Advice welcome!

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Ivostas66

Ivostas66

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Relationship to Diabetes
Type 1
Good afternoon folks!

A couple of weeks ago I had a nasty hypo at work - one of those where BG takes a lot longer than you would hope to return to normal and you end up feeling completely done in afterwards. Anyway, I was sent home from work to recover once my BG had risen to a 'safe' level. I then had flu like symptoms without the flu (swollen glands, headache, painful ears, aches and shivers all over) and my BG was running very high, with sudden/ unexpected drops. Things did not really improve, with one morning seeing 4 hypos in quick succession, so after a few days I contacted my GP and DSN. GP sent me to A&E for blood tests (9 hours!). DSN suggested rest, a slight adjustment to basal insulin and to keep a close eye on my Libre. Bloods came back clear of any sign of infection etc. A&E also told me to rest for a week or so and said that I was probably suffering from a nasty virus. I was keen to return to work on Monday and starting to feel better over the weekend, but was woken by my wife around midnight on Sunday, telling me that my Libre alarm was sounding loudly, but I was sleeping through it and when she scanned my arm I was once again having a bad hypo - she said I wasn't really with it, but ate and BG gradually improved. Not been in work since - just about managing to avoid hypos, but running around 9 average mmol/L, 60% in range. Very tired, headaches and my mental health is now pretty much on its backside!

Does anyone have any advice other than what I have been told by DSN? GP is pretty much unavailable, with the receptionist apologising that the surgery is constantly packed with children whose parents think they have Strep A.

This is the first year that I was not ill during November since diagnosis 5 years ago and my wife and I were so pleased that I avoided picking something up from school (teacher surrounded by coughing, sneezing kids all day). Typical that at the start of December I become ill!
 
Sorry to hear you are going through a rough patch. Do you know what your BG level was when your wife woke you up? I am guessing you didn't double check it with a finger prick if you were that out of it.

I think the first thing I would start with is some basal testing to see what your basal insulin is doing in the absence of food. I could never manage with a long acting basal insulin like Toujeo because I need 4-5 times more insulin during the day than overnight. It may be that your body has changed and Toujeo is now no longer working for you or perhaps it is "crystallising" and releasing when you least expect it as I believe Glargine can do sometimes.
How much do you use, where do you inject it and have you tried splitting the dose between 2 sites? For instance I need 20 units of Levemir on a morning so I inject 10units into each buttock because I think 20units all in one place is quite a lot and two sites means that the absorption is likely to be more uniform if that makes sense. Obviously, if your sites are lumpy then that could be causing problems so check that out or change to a different site, like buttocks or thighs if you currently use your stomach. Or ask to swap to a different basal insulin like Levemir particularly if your basal testing shows u are struggling to cover your basal needs with such a long acting insulin. It certainly doesn't suit everyone and particularly if you have a job in a school where I imagine you are run ragged during the week days but less so at the weekend/holidays.
I absolutely love my Levemir for the flexibility it gives me to adjust it to my lifestyle and my bodies needs and I would fight tooth and nail if they tried to replace it with a very long acting insulin like Tresiba or Toujeo as they just would not work for me. Personally I think they may be better for people who need large doses due to insulin resistance rather than most Type 1s who are sensitive to insulin.

I hope you are able to get to the bottom of the problem. Personally I would not go to my GP or diabetes (practice) nurse with such a problem as they do not know enough about insulin usage. Your DSN and consultant are the people to rely on if you can't figure it out yourself, but certainly try basal testing first to see if that highlights anything.
If you don't know how to basal test it is a system of skipping meals in rotation over a few days to see if your basal insulin is holding you steady during that period of the day without food and bolus insulin. So one day you might skip breakfast and the next you skip lunch and the 3rd day you skip your evening meal and see what your BG levels do when there is no other insulin or food in your system.
There is a thread in the Pumping and technology section of the forum on how exactly to do it. I often skip meals so I don't do it as formally as the instructions there, but you would be best following that framework if you haven't done it before. I think it may be a sticky at the top of that section... will see if I can find and link it...
 
Here we go....
forum.diabetes.org.uk

Basal Testing Made Easy

Here's a link for basal testing, which will hopefully clear up the myths for anyone starting on their pump journey http://diatribe.org/issues/13/learning-curve Plus this might help as well. http://diatribe.org/issues/26/thinking-like-a-pancreas
forum.diabetes.org.uk forum.diabetes.org.uk
 
Thanks for the advice @rebrascora ! I inject a dose of 11 Toujeo each morning and I rotate the area that I inject each day - usually buttocks or side. If I wake slightly higher than I would like, then I might inject into my abdomen as a few years ago my DSN stated that gets things going quicker. Over the past few years I have worked out decent timings for administering my Fiasp to avoid post-prandial spikes (half an hour prior to breakfast and then 5-10 minutes before other meals dependent upon my level at that time). I dropped the dose to 10 last week following advice from my DSN.

I was put onto Toujeo by the clinic shortly after diagnosis. At the time all of the research stated it was the best that was available - my consultant and DSN were both adamant that for my 'lifestyle' as teacher and also father to a toddler at the time, it would be the best option. My GP kicked up a stink as he claimed it was too expensive and also too strong, which my consultant said was nonsense. I have never had any issues with it and when I have basal tested things are fairly consistent. This morning I basal tested and was 7.1 when I woke at 6:30am and 7.2 at 12:30pm. My BG did creep up to 10.5 for a short time around 9:30am, but then headed back south around 10am.

I think tomorrow I shall test around lunchtime and see what the results are then. I also think the stress of not being at work is causing issues. Teachers are expected to set work if they are not in, which takes a lot of time and effort and is not something that you want to spend an hour or two doing when feeling dreadful. The flip-side is that I know colleagues will be teaching my lessons and so I don't want to leave them in the lurch. My GP took this out of my hands and said that if I am signed off from work then I am signed off from work - I cannot be expected to work at home. He even asked why I would want to work for an employer that acts in this way, which I suppose is a fair point!
 
@Ivostas66 I have a similar virus and at the start of it, my blood sugar was persistently low. It hardly went up after meals. I reduced my basal (I’m on a pump) and also went to bed at a higher level than I would usually. It’s a nasty virus - and one of many around.
 
Inka said:
@Ivostas66 I have a similar virus and at the start of it, my blood sugar was persistently low. It hardly went up after meals. I reduced my basal (I’m on a pump) and also went to bed at a higher level than I would usually. It’s a nasty virus - and one of many around.
Click to expand...
Stay safe! My DSN said that the clinic have increased there response time for non-emergency calls from 24 hours to 48 hours due to so many diabetics with virus/ infection.
 
The best insulin is the one that works for your body at that point in your life and it can change. Saying a basal insulin is the best that is available is nonsense in my opinion as it can only be best if an individual tries it and finds it to work well for them. Basal insulins have different profiles of activity and matching that profile to your liver output is all that matters,

So far your basal test looks promising but I would wonder about evening and night time if it is holding you reasonably in range in the morning as many people need less then but Toujeo should continue to release the same amount over the 24hour period. Some people have very little difference in needs between day and night and work days and days off, so Toujeo or Tresiba can work well for them, but it really isn't very flexible if you have a more variable lifestyle or your day and night basal needs vary significantly.

Pleased to read (before I hit "post") that @Inka has some reassurance regarding the possible virus you are experiencing and hopefully things will settle down again when it passes, but if not, and your basal test for afternoon/evening is showing problems then don't be frightened to ask for a change.
 
Screenshot_20221215-115636[3883].jpg
So this is me today basal testing. Very similar to testing yesterday morning. Woke at 6:30am to get my daughter ready for school, injected around 7am. BG has remained fairly stable, although a little higher than I would like.
 
I always inject my basal before I get out of bed because my levels start to rise as soon as I get up, so the sooner I get that basal in and starting to work, the sooner it prevents my levels from rising. I know Toujeo has a long profile but it will be tailing off a bit when you wake up, so getting that next dose in and working ASAP should help. Even just half an hour could make a significant difference, so you might try that as a very simple fix for it rising during the morning, but obviously your breakfast bolus ratio can help this too and that is a legitimate tactic. If I am not going to have breakfast I sometimes still need to inject 1-2 units of bolus insulin to deal with that Foot on the Floor rise.... unless I have done a lot of exercise the previous day and then I don't need it.
 
Yep. I usually inject both basal and bolus when I wake up, as leaving around 30 minutes between that and breakfast tends to reduce the likelihood of post prandial spike. I suppose as I am not at work at the moment and out of that routine, I was keen to help/ encourage my daughter with breakfast and dressing (5 years old going on 15!) whilst my wife readied herself for work.
 
Sorry you’ve had such a rough time @Ivostas66 :(

Sudden changes and unpredictability like this can be a real kicker.

How are your sites? Any lumpiness? Any possible scarring? Sometimes parts of injections can get locked away and then release when you don’t need them!
 
OTOH maybe the moon wasn't in the 7th house or Jupiter wasn't aligned with Mars that week .... just sometimes, there are no logical reasons. The other thing that happens to everyone is that as we go on, our body changes and whilst we know our hair will go grey, our periods change if we're women, we'll get lines on our face etc, really we have no advance clue about every minute thing our bodies do 'automatically' - until summat malfunctions. Just because insulin X or Y has worked really well for the last however many years, does NOT mean it always will or even still does.
 
Thank you all for the support and advice. I ditched my Fiasp pen and started a new one (just in case). I checked the areas I inject and there doesn't seem to be anything amiss - I remember the scare photographs we were shown at my 'training' session after diagnosis, so have always tried my best to rotate sites.

Anyway, things seem to have settled over the past few days. Basal testing seemed to suggest long acting was OK. No post prandial spikes either and only a couple of dips, but not really near to hypo territory.
 
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