Sudden uncontrollable blood sugars, please help !!

[SimonP78]

I don't think I'd necessarily classify any of it as poor choices. I make what with hindsight are obviously poor choices re diabetes, but as long as I learn from these choices (i.e. don't do it often as it produces a poor outcome, or work out how to deal with it so I can do it, whatever "it" may be be) all is good.

If he isn't able to live a relatively normal life then I can see how the condition may become a burden leading to burnout and depression, etc., and/or rebellion and complete loss of (interest in) control.

With that said, he sounds quite sensible, and it looks like he's trying to fix the situation, so my best wishes to him and please keep us up to date

 

[CoolUserName]

I don't think I'd necessarily classify any of it as poor choices. I make what with hindsight are obviously poor choices re diabetes, but as long as I learn from these choices (i.e. don't do it often as it produces a poor outcome, or work out how to deal with it so I can do it, whatever "it" may be be) all is good.

If he isn't able to live a relatively normal life then I can see how the condition may become a burden leading to burnout and depression, etc., and/or rebellion and complete loss of (interest in) control.

With that said, he sounds quite sensible, and it looks like he's trying to fix the situation, so my best wishes to him and please keep us up to date

Sorry, I didn't mean to sound so unsympathetic.

As someone who doesn't have T1D I can only imagine how much of a PITA it is. When I see my son tucking into carb heavy meals I imagine I wouldn't do that in the same situation, but of course I probably would if I happened to feel like it. I have the upmost respect for him and how he's dealt with it all since diagnosis because I know if I'd developed T1D in my late teens I wouldn't have handled it well at all!!

 

[SimonP78]

Sorry, I didn't mean to sound so unsympathetic.

As someone who doesn't have T1D I can only imagine how much of a PITA it is. When I see my son tucking into carb heavy meals I imagine I wouldn't do that in the same situation, but of course I probably would if I happened to feel like it. I have the upmost respect for him and how he's dealt with it all since diagnosis because I know if I'd developed T1D in my late teens I wouldn't have handled it well at all!!

I used to eat vats of pasta as a student before going off to rugby training, or out for beers and dancing, mainly because I was always hungry. I didn't have a libre in those days so can't comment on quite what it did in the short term to blood glucose, but my hba1c was always good and I was able to just get on and do normal things.

I couldn't easily eat that much nowadays, mainly as a I'm not growing (nor do I want to horizontally!) and do less, or at least less regularly. All the continual rushing around and being out all the time made and still makes me go low, so there was some method to the madness.

I also wasn't meaning to criticise your comment, I just thought I should make the point about experimentation to ensure as normal a life as possible can be lead (with injections being somewhat abnormal, but aside from that it should ideally just be like a normal life, with the occasional hypo-prevention snack ) and also that we have different needs at different points in our lives re quantities/types of food - low carb isn't necessarily for everyone.

 

[Jaylee]

Co

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.

Could he be loosing track of snacks?

 

[CoolUserName]

Co

Could he be loosing track of snacks?

It's a possibility. So far today things appear to be a better (according to his CGM). In range since the graph started at midnight apart from a spike up to 11.9 for 15 minutes after breakfast so fingers crossed he's managing to wrestle it back under control I know that's not perfect, but I don't expect him to be perfect and it's a lot less crazy than what's been happening over the past few weeks.

It must sound like I'm monitoring him 24/7. I'm not. In fact I don't usually look at his graph from one day to the next. I've got into the habit as he started phoning me up to ask my advice and now I'm on worry alert !!

 

[Jaylee]

It's a possibility. So far today things appear to be a better (according to his CGM). In range since the graph started at midnight apart from a spike up to 11.9 for 15 minutes after breakfast so fingers crossed he's managing to wrestle it back under control I know that's not perfect, but I don't expect him to be perfect and it's a lot less crazy than what's been happening over the past few weeks.

It must sound like I'm monitoring him 24/7. I'm not. In fact I don't usually look at his graph from one day to the next. I've got into the habit as he started phoning me up to ask my advice and now I'm on worry alert !!

Not judging at all.

No mobile phones back in my day, let alone sensors.. it’s better things improve steadily, than not at all.

 

[SimonP78]

It's a possibility. So far today things appear to be a better (according to his CGM). In range since the graph started at midnight apart from a spike up to 11.9 for 15 minutes after breakfast so fingers crossed he's managing to wrestle it back under control I know that's not perfect, but I don't expect him to be perfect and it's a lot less crazy than what's been happening over the past few weeks.

tbh that sounds very reasonable - while not in the typical range for non-diabetic BG swings (depending on which data you look at), it's not far outside it afaiu. I'd be quite relaxed about that.

 

[CoolUserName]

tbh that sounds very reasonable - while not in the typical range for non-diabetic BG swings (depending on which data you look at), it's not far outside it afaiu. I'd be quite relaxed about that.

Yes, I agree.

 

[CoolUserName]

Hello everyone who was kind enough to comment and offer advice.
I'm pleased to say that my son appears to be having some success getting his BG back under control which is wonderful. He increased his basal again and after a couple of days that really seems to be helping. He's just had a whole 24 hours in between 5-9mmols and any higher BG are just short lived spikes up to 11/12mmols and straight back down again.

He still isn't sure why his BG got so uncontrollable but I suspect a mixture of reduced exercise because it's winter, eating at less set times as he's revising and once his BG got higher it then became more difficult to get under control - and also the unpredictable sometimes random nature of the human body !!

He's home from uni tomorrow for Christmas

 

[Juicyj]

Changes in insulin requirements do happen, stress, exercise, even a dental infection can be causes, however so can a change in the weather too.

In future always start with a basal fasting test to determine basal insulin is correct as this is the foundation underpinning everything, once that's been done then adjustments to bolus ratios can be done: https://www.mysugr.com/en/blog/basal-rate-testing/

Hope you can relax once he's home.

 

[SimonP78]

He still isn't sure why his BG got so uncontrollable but I suspect a mixture of reduced exercise because it's winter, eating at less set times as he's revising and once his BG got higher it then became more difficult to get under control - and also the unpredictable sometimes random nature of the human body !!

He's home from uni tomorrow for Christmas

It's interesting how a reduction, even if it's not to zero, can make a significant difference. I find this too.

One thing to be aware of with coming home from e.g. uni - in my experience, I would tend to be doing less when at home on holiday (not needing to worry about sorting things out myself for one thing, and also less of the generally going out and dancing sorts of things) so would always need to take more insulin.

In fact the same was true when I was at (boarding) school (so it's not just the partying), but more the fact you're more aware and needing to deal with more things when not "at home".

I hope you all have a lovely Christmas

 

[Jasmin2000]

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).

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

Hi @CoolUserName, this is all too familiar to me. At about 3-4 pm every day I embark upon a BG rise that takes me from a nice 5 mmo/L to over 8 mmol/L without any carbs in the hours before and despite 3-5 units of fast acting insulin. I am Type I and on a low carb diet.

On another forum we called this the 'liver dump'. It's a response of the body to long-term low BG (but not a hypo) and results from glycogen breakdown in liver and muscle to release glucose. The response is really strong and seems to ignore insulin - I guess this is evolution getting me ready for the afternoon dinosaur hunt, and is similar to the dawn phenomenon.

Not sure if this is the same problem you have, but if you can estimate when the liver dump is going to happen, you can head it off by taking your insulin and carbs (your lunch or dinner) to coincide with the expected liver dump. A bit counterintuitive, but for me a good snack at 2 pm flattens it.

 

[CoolUserName]

Hi @CoolUserName, this is all too familiar to me. At about 3-4 pm every day I embark upon a BG rise that takes me from a nice 5 mmo/L to over 8 mmol/L without any carbs in the hours before and despite 3-5 units of fast acting insulin. I am Type I and on a low carb diet.

On another forum we called this the 'liver dump'. It's a response of the body to long-term low BG (but not a hypo) and results from glycogen breakdown in liver and muscle to release glucose. The response is really strong and seems to ignore insulin - I guess this is evolution getting me ready for the afternoon dinosaur hunt, and is similar to the dawn phenomenon.

Not sure if this is the same problem you have, but if you can estimate when the liver dump is going to happen, you can head it off by taking your insulin and carbs (your lunch or dinner) to coincide with the expected liver dump. A bit counterintuitive, but for me a good snack at 2 pm flattens it.

Thank you, that's very interesting and not something I've come across before

 

[Jasmin2000]

My explanation was a short version of a longer story described here https://www.masteringdiabetes.org/i-eat-almost-no-carbs-and-my-blood-sugar-is-still-high/

It's from someone who though that a low-carb diet would help control her blood sugar. In the long-term it has the opposite effect that you described and needs a different strategy - one in which you eat more carbs and have better control. Have fun!

 

[CoolUserName]

My explanation was a short version of a longer story described here https://www.masteringdiabetes.org/i-eat-almost-no-carbs-and-my-blood-sugar-is-still-high/

It's from someone who though that a low-carb diet would help control her blood sugar. In the long-term it has the opposite effect that you described and needs a different strategy - one in which you eat more carbs and have better control. Have fun!

Thank you, that's the opposite of what you think would happen!!! I see your low carb research and raise you this medium carb research that by coincidence I was just reading about:

https://www.thelancet.com/journals/lanepe/article/PIIS2666-7762(23)00218-1/fulltext

 

[lovesilver]

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?

Did your son's blood sugar get back under control? I know its over a month since you posted this but I had Covid in October when my blood sugars rose as expected. My blood sugars are sometimes still rise more than I would expect and my diabetic nurse has said that the Covid infection has increased my insulin resistance. It mostly seems to rise randomly during the night and I have increased my basal insulin (Levemir) by 2u am and 2u pm and also use more Novorapid. It varies from day to day and is concerning as I always considered myself to be well controlled. I have used Libre 2 for the last 3years which is great, have been Type 1 for 35 years and am 70.

 

[CoolUserName]

Did your son's blood sugar get back under control? I know its over a month since you posted this but I had Covid in October when my blood sugars rose as expected. My blood sugars are sometimes still rise more than I would expect and my diabetic nurse has said that the Covid infection has increased my insulin resistance. It mostly seems to rise randomly during the night and I have increased my basal insulin (Levemir) by 2u am and 2u pm and also use more Novorapid. It varies from day to day and is concerning as I always considered myself to be well controlled. I have used Libre 2 for the last 3years which is great, have been Type 1 for 35 years and am 70.

Hello, thank you for your message and I'm sorry to hear your blood sugar has become more difficult to control.

Our sons BG did calm down and is now much more stable (unless he decides to eat pizza, in the evening ) He's now back in range most of the time and the wrangling appears to be over, for the time being anyway.

He did have to increase his basal quite a lot to do this and his bolus too and I'm not sure if he has ever reduced it back down to pre-December levels. I suspect it was a mixture of having a virus/Christmas partying/being 20 years old and revising more than going to lectures so less active. Also as someone upthread pointed out, one your BG gets high, it is twice as hard to get it down again as it's like you almost become resistant to the insulin.

If your BG is rising overnight then to me at least it sounds like to need to increase your basal. Also, I'm not sure where you are geographically, but I've read that cold weather can increase your BG.