New to insulin injections, can you explain this confusing BG result?

I have been type 2 for 5 years and was put onto insulin last week as I was no longer able to control blood sugar through diet and Metformin alone.

I wonder if anyone can explain my latest blood readings please as I am baffled by it. And it is causing me great concern how I will be able to accurately control my sugars when I've had two results which are so inconsistent.

I had the exact same breakfast yesterday and today. A greek yogurt and single piece of toast which is 20g carbs total. (I gave up bread altogether as type 2, but my specialist explicitly encouraged me to eat some toast and potatoes etc. and to just bolus for it.) I'm on a regimen of 6 basal units before bed, and novorapid 1 unit per 10g carbs.

These were my results.

Yesterday. 2 ui. before eating, 7.2. 1 hour: 8.9. 2 hours: 7.8.

Today. 3 ui. before eating, 6.3. 1 hour: 6.6. 2 hours: 10.2

I tested my blood again straight away in case it was a rogue result, and got a 9.9. So the high result is accurate. But why?!

Of course, I can't just conclude I need to bolus more beforehand, because if everything had behaved like it did yesterday, it could have ended up too low. I already took more insulin than yesterday, as it was still too high after 2 hours yesterday anyway. But even that wasn't enough. So I really don't get it.

karen8967 said:

hi dave im a type1 but i find when i have toast i tend to spike around the 1-2 hour mark but i am always back in range by the 4 hour mark .how are your ranges after 4 hours

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I only have one day of data for that as yesterday was the first time I've had toast for years, and also I took more insulin in-between the four hours which would have skewed the results, but it was 8.5 after 3 hours and 6.7 after 5 hours.

If I always got a sharp rise after 2 hours of eating toast then that's one thing, but why do it today but not yesterday? That's what concerns me because it's so weirdly inconsistent to what I've seen before in 5 years of testing. Such a sharp rise between the 1 hour and 2 hours! Crazy (for me).

There are many things which can affect our BG: food, alcohol. exercise, stress, medication, time of day, month, year, weather, illness, how well you slept, anything on your fingers, ...

For this reason, I look for repeatable trends rather than one odd number.

Juicyj said:

Hello @Dave P

I eat the same breakfast every day and get different results too, exercise, stress, digestion speed, fat eaten, there's a number of reasons why there is a difference from day to day, it's the joys of insulin.

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So you reckon I shouldn't be concerned? This is normal?

It was all going so well at first... everything made sense and correlated with what I was doing, and now this today has left me scratching my head.

I know the odd high number isn't the end of the world but I had very good control for most of my time as T2 and I am determined to get as close to that as possible. Seems I may need to slightly lower my expectations then if results can be THIS unpredictable I guess!

karen8967 said:

sometimes i can go from bgs being inthe 5s to 18s after 2 rounds of toast and other times i hardly rise at all but if i have toast at lunch or tea time it doesnt hardly rise me at all only breakfast so i tend to have 4 ryvita and cheese for breakfast and i have a lovely flat line .i am also on metformin due to being very insulin sensitve/resistant .

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I see. I am still on Metformin for now, though my specialist reckons I won't need to keep taking it. I am slim (skinny even) and he sees this as definite proof I cannot be insulin resistant, but AFAIK he is mistaken, ie. skinny people can still be resistant. I hope he's right, but I will keep taking Metformin while they keep letting me have it I think.

Scott-C said:

Hi, @Dave P , along with the other variables mentioned in earlier posts, after you inject insulin, it goes on a long journey round the body before getting to work, and during the course of that journey, some of it can get destroyed. So 2u one day will not necessarily have the same effect as 2u the next day.

Cgm, continuous glucose monitoring, is slowly becoming more common. Those of us using it can see when a dose is not quite working to plan and can take an additional corrective dose to fix it.

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CGM would be invaluable for sure. I was wondering whether I should have injected again as soon as I saw the 10 figure, but I didn't because I'm assuming (?) it isn't a good idea to be playing catch-up with what the meter says. As I'm a novice to all this, for all I knew the number could soon have dropped sharply on its own, and if I'd injected more I'd have caused a hypo. I am mindful of being extra careful to minimise these (haven't had one ever, yet, but I know they are inevitable) especially as I live alone so I need to be able to deal with it myself.

Just tested again... 6.4. So there's the sharp drop! Quite a rollercoaster. Panic over then I think

Dave P said:

but AFAIK he is mistaken

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He is definitely mistaken. It is factually incorrect to state that slim people cannot be insulin resistant. In fact, in some respects they are more likely to become insulin resistant since they may not have the buffer of adequate adipose tissue into which the converted glucose can be stored.

Jim Lahey said:

He is definitely mistaken. It is factually incorrect to state that slim people cannot be insulin resistant. In fact, in some respects they are more likely to become insulin resistant since they may not have the buffer of adequate adipose tissue into which the converted glucose can be stored.

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I thought so, but thought it better not to be contradicting the 'expert'!

He also strongly advised me to take statins (which I have always declined and will continue to do). He said I am at high risk due to my cholesterol levels. Though my cholesterol ratio is only 3.28 which is supposed to be healthy. He also told me to re-use needles several times and put the cap back on each time, which contradicts the manufacturer instructions completely, but maybe this is NHS practice, who knows.

slip said:

Typical insulin dependent diabetic scenario you have there - no 2 days are the same! glad your levels have bottomed out so to speak.

Has anyone mentioned LADA to you?

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Thanks and yes my GP mentioned that to me when she referred me to the diabetes clinic. It's early days at the moment for them to decide exactly what the score is, and even whether I need to continue on insulin injections permanently, but early indications are that this will be the case. I'm just delighted the insulin is working because for most of the last month I've been stuck at double figures or high single figures. On insulin I got down to 5.1 before bed last night which is a great relief. I look forward to lots more testing and fine tuning of insulin dosage and timing, to really take back control, so to speak.

Jim Lahey said:

He is definitely mistaken. It is factually incorrect to state that slim people cannot be insulin resistant. In fact, in some respects they are more likely to become insulin resistant since they may not have the buffer of adequate adipose tissue into which the converted glucose can be stored.

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That’s very interesting although not something I had read previously.
Do you have any further reference material I can read on this topic?
Do you know if exercise makes a difference?