Unlikely Highs

[DunePlodder]

I have an intermittent problem with what I call "unlikely highs".

I carb count and keep a pretty good record of insulin/carbs/exercise. Recently I've been working from home with a very consistent daily routine so these events are more clearly defined.

I have say, breakfast (3 carbs) with a Bg near my target of 6. I inject my humalog as usual & have a 20 minute walk. Then I work on the computer. By lunch I expect a reasonably good result but yesterday for example it was 12.6! I waited 10 minutes and did a check with a different meter - 11.9.

I currently use a ratio of 1.5/carb and I ate 4 carbs so 6 units for the food. Theoretically I would take 6 units to correct the 12 down to 6.However I was worried and cut the correction to 3, splitting the difference, that worked out at a total of 9 units at 12:45.

By 3:00pm I was wrestling with a 3.2 hypo! Then I gave myself a very hard time, thinking "it was obvious that would happen.." This disease is so unpredictable though we just can't be sure. If I'd ignored the high & only injected for the food, the next reading would probably have been way up!

It may be a question of injection site problems. I rotate them pretty carefully, but with 1800+/year (horrifying when you work it out) and a limited number of places to jab, there are going to be some problems. What else could it be? It seems as if the insulin sometimes takes much longer to absorb and hangs around in the background. The morning injection was in my buttock as it had been on the previous 2 days.
Does anyone else experience this?
Robert

 

[shop]

Hi Robert,

I am not as knowledgeable or experienced as alot of T1s on here. Learning to carb count at the mo so understand what you are saying. The only thing that struck me is that I was told to always do my basal in my buttock/thigh and to always do my bolus in to my stomach because the buttock/thigh takes longer to get int the system. The stomach is better for quick acting as it takes a shorter period of time. Just wondering if this may be the case!

Lucy.

 

[noblehead]

Robert,

It might be injection site problems (although I wouldn't use the buttocks for QA insulin) but on the other-hand it could be that you basal insulin needs increasing if your lunch-time bg is often high......only if you are sure your breakfast ratio is correct :crazy:

When you say you inject 1.5 units to 1g of carbs, do you mean 1CP or 10g of carbs or are you a very low-carber?

 

[DunePlodder]

Noblehead I mean 1.5 units to 10g of carbs, sorry that wasn't very clear.

Some time ago I realised that I was over using my stomach - it was easy - and made a conscious effort to give it a break. It's now back as part of the rotation, but less intensively used. It's a good point about using the buttocks, though as I said, the previous couple of days were fine. I usually walk fairly soon after eating which, I hope, gets the blood & therefore the insulin flowing. I do my basal in my thighs.

 

[noblehead]

DP,

Take a look at the following site which offers some useful advice with regards to injecting insulin:


http://www.bd.com/us/diabetes/page.aspx ... 01&id=7282

 

[shop]

Noblehead,

I took a look very useful information and interesting. Am I right in saying you would use the arms and legs if you were having probs with the abdomen and buttocks?

Lucy.

 

[DunePlodder]

The web site is excellent. I think I was overdue for a "back to basics" on injection sites.
Time for a rethink about my routine. I record my data using a program I wrote for my Android device - records BG, carbs & exercise then calculates a suggested dosage. Looks like I need to add injection site locations into the log.. There's always something to learn in this game.
My lunch time reading today was 8.2 by the way. Not ideal but a lot better than 12.6.
Thank you both for your thoughts.

Robert

 

[pickle76]

Hi,

Just to comment on another part of your original post....you said you would have 6 extra units to bring your Bg from 12 down to 6. Dos 1 unit of insulin only bring you down by 1? You did only have 3 extra units after all, and still had a hypo, so would suggest that 1 unit actually brings you down by 3 (ie you had 3 extra units and that brought you down by 9 in total, from 12 to 3). Might be worth making a note of to avoid hypos after correcting.

Really hope you find some sort of pattern for the random highs! They're so frustrating aren't they! Could it also be the type of food you're eating? Foods higher in fat mean that you can spike a bit later than you'd expect. Or could it be down to your background dose, or breakfast ratio? :crazy:

 

[robert72]

You'd have to be on 100 units insulin per day (basal and bolus added together) to bring your BG down 1 mmol/l with 1 unit of rapid acting insulin.

You can calculate you correctional dose by dividing your total daily units into 100. In my case it's 100/32 units which means my correctional dose is 1 unit of insulin brings my BS down by 3 mmol/l.

 

[pickle76]

Yes 1 unit brings me down by about 3 too. That calculation seems to be pretty accurate and a good place to start if you're unsure I guess.

 

[robert72]

The 100 rule is cited in many sources and applies to analog insulin. 'They' also say that for non-analogue insulin (e.g.: animal or human) then it's 85 divided by total daily insulin.

BTW Greetings pickle76, I'm also originally from Norfolk

 

[pickle76]

The 100 rule is cited in many sources and applies to analog insulin. 'They' also say that for non-analogue insulin (e.g.: animal or human) then it's 85 divided by total daily insulin.

BTW Greetings pickle76, I'm also originally from Norfolk

Woo hoo hello fellow Norfolk-onian! :wave:

 

[DunePlodder]

This forum is great. I really love the fact that this is making me think again. It's 18 years or so since diagnosis.
I printed out the injection site rotation template from the web site Noblehead recommended, very useful.

My total daily dosage is about 63, which would equate to 1 unit causing a drop of 1.6 in my BG. This is meant to be a start point though, everyone is different. I may experiment again, but I'll concentrate on injection sites for now.

The values I've been using do normally work fairly well. As I said these unlikely highs are intermittent - 2 or 3 times a month ish. It goes wrong on other occasions of course but usually I have a reason - too much/little exercise for example. The "unlikely highs" are occasions when I've racked my brains but cannot explain it.

As Pickle76 says the 3 units appears to have brought me down by 9 on this occasion, but my gut feeling is that the lunch time 12.6 was misleading, perhaps hiding a quantity of insulin remaining in my system from breakfast. My breakfast is very consistent - 2 slices of toast & Marmite. Yes, random highs are very frustrating.

Thank you all.
Robert

 

[iHs]

This forum is great. I really love the fact that this is making me think again. It's 18 years or so since diagnosis.
I printed out the injection site rotation template from the web site Noblehead recommended, very useful.

My total daily dosage is about 63, which would equate to 1 unit causing a drop of 1.6 in my BG. This is meant to be a start point though, everyone is different. I may experiment again, but I'll concentrate on injection sites for now.

The values I've been using do normally work fairly well. As I said these unlikely highs are intermittent - 2 or 3 times a month ish. It goes wrong on other occasions of course but usually I have a reason - too much/little exercise for example. The "unlikely highs" are occasions when I've racked my brains but cannot explain it.

As Pickle76 says the 3 units appears to have brought me down by 9 on this occasion, but my gut feeling is that the lunch time 12.6 was misleading, perhaps hiding a quantity of insulin remaining in my system from breakfast. My breakfast is very consistent - 2 slices of toast & Marmite. Yes, random highs are very frustrating.

Thank you all.
Robert

Hi

I think its possible that as it is generally thought that people need more insulin to carb at breakfast and less insulin to carb at lunchtime, its also possible that correction factors also need to change according to the time of day that the correction dose is needed. Might pay you to use a target of 8mmol instead of 6mmol to correct to as when carb bolus is added to correction bolus, you've got to be careful that you don't 'over correct'.

With regards to injection sites, in the 20 years that I used twice daily insulin, I always did my morning injection (24u) in my backside and my evening injection (10u) in my upper arms. On bolus/basal, my background insulin was always injected in my backside and my bolus's were nearly always done in my upper arms or tummy if my bg was on the high side. Never had a problem really and I'm so glad that I used my arms for most of my jabs as I now have a pump and tummy is all ok (most of the time) for infusion sites.

 

[noblehead]

Noblehead,

I took a look very useful information and interesting. Am I right in saying you would use the arms and legs if you were having probs with the abdomen and buttocks?

Lucy.

Yes of course, the following diagram shows you the best places to inject:

http://www.bd.com/us/diabetes/page.aspx ... 01&id=7261

I use the arms for QA quite a bit, make sure you inject in the back of the arm where it's more flabby and remember to swap sites regularly.

 

[shop]

Thanks Noblehead. I have downloaded them too.