Persistently high (30+) blood sugar not responding to insulin

[EllsKBells]

Hi

The last three or four days, in the late afternoon my blood sugar has been shooting up into the mid to high 30s, and refusing to come down again. For example, at 8.30 this evening it was 31.9. 6 hours and 34 units of insulin later ...29.9. I suppose I should be grateful it’s actually gone below 30. The mystery continued because it’s been fine on waking (6.4 today, 6.5 yesterday). I’ve changed both insulin cartridges, and needles. Neither has helped. On the urine strips, ketones are reading as ‘faible ‘ (?sp). Unsurprisingly, I feel like death.

Any advice on what to do next? I don’t have a DSN to contact, and my GP is...an idiot who is “scared” of insulin. It’s getting difficult to do my job, I can’t sleep because of constant toilet visits, and I’m scared to eat.

Help!

 

[EllieM]

More things to check
1) Are you sure your blood testing strips are in date? I take it you're repeated the test and it's still high?
2) You aren't overusing your injection sites?
3) Has what you're eating for lunch changed? Could you be drastically underestimating your carb intake? (eg the diet coke in the fridge is actually full carb coke...)

I don’t have a DSN to contact, and my GP is...an idiot who is “scared” of insulin.

You need to be referred to a clinic then. Maybe try phoning 111 for now to get help? (I assume you're in the UK).

I must admit I am puzzled as to how it's going down to normal overnight and then shooting up high in pm. Could your insulin to carbs ratio have drastically changed?

 

[kitedoc]

As a T1D, not as professional advice or opinion:
Go to an A&E. asap. You are in danger, Do not delay !!
As you say you have no reliable health professional support in the community.
Whilst at hospital please set up visits with a hospital or clinic doctor and DSN/ - never be without appropriate support again!
And find a braver GP!! Something better done maybe a year ago but do this asap too.
Good luck and please hurry!!

 

[DCUKMod]

Hi

The last three or four days, in the late afternoon my blood sugar has been shooting up into the mid to high 30s, and refusing to come down again. For example, at 8.30 this evening it was 31.9. 6 hours and 34 units of insulin later ...29.9. I suppose I should be grateful it’s actually gone below 30. The mystery continued because it’s been fine on waking (6.4 today, 6.5 yesterday). I’ve changed both insulin cartridges, and needles. Neither has helped. On the urine strips, ketones are reading as ‘faible ‘ (?sp). Unsurprisingly, I feel like death.

Any advice on what to do next? I don’t have a DSN to contact, and my GP is...an idiot who is “scared” of insulin. It’s getting difficult to do my job, I can’t sleep because of constant toilet visits, and I’m scared to eat.

Help!

EllsKBells - In your shoes, I would be picking up the phone to call my local diabetes centre. I cannot imagine calling a diabetes centre and describing your symptoms they'll just tell you to make a routine GP appointment.

If you feel that isn't for you ask your GP to contavt the clinic for advice, as well as getting yourself referred. I would think you need to talk to someone urgently about this if it recurs each day.

As EllieM suggests, are your afternoon injection sites becoming inefficient?

 

[kitedoc]

Please @EllsKBells, you need help.
We cannot see you or assess you nor have the professional skills to diagnose and treat you.
At the moment the people who can do that are in the nearest hospital.
With your ketones and BSLs high you are already ill and this can become very much worse..
It is not the time to be debating doses etc, it is time for hospital where you can be properly assessed and treated.

 

[jackois]

Kitedoc's advice is the one I'd go for.

With those numbers I'd be straight down to A and E.

Also, as they say, whilst at A and E talk to the consultant about finding better support than your GP.

 

[Brunneria]

Hi @EllsKBells

I would agree with everyone above that you definitely need to get some proper advice from someone who isn’t ‘scared’ of insulin!

However, I would suggest that since you are seeing a pattern to these bg rises, that you time your visit to A&E (assuming you are in the UK) to when your numbers will be highest. That way your situation will be taken more seriously. If you turned up in the morning, with normal numbers they will just refer you back to your GP.

I know that decision making isn’t easy with high bg and possible ketones, so I suggest you set out a plan of action, and then act on it. Do you have anyone who can drive you to A&E and stay with you? If not, a call to 999 or 111 will ensure you are properly assessed.

Please let us know how it goes.

(Edited to replace ‘ketosis’ with ‘ketones’. Dratted autocorrect!)

 

[EllsKBells]

Hi everyone,

Thanks for your advice - it's kind of reaffirmed what I already thought, but really didn't want to go if it was just going to be wasting their time.

If (when) the pattern repeats itself this evening, I will give 111 a call. My injection sites are fine (mega paranoid about rotating them properly so I have a little diagram). I have the same lunch every day, and about 4 dinners that I rotate through, neither of which have changed. None of my other medications have changed. So it's a puzzle!

 

[hh1]

Hi everyone,

Thanks for your advice - it's kind of reaffirmed what I already thought, but really didn't want to go if it was just going to be wasting their time.

If (when) the pattern repeats itself this evening, I will give 111 a call. My injection sites are fine (mega paranoid about rotating them properly so I have a little diagram). I have the same lunch every day, and about 4 dinners that I rotate through, neither of which have changed. None of my other medications have changed. So it's a puzzle!

@EllsKBells I didn't realise I had lipohypertrophy because I too rotated my sites regularly and had a lot of sites to rotate. However, after 30+ years one area has simply had enough. Nevertheless, that didn't result in the kind of sudden and extreme rise you describe, though as we're all different, that may happen with some people I guess. Is there anything at all different happening after lunch recently? Do you use the same pen for all your bolus injections? I also agree with the advice to seek medical advice about this, it's way too high to let this run on. Best wishes with getting it sorted and do let us know how it goes.

 

[Bluey1]

Check your insulin. I had a similar problem and I discovered that a pen of insulin was way out of date (not that I realised it at the time) and had some how hidden for years and then snuck into my “good” supply. I have also accidentally cooked half a pen (not hard in summer in Australia) 43C in Melbourne on Friday. A car can be well over 50C when in the sun for over 30min. I may as well have been injecting glucose.

 

[DunePlodder]

Like @Chowie I think it's an insulin problem.
I would try insulin (basal & bolus) from new boxes, not just new cartridges.
With readings like that though you should certainly be contacting your GP/hospital DSN if not A&E.
I hope you can gert this sorted out very quickly, you must be feeling pretty awful.

 

[O_DP_T1]

sounds like a dodgy pen issue.

 

[satindoll]

@EllsKBells ,
Hope you are feeling better, as a follow on to O_DP_T1's post when was the last time you checked your pens are giving the correct doses, I had a similar situation happen a while back and now make it a part of my routine at every cartridge change to check my pens are giving me the right amount, a small dose shortage can make such a big difference to our levels.

 

[Deleted Account]

@Ellsbells as your BG is returning to normal over night, it suggests to me to be a problem with your Basal insulin as your Bolus seems to be working to bring your BG down (Basal maintains your BG).
I agree with comments about checking your pens. I was advised from the start to make sure I had spare pens as these can fail and, as suggested, not give the correct dose. If you have spare pens, it is worthwhile changing them.

 

[therower]

@EllsKBells . Sorry to hear you’re frustrated and struggling at the moment.
Not sure if you are aware but you can check if your pen is dispensing the correct dosage.
1 . Prep pen with needle as normal.
2 . Do a 4 unit air shot.
3. Replace the needle cap.
4. Dial up 20 units and holding pen pointing downwards inject the 20 units into the needle cap.
5. The 20 units should fill the cap upto and level with the 4 fluted fins on the outside of the cap. See attached photo.
Hope this is useful.

 

[EllsKBells]

Hi everyone! The mystery is solved.

When I was having more injections at 3 am, I realised I could smell the insulin really, really strongly - lo and behold, there was a crack in the humalog cartridge. There was also a crack in the first cartridge, which I changed, assuming it would fix it. This is across two different boxes, the second of which I have only had for a few days. Needless to say, I will be filling out a yellow card.

Basically, beware! Possible fragile/broken humalog cartridges in circulation - I need to check the batch numbers!

Thank you so much for all of your support - I was at my wit's end yesterday.

 

[kitedoc]

Hi everyone! The mystery is solved.

When I was having more injections at 3 am, I realised I could smell the insulin really, really strongly - lo and behold, there was a crack in the humalog cartridge. There was also a crack in the first cartridge, which I changed, assuming it would fix it. This is across two different boxes, the second of which I have only had for a few days. Needless to say, I will be filling out a yellow card.

Basically, beware! Possible fragile/broken humalog cartridges in circulation - I need to check the batch numbers!

Thank you so much for all of your support - I was at my wit's end yesterday.

So glad @EllsKBells, so I assume the leak led to inadvertent under-dosing. Another one to add to the list of cause and effect. Well done. Things were getting quite worrying for a while. Please still find a braver GP, and a DSN though !!