Why is my blood sugar high (8+) and staying high despite insulin

What is your carb to insulin ratio for evening meals? What was your carb estimate?

My best guess would be 200+ and it doesn’t sound like 14 is enough to cover the carbs. I’d wait until 2hrs after the meal & then use a correction dose.

With Type 1, we can eat carbs if we know how to dose. Initially, we are taught to carb count and dose according to the carbs. No rough guess but actually count. Then, we need to consider when to dose. For some meals this could mean splitting our dose,

A healthy pancreas dose this itself. But to mimic a healthy pancreas is not easy. We have to chose how important managing our blood sugars is to our lives. Some choose to limit their carbs to make this easier, some chose to repeat a similar level of exercise every day to make this easier, some chose to rely heavily on technology through looping, and some decide these are not things they are willing to do because it stops them having the life they want today.

Rough guessing carbs will result in some highs.
Limiting carbs or limiting choice makes this easier as the errors are smaller or you have to do less guessing.

I chose not to limit my carbs, to exercise when I want, to have tough meetings at work. But this means I have to keep a closer eye on m6 blood sugars and may lots of adjustments.

Grumpy Porridge said:

I’ve asked the diabetes clinic several times and they just say the general guidance being 1 units = 10g of carbs or 1 unit bringing blood sugar down by 2. Something.

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1-10g is the go to after diagnosis but after things settle down you can work out more accurate ratios. Do you have any regular meals that you know the carbs for sure & the insulin dose doesn’t rise more than 2? From there you can work out your ratio. Plus just to confuse things your ratios can be different at different times of day.

Same with correction doses, they’re not the same for everyone. If 1:2 doesn’t work try increasing it.

Have you looked at Bertie online? It talks you through carb counting & figuring out your own ratios. If your team aren’t helping you need to figure this out yourself. You can do it.

@Grumpy Porridge it is time to take control. Carb counting is key not guessing I’m afraid. Take some time when you are not working/distracted to start testing your reactions to common foods at different times of the day. Until you are confident with this, and it may take a few months, I wouldn’t be throwing in random foods and guessing. You will never arrive at the correct dosage. Unfortunately Type 1 is a hard slog and requires effort. You can get support from a good health team, but ultimately you have to do these things yourself. You are still early into your diagnosis. To be frank it took me a lot longer to feel confident about what I was doing. And even longer to introduce food stuff that I knew would be hard to balance. I never did reintroduce sweet stuff. But that is a personal decision.

Hi, I find that when I have to correct lots for high doses, simply increasing my basal (often just by 1 unit) stops my need for correction. So I'd look into a basal test first. The idea is that your basal should be sufficient to keep your blood glucose stable without you eating anything. You mentioned going high overnight which might also be sorted by tweaking your basal. If you search for 'basal testing' there are threads which explain how to do it. Remember that any change can take a few days to stabilise, so I'd make small changes every 3-4 days so you get chance to see the effects without risking hypos.

Once you're happy that your basal is right, then I agree with others that getting a better idea of the carbs in your meals will help. This could be looking at the packaging your food comes in, or using apps which suggest the carbs in typical meals. It doesn't have to be completely precise, but you'll find it helps your levels.

Injected insulin is not like a normal person's insulin and follows a fixed curve over 5 hours. You are eating carbs which mean you will spike as injected insulin doesn't match your food. In your graph, your blood sugars came back down after 5 hours so the dose looks correct. On the DAFNE course, I completed their advice is to ignore the spike after eating and check your blood sugars have returned 5 hours after eating. If they have returned, you should be happy.

The main way to avoid the spike is not to eat normally, to eat low carb which is what I choose to do. I also walk for 30 minutes after eating which helps too.

This is a good carb counting course: https://www.bertieonline.org.uk/

Even for someone without diabetes surely half a swiss roll is excessive.

Hi. Some T!/LADAs can't just eat whatever they like. If I have too many carbs my BS goes up on a non-linear curve and I need to increase both my Basal and my Bolus using a different ratio to cope. It sounds like you do need to work out the carbs you are taking and also keep some control on them i.e. no half swiss-rolls!

I guess we are all different. I have no trouble eating what I want, just did need to be confident my basal was appropriate, and that I knew my bolus ratio before attempting it. First thing to identify was whether my basal dose and timing was correct. That should be way easier for you with the libre!

As you're only 5 months in I would suggest there is more about how your body reacts to things for you to learn. Try to keep asking questions when you have them/feel like it. I go through phases of being really thorough and staying in great personal target ranges, and others where I am not. Its great you're interested, but don't beat yourself up if you don't have time to do everything every day. All small steps still help.

Keep in mind there are a lot of factors influencing I:C ratio, that vary even through the day, day by day, meal by meal. I can say Im in the non-hard spiker category as I still believe to have some C-Peptide and maybe a milder form of onset(LADA or T1 idk, I was dx'd at 18 years ) and didnt need insulin for like 2.5 years until I started to eat poorly. But swiss roll has a high GI and if you're not using a very fast insulin like fiasp(that's still slower than human-made insulin) you'll need to prebolus. 1-10 is the "average" I:C ratio but it varies, for example I had a bad hypo with 1:20 with white pita but spiked like crazy at a party with cake+french fries(might have miscalculated as I couldn't measure the portion entirely). Also correction doses aren't stable aswell. Usually it drops me by 1mmol/l(20mg/dl) but sometimes it happens that it doesn't drop me at all(probably cause of left food protein or fat) or if I drink alcohol or exercise it drops me hard(my only hypos, in the high 2s).
Also basal matters aswell as there are some basals that will constantly drop you and you'll need to snack sometimes(like abasaglar) or some like tresiba that works for me and keeps me constantly in the same range(3.8-4.3)