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Puzzled and out of control

C

ChasM

Newbie
Messages
2
Type of diabetes
Type 1
Treatment type
Insulin
I have been Type 1 for 44 years, am fortunate not to be suffering any long term effects and am generally well controlled (last HbA1c 52 mmol/mol). I use Lantus (12 units taken early evening) and Humalog (1.5 units per 10g carb - carb counting has always been part of my regime).

At the beginning of this month I started experiencing high readings - mainly in the 20s. I've tried corrective doses and more vigorous exercise (usually in the morning - regular walks are part of my lifestyle) but these have no immediate effect although on several evenings my blood sugar has dropped to lower levels a couple of times near hypo level (7 out of 17 days). At the outset of this episode I was experiencing a runny nose (can hardly be called a cold as my temperature was normal) but this cleared up a couple of weeks ago. I'm not suffering any other symptoms, a fresh batch of Humalog has been used during the episode so I have no clue as to what's wrong.

Has anyone any ideas please?
 
Hi Chas and welcome to the forum. It sounds like your basal requirement may have changed from where it was before (which can happen) or you are seeing inconsistent absorption of Lantus (which can also be a problem).

Have you undertaken any kind of basal testing to try and check that that is okay?
 
ChasM said:
I have been Type 1 for 44 years, am fortunate not to be suffering any long term effects and am generally well controlled (last HbA1c 52 mmol/mol). I use Lantus (12 units taken early evening) and Humalog (1.5 units per 10g carb - carb counting has always been part of my regime).

At the beginning of this month I started experiencing high readings - mainly in the 20s. I've tried corrective doses and more vigorous exercise (usually in the morning - regular walks are part of my lifestyle) but these have no immediate effect although on several evenings my blood sugar has dropped to lower levels a couple of times near hypo level (7 out of 17 days). At the outset of this episode I was experiencing a runny nose (can hardly be called a cold as my temperature was normal) but this cleared up a couple of weeks ago. I'm not suffering any other symptoms, a fresh batch of Humalog has been used during the episode so I have no clue as to what's wrong.

Has anyone any ideas please?
Click to expand...
Have you checked the physical condition of your Lantus cartridge? Do you change the needle every time you inject? I ask because I had this happen - my bloods rising gradually over a week to a month - until it looked like I wasn't using a basal insulin at all, and I found a few things. Once, as I injected the Lantus, I actually felt it run over my hand. The cartridge leaked. I look back and think the needle must have been blocked. That time my problem lasted a few days and I was visiting a hot country and running out of needles). Another time, the same thing kept happening but over a month - I got a new box of pens. Immediate solution. The other thing that happens with Lantus is that the last 10% of the cartridge is something like 25% less effective than when you first "breach" it (or vice versa - sorry that's a huge difference but I stopped using it and can't remember). I found this out years ago, by googling, when I observed that, but found it hard to believe. After that I always kept my Lantus in the fridge, and tossed the pen when it was near the end and I was observing my bloods rising. This problem will be particularly acute for people on low doses (I was on 16 units Lantus a day) because that last bit in the cartridge will last longer. I mentioned this to a friend of mine who is a midwife dealing with pregnant diabetics, she went away, and came back a week later and confirmed it. I also mentioned it to my endo, before I changed to the pump, and he confirmed it too.
 
Is your Lantus ok and as @tim2000s has asked have you checked your basal?
 
Thank you all - something to work with. I'll put in fresh Lantus and do some basal checks (never heard of this before!) but the ratio of basal to bolus is relatively low (12 to approx 28) so I would expect extra bolus should correct any basal shortfall.
 
Hi,
The needle cap takes exactly 20 units up in the tip to where iy starts to flute out..? A quick check to see if the delivery from the pen is accurate is fire a 20 unit dose into the opaque cap.. Hope this helps narrow down your issue...?!!
 
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