My insulin is not working.

60g of iceberg lettuce - 2g carbs
60g chia seeds - 25g carbs
1 can of tuna - no carbs
4 strawberries - 2g carbs

So say 30g carbs. You took 5units. So does a 1:6 ratio sound about right? Is that what you're aiming for or is that a ratio you've discounted by previous experience?

Poor sleep can impact on your insulin sensitivity. So I'm not sure your DSN is entirely correct to say erratic working patterns won't make a difference. If you're working the night shift (and you've got blackout blinds) you could find you're having dawn phenomenon to wake you up when you get up in the evening. Again, basal testing could help you determine that. Or you might find you need an increased I:C ratio in the evening.

When you say that your ratios keep changing dramatically, is there any correlation to your menstrual cycle? I know I get more insulin resistant when ovulating and the week before my period and drop like a stone the second I come on. I started using an app called natural cycles which require daily temperature and infrequent ovulation tests to track exactly where I am in my menstrual cycle, because I have irregular periods. I found it helped a lot.

Catsymoo said:

Up to 24.8 now.. at what point do I start to panic and go to the emergency room?

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Its actually not a number. Its all about how you feel!
Some diabetics walk around in the upper twenties and still feeling great and hardly any symptoms.
(we were actually many diabetics in last century who lived up in that range for tens of years. Not good, but we did...)
Others will start to feel dizzy and get nausea etc. up in that range these days if used to being very low range bg.

You already shared with us the great news that you have no ketones in your urine, so definitely not any emergency situation as it is. As it shows that your body is still metabolizing carbs and have free insulin to support it. But its important that you keep drinking plain water to help your body/kidneys to rinsing out the excess bg as much as possible. As also your body increases urine level for that same reason and your blood plasma therefor needs extra suppirt to keep volume up (and acidity down) And then keeping your routine up to check your bg every 2-3 hours and bolus adequately to get your bg down to a more reasonable level.

You also shared with us that you take approximately 30 units of Lantus per day. So your daily rate of bolus is probably also up in the 30-40 units range. The small number of units you take for correction (2-4 units) does therefor indicate to me that it is way too low to have much/any impact at all. I would even myself (being like 3 times more insulin sensitive than you) have taken more units to correct being up in the 20-25 mmol/L range.

You see it works like if you are up in the 20+ range, then even taking your 'normal dose' for a main meal will further increase your bg level to be even higher, as you are less insulin sensitive when up there. Its like you need to get above that threshold to help it get back down again. But then the trick is to observe when it starts ramping down, as then your insulin sensitive goes back up to normal again. But to kick off that ramping down, I would myself need to take probably 8 units or so of bolus if I was up in the 20-25 range. And please notice I only take 11 units of bolus in total for my 3 main meals during a full day when in normal range. And I eat 'normal full fat carb meals'. Like 120-140g per day.

If I were you I would also throw out my current basal insulin pen and take a fresh out of the fridge, to make 100% sure my basal is there doing its job in the background as intended.

Can you just clarify how long it is since:
1. Last bolus
2. Last correction
3. Last food

Amazing thread in so many ways.

Catsymoo said:

Just an update I think the ordeal is over. I managed to sleep in the afternoon and I'm down to 11 now. I feel much better but still really rough and have no appetite. I ate a couple of seafood sticks just to get something inside me and going back to bed to hopefully sleep more and let my basal do the rest of the work.

Thank you to the majority of you for helping and being supportive.. I couldn't have calmed down and got through this without kind reassuring messages especially from you @Celsus

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Fantastic news @Catsymoo - So happy to hear that you are feeling better - Well done!
Thank you also for having accepted my private messaging on subject, as found it obvious you needed a little extra care and attention to support you through that tough situation. Life is already complicated as it is as any adult person can confirm. But on top of this we have to deal with the diabetes monster 24/7. And as a Type1 despite all the kind support from relatives, friends, healthcare professionals etc, then you are often very much alone in some of the most critical situations. Its you in your malfunctioning body, its you who ultimately decide if you should take more bolus or not and if so how much. It is you who go too high or drop into a hypo abyss. And its only you who knows how you feel when going through all that.
Despite all the modern diabetes gadgets, diets, research, choice of insulins, etc then we are still walking on a knife edge to keep that bg within healthy range. We are only humans and we all from time to time drop off that point of ultimate control.
Don't blame us; we are already penalized.

Celsus said:

The GastroEsophageal Reflux Disease is a typical high risk complication of years with diabetes.

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...and another one for the list.

Truly is there anything that can go wrong with a human being that is not a likely side effect of diabetes?

Glad yesterday’s over for you Catsymoo, but please don’t hesitate to move a little more slowly at work, if you can. Your body’s taken a bit of a battering.

Naughty insulin! Maybe change it

Celsus said:

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.

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hi celsus im type 1 and take metformin of a morning with my insulin and at tea time due to insulin sensitivity/resistance not sure which one but in definately type 1

Maybe you have a ‘bug’ @Catsymoo?

Celsus said:

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.

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Some type 1's use metformin in addition to insulin. Please dont assume on the mention of metformin and obvious bolus/basal regime that OP is a T2...

Hi @Catsymoo unfortunately you are having to deal with a huge amount of stress on top of your type 1, this will have a negative impact on your control as stress hormones will increase insulin resistance. I think you doing everything you can and are still finding that the negative impact of the stress in your life is making control difficult.

Firstly just try and take it easy, so one day at a time, your boss needs to understand what stress you are under and make reasonable allowances for you. Call up your DSN first thing explain what's going on, you need a day to day game plan to help minimise the stress and impact of your control on your mental health, things will get better but the yo yo effect of high/normal bg control will only get better once you get some support and a plan on how to deal with this, ask for a CGM or to loan a Libre, something to help you see patterns and speed/direction of your bg levels, running high isn't healthy for you mentally as it will impact on your anxiety levels so a Libre would be ideal to help you see a better picture of your carb/bolus effect, you all need to gain confidence in maintaining regular 'normal' levels too as your hypo anxiety will be helped hugely by using the Libre, you have a good case to get one from your trust so try this route with your DSN.

Catsymoo said:

I don't think so. I noticed when my sugars are out of whack my stomach problems tend to arise and I don't eat properly. I came back home after I left the house, really wasn't feeling well enough. I got a passive aggressive email from my shall we say less than understanding boss and I sent him a really long and boring email about diabetes and the dangers and effects of blood sugars in the 20s and swings of up and down. I think it's stress causing this because this year has been so harsh on me so far. Struggling to make ends meet, and losing a relative to suicide is horrible, I've been through it before when I was a teenager. My uncle went missing in January and they found him last week. He's left a giant financial mess and now me and mum have to sort everything including his insensitive landlord trying to sue for 3K when we did an inventory and the damages were 400 max! Plus I have been to about 500 doctors in the last few months with my tummy, trying different drugs. I have a gastroscopy next month and I'm terrified. Depression and anxiety is settling in and I'm just a bit of a mess at the moment. I want my life back. x

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Ok... sorry to hear you ate on a roller coaster at the moment..

Have you got an accuchek aviva expert for a meter?

I personally have lots of stomach and colon issues and they an cause problems with bloods.

Now, honestly, you need to really sit down and map out each days bloods, food, stress, and even bowel habits and meds. And the insulin taken.
I had chronic stomach & bowel problems and also diagnosed with 1st lot of breast cancer... but it is hugely important that you spare time each day to record things off your meter and to see whether your food or insulin is taking a longer period to work but to also gain evidence to prove it.

Also, for me, I dont do more corrections within a 4 hour period from first correction.
When I was above 12, I always had to double my correction up. Are you adding more bolus to your first correction when you are heading upwards.

How soon after you eat have you started to go high?

I really would recommend basal testing for days when working and days when off, and starting back at basics again.
Honestly believe me, I've had to start at basics with everything time and time again and I've been T1 for far too many decades!

This is a copy of my logs that I used to do every day. It allowed me to see and compare etc especially during my first operation and radiotgerapy and when I was on horrendous painkillers.
It kept me in control as my colon literally stopped working and was absolutely dire.

I even had to weigh myself and record as this sheet shows it took ayear for put to put on 12lb as I was so limited on food.

In the end it took me to ask for change of insulins and to sork out which insulin I could take as a background one. Still on novorapid though.

Please see if you can take a short while each day tocare for yourself, it sounds as if you've got heaps of pressure and anxiety...but giving yourself time out each day to record
and assess your own health is vital.