Sudden uncontrollable blood sugars, please help !!

[CoolUserName]

Hi,

I've posted here a few times in the past about my son who was diagnosed with T1D about 3 years ago. He is at university now and is generally sensible and very engaged with managing his T1D. I'm very proud of him and how he's coped since diagnosis.

Unfortunately, over the last month his BS seems to be uncontrollable no matter what he does. He has:

* Changed both bolus and basal insulins cartridges
* Increased both basal and bolus carb ratios by quite a lot
* Not been unwell
* Is not taking less exercise
* Pens all seem to be working properly
* He rotates injection sites

He has got it to a stage where he is stable again at night, so presumably his bolus is okay.

He says it's as if he's become insulin resistant and it's really worrying him and me. For example at 12.30 today he took 8 units, waited 20 minutes and ate lunch. His BS went up to 18mmols gradually over the next 3 hours despite also taking 2 correction doses of 2 units each. At no point did it go down, it just kept going up (he uses a CGM).

He said it's as if his insulin has stopped working. It is coming down now, but I suspect because he has gone out for a walk.

Does anyone have any advice please as we're both running out of ideas?

 

[KennyA]

Hi - as a T2 non-insulin user there's not much I can help with personally - but tagging a few helpful T1 folks:

@EllieM @Antje77 @Jaylee @In Response

 

[Rokaab]

He said it's as if his insulin has stopped working. It is coming down now, but I suspect because he has gone out for a walk.

Just as a query - the insulin he's using could it possibly have not been stored properly in a fridge and either frozen (in the fridge), or just run past its 30-days of non-fridgerated time.
ie has he ordered and tried completely new insulin rather than stocks he's had for a bit

 

[CoolUserName]

Just as a query - the insulin he's using could it possibly have not been stored properly in a fridge and either frozen (in the fridge), or just run past its 30-days of non-fridgerated time.
ie has he ordered and tried completely new insulin rather than stocks he's had for a bit

Hi, thanks for your reply. He has tried a new cartridge AND when that didn't seem to help a new order of insulin.
He stores his insulin in his fridge so I'm pretty sure it won't have been frozen.

He went out for a walk which helped reduce his BS but as soon as he got back it's started climbing again. He's had so much insulin for only a sandwich almost 5 hours ago !!

 

[Antje77]

I've posted here a few times in the past about my son who was diagnosed with T1D about 3 years ago. He is at university now

The honeymoon phase, where you still produce enough insulin to make a difference can last longer than 3 years. I'm 7 years in, and it's only for the past 2 years or so that my insulin needs have stayed relatively stable.

If he's in university, I'm guessing young adult, so puberty hormones, or those hormones starting to settle may make a big difference as well.

The amount of insulin we need throughout our lives is by no means static, we need to keep adjusting.

For example at 12.30 today he took 8 units, waited 20 minutes and ate lunch. His BS went up to 18mmols gradually over the next 3 hours despite also taking 2 correction doses of 2 units each.

Does he carb count and use an insulin to carbs ratio?
If so, it looks like either he miscalculated the carbs in his meal, or he needs to tweak his ratio.
It might be worth for him to keep a food/insulin/BG diary for a while to see what the patterns are, to help him and his diabetes nurse work out his current ratios.

Good luck!

 

[Antje77]

over the last month his BS seems to be uncontrollable

He's had so much insulin for only a sandwich almost 5 hours ago

If the sandwich of today is a one off, unlike it was the rest of the month, it could just be one of those days, or a forgotten basal dose, or he could be coming down with something. Or possibly a bought drink that was full sugar instead of diet?
I think it makes more sense to look at what has been happening over the past month than just today.

If he has been in the high teens all afternoon, he might want to check for ketones if he doesn't drop soon.

 

[CoolUserName]

The honeymoon phase, where you still produce enough insulin to make a difference can last longer than 3 years. I'm 7 years in, and it's only for the past 2 years or so that my insulin needs have stayed relatively stable.

If he's in university, I'm guessing young adult, so puberty hormones, or those hormones starting to settle may make a big difference as well.

The amount of insulin we need throughout our lives is by no means static, we need to keep adjusting.

Does he carb count and use an insulin to carbs ratio?
If so, it looks like either he miscalculated the carbs in his meal, or he needs to tweak his ratio.
It might be worth for him to keep a food/insulin/BG diary for a while to see what the patterns are, to help him and his diabetes nurse work out his current ratios.

Good luck!

Hi, yes he does carb count, usually quite well, but this issue has been going on for a few weeks now.

He's tweaked his ratios a few times, gives correction etc but nothing seems to work. It's as if his insulin has suddenly stopped having any effect.

I've suggested eating low carb, high protein for a week to try and get things back under control, but unfortunately that didn't go down very well.

 

[CoolUserName]

If the sandwich of today is a one off, unlike it was the rest of the month, it could just be one of those days, or a forgotten basal dose, or he could be coming down with something. Or possibly a bought drink that was full sugar instead of diet?
I think it makes more sense to look at what has been happening over the past month than just today.

If he has been in the high teens all afternoon, he might want to check for ketones if he doesn't drop soon.

Thanks, yes I've reminded him to check ketones which were 0.1.

He's definitely not forgetting any doses. Goodness knows what's going on. At first I assumed he must have been fighting off a bug but its been going on for weeks now.

 

[Rokaab]

He stores his insulin in his fridge so I'm pretty sure it won't have been frozen.

Some fridges most definitely can, I know when I got my current fridge I had to put it down to 1/5 to stop everything in the salad drawer freezing, and even on that if I have something touching the back or sides for too long it does freeze - maybe its just nota great quality fridge - but if he's in uni dorms or in rented accommodation it could well be similar

So it could actually be that - it may well not be, but worth checking

 

[CoolUserName]

That is a fair enough point. I'll mention it to him but I think he'd notice if that were the case. He has a fridge in his room, supplied by the uni. It's the second one they've supplied after first, in error, giving him freezer which did ruin his insulin. He noticed that immediately though.
I'll still mention it as a theory though, thank you

 

[SimonP78]

Stress? Does he have exams coming up after Christmas?

It's also quite possible to have some underlying lurgie and not even realise it aside from the fact that BG is raised.

If that's the case, I tend to eat fewer carbs just to avoid needing to take massive doses, which I'm generally not keen on just in case I suddenly get better and need to deal with loads of IoB!

Out of interest what sort of carbs:insulin ratio was he on and is he on now and how much has be upped his basal?

In any case I hope his results head back to normal soon.

 

[SimonP78]

That is a fair enough point. I'll mention it to him but I think he'd notice if that were the case. He has a fridge in his room, supplied by the uni. It's the second one they've supplied after first, in error, giving him freezer which did ruin his insulin. He noticed that immediately though.
I'll still mention it as a theory though, thank you

"Perfect" Xmas present, a thermometer with max/min memory, if he doesn't already have one!

Probably better than socks at least, just about!

 

[EllieM]

I think that revisiting his ratios may be the way to go, as university is a big change and 3 years isn't a very long way into a T1 journey.

I find that if my bgs go high my insulin resistance increases dramatically, so if he isn't used to high bgs then that may be a factor. Some sort of hidden infection? (UTIs, long covid, worms??? I remember friends with all sorts of weird infections when I was at university).

Any chance he can contact his team for advice?

I second the suggestion to keep a careful diary for a while so as to be able to work out new ratios,, patterns erc

 

[Jaylee]

Hi,

I have to admit when I was away from home studying the “arts” I wasn’t exactly a model T1.
If I could have my time again…? Start with a basal test as the foundation.

 

[CoolUserName]

Stress? Does he have exams coming up after Christmas?

It's also quite possible to have some underlying lurgie and not even realise it aside from the fact that BG is raised.

If that's the case, I tend to eat fewer carbs just to avoid needing to take massive doses, which I'm generally not keen on just in case I suddenly get better and need to deal with loads of IoB!

Out of interest what sort of carbs:insulin ratio was he on and is he on now and how much has be upped his basal?

In any case I hope his results head back to normal soon.

Hi, yes he does have exams after Christmas but I don't think it's that. When he took his A levels this didn't happen to his BS.

I'm not 100% sure what his ratios were before but he tells me he's increased them by ag least 50%

 

[CoolUserName]

I think that revisiting his ratios may be the way to go, as university is a big change and 3 years isn't a very long way into a T1 journey.

I find that if my bgs go high my insulin resistance increases dramatically, so if he isn't used to high bgs then that may be a factor. Some sort of hidden infection? (UTIs, long covid, worms??? I remember friends with all sorts of weird infections when I was at university).

Any chance he can contact his team for advice?

I second the suggestion to keep a careful diary for a while so as to be able to work out new ratios,, patterns erc

I'm starting to think that you could be right. High BS = insulin resistance.
He has made an appt with his GP next week. Being 20 means that he takes it seriously, but not as much as I'd like him to

 

[CoolUserName]

Hi,

I have to admit when I was away from home studying the “arts” I wasn’t exactly a model T1.
If I could have my time again…? Start with a basal test as the foundation.

He's home next weekend so a basal test is one of the first things I'd like him to do. He told me he was going to do one, but I've not heard he actually did it! According to his cgm he isnt hyper overnight though.

It seems to kick off when he eats no matter how much insulin he takes or how many corrections.

 

[Antje77]

According to his cgm he isnt hyper overnight though.

It seems to kick off when he eats no matter how much insulin he takes or how many corrections.

If his overnight numbers are good I'd suspect the ratio first.
Ratio can differ a lot depending on time of day as well.

 

[SimonP78]

If his overnight numbers are good I'd suspect the ratio first.
Ratio can differ a lot depending on time of day as well.

Though..... when I was at uni, I spent quite a lot of time drinking (alcohol) and socialising (dancing into the early hours) which always resulted in my needing a bedtime snack and I'd run in-range or low overnight (I'd wake up with good numbers, and sometimes need to get up to treat a hypo.) This was pre-CGM and pre-basal-bolus (for me at least) so hard to know more than that, but it certainly had a significant effect.

I realise the youth of today are (apparently) not such big drinkers and who can blame them when it's not good for you and is expensive to boot, however, I could see that this could potentially mask an incorrect (i.e. changed) basal rate.

 

[CoolUserName]

Though..... when I was at uni, I spent quite a lot of time drinking (alcohol) and socialising (dancing into the early hours) which always resulted in my needing a bedtime snack and I'd run in-range or low overnight (I'd wake up with good numbers, and sometimes need to get up to treat a hypo.) This was pre-CGM and pre-basal-bolus (for me at least) so hard to know more than that, but it certainly had a significant effect.

I realise the youth of today are (apparently) not such big drinkers and who can blame them when it's not good for you and is expensive to boot, however, I could see that this could potentially mask an incorrect (i.e. changed) basal rate.

I can see your point and I don't doubt that at least some of his BS issues are probably down to 'poor choices' re: what and when to eat. As far as I know he's not a big drinker, but I'm sure like most he enjoys a few drinks. He's decided to increase his basal a bit more to see if that helps but it will take about 2-3 days to see the results because of the basal insulin he's on.