Covid

[Jacen017]

Hi Everyone,

Covid has finally caught me. It's the first time I've been sick since diagnosis and I'm really confused.

Everything I've read says that my body should be releasing glucose to help fight the illness and that my BG should be rising?

I'm experiencing the opposite, nothing I do will keep my levels up, I'm having to constantly eat and it's the last thing I want to be doing when I feel so sick.

Anyone else experienced this?

 

[Lucyr]

some illnesses make you high and others make you low. if this one is making you low then reduce your insulin and / or sip sugary liquids

 

[SB2015]

Hi Everyone,

Covid has finally caught me. It's the first time I've been sick since diagnosis and I'm really confused.

Everything I've read says that my body should be releasing glucose to help fight the illness and that my BG should be rising?

I'm experiencing the opposite, nothing I do will keep my levels up, I'm having to constantly eat and it's the last thing I want to be doing when I feel so sick.

Anyone else experienced this?

It is the frustrations of Diabetes.
as @Lucyr says sometimes we go high and sometimes we go low.

How do you manage your T1?
Are you on Multiple Daily Injections and have you been taught how to adjust your doses to match what you need. I am not sure how long ago you were diagnosed and some people are out on fixed doses initially so that needs adjusting when you are ill.

 

[Jacen017]

It is the frustrations of Diabetes.
as @Lucyr says sometimes we go high and sometimes we go low.

How do you manage your T1?
Are you on Multiple Daily Injections and have you been taught how to adjust your doses to match what you need. I am not sure how long ago you were diagnosed and some people are out on fixed doses initially so that needs adjusting when you are ill.

I'm about 8 months in now.

MDI and already changing doses - I had no bolus with dinner last night and still went low!

I use Tresiba for a basal which takes a while for any changes to show 🙄

 

[rebrascora]

If you had no bolus with dinner and still went low then you obviously need to reduce the Tresiba. I would try maybe 10% reduction if it was me and do keep a close eye on things overnight. If you are going low after an insulin free meal then a bad hypo at night is a real concern, especially with Tresiba which will take time for changes to take effect and ring your DSN tomorrow to seek further advice. I hope you have Libre 2 to alert you to levels going low.
Do let us know how you get on and take care. Hope the symptoms are not too bad.

 

[Jacen017]

If you had no bolus with dinner and still went low then you obviously need to reduce the Tresiba. I would try maybe 10% reduction if it was me and do keep a close eye on things overnight. If you are going low after an insulin free meal then a bad hypo at night is a real concern, especially with Tresiba which will take time for changes to take effect and ring your DSN tomorrow to seek further advice. I hope you have Libre 2 to alert you to levels going low.
Do let us know how you get on and take care. Hope the symptoms are not too bad.

I do indeed have a Libre - it hasn't let me sleep for days

 

[rebrascora]

Good that you have Libre of course but the "OH NO" response is that you are getting alarms all the time! Hope you have plenty of hypo supplies in stock or someone who can go out and get you more.

 

[SB2015]

I do indeed have a Libre - it hasn't let me sleep for days

Hi again

As others have said if you are going low with no meal and bolus then the insulin you have on board is too much. Also if that is resulting in you not getting the sleep and rest you need it is likely to hinder your recovery.

looking ahead it might be worth asking about switching to an alternative basal insulin such as Levemir. It has a shorter time on the active profile and is usually split into a morning and night time injection, so an extra injection, but it gives you more flexibility to adapt your doses and the changes come into effect more quickly. You can change the dose during the day without impacting your overnight one, so make changes in the morning with the weather, or amount of exercise you will be doing during the day, and then leave the one overnight. Or if you are having hypos overnight reduce that without having to change the morning one. Basically a lot more flexible.

I hope that you feel a lot better soon.

 

[Proud to be erratic]

Hi @Jacen017,
I've found that the hot weather here in Bucks has needed me to reduce my Tresiba. It is less flexible than, say Levermir, but in practice a 1/2 unit change from 8.5 to 8 showed an improvement the next day and consolidated that after a further 24 hrs.

BUT, I would just caution you to be alert to any differential between actual BG and your Libre interstitial values - when at steady state. I've just had 2 sensors starting high, ie above actual BG then steadily drifting down to being consistently below actual BG, before either naturally expiring or failing early; now I know that my body and Libre don't seem to completely enjoy each other's company, so that makes me more conscious of the differential. It also means I'm more wary about what my Libre alarms are really telling me; for example I routinely have my alarm at 5.6 and accept that I get a few too many early warnings - but find I'm resetting my alarm to a much lower setting as the 'differential' alters downwards. The mental challenge is reminding myself what my current setting is!!

I generally have my Tresiba optimised to keep me above 6 (actual BG) through the night and manage the day with my bolus.

I've just had an odd week, consistently going hypo from above 7 while eating breakfast and staying in the 4s for 3 or 4 hours before a rebound. I now think 2 factors are playing a part: the enduring hot weather is reducing my insulin resistance (so its going further and/or working more rapidly) but also my activity level has been steadily increasing; this latter aspect is because I've been recovering from abdominal surgery and gradually getting better, without particularly realising it.

So I'm now reducing my calculated bolus doses by (today) 70% to compensate for the activity and expect to be making 50% reductions very shortly. I appreciate this doesn't help you when you're eating with no bolus (yet still going low) - but how many carbs was that with no bolus and how much bolus might have already been on board?

But overall, if no bolus on board, it has to be a basal that is too high! Even Tresiba needs adjusting periodically; and without seasonal variations our bodies change - for a multitude of reasons; could your pancreas be releasing some insulin unexpectedly (the honeymoon risk?). A change to a shorter profile basal such as Levermir may well be the answer, just be aware that you will be adopting a somewhat different routine and then using your basal to optimise for 2 parts of the 24 hour day.

Good luck; at 8 months into this marathon there are still so many confusion factors to wrestle with!

 

[helli]

I generally have my Tresiba optimised to keep me above 6 (actual BG) through the night and manage the day with my bolus.

I don’t understand how you optimise basal to keep you above a level.
Basal is optimised to keep your levels stable in the absence of other factors (e.g. food and exercise). Your bolus is optimised to keep you above a certain level before you go to bed and your basal keeps you there. If you went to bed at 4.5, your basal should keep you there without adjusting your basal dose.

 

[Proud to be erratic]

I don’t understand how you optimise basal to keep you above a level.
Basal is optimised to keep your levels stable in the absence of other factors (e.g. food and exercise). Your bolus is optimised to keep you above a certain level before you go to bed and your basal keeps you there. If you went to bed at 4.5, your basal should keep you there without adjusting your basal dose.

Hi, not sure why you don't understand ... sorry if I'm having an off day.

My aspiration is to use my Tresiba to give me a steady, alarm free night, ie during a lengthy fasting period. In general I have my last food before 8pm, preceded by whatever bolus is appropriate, including any correction.

Sometimes, particularly this last week, I've found I'm drifting low during the late evening and taking modest snacks; I'm now monitoring my evening bolus ratios, to see if they need adjusting. But I think it's the weather and my increased activity that is causing this - which I've realised only last night, so only compensating for today (so far so good). I've also reduced my basal from 8.5 to 8 for the last 3 days. So as I approach bedtime, c.midnight, I'm in a reasonable steady state and no expectation of bolus still on board. Hence my optimisation aspiration. But this week has been messy, not helped by a sensor steadily sliding downwards in the daily calibration checks and sounding erroneous alarms. But I'm not prepared to turn the alarm off.

When the weather was, briefly, cooler and on a different sensor, with much less activity then (still post surgery) I found I was getting erroneous hyper alarms, usually 10 mins after shutting my eyes, which still had actual BG in the 8s. So I took modest corrections at midnight, targeting above 6, but obviously going to sleep with insulin on board and so overtaking my aspiration for the basal to work on its own during the night.

I won't as a principle go to bed at 4.5, not even actual 4.5; simply too close to a possible hypo during the night and certainly likely to sound an alarm and create an erroneous Low Glucose Event. My Endo tells me to set my expectations at 7; if I were on a closed loop pump that might be in my vocabulary, but not on MDI; I don't live in an ideal (fairytale?) world where I get even 9 days out of 10 the same! I'm c.30 months into managing D. My perception continues that no week or month is the same and I'm still responding to D demanding attention or hobbling my daily activity. Nor would I suggest that sort of figure in any dialogue with someone new to T1, or T3c with no panc'y (so no honeymoon spurges of insulin).

 

[Proud to be erratic]

Sometimes, particularly this last week, I've found I'm drifting low during the late evening and taking modest snacks; I'm now monitoring my evening bolus ratios, to see if they need adjusting. But I think it's the weather and my increased activity that is causing this - which I've realised only last night, so only compensating for today (so far so good).

Spoke too soon! Now comfortably in the 12s on Libre, actual =11.7. So now taking bolus correction as well as some for a latte and snack. Nothing seems very stable this week.

 

[helli]

My aspiration is to use my Tresiba to give me a steady, alarm free night, ie during a lengthy fasting period. In general I have my last food before 8pm, preceded by whatever bolus is appropriate, including any correction.

Tresiba will keep you at the same level. It will not do any corrections.
If your level is 6, it will keep you around 6 and alarm free.
If your level is 5 (and your alarm is set at 5.6), you will get alarms through the night.

Tresiba will not reset a 5 up to 6.

 

[rebrascora]

Tresiba will keep you at the same level. It will not do any corrections.
If your level is 6, it will keep you around 6 and alarm free.
If your level is 5 (and your alarm is set at 5.6), you will get alarms through the night.

Tresiba will not reset a 5 up to 6.

Tresiba will only keep you level if your needs are stable, even through the night.
What Roland is saying is that he sets his Tresiba dose to keep his levels as good as possible through the niht and corrects with bolus insulin during the day to make up for any short fall in basal during the day.
For me, I seem to need much less at night so I would be going through silly amounts of bolus insulin during the day to firefight my daytime highs in order not to hypo through the night if I was on Tresiba. I would find that really frustrating especially as I often skip meals.

 

[Proud to be erratic]

Tresiba will keep you at the same level. It will not do any corrections.

In principle, of course. But is something is changing, such as a delayed batch of fatty carbs with no bolus on board or just brain activity tapping existing glucose, then Tresiba, indeed any basal, is there to assist - mitigate if you like against modest blips in BG.

If your level is 6, it will keep you around 6 and alarm free.
If your level is 5 (and your alarm is set at 5.6), you will get alarms through the night.

If my level is 5, according to a variable sensor, then I first have to establish what is my actual BG. I have consequently reset my alarm from 5.6 to something below what is triggering that alarm, once I'm happy my actual is fine - even if my actual is lower - reasonably confident my Tresiba will keep me safe.

Tresiba will not reset a 5 up to 6.

Nor have I ever expected it to do that. But you are starting from a premise that I'm wearing a sensor that is consistent, even if not overly accurate. My reality is different. My only hope, other than muddling along mentally juggling with variable differentials (in steady state- which is not always absolutely the case, but is my best estimate), is that I can convince my Endo to let me try another system and see how that works. I have the evidence of a 50% Libre failure rate, both from LibreLink, as well as the paperwork from every replacement Libre. As it happens I have a Face to Face with him on Wednesday; I'm not overly optimistic.

Overall, I am happy with Tresiba; but admit that my experience of Levermir was before I had Libre and while I was post op then receiving chemo - so not a particularly fair period to make long term decisions on 'which basal'. What is, to me, far more relevant is the variability and unreliability of Libre 2 in conjunction with my body! It's a pretty constant firefight and intrusion every day. Even unicorn days, satisfying as they can be, are a consequence of vigilance and reacting to alarms. Anyway, this is not really helping the OP' thread of Covid.

 

[helli]

@Proud to be erratic , many of us who have been managing our diabetes with basal bolus have done so for most of our lives without sensors. When I write about being stable and having a blood sugar around 5 or 6, in my mind this is finger pricks not stable, reliable sensors.
You complain about 50% reliable Libre sensors. Maybe I am more tolerant to inaccuracies because I don’t rely on them. I am a heavy user of CGMs (Libre with add one that allow me to calibrate and other CGMs) but I do so with my eyes open.
I also don’t expect a flat line - I know people without diabetes see wobbly lines and perfection is not something I strive for. I strive for the kind of numbers that allow me to live a full life with a busy career, lots of exercise and socialising.

 

[gll]

I'm experiencing the opposite, nothing I do will keep my levels up, I'm having to constantly eat and it's the last thing I want to be doing when I feel so sick.

Anyone else experienced this?

my time in range is looking amazing right now due to this too 😉
last night was a struggle to get down and today is like magically behaving itself
normal for me is still about 10-12 and been hanging in the 8s.
Thankfully I'm just at better numbers and not hypo.
Noticed the drop alongside a raging temperature.
How u feeling today? I've dragged myself out of bed to cool off and stretch but already ready to get back in x

 

[Proud to be erratic]

@helli, this is not helpful and even if not intended feels patronising.

@Proud to be erratic , many of us who have been managing our diabetes with basal bolus have done so for most of our lives without sensors.

Of course you have. You grew up in a pre-tech era. But the tech now exists and I'm certainly not going to ignore it. Its been a game changer for me over the last 18 months.

When I write about being stable and having a blood sugar around 5 or 6, in my mind this is finger pricks not stable, reliable sensors.

Fine, but I regularly don't have stable, reliable sensors [or rather that my body doesn't find them to be stable].

You complain about 50% reliable Libre sensors. Maybe I am more tolerant to inaccuracies because I don’t rely on them.

I complain (observe?) partly because its a further strain when managing D, partly to balance the expectation of others; you paint a picture of perfect sensors, everything is rosy (oh and you can calibrate them anyway and attain fractional hourly changes in your pump). Most of us newer to D, without 30 years experience, muddle on trying to avoid 2 hourly finger pricks on freshly washed hands, living with the additional uncertainty of "is the sensor reading sound?"; or blindly ignoring the Libre limitations. Elsewhere you've rightly made the point that one needs to be aware of the limitations of Libre; and I completely agree with that premise.
You infer that I am NOT tolerant to inaccuracies? How do you imagine that I cope with sensor results that start high and drift low without tolerating this and continuously mentally juggling? If I didn't I would be replacing nearer 100% of my sensors! I tolerate, because it's a real, further, D nuisance to have unscheduled sensor replacements.

I am a heavy user of CGMs (Libre with add one that allow me to calibrate and other CGMs) but I do so with my eyes open.
I also don’t expect a flat line - I know people without diabetes see wobbly lines and perfection is not something I strive for. I strive for the kind of numbers that allow me to live a full life with a busy career, lots of exercise and socialising.

I'm not striving for perfection, don't expect to see flat lines (particularly by day, although can be pretty good by night). I would like to live a fuller life, have a restful retirement, etc; but my D interferes and ignoring alarms and risking going hypo is not an option. Been on the hypo / hyper roller coaster for the best part of a year - not doing that again [Covid and an overstretched NHS in 2020 didn't help]; learnt a huge amount from this forum and generally made it MY business to manage MY D as best I can. It would be nice to have even 6 days continuously where I haven't had to "freeze" and deal with a potential, persistent, hypo; each has been avoided, intercepted by my vigilance (which I wholly accept is my remit) but each can become a significant intrusion into my desired restful retirement. Last week I had to ask for a lift to a scheduled medical appointment, because I suddenly, unexpectedly of course, plummeted close to 4 and knew I shouldn't drive - an unwanted intrusion, but hypo avoided thanks to the tech.
I got into this thread because I thought it would be helpful to comment on an aspect of Tresiba to someone who is still relatively new to D; and Tresiba does seem to need a somewhat different approach. Please either PM me or start a new thread if you want to sustain this dialogue.