoo

    Catsymoo Type 1 · Well-Known Member

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    It kept going up and down and now it's too high again but I feel terrible! I'm really shaky laying in bed and I actually feel slightly hypo and nauseous but I'm at 16.7 now! Grrr. I don't know if I should take some more insulin to make sure it doesn't go back up into the 20s?

    Fast drops feel worse than hypos in my opinion. I never know HOW low it's gonna drop. The lowest it went was 6.1 but I was shaking like CRAZY because it dropped so fast and so intense. I'm testing every 15 mins or so and I'm seeing a steady climb now. I feel so ill and tired.

    I've had a can of milk tea (20g), a can of cream soda (35g), that took me up to 11. But then it started to drop again and I still had the shakes so I ate some jaffa cakes (20g), a slice of bread and 3 digestives. I was scared all the bolus was just sitting there for hours and decided to absorb (can that happen??), I really didn't know what was going to happen, normally I just have about 30g and I'm fine after 10 mins. I have been feeling like this for 2 hours now. I'm assuming my body is in shock from the sugar swings and adrenaline?
     
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  7. Fairygodmother

    Fairygodmother Type 1 · Well-Known Member

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    Maybe, but if it keeps on like this perhaps 111 again and mention DKA?
     
  8. Celsus

    Celsus Type 1 · Well-Known Member

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    Hi @Catsymoo , I hear you - periods like that can be very very frustrating!

    Don't know your age, weight and normal insulin intake, so wont and cant offer specific advice. But you certainly have my sympathy as your subject header text was catching my attention as think most Type1s have experienced situations where we ask ourselves exactly that same question: "WTH, is my insulin no longer working or what is going on here???"

    And in your description above I can see a few things at play here, that all contribute to keeping you in that unfortunate bad catch22 situation.

    1. High blood sugars makes you less insulin sensitive
    When our bg is below 10-12 mmol/L we are typically the most insulin sensitive. E.g. 1 unit will drop my bg with 3.3mmol/L.
    When our bg gets in the 12-18 range, we become less insulin sensitive. E.g. 1 unit will drop my bg with 1.8 mmol/L.
    When our bg gets above 20 and up, we become even less insulin sensitive. E.g. 1 unit will drop my bg with less than 1 mmol/L.
    So like with your strawberry situation above, I would have had to bolus 3x the normal units if my bg was already up in the 20-range compared to if my bg was down below 10mmol/L.

    2. Stress increases our bg and can keep it high despite you inject insulin
    Bodily stress that impact our bg levels can be of various kinds: Emotional (aka anxiety, worry, or depression), physical, nutritional, chemical, etc. So stress can be triggered by many things like physical pain or illness. Or a personal situation like an accident, the death of a friend or relative or even confrontations with other people. And when we get stressed our adrenal glands release hormones in response to this stress to help us deal with it. These two hormones are pinephrine (adrenaline) and norepinephrine. The main purpose of norepinephrine is to keep your blood pressure up and have limited impact on our bg. The adrenaline however is an important bg regulating hormone! Its the same that helps with a liver dump if you go hypo. It is the hormone that catalyzes the conversion of glycagon into glucose, which you have stored in your muscles and in your liver.
    So even if you take some insulin to get your bg down, your stress will release more adrenalin to release more glucose as your body is in 'escape & run' mode and wants to keep your bg high.
    E.g. this last week I was out traveling with my job to support some critically ill patients through some high risk procedures with some new technologies being piloted. Non-stop stress, limited sleep, no appetite so didn't eat much, ... And still my bg went up into the 15-25 range. Very unusual for me! I kept taking my basal as always. And still just hardly eating anything but my bg just kept staying high and higher... So could pose the question: Is my bolus insulin no longer working? Had I exposed it to a too high temperature for too long, or what is wrong with it??? I switched to use one of my other bolus pens just to be on the safe side, but it didn't change anything with regards to getting my bg down. And it wasn't until I left the last hospital yesterday at noon, got into the plane to fly home that I could relax. I even felt hungry for the first time this week. :)And within next 6-8 hours or so my bg started coming down to be below 10 mmol/L.

    3. GERD is unfortunately a frequent companion to Diabetes Mellitus
    The GastroEsophageal Reflux Disease is a typical high risk complication of years with diabetes. Reason being that the gastroparesis is a type of neuropathy that affects the digestive tract and this increases the risk of GERD. With gastroparesis your stomach may be slower to empty as a result of nerve damage. And the longer term sustained pressure within your stomach subsequently cause your lower esophageal sphincter to relax. That then allows reflux of your stomach contents into the esophagus. I have had a few years in my past where I had this reflux syndrome. Very uncomfortable especially as it happened while laying down sleeping/going to sleep. And due to little sleep/stress etc it was mainly just acid coming up, giving me severe throat infections right away needing antibiotics every single time, as my throat and mouth mucous tissue and membranes got burned away non-stop. That unfortunately meant I had to be more serious about getting the sleep I truly needed and also having to give up the late night snack I had enjoyed since I was diagnosed. And to make matters even worse: No wine or chocolates after 10pm at night. Darn, I loooove dark chocolates...... But I no longer have the reflux, no sore throat infections non stop, no antibiotics non-stop.

    So I have just to ensure I enjoy all those small pleasures in life before 10pm at night, so my stomach has sufficient time to digest and empty before going to bed and laying horizontal. :)
    Most important for me has always been getting the basal right. When you have that set then the rest is all about matching the insulin to your food and bg levels. (easier said than done...)

    So yeah, its a crazy world and its not always easy being a diabetic. Keep the faith, never give up.
    There is always a way through the mess even though it can look pretty dark when in the middle of it. ;)
     
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    #8 Celsus, Apr 28, 2018 at 10:10 AM
    Last edited: Apr 28, 2018
  9. Catsymoo

    Catsymoo Type 1 · Well-Known Member

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    It's past my bed time now and I've hit 18.5 mmol so I've just bolused 2 units to try and stop it going into the 20s and making me feel worse. I don't want to take a full correction dose in case this situation repeats itself :( i don't know how long Novorapid can sit in your system for and quite frankly I'm starting to hate this bolus insulin. It's either too strong or does nothing.

    I know my Lantus is at the right dose (30 units around 6pm) because usually upon waking my sugars are OK. It's later in the day I have extreme highs the last couple of weeks. Lots of 18s and 19s, few 20s. :(
     
  10. Alison54321

    Alison54321 Type 1 · Well-Known Member

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    I've had this sort of thing happen to me a few times. I would try and nudge it down a little bit, or at least stabilise it. I always consider getting it to about 13 after one of these zigzag periods is good enough. It isn't great, but it's not the end of the world. Don't try to return it to the normal range, just at the moment. I reckon that's about 100g of carbs you've had there, so it might well rise a bit more.

    If that were me I might just try a walk round the local shops to burn it off, rather than insulin, have you got any nearby? It's amazing how many carbs you can burn just trying on a few clothes. Try to do something enjoyable, not stressful. But if you don't feel well enough to go out, then you might need a couple of units of insulin to keep it stable, at least.

    Try not to worry about it being too high, just try and reduce it gradually over the course of the day.
     
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  11. Catsymoo

    Catsymoo Type 1 · Well-Known Member

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    It went up to 20.3 and now it's 19 after i took 2 units. I am worried about DKA so I called the pharmacy and my BF is running out to get some keto urine sticks. I'm going to keep testing and bolusing 1 or 2 units every 2 to 3 hours if it doesn't go down at all. But if it's 19 now that's a good sign it won't climb any higher hopefully.

    I don't want to move about too much incase there's still bolus hanging around from last night that suddenly decides to absorb. I took a lot of big correction doses last night (7-8 units 3 times over 10 hours) and my BG wouldn't budge until this morning. I'm quite resistant to insulin so 8 units for me isn't a lot. I usually need 10-15 for meals that aren't particularly carb heavy.
     
  12. Celsus

    Celsus Type 1 · Well-Known Member

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    NovoRapid typically 'sit in your system' for 3-4 hours before no more effect is coming from it. Peak effect point is 40-60 mins after injection, so if measuring your bg approx. 2 hours after last injection you will have a good grip on what it meant to your bg level. (This is actually at this point the Libre sensor is of greatest help to me, as if trend curve still goes down I know I need a bit of sugar to avoid hypo or if I see trend arrow going up I know I need just 0.5 unit or so to avoid going too high after my last main meal). So not easy always to decipher if just getting the bg read at that single static point. But compare it to your pre-meal measure, how many carbs you ate, how many units you took and you should be able to be close.)
    But true, NovoRapid/Humalog and that type of very fast acting insulin can kick like a horse if getting it wrong!:wacky:

    And we all do from time to time...
    Most important is then not to overreact with over-indulging in gorgeous sugar rich treats of all kinds, which I confess I also do very often myself. Starting the bg rollercoaster ride...

    Just made me think of this great book on the subject:
    https://www.amazon.com/Stop-Rollercoaster-Charge-Sugars-Diabetes/dp/1884804829
    I know reading a book doesn't solve your problem, but its a great read and inspirational about how to better handle the subject of swinging bg levels.

    Have a good resting sleep ! :angelic:
     
    #12 Celsus, Apr 28, 2018 at 10:49 AM
    Last edited: Apr 28, 2018
  13. catapillar

    catapillar Type 1 · Well-Known Member

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    What was your blood sugar before the salad or the curry? Did you bolus and then eat or did you pre bolus?
    You know salad will have some carbs in it, right? Unless you're eating an air salad. Spinach has 4g per 100g, if you had dressings, radishes tomatoes corn they have carbs too.

    If you were high pre and didn't pre bolus it's no suprise diner rose you further. That doesn't suggest your insulin isn't working. It suggests your high made you insulin resistant and you digested the carbs in your meal before the insulin has a chance to start working.

    Are you carb counting? Half of what your boyfriend had of rice seems like a strange measure for working out your bolus.

    Have you actually basal tested? Walking up similar to what you went to bed at is great. But it doesn't mean your lantus is at the right dose. Lantus last about 16-18 hours, so if you're taking it at 6pm it could have run out by the time you eat your evening meal. You can get around this by increasing your IC ratio in the evening or splitting your lantus to take some am an some pm. But you really should basal test to find out what's going on with it.

    You've got hypo anxiety, but you're happy to stack your insulin? What's you're correction factor - how much does 1 unit lower your blood sugar? The default is to start with 1 unit lowers by 3. So if you have a blood sugar of 22 you want to get it back down to 7. 22 - 7 = 15. To drop 15 units if 1 unit lowers you by 3 mmol/l you need 5 units. You took 16units + more, how long did you wait between correction boluses? If your blood sugar is 22 its going to take a while before the insulin starts working. All that glucose it crowded round your cells (like a crowded bar) your insulin has to get to the cell and get into the cell before it can start working, to get there it's got to elbow it's way through crowds of glucose. Once it gets into the cells it starts working just the same.
     
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  14. Catsymoo

    Catsymoo Type 1 · Well-Known Member

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    You are coming across very rude. Just saying. I've had type 1 for a long time and I know to make a no carb salad. I've been having problems with Novorapid for a while now. My ratios keep changing dramatically and my readings are all over the place. I've just lost a relative to suicide and I have stomach problems with a gastroscopy coming up. So please don't fire 500 questions at me. I'm trying my hardest here.
     
  15. Catsymoo

    Catsymoo Type 1 · Well-Known Member

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    The good news is I don't have any ketones in my urine. Complete negative test. I know it's less accurate than blood testing but I think my strips got lost when I moved a few months ago, I can't find them anywhere.
     
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  16. catapillar

    catapillar Type 1 · Well-Known Member

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    Sorry if you think there was 500 questions. Or if you think it was rude. It certainly wasn't intended to be. I'm not sure how it was taken as rude, but I apologise.

    What are you putting in your salad that has no carbs? I'm sure some of the keto people would love the recipe.

    I hope you consider basal testing to see if that's playing any part in evening highs. Here's a good guide on how to basal test - https://mysugr.com/basal-rate-testing/ - the values are in mg/do so divide by 18 to get to mmol/l.
     
  17. Catsymoo

    Catsymoo Type 1 · Well-Known Member

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    It was the most boring salad you could imagine. Iceberg lettuce, chia seeds and fish. I ate like 4 strawberries and my sugar levels were around 9 before I had this.

    I need to highlight that I don't keep a normal schedule. My evening meal is usually around 8 to 9pm and I take my basal at 6. I usually stay up all night and sleep during the morning and day to about 3. My "evening meal" is more like my first meal. I only eat small meals or snacks after this. Think of it as a heavy breakfast and light lunch and dinner.

    My routine changes all the time for work demands but my DSN has assured me this will not make a difference as long as I take basal at the same time. I am very stressed lately with possible gastroparesis or hernia, and I stopped Metformin to help my stomach. But it seems some days 10 units of Novo gives me a hypo and other days its not enough and it can be same pre meal readings and same meal. I've started exercising more lately and eating a lot healthier and I feel great compared to the hell I've been through with my stomach but I can't seem to get my sugars in control.
     
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  18. Catsymoo

    Catsymoo Type 1 · Well-Known Member

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    I will add though I have barely any hypos now and used to have loads, now it seems my sugars are always too high as soon as I eat anything. Hypo anxiety is playing a part here for sure.
     
  19. Celsus

    Celsus Type 1 · Well-Known Member

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    Metformin?
    OK @Catsymoo , so are you actually a type2 diabetic and not a type1 as your online avatar says you are?
    That will certainly make some difference in how you best get in better control if you are one type and not the other.
     
    #19 Celsus, Apr 28, 2018 at 12:04 PM
    Last edited: Apr 29, 2018
  20. Catsymoo

    Catsymoo Type 1 · Well-Known Member

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    Type 1. :)
     
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