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Unexplained blood glucose rises throughout the day

Discussion in 'Type 1 Diabetes' started by Greg1986, Mar 29, 2018.

  1. Greg1986

    Greg1986 Type 1 · Newbie

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    Hello,
    Sorry in advance if this goes on a bit!
    I’ve been diabetic for 23 years and was going along perfectly fine controlling my diabetes through carb counting, novorapid and lantus/tresiba until a few years ago when my BG started to increase in the morning- which the dr said was the dawn phenomenon. That was irritating but I got over it.
    The problem is that it’s now getting worse! I go to bed at 5.5 and roughly half the time I’ll be woken up between 2 and 3 and it will be between 9 and 15. It wakes me up because it makes me feel very nauseous. The insulin resistance that is associated with it has kicked in and so I end up injecting between 6 and 12 units of novorapid to get it down to a normal level- I know this works because sometimes when I get up for work my BG is back down to a normal level. Every morning without fail it then spikes again with similar readings, sometimes before I’ve woken up and sometimes shortly after.
    On top of that it spikes again mid-morning roughly one day in three, and sometimes late afternoon/early evening. For example today I had my lunch, looked up the carbohydrates in that bread roll on the Sainsbury’s website, injected accordingly and three hours later it was 23! I did 9 units of insulin, just in case I’d somehow messed up, but 90mins later it had gone up to 24. It’s very frustrating!
    My diabetic nurse is useless, luckily I’m being treated by my consultant but even he seems to be at a loss what to do and when you go in his office he has certificates from all over the world saying how good and helpful he is. I did two weeks with the Libre this time last year and it was brilliant, although at that point it was only happening once per day.

    Does anyone have any ideas? Prior to this I felt fine, perfectly happy living with diabetes but now it’s starting to get me down. Any suggestions welcome!
     
  2. Chowie

    Chowie Type 1 · Well-Known Member

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    Has your consultant spoken to you about a pump? Mine is programed to give a little more for the dawn phenomenon. You need to go to bed at the same time etc. I have gone from a HbA1c of high 8 to low 7 and it's still being tuned. I was noticing insulin resistance on MDI that is rapidly changing on the pump. They are not for everyone, but most people that go onto a pump love them.
     
  3. eventhorizon

    eventhorizon Type 1 · Well-Known Member

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    What basel insulin do you use now? What time do you take it and do you split it?
     
  4. JenP

    JenP Type 1 · Newbie

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    Sorry Greg1986, I don't have any suggestions to help with this, but what you are describing is exactly what I'm experiencing and it is really getting too much for me to cope with. I've had Type 1 for 40 years now and until about 6 months ago, was in control and could explain any highs etc by relating to what I'd done. Not any more! I take Landtus Glargine - one dose in the morning, and Novorapid whenever I eat. My GP isn't helping by just suggesting I take more insulin (she has obviously never experienced a scary 2.6 in the middle of the night or realises what it is like to go to sleep with a reading of 7.6 and wake with 15.2!!). So probably of no use to you, but I'm getting to the end of my tether and seeing my Endocrinologist in June is all I'm hanging on to at the moment. I'll follow your post with real interest.
     
  5. catapillar

    catapillar Type 1 · Well-Known Member

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    @Greg1986 have you basal tested? Here's a guide on how to do it - https://mysugr.com/basal-rate-testing/ - units are in mg/dL so divide by 18 to get the mmol/l equivalent.

    With significant dawn phenomen then a pump woul be a good idea as you can tailor your basal delivery hour by hour to give you exactly what you need to avoid the DP rise.
     
  6. Fairygodmother

    Fairygodmother Type 1 · Well-Known Member

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    Hi @Greg1986, and welcome to the forum.
    It’s hard to know how I’d act in your situation without knowing what your long-acting (basal) insulin is as the profiles of Lantus and Tresiba are so different.
    @JenP, have you considered asking to switch from Lantus to a different basal? Lantus only acts for 24 hours at higher doses and for some people there’s a defined increase in its potency four to six hours after injection.
     
  7. urbanracer

    urbanracer Type 1 · Moderator
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    Hi @Greg1986 ,

    I was diagnosed diabetic almost 4 yrs ago and spent most of that time on 25/75 mixed insulin with the occasional top up of extra rapid acting insulin if I wanted some carbs. Managed to keep my A1C in range over most of this period until around Christmas 2017 when my control went out the window and nothing I was doing was working.

    My endo' switched me over to MDI in mid January and my control was great for the first couple of weeks. Again things started to go wrong and my Libre is now telling me that even when I go to bed with blood sugars of around 8mmol, I am regularly rising to 15mmol at around 2am and falling back to 10mmol by the time I wake up at 6am.

    Nothing I do in terms of dosage or timing really seems to make a difference. I called the Endocrine Centre via their 'hotline' this week and was told that the night time rise is 'hormonal' - whatever that means. I have to show them my Libre data before going any further.

    One day this week I was just over 5mmol on waking, next day back to 10mmol again. All quite frustrating.

    Edited to add:- I'm now on Abasaglar, a Lantus biosimilar product.
     
    #7 urbanracer, Mar 30, 2018 at 11:35 AM
    Last edited: Mar 30, 2018
  8. DunePlodder

    DunePlodder Type 1 · Well-Known Member

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    @urbanracer I would try a different basal insulin. I couldn't get Lantus to work for me - dropping around 2:00am then rising around 4:00. For me Levemir has been a big improvement.
     
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  9. urbanracer

    urbanracer Type 1 · Moderator
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    Thanks but jeeez, it's taken me 3yrs to pursuade the endo to take me off mixed insulin!

    I think I've been put on Abasaglar because it's cheap so I'm going to have a fight getting onto something else so soon. I uploaded my Libre data to diasend this morning so let's see what sort of response I get when they're back in the office.

    Thanks again,
    Urb'
     
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  10. therower

    therower Type 1 · Well-Known Member

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    Hi @urbanracer . Sorry you're struggling at the moment, especially with overnight highs.
    It's so frustrating for everything to go wrong whilst we're asleep and can't do anything at the time.
    This is only a suggestion and maybe something you have actually tried already.
    As T1's we are forever watching what we eat and when we eat it.
    Have you considered having a very light snack and a small bolus prior to bedtime.
    I will on most nights eat before bed. Currently my favourite is half of an apple with peanut butter. Depending on what my BS is dictates any bolus I have.
    If I was 8 then I would do the apple and pnb with a 2 unit bolus.
    If I was at 5 then I would forgo the bolus.
    This keeps me very level overnight ( Dexcom is a great source of information) 8 times out of 10 I would say.
    We are all different and this probably is a ridiculous option for many but it seems to work for me.
     
  11. urbanracer

    urbanracer Type 1 · Moderator
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    Hi @therower ,
    Thanks for the hints, that's interesting and I will give it a go (note to self, add apples and peanut butter to shopping list), - but what happens if you bolus but don't go high overnight? (Or is that a silly question?)

    @Greg1986, apologies but I seem to have hijacked your thread. Wasn't intentional.
     
  12. therower

    therower Type 1 · Well-Known Member

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    Hi @urbanracer . The idea of bolusing for me is to counteract the carb rise from the apple and pnb.
    What actually helps with the increased blood levels during the night is the apple and pnb not the bolus. Providing your basal level is correct then for me the trick is stopping the liver providing glucose I don't need at that time of night.
    Apple is not overly carby and the pnb really slows down the digestion process, so in theory I get the carbs a good few hours after going bed. It then seems that my body/ liver has no need to provide glucose on account it's already there.
    Hope this makes sense and I'm not sure there's any science to it. It's one of those hit or miss things that makes diabetes so damn interesting :banghead::banghead::banghead:
     
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  13. urbanracer

    urbanracer Type 1 · Moderator
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    Thanks, got it. Yes, interesting is one way of describing it.
     
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  14. James472

    James472 Type 1 · Member

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    Greg, your description is sounding very close to what I'm getting - in this thread (Blood sugar levels - way out of control for 2 years !!) - am too new to be allowed to post a link to it.

    And JenP sounds like same thing.

    Really weird.

    I'll follow this thread too.
     
  15. Celsus

    Celsus Type 1 · Well-Known Member

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    @James472 was so kind to lead me here!
    It may be a sensitive subject, but.... here we go! :)

    Mid-life crisis...

    Yep, I can certainly recognize most aspects in the personal stories shared above in this thread.
    After I got onto the intensive multiple daily injections insulin regime and instant home monitoring of my bg back in the 80ties, I got really my Type1 under tight and very consistent control. Almost to the extreme.
    No limits! Certainly nothing that disease kept me from doing. (or that was maybe my naïve idea?)
    Super active, super energized, super.... yeah ok, I started to get older and learn more about life realities as well. :)
    Got children, got married with their mother, starting having more responsibility at the job. Less hours spent on crazy active hobbies/leisure.

    First bump on the road came around age 38. Clearly my background metabolism had reduced. Never having the same raw hunger anymore. Not really eating the same high quantity of calories every day. Didn't feel needing them either though.
    But my basal had to be increased quite some, and started taking less bolus as I ate less.
    And result was that my bg got overall much more sensitive to my daily activities. Its like your human body capacity to sustain some crazy activity was no longer up where it used to be. 7 hours of downhill skiing now needed some more planning, tighter check of the bg levels and more steady flow of carbs to keep it in range. The bg control became more 'fiddle' if you will.

    And with further increased age, the muscle mass also reduce further, which again adds to the complexity to manage the bg well, as the buffer becomes smaller. The road becomes narrower and the car you drive more stiff and less agile to take the bumps, if you want another analogy? ;o)

    I am not saying that we all need to accept defeat and slow down on that road, but we may want to prep for our trips better.
     
  16. Heathero

    Heathero Type 1 · Well-Known Member

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    I know I’m not the only one with probs/ BG levels unexplainable! Diabetic since 1965. Last few years converted from multiple daily injections Lantus - didn’t appear to do anything even when split!
    Been using pump approx 4 years ( will have to check) and all was going well . Lately with no explaining my BG swings fron high to low daily! Spent 3/4 hr in gym BG 6when started when finished was 14 mmols No hypo occurred ,insulin and 16 g carb for breakfast! 1hr later low (correction was reduced earlier) ! So it goes on high low high low. Now using Libre due to sudden hypos frequent tests etc.
    Feel as though I’m expected to know the answers by clinic and sort it out but I don’t 3/4 of day with no food high BG ! Fasting re set ratios gets worse. Re fast again same period totally different readings high not 4-7 on same Basel settings. Two changes advised increased hypos felt unsafe. Where on earth do I start always lived with Diabetes and managed it but now it’s ruining my life and I’m moody irritable too.
     
  17. helensaramay

    helensaramay Type 1 · Expert

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    @Heathero you have responded to a thread which is more than a year old.
    You may get more responses (and help) if you start a new thread.
     
  18. Heathero

    Heathero Type 1 · Well-Known Member

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    Tried to do that after I added to discussion but unable to find out how ? Can this be copied and re posted? If so how?
     
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