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Yo-Yo levels

ConantheLibrarian

Member
Messages
11
Location
Sheffield
Type of diabetes
Type 1
Treatment type
Insulin
Getting super stressed out recently... My levels on waking seem to be super high, so i increase my night long acting insulin (levemir, currently 12u, going to try 13u tonight)

Going to bed last night was 7.8mmol, (around 10pm) then at 2am i woke and tested and it was 15.3mmol, so i did 2u of quick acting (Humalog) which should have brought it to around 9-10mmol for waking up at 7am for work. Instead it was 17.3mmol, i do corrective to bring this down 1u to lower by 3mmol, as agreed with my nurse) i did the insulin at 8:30am (6u humalog 18u Insulatard, i had 2 slices of toast, hence the extra 2u, then by 12:30pm level had dropped to 4.1mmol and i started feeling weak. I dropped 2u off my lunch insulin, but then when i check at 4pm, its shot up to 16.6mmol. I then do 3u to lower the level, but when i check at 7pm, its gone UP to 18.8

For evening meals, i check the carbs on the food packets so i know its right, and do 1:1 ratio, but then the level plummets within 1 1/2 hours. If i do 1/2 before the meal and 1/2 after, the same thing. If i lower to a 1/2:1 ratio, it drops lower, and looks like it will remain stable, but then shoots up overnight, ending in the super high morning BG.

Really not sure what to do, as last week i was trying to go bed on around a 7 or 8, with BI of 12, and had a diabetic seizure which required paramedic assistance. It's really getting me down, and I'm scared to even eat in case it goes super high or low...
 
Have you ever basal tested during the day time?

Are you under a comsultant or GP? I f consultant. I
would really ask for an emergency quick appt to see the team.. Whether it be dsn or consultant etc...
 
Reading through your post, is the following correct ?
Night time: Levemir 12 units.
Morning: Insulatard 18 units?

Two different basal insulins ? If so, why is that ?

I love your username, by the way

Signy
 
Wot she said, and

When you say a carb ratio of 1:1 are you talking 1u of insulin per DAFNE unit = 10g of carb? Or actually 1u per 1g of carb? Because I would not expect a 1u:1g carb ratio in a person with a 1u:3mmol/L correction ratio.

It's a very confusing situation and my gut instinct is there is more than one thing going wrong here. Some of the insulins could be 'off', injection sites could be dodgy, you could have an infection, some of the ratios could be wrong, basals could be wrong. I'm not even sure where to start. But maybe start with a fasting basal test. That or call your HCP.
 
I'm agreeing with @Spiker , it's all a bit of a mess

How long have you been diagnosed ?

If you are indeed taking two different basal insulins, I would have expected you to go low at 12.30, because Insulatard had a definite peak at 4-5 hours after taking it, but it doesn't explain the rest .

I would certainly see your diabetes team again and perhaps start from scratch on establishing a stable basal rate ( why on earth two ?? ) and ratios for different times of the day .
Are you carb counting for everything you eat, not just the evening meal ?

Signy
 
What are the reasons why you take two different basal insulins? It certainly complicates matters and would you not be better on a basal insulin such as lantus or better still Tresiba that can give up to a 42 hour coverage (provided your consultant will prescribe it), I'll tag @smidge as she was recently using both these two basals together before moving over to Tresiba.
 
@donnellysdogs Pretty much every weekday i do a morning basal (I rarely eat breakfast) and on the rarer days when the waking bg is normal, the bg holds fairly steady until lunch. Under a consultant at hospital, due to see them again monday, hoping to have a CGM fitted again, so i can see the patterns better, and also feel a bit less scared about having a diabetic seizure again

@Heathenlass Sorry, old brain... Levemir morning and night, been diagnosed for 22 years now and carb counting all meals (I usually don't eat breakfast, and the nurse put me on 1 1/2:1 ratio for lunch, 1:1 for evening meal, or if i eat breakfast then 1 1/2:1 breakfast, 1:1 lunch and evening meal)

@Spiker again, sorry, old brain. Yes, I'm following the DAFNE 1u=10g carbs

Will check BG before bed tonight, do QA and BI to have a level of around 8mmol, then check at 7-8am and do a fasting basal and report back here for you. Hoping to get to the bottom of this soon

Thank you all for your help and advice too
 
Hey there! I'm glad you're not on the two basal - my experience of that was that it was really hard to manage!

So, you've at some time switched from Insulatard to Levemir? I made a similar switch and my fasting levels went mad - Levemir simply didn't last long enough for me - 10 hours maximum, so I was running short overnight (hence the high fasting) and running short mid to late afternoon. Because of this, I was having to add correction units to my bolus with breakfast and tea. On top of that, Levemir seemed to have a random peak action for me after about two hours - so I would hypo mid morning (although this could have been the extra bolus with breakfast causing that) and about two hours after taking my evening Levemir despite having no other active insulin. It all added up to yo-yo BGs and drove me to distraction!

After experimenting with two different basal (which I really don't recommend), I changed to Tresiba last December. I've had a lot of teething troubles while trying to get the levels right, but my BG are so much more stable and I've reduced both my basal and bolus requirements considerably.

I think Levemir just doesn't suit some people, so my advice would be to ask your consultant to have a try on Tresiba and ditch the Levemir completely - it's just not worth persevering with an insulin that isn't working for you.

Smidge
 
You are like me then and rarely eat breakfast!!

Good to hear that you use this as basal testing! To be honest I eat so little I count my food as bolus testing instead!!

Anyhow, it would be great to see a full day of results,insulin and times. I think the guys on here can help to improve..

Glad to hear you are with a consultant too.
I've been on a pump too long now to advise about ghe workings of different basal insulins etc, but the guys here know so much they will certainly help if they have figures etc..

Glad the basal was a typo error rather that two types!!
 
Sorry i didn't make it back yesterday...

Here are the results:

Tuesday 10:00pm
BG 16.7mmol
BI 12u Levemir
QA 3u Humalog

Wednesday 7:00am
BG 4.3mmol
CP 20g Carbs

9:15am
BG 12.8mmol
BI 18u Levemir
QA 4u +2 corrective Humalog
CP 40g carbs

12:00pm
BG 12.9mmol
QA 8u + 2u corrective Humalog
CP 82g carbs

5:45pm
BG 16.0mmol
QA 6u + 3u corrective Humalog

9:00pm
BG 12.0mmol
BI 11u Levemir (my partner insisted i drop 1u because this had caused the diabetic seizure previously, more info on this below...)
No QA given (also more info below)

8:00am
BG 23.7mmol
BI 18u Levemir
QA 2u + 8 corrective Humalog
CP 20g carbs

10:45am
BG 9.9 mmol

12:30pm
BG 7.5 mmol
QA 8u Humalog
CP 82g carbs

As you can imagine with all the highs, correctives and then the inevitable lows that follow, this is causing tension in the relationship, leading to even more arguments and stress (which only makes things worse still) I was told last night that if i did the corrective QA and extra unit of BI, then if/when my level dropped and caused a seizure, she wouldn't be there again to help me out, as its taking it's toll on her too. I kind of see where she is coming from on this, as i think I'd be tearing my hair out if i were on the other side of this too, but all its doing is making me feel like s**t...

Once again, thank you for listening (and helping out)
 
My impression is that your correction and carb ratios are very broadly correct (as far as we can tell) but your overnight basal is clearly too low. You need a lot more basal overnight at least. I would shift gradually in the direction of 18 am/18 pm over a one week period and see how that goes. Your partner may believe that 1u of basal caused a seizure but that's very unlikely. Much more likely to be a QA dose that caused a seizure. Your partner's fear is understandable but you can't run such high BG out of fear.
 
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The clearest signal is 9pm Wed to 8am Thu. That huge rise shows you need a substantial increase in overnight basal. As I said, move it up in stages to 18. Maybe 16.

Also I think your carb ratio 1u:10g may be too low. It's hard to tell without sorting the basal out first.

As this issue is causing an immediate threat to your relationship and your health I think it's worth you doing an immediate fasting basal test. That means eating nothing calorific, no caffeine, and testing at least every 2 hours. Can you do that?

We also need to bear in mind the possibility of some other medical cause so please do check in with your medical team.
 
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You might also need to increase the daytime basal. But fix the biggest problem first, the clearest problem first. As you fix the bigger problems, the smaller problems then become clearer.
 
I can't make sense of your correction ratio of 1u:3mmol

Did you really take 8u corrective at 8am? Surely you should have only taken about 6u with a BG of around 24?

If your correction ratio is definitely 1:3 and you took 8u, that would push your BG down to (theoretically) zero four hours later and you would go hypo after 2-3 hours. Even if your day basal is too low and even if your carb ratio is too low (we don't know either yet) you would still go hypo.

If that was a calculation error, is it possible your hypos are being caused by calculation errors?
 
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Hi Spiker, yes, really 8u @ 8am.

HCP said if BG is over 20, then 2:1 ratio, so that's what i am working with currently...
 
@ConantheLibrarian, once you know your basal insulin is right you can then concentrate on your I:C ratio's, tbh there's little point in looking at your I:C now until you know that your basal dose is set at the right dose, Spiker will tell you this is one of the most important aspects whether your on MDI or a pump.
 
ConantheLibrarian said:
Hi Spiker, yes, really 8u @ 8am.

HCP said if BG is over 20, then 2:1 ratio, so that's what i am working with currently...
Click to expand...

I always have to increase my correction level ratio and add 50% extra on if over 12.0 so you're not the only one....
 
the mystery deepens!!!

2:15pm
BG 4.7 mmol (felt like BG was dropping further so treated with 1 1/2 CPS)

5:00pm
BG 17.0 mmol
QA 3u corrective humalog

6:30pm
BG 9.8 mmol

7:45pm
QA 6u Humalog
CP 120g carbs (had planned to do 1/2 insulin before meal, half after finishing meal)

8:10pm
BG 9.8 mmol
(went for a hot bath)

9:15pm
BG 3.9 mmol
CP 25g carbs (lucozade)

9:45pm
BG 3.7 mmol
CP 25g carbs (bread and butter)

I know the hot bath could cause the insulin to be absorbed faster, but the insulin was done JUST before the food, and only half was done at a 1:1 ratio, so I'm puzzled as to why it dropped so much, as i thought the food should be there to cover it pretty much.

Could it possibly be that the humalog gets to work too quickly, but then also runs out before it has chance to counter the food, if you know what i mean?
 
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