Bad day of control today

[Hellospringett]

Today was a terrible day. During work I checked my levels and they were at 18 so I insulated for this and next thing I have dropped to 3. I had some glucose drink and a roll for some carbs, and of course an hour later it shoots back up to 16 I insulate and it drops to a number so low even my libre cannot tell me the number.
where am I going wrong?!

 

[Pumper_Sue]

You are imitating a yoyo What you have done is stacked your insulin hence the roller coaster ride it's all built up and crashed.
No1 rule is do not correct for at least two hours after your last bolus.
The 18 did you recheck the reading by washing your hands then retesting. Most of us had made the clanger of not washing hands and getting the wrong reading.
Hope you are ok now.

 

[Abi]

Probable over treatment of a hypo- so easy I know when craving handfuls of biscuits and toast but very often a modest fix of glucose is all that's needed.

 

[Hellospringett]

Hi Sue,
Ah I see I have the libre so I can just scan my arm and it tells me.
I think because my nurse has told me I NEED to keep it below 10 I panic and insulate to get it down. But I have just been up and down all day like you said a yo-yo. Makes me not even want to eat dinner because I’m scared to inject

 

[pm133]

You might be over-compensating.
For a low, you migt want to limit yourself to 3-5 glucose tablets and then wait 15 minutes efore testing again. You ate a roll which will have a lot of carbs and would have needed a bolus which presumably you didn't take. That could explain the return to a very high level.

You also need to look at how many insulin units you are taking. It looks like you are taking too much, hence the hypo. How many bolus units did you take when you were at 18?
Today I hit a 17 blood glucose reading and went for an hours brisk walk to get that back down to under 7. Alternatively I could have gone for 2 units of bolus immediately and then re-tested in an hour and repeated if necessary. You may require different amounts.

I am pretty new to this so still finding my feet but a combination of a little bolus and/or exercise always sorts me out when I go high. The key is not to panic when you get either highs lows. I did that last month and spent 2 days oscillating between very high and very low until I figured out how to sort myself.

 

[Hellospringett]

Probable over treatment of a hypo- so easy I know when craving handfuls of biscuits and toast but very often a modest fix of glucose is all that's needed.

I think I panic that it is so low so I drink this glucose drink. Maybe it is too strong and that’s why it shoots? But I panic a bit of choc or biscuit just isn’t going to bring it up in time

 

[Hellospringett]

You might be over-compensating.
For a low, you migt want to limit yourself to 3-5 glucose tablets and then wait 15 minutes efore testing again. You ate a roll which will have a lot of carbs and would have needed a bolus which presumably you didn't take. That could explain the return to a very high level.

You also need to look at how many insulin units you are taking. It looks like you are taking too much, hence the hypo. How many bolus units did you take when you were at 18?
Today I hit a 17 blood glucose reading and went for an hours brisk walk to get that back down to under 7. Alternatively I could have gone for 2 units of bolus immediately and then re-tested in an hour and repeated if necessary. You may require different amounts.

I am pretty new to this so still finding my feet but a combination of a little bolus and/or exercise always sorts me out when I go high. The key is not to panic when you get either highs lows. I did that last month and spent 2 days oscillating between very high and very low until I figured out how to sort myself.

I think you are right. I took three units of insulin after I was 18 and I am a builder so I guess I am exercising my body by labouring after I have insulated so maybe I done too much

 

[pm133]

Hi Sue,
Ah I see I have the libre so I can just scan my arm and it tells me.
I think because my nurse has told me I NEED to keep it below 10 I panic and insulate to get it down. But I have just been up and down all day like you said a yo-yo. Makes me not even want to eat dinner because I’m scared to inject

While she is technically correct, that's really not a helpful piece of advice to give a newbie because it can make people panic.
Whilst not ideal, short bursts of high's are a lot less harmful than longer periods of being high. Over time your levels will come down and you'll find you have fewer spikes like that.

 

[Bruce Stephens]

I think because my nurse has told me I NEED to keep it below 10 I panic and insulate to get it down.

The usual (generic) guideline is to try to stay between 3.9 and 10.0, and to try really hard not to go below 3.9 and try not to be over 10.0 for too long (so over 70% between 3.9 and 10.0 if you can). But going a bit over 10.0 now and again is normal and really hard to avoid for most of us.

Reducing the lows can really help with the highs. After a hypo you need less insulin for a while, so if you can avoid the hypo then dealing with things is easier to understand. (After a hypo if and when you go a bit high, you're guessing a bit about how much insulin to use.)

And if you're going low, just take some fixed amount of glucose and wait for longer than it feels like you ought to need to. 15g and wait for 15 minutes is the usual rule, but with the Libre you won't see anything for another 10-15 minutes. So test with a test strip after 15 minutes, or (if you're not feeling too bad) wait a bit longer. It's all too easy to over correct.

 

[Pumper_Sue]

Hi Sue,
Ah I see I have the libre so I can just scan my arm and it tells me.
I think because my nurse has told me I NEED to keep it below 10 I panic and insulate to get it down. But I have just been up and down all day like you said a yo-yo. Makes me not even want to eat dinner because I’m scared to inject

Hi Tom,
It's a good idea to do a finger poke when you have numbers like that as the sensor could be well out.

Please don't panic there is no one on this earth who has never been over 10 and not lived to tell the tale 🙂
You need to remember you are a human being and not a machine so things do not go like clockwork all of the time (unfortunately)

Try very hard to stick to set meals and the dosage to match without any corrections and see how you get on. This will give a clearer picture of what is happening.

As a matter of interest what insulin are you using?

 

[pm133]

I think you are right. I took three units of insulin after I was 18 and I am a builder so I guess I am exercising my body by labouring after I have insulated so maybe I done too much

I think you are probably correct. Maybe 1 or 2 units followed by moderate exercise over the next hour would have been better but the key is to retest and monitor regularly until things settle down over the following hour or 2.

 

[pm133]

I think I panic that it is so low so I drink this glucose drink. Maybe it is too strong and that’s why it shoots? But I panic a bit of choc or biscuit just isn’t going to bring it up in time

I think each person has a different amount of time to get over a hypo. You should check how many carbs are in that glucose drink. You might find it's way too much. I seem to recall the advice being the equivalent of 125ml or 250ml (sorry, I can't remember which) of full fat coke being ideal. For me, it's just a straight 5 dextrose tablets which I carry everywhere. Just remember that any glucose will send your level spiking for a while because you don't take a bolus when treating a hypo sp be careful about how much you take.

 

[Hellospringett]

Yes, and a test strip can be quite a bit out. So take the exact numbers reported with a pinch of salt.

I think when I feel that rough and no how low I am I just want it to get better so I panicked.
I also find I cannot use the finger tester and that is why I have the libre. I am a builder and over the years I feel like my hands have turned to cement themselves. Cannot get any blood out of them!

 

[Pumper_Sue]

Yes, and a test strip can be quite a bit out. So take the exact numbers reported with a pinch of salt.

Test strips have to be within a certain %

 

[Hellospringett]

Hi Tom,
It's a good idea to do a finger poke when you have numbers like that as the sensor could be well out.

Please don't panic there is no one on this earth who has never been over 10 and not lived to tell the tale 🙂
You need to remember you are a human being and not a machine so things do not go like clockwork all of the time (unfortunately)

Try very hard to stick to set meals and the dosage to match without any corrections and see how you get on. This will give a clearer picture of what is happening.

As a matter of interest what insulin are you using?

Yes I am even struggling with that. I feel like one day I can have my 11am roll and insulate 3 units and be fine and the next day do exactly the same and it can drop.
I take lantus in the evening (8 units) and a Nova rapid for my before meal time injections. I have no ratio at the moment as every day is different for me.

 

[rebrascora]

Hi
Are you checking your levels with a BG meter when you are high and low. Libre is not as accurate as a finger prick when you get out of range (ie too high or too low) so you should really check with a finger prick before deciding how much insulin to use to correct a high or deal with a hypo. That 18 may well have only been 14 or 15 on a finger prick. It is also advised not to do any corrections after a hypo as the liver will often claw some glucose back out of the blood stream up to several hours later so if you have also injected more insulin the levels can come down twice as quickly and even more so if you are physically active like in your job, creating a really dangerous situation, so try to resist the urge to correct a high after a hypo.

Also the Libre will take longer to show that your levels have come up after your hypo treatment. It will usually take another 15 mins on top of the 15 mins for Blood Glucose to come up, so take your 15 grams of carbs (glucose tablets are easiest because you just chew 3) and be patient for 30 mins or retest with a finger prick after 15 mins and have another 1 or 2 tablets if you are still low and then test again in another 15 mins.

 

[pm133]

I think when I feel that rough and no how low I am I just want it to get better so I panicked.
I also find I cannot use the finger tester and that is why I have the libre. I am a builder and over the years I feel like my hands have turned to cement themselves. Cannot get any blood out of them!

That's going to cause problems for your ability to drive because I am pretty sure you can't rely on the Libre readings amd must confirm with blood tests a maximum of 2 hours before driving and then every 2 hours after that if long distance. There are alternative sites you can use for taking blood but I don't know what those are.
Have you spoken to the DVLA about this? It's a legal requirement to tell them about your diagnosis.

 

[Bruce Stephens]

Test strips have to be within a certain %

Yes, +/- 15%. Still quite a lot when you're high enough. But I agree if the Libre says I'm 18 I don't believe anything more than I'm high: I certainly wouldn't rely on the number to calculate a correction dose.

 

[Bruce Stephens]

That's going to cause problems for your ability to drive because I am pretty sure you can't rely on the Libre readings

That's changed now. (Obviously check the precise rules to see what's necessary.)

 

[Hellospringett]

That's going to cause problems for your ability to drive because I am pretty sure you can't rely on the Libre readings amd must confirm with blood tests a maximum of 2 hours before driving and then every 2 hours after that if long distance. There are alternative sites you can use for taking blood but I don't know what those are.
Have you spoken to the DVLA about this? It's a legal requirement to tell them about your diagnosis.

I do not drive anymore. I have someone to drive for me.