At what point would you seek emergency help for high BGs?

[PattiEvans]

I've only once called for help and that was because corrections did help a bit, but nowhere near enough. What made me think of testing for ketones I don't know, but I had this rolling nausea and the runs. I called 111 and hung on for 48 minutes, during the last 10 minutes of that time ketones had risen from 2.6 to 3.9 and were going up fast - It was only then it dawned on me that I'd had a cannula failure and although it was delivering a trickle it was nowhere near enough, so I changed cannula, hubby bundled me into the car and took me to A&E.

How is it going now @Lucyr ?

 

[Lucyr]

I've only once called for help and that was because corrections did help a bit, but nowhere near enough. What made me think of testing for ketones I don't know, but I had this rolling nausea and the runs. I called 111 and hung on for 48 minutes, during the last 10 minutes of that time ketones had risen from 2.6 to 3.9 and were going up fast - It was only then it dawned on me that I'd had a cannula failure and although it was delivering a trickle it was nowhere near enough, so I changed cannula, hubby bundled me into the car and took me to A&E.

How is it going now @Lucyr ?

Scary! What did they do at a&e? I didn’t realise there was an NHS callback service but it seemed to work well for me. Was about an hour till someone called me back then appointment was about 20 minutes later (had to go quick!)

I’m feeling better compared to last weekend of being so high, but still feeling slightly under the weather, though nothing specific.

BGs since hospital have been:
Tuesday 15.5 - 23.1
Wednesday 11.8 - 18.6
Thursday 8.9 - 21.3
Friday so far 8.0 - 18.9

So it feels like I’m still running high, the lows are getting closer to normal range, but still getting some really high spikes. The tests I’ve done are premeal and 2hrs after a meal so I’ll be going higher than those highs.

Not sure if i need to assume it takes your body a while to recover and wait longer since the low point is coming down, or adjust doses, or call and ask to speak to DSN again or what.

 

[Inka]

Or @Lucyr might find that purposely depriving herself of carbs causes her body to pump out more glucose… I find that when I’m ill it does that more. What works for me is to try to get back to normal meals with normal amounts of carbs. I find normal meals plus insulin works best.

Your blood sugars are coming down @Lucyr If it was me, I’d simply correct those spikes with the appropriate amount of fast-acting insulin. You could, of course, tweak your meal ratios but if you feel things are on the way back to normal you’d then have to watch out for going too low. You’d have to judge what number you’d correct at. Depending on the illness and my circumstances, I’d probably correct if 12+ but it’s not a hard and fast rule and you need to use your instincts a bit. Getting those spikes down will hopefully mean you feel better in yourself.

 

[Inka]

Come on @Inka, with such high blood glucose levels the only 'deprivation' is of insulin.

No, you “come on”, Benny. There’s no need to avoid carbs when ill and, in fact, doing so can often prolong the problem. Eating normal amounts of carbs and getting the insulin in is the way to go. It’s what gets the body and blood sugar back to normal.

A body needs insulin when it’s ill and when blood sugar is high.

 

[Lucyr]

The DSNs advice in hospital was to eat normal meals, unless I felt too ill and then just whatever I felt i could manage. I don’t want to cut carbs too much as I’ll get ketones then.

Weirdly the highest reading is consistently 2hrs after lunch which never used to be a problem for me. The lowest reading is just after that, before dinner, though occasionally lowest reading is before bed or first thing in the morning.

I can try bolusing for lunch earlier or eating something different for lunch. Woken up feeling really rough today so have corrected and not eaten also, see what that does to blood sugars.

 

[Inka]

Hope you feel better soon @Lucyr xx

 

[Lucyr]

I’ve also slightly changed my meal and correction ratios this morning, since I’m not yet getting down to normal bgs.

 

[EmmaL76]

Hi Lucy,
I’ve been reading through your thread and am I’m really hoping your feeling a little better. You have been helpful to me in the past and this reminds me that others have gone out of their way when they are struggling themselves. Some proper decent folk on here xx

 

[nonethewiser]

The DSNs advice in hospital was to eat normal meals, unless I felt too ill and then just whatever I felt i could manage. I don’t want to cut carbs too much as I’ll get ketones then.

Always ate normal when ill, only exception is when have bad guts, so might have chicken soup & roll or scrambled eggs on plain toast, important to keep eating whenever possible as it aids recovery.

 

[Kaylz]

Lucy you need to do what works for you and only you know what that is, pretty sure even sick day rules state that if you can't eat you drink full sugar drinks, confirmed - If you do not feel like eating normal meals, try to eat foods that are easy to digest (e.g. soup, ice cream, milk puddings). If you are unable to eat, sip carbohydrate-containing fluids (e.g. fruit juice or a soft drink).

I really do hope you feel better soon xx

 

[Proud to be erratic]

The DSNs advice in hospital was to eat normal meals, unless I felt too ill and then just whatever I felt i could manage. I don’t want to cut carbs too much as I’ll get ketones then.

Weirdly the highest reading is consistently 2hrs after lunch which never used to be a problem for me. The lowest reading is just after that, before dinner, though occasionally lowest reading is before bed or first thing in the morning.

I can try bolusing for lunch earlier or eating something different for lunch. Woken up feeling really rough today so have corrected and not eaten also, see what that does to blood sugars.

Hi @Lucyr , your thread is fascinating and potentially really useful. Sorry it has arisen because of your current round of high BGs.

I think the question is sensible. Someone remarked: particularly for a person living on their own; I think equally useful for a partner. I'm pretty new to DM and my wife sometimes asks me why I don't reach out to our GP or a DSN when things are 'awry'; and I'm hoping a consensus view will emerge to answer your thread and give my wife some sort of guidance if I'm not being very sensible!

Occasionally I get high BGs which seem to stick and are inexplicable at the time (a couple of times infections arrived 48 hrs later, to explain ...). I have found that if I hit enduring highs very hard, ie with stronger correction ratios, and get myself back into the high 5s or low 6s then I regain control and that control seems to stick. I deduced this from using my normal correction when really high, getting a bit below 10 then quickly rising again; the correction needed to be stronger to get myself fully "down the hill". This has included missing a meal, if I just feel rubbish (but I like my food, dislike feeling hungry and broadly agree with the principle about eating to maintain energy levels while ill). So I hope your fast this morning helps you 'break the mould' and gives you some normality.

Presumably you are already aware that when one's BG is high one's natural resistance to insulin increases. I use a stronger correction ratio if above 15 to what I use between approx 9-15.

I hope you get some proper respite soon. I'm lucky in that I generally don't feel unwell when very high (don't seem to be hyper aware), but I very much dislike the idea that my BG is anywhere above 10 and potentially setting me up for other problems in the future.

Hoping things improve for you very soon.

 

[Lucyr]

Tried not having breakfast yesterday (as felt too sick for any) and bg started 12.9, stayed around 13 on following tests, then went to 15 before lunch

At lunch I had pasta, split the bolus and correction over a couple of jabs, started at 15, got down to 9 afterwards.

At tea I was 11 so I tried overlapping the correction in a couple of small boluses half hour apart, then bolusing for and eating tea half hour after that. You’re not supposed to overlap too many boluses because it can drop you more than expected is why I tried that.

Was 7.4 before bed and 5.6 this morning.

 

[rebrascora]

Did you inject any correction units at breakfast time Lucy to bring your levels down? I think the point @Benny G was making was that there is plenty of glucose in your system when your levels are high and you need insulin to access and remove it, rather than more carbs.
I try not to eat until my levels are about 5-6. If they are higher I inject fast acting insulin and wait until they come down. That might be an hour or it may be that in 3 hours they still haven't come down and I need to inject another correction/bolus.... which is starting to look like it may be the case this morning. 6 units has only brought me down from 10.9 to 7.2 in nearly 2 hours.... I am suffering a strong Dawn response this morning for some reason. My breakfast is all ready to eat but I won't starve for another hour or so until my levels comes down to a better range. I appreciate that this may be taking it a bit far for many people and obviously it isn't always possible to wait until levels come down into range but when you can, this really helps because once levels get high, corrections become much less effective, but carbs still bump the BG higher. That is how my body works anyway and hopefully this way I can prevent getting into the upper 20s with my BG levels.

 

[Lucyr]

Yes at breakfast I was 12.9 and did 4u of correction
1hr later was 13.3
2hrs later was 12.1 did another 2u of correction
3hrs later was 11.1
4hrs later was 15.0

If I waited till my levels were 5 before eating I wouldn’t have eaten anything in over a week!

 

[rebrascora]

Yes at breakfast I was 12.9 and did 4u of correction
1hr later was 13.3
2hrs later was 12.1 did another 2u of correction
3hrs later was 11.1
4hrs later was 15.0

If I waited till my levels were 5 before eating I wouldn’t have eaten anything in over a week!

If those numbers were mine it would suggest my basal needed increasing. Which is what I may be looking at tomorrow again myself. I upped my morning Levemir by 2u yesterday and 3.5u last night and I was still drifting upwards this morning, so clearly more basal needed.
Thankfully my Fiasp has eventually overcome DP and I hit 5.9, so now eating breakfast but may well need another correction later. I would not be able to manage my levels like this without Libre so I am really grateful to have that on prescription. I know you self fund and really hope the new NICE guidelines enable you to access it on prescription.

I wonder if the communication between your pancreas and liver is faulty so high BG doesn't shut down your liver from producing glucose but food hitting your stomach does. My gut feeling is that you have elements of Type 1 and Type 2 diabetes which make it more complicated.

 

[Lucyr]

I don’t think my basal needs increasing because even when crazy high I always drop overnight. I do think that a part of T2 that isn’t always recognised is that your pancreas can be erratic in if/how/when it helps out, the same going for what your liver does and what your insulin resistance is like. I find everything to be quite unpredictable, a bit like a T1 in honeymoon would do.

Haven’t had a libre on for a couple of days as I had to remove a new one for my MRI and couldn’t justify buying another when I was running so high. Would be good if I can get it funded, will ask at my next appointment. It’s in March so probably before guidelines change, but I’m easily testing 8 times a day.

 

[BeeBusy]

I'll be rooting for you, @Lucyr, hoping you get well and that you can get the Libre on prescription. If I may, I'm sending a cyber hug. You went through such a rough patch! I'm happy they gave you that bed and the care you needed.