random highs - has my pancreas finally given up?

[stardust92]

Good afternoon everyone,

I would really appreciate some advice from 'experienced' type 1s who have had the same problem as me!

I was diagnosed with Type 1 in February, since then my blood glucose control has generally been very good. Just recently I have been experiencing random post-meal highs, usually in the afternoon, although at other times my BG readings have been spot on.

I saw my diabetes nurse yesterday who put it down to me not changing the lancet on my pricker often enough and to use a fresh one for every reading. However this morning another random high of 10.3 after just 2 pieces of toast (woke to a 7.6, took my usual 3 units of Novorapid).

I have been told I have extremely high levels of the antibodies attacking my pancreas - is it possible this just means the honeymoon period is over, and I should up my Novorapid doses..?

Many thanks for your suggestions!

Ruth

 

[Type1Bri]

Hi Ruth
Firstly your nurse is just saying that to get you to change your lancet more often, mine tryst the same trick!! Having said that it is important you have clean hands before testing though
Before upping any doses do check with your dsn. If 4 hours ish after eating your bloods are back in range then I would say your doses are about right. If they are still really high after 4 hours then possibly they need reviewing.
Personally I would look at the timings of your injections, how long before food do you inject?


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[stardust92]

Hi thank you for your reply!
I always inject either just before or straight after eating - literally a minute or so either way.
My blood sugars usually go high then sort of plummet and are always back in the normal range 4 hours later. If I try a correctional dose, even just 1 unit, I have a hypo, so I don't do correctional doses any more.
I havent been doing anything differently which is why I'm so confused!

Thanks again

Ruth

 

[Juicyj]

Hi Ruth, to be honest if you're taking the right carb/ratio insulin dose then your BG levels will come back down to normal say 3-4 hours later, I tend to find carbs spike my BG levels, so if I eat bread then i will go high 2 hours later then back down to normal, which is fine if you want to eat carbs. DAFNE instructions are to only test before upon waking, before eating, before driving/exercise etc then before bed, they don't recommend testing after eating as the temptation to correct is high, which would of course then cause a hypo. What's important here is that your levels do come back down, if they stay high 3-4 hours later then either your carb ratio is wrong or your basal need adjusting, so it's not something I personally would worry about

 

[Type1Bri]

What you are doing is not the wrong thing to do. It is wise to avoid corrections if they always cause you to hypo
I personally always inject 10 to 20 minutes before eating and that avoids my spikes. Please speak with your Dsn before making any changes, what works for me might not work for you.

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[azure]

Hi thank you for your reply!
I always inject either just before or straight after eating - literally a minute or so either way.
My blood sugars usually go high then sort of plummet and are always back in the normal range 4 hours later. If I try a correctional dose, even just 1 unit, I have a hypo, so I don't do correctional doses any more.
I havent been doing anything differently which is why I'm so confused!

Thanks again

Ruth

If it was me, I'd try moving your bolus more in advance of your meal. Move it very cautiously and test lots. I found that having my bolus more in advance stopped my spikes : )

Even when I was first diagnosed I never injected after eating. Injected insulin takes a while to get working (unlike your own natural insulin) so if you inject after the meal or too close to it, then the carbs can put your blood sugar up because the injected insulin hasn't had a chance to get working.

Edited to add that you even find you can reduce your bolus slightly as the insulin will be more closely matched to your food absorption.

I also wonder whether you'd find a half unit pen useful or do you have one already?

 

[stardust92]

Hello,

No I do not have a half unit pen but have been informed I can request one at the next appointment with my consultant.

Injecting prior to meals sounds like a good thing to try, how long before eating do you suggest injecting?

Plus on a slightly random note - do you find different injection sites have different absorption rates?

Many thanks

Ruth

 

[azure]

Hello,

No I do not have a half unit pen but have been informed I can request one at the next appointment with my consultant.

Injecting prior to meals sounds like a good thing to try, how long before eating do you suggest injecting?

Plus on a slightly random note - do you find different injection sites have different absorption rates?

Many thanks

Ruth

Of course, if you're in any doubt you should always check with your DSN and also understand we're all different, but many people here find 15-20mins in advance works. I'm guessing you're on an analogue insulin? When I was on an analogue, I initially injected 5 mins in advance, which worked ok for my evening meal, but for other meals I had to move my bolus further in advance. It would be wise to start, say, 5 mins in advance and proceed very cautiously. Test lots and keep records so you can see what works for you.

Yes, different body areas can have different absorption rates, and if you find this is an issue for you, you should also bear that in mind eg if you find your tummy is superfast, then you may not need to inject too much in advance if you use that for a bolus. Your own experience will inform your choices : )

You could also pick a 'problem meal' and eat it (exactly the same amounts) a few days in a row until you find what bolus amount and timing works best. That's what I did for my cereal breakfast and I'm very pleased with the result.

Do get a half unit pen - it's far more flexible for both boluses and corrections.

 

[Diamattic]

Hi thank you for your reply!
I always inject either just before or straight after eating - literally a minute or so either way.
My blood sugars usually go high then sort of plummet and are always back in the normal range 4 hours later. If I try a correctional dose, even just 1 unit, I have a hypo, so I don't do correctional doses any more.
I havent been doing anything differently which is why I'm so confused!

Thanks again

Ruth

I think this is the problem here - along with your pancreas throwing in the towel lol

When you are first diagnosed and in your honeymoon period you pancreas can still put out some insulin to help out when it can, which could be the reason why you didn't have post meal spikes.

Post meal spikes are normal if you aren't injecting before eating. I find i have to inject at least 15-25 minutes before i take my first bite of my sugars spike up a lot. They always go back down but its just not healthy, and should be avoided whenever possible.

I usually figure out what i want to eat, inject for it, set a timer on my phone and prepare my meal, and then when the timer goes off i sit down to start eating. The only time i don't do this is when I know i will be active and that will counter my spike (this is usually when I am doing field work)