High blood sugars

[ShellyG]

Good morning,

My son is 14 and has been diagnosed with type 1 diabetes since February. He was initially on Novorapid, this seemed to have no affect on his blood sugars, and he is now on Fiasp. This was working great for the last couple of months, but since Sunday it seems to have no stopped working. He's blood sugars have been in the 20's and no lower than 18, this morning he woke up and was 20.8 he did 12 units he ate a slice of toast and 2 hours later was 25.2. I have checked the injection to ensure insulin is coming out and gave even tried new ones. He did another 10 units and an hour ago and is still 22.7. The hospital have said it could be a surge in his hormones, but other than that have been unhelpful. Please if anyone has and ideas, suggestions or similar situations I would be so glad to hear.

 

[Paulbreen]

It maybe the dreaded and unpredictable DP that’s affecting him, toast might not be the right thing to give him until his level comes down a bit, does he have a libre/libre2, if he does you should be see what’s going on during the night, DP usually starts around 3:30-4:30 am so you will see his BG starting to rise. If he hasn’t got a Libre yet get onto his team to get him one on prescription, it will change his life!!
And of course hormones could be at work as the hospital mentioned, I had similar issues back in the day and I just put it down to crappy BG measuring and bad control

 

[Inka]

@ShellyG Could it be that his basal needs increasing? I’ve checked back on your previous thread and he’s on Levemir? Also, on that thread I suggested swapping to Humalog. Google Fiasp and “like water”. A number of people have said it’s like injecting water. For some people it’s fine, but it simply doesn’t work for others, or works to start with and then stops. It also seems more variable at larger doses.

So although teenage hormones could definitely be contributing, I’d look at his basal first. See if tweaking that helps stop him waking so high. I’d also consider swapping to Humalog for boluses.

I’m presuming you’ve swapped both insulins to new cartridges in case one of them has degraded? The other thought that came to me is perhaps he’s coming down with an illness.

 

[ShellyG]

It maybe the dreaded and unpredictable DP that’s affecting him, toast might not be the right thing to give him until his level comes down a bit, does he have a libre/libre2, if he does you should be see what’s going on during the night, DP usually starts around 3:30-4:30 am so you will see his BG starting to rise. If he hasn’t got a Libre yet get onto his team to get him one on prescription, it will change his life!!
And of course hormones could be at work as the hospital mentioned, I had similar issues back in the day and I just put it down to crappy BG measuring and bad control

Thank you for replying and sorry to be thick but what is DP ?

 

[Amity Island]

Good morning,

My son is 14 and has been diagnosed with type 1 diabetes since February. He was initially on Novorapid, this seemed to have no affect on his blood sugars, and he is now on Fiasp. This was working great for the last couple of months, but since Sunday it seems to have no stopped working. He's blood sugars have been in the 20's and no lower than 18, this morning he woke up and was 20.8 he did 12 units he ate a slice of toast and 2 hours later was 25.2. I have checked the injection to ensure insulin is coming out and gave even tried new ones. He did another 10 units and an hour ago and is still 22.7. The hospital have said it could be a surge in his hormones, but other than that have been unhelpful. Please if anyone has and ideas, suggestions or similar situations I would be so glad to hear.

Hi @ShellyG

I think as a starting point, a basal test would get you going in the right direction. By missing a meal and testing blood sugars during a missed meal period. If blood sugar pretty much stays the same then that will help in excluding the basal as the cause of the problem. If levels are flatish during a missed meal, then I'd be next looking at how the bolus (mealtime) insulin is working or not working as the case may be. I too have read the issues with Fiasp, works great for about a week then fails to do the the same job. If blood sugars are rising during the missed meal, then that points towards the basal being insufficient.

It may well be a combination of both. Obviously, doses can vary for many other reasons.

A freestyle libre would be extremely helpful for your son and the hospital.

 

[Amity Island]

Thank you for replying and sorry to be thick but what is DP ?

Dawn Phenomenon. A natural rise in blood sugars upon waking time. This can increase blood sugars by a few points. but i've not heard of increases into the 20's though.

 

[Paulbreen]

Thank you for replying and sorry to be thick but what is DP ?

Hi ShellyG it’s always good to ask, I often get confused with all the abbreviations used here. a simple explanation is Dawn Phenomenon is a strange and often random occurance when our livers decide to to prep us for the following day and it dumps some glucose into our blood during the night, it doesn't always happen so its difficult to mediate for it, I get it sometimes maybe for a week or two and then it stops again, a Libre/Libre2 sensor or dexcom6 sensor will show you a graph of the blood glucose so it makes it easy to see when you check his graphs. its only one possibility, as you both will find out over the years the diabetic goal posts are forever changing and I'm sure there will be more people will give you more pointers here
Here's a little diagram of a couple of the strange night time happenings

Thank you for replying and sorry to be thick but what is DP ?

 

[helli]

When our levels are high, we become insulin resistant so will need far more insulin to bring down a level in the 20s.
Added to this, I find that the speed Fiasp works seems to be related to my levels - Fiasp works much faster with lower levels and seems to have a very long delay with higher levels.
This can be making things harder for your son to manage.

I agree with @Inka that his basal dose may need increasing and his insulins should be changed ... possibly even get a new batch form the pharmacy as it may be damaged in transit. Whilst this is very rare, it is possible.

 

[rebrascora]

Another vote for a basal check here. Could he have forgotten to take his basal insulin or deliberately not be taking it for some reason. Many people have difficulty coping with their diabetes diagnosis at times and can go through phases of not being able to give themselves their insulin. Your son is at a difficult age without having diabetes to cope with on top of that and teenagers are known to be rebellious. I am not saying this is the case but it certainly does happen because there are people here on the forum who have admitted to doing it..... So, I would check firstly that he is taking his basal injections and secondly that his basal dose is correct by doing a basal check.... ie skipping one meal a day and fasting for that period so that no Fiasp is used during that time and see if levels are steady or go up or down. A few units too little with your basal dose can translate to an awful lot more Fiasp or whatever other quick acting insulin you use and if you then add in a few carbs that can easily see levels escalating even with effective bolus insulin being injected.

I would say that you really need to get back on to your clinic team for more help. Leave a message saying that levels are reaching the point that you fear he may need to be hospitalized and hopefully that should provoke a more rapid response. Certainly if his readings hit 30 and won't come down then you need to be heading to hospital. Are you testing for ketones? When his levels are regularly mid teens and above you should be testing for ketones and if you get readings over 1 then seek medical advice. If you have no means of testing for ketones then ask for some.... Ketostix urine testing strips at the very least but ideally some blood ketone test strips and make sure you have a meter which will accept them.

 

[rebrascora]

The other thing I would say is that it is best to wait to see the insulin taking effect before he eats otherwise the insulin is on an uphill struggle battling already high and rapidly rising BG levels and above certain levels it is less effective. Having something like an egg and bacon breakfast or an omelette would feed him without rapidly increasing his levels and give whatever correction of Fiasp he needed, a chance to start lowering his levels.

Do be careful injecting a second or third large dose of Fiasp if the first one still has time to act (ie within 4 hours) as it can be funny stuff and sometimes sit there and do nothing until you add some more or do a bit of exercise later and then it can suddenly all kick in and catch you out with a nasty hypo and suddenly coming down from mid 20s can be rather unpleasant.

 

[ShellyG]

Another vote for a basal check here. Could he have forgotten to take his basal insulin or deliberately not be taking it for some reason. Many people have difficulty coping with their diabetes diagnosis at times and can go through phases of not being able to give themselves their insulin. Your son is at a difficult age without having diabetes to cope with on top of that and teenagers are known to be rebellious. I am not saying this is the case but it certainly does happen because there are people here on the forum who have admitted to doing it..... So, I would check firstly that he is taking his basal injections and secondly that his basal dose is correct by doing a basal check.... ie skipping one meal a day and fasting for that period so that no Fiasp is used during that time and see if levels are steady or go up or down. A few units too little with your basal dose can translate to an awful lot more Fiasp or whatever other quick acting insulin you use and if you then add in a few carbs that can easily see levels escalating even with effective bolus insulin being injected.

I would say that you really need to get back on to your clinic team for more help. Leave a message saying that levels are reaching the point that you fear he may need to be hospitalized and hopefully that should provoke a more rapid response. Certainly if his readings hit 30 and won't come down then you need to be heading to hospital. Are you testing for ketones? When his levels are regularly mid teens and above you should be testing for ketones and if you get readings over 1 then seek medical advice. If you have no means of testing for ketones then ask for some.... Ketostix urine testing strips at the very least but ideally some blood ketone test strips and make sure you have a meter which will accept them.

Thank you so much for your help, we regularly check for ketones and has been no higher than 0.2. I see him most of the time actually doing his injections and keep a check everytime that he is doing the correct doses.
His levels are definitely peaking during the night he usually does his night time injection about 10pm and does 18 units. And if he skips a meal he still has to do insulin as he is so high when he wakes up.

 

[rebrascora]

Thank you so much for your help, we regularly check for ketones and has been no higher than 0.2. I see him most of the time actually doing his injections and keep a check everytime that he is doing the correct doses.
His levels are definitely peaking during the night he usually does his night time injection about 10pm and does 18 units. And if he skips a meal he still has to do insulin as he is so high when he wakes up.

That highlighted bit tells you that his basal insulin likely needs increasing.... unless he is having a midnight feast of mars bars and crisps every night.... again something you can't just assume with a teenager and if he is then don't tell him off but just encourage him to take the right amount of insulin to cover it. I really don't know if I could have coped with being diabetic as a teenager and it must be even worse as a parent of a child with diabetes, trying to balance giving them independence against concern and wanting to make things right for them, but not always knowing the full picture
Your team need to help you with getting his basal dose right. Push them for help. Nothing makes sense if basal dose is not right and it is something which can need tweaking quite frequently, particularly as hormones fluctuate and activity levels vary from day to day. Does he do much/any sport?
I have just started doing more exercise (mostly power walking) and my insulin and BG levels behave so much better when I am doing regular exercise. It is a massive relief not to be battling high levels and everything just works so much more predictably. I have been in the 5s most of the day today and it has been bliss! I am now in the process of reducing my basal insulin after several months of having to slowly increase it. Hope you find the balance soon but please do keep pushing for help from the clinic as we are not qualified to give you dosing advice.

Pleased to hear that you are checking for Ketones and levels are OK

 

[Inka]

Thank you so much for your help, we regularly check for ketones and has been no higher than 0.2. I see him most of the time actually doing his injections and keep a check everytime that he is doing the correct doses.
His levels are definitely peaking during the night he usually does his night time injection about 10pm and does 18 units. And if he skips a meal he still has to do insulin as he is so high when he wakes up.

That will make it hard to do a proper basal test then. I’d speak to his team and see if his evening basal can be put up. You could also discuss the timings of his basal injections as sometimes a small change in that an make quite a difference.

 

[Pumper_Sue]

Thank you so much for your help, we regularly check for ketones and has been no higher than 0.2. I see him most of the time actually doing his injections and keep a check everytime that he is doing the correct doses.
His levels are definitely peaking during the night he usually does his night time injection about 10pm and does 18 units. And if he skips a meal he still has to do insulin as he is so high when he wakes up.

What insulin is he using for his background (basal)
It's obviously the problem as he is waking so high.
Hope it's sorted soon