Frustrating days

[lilly the pink]

Hi ,call, my daughter is away at univercity and having a frustrating time with her diabetes . She is currently under a lot of pressure with her course so is feeling very stressed, her blood sugar just can't seem to stabilize , she is doing the same thing each day and eating exactly the same but she can't get her bloods down and darn't change her insulin requirements as she is currently having about 4 hypos everyday !!!, the highs are rebound highs from treating the hypos , but she can't get them down even with corrections . She has been diagnosed 6 years and so far we have been "lucky" and diabetes has always pretty much behaved . Could it be her stress and anxiety about this making it worse , she's on injection and has the libre.

 

[MrDaibetes]

Stress and anxiety can make managing diabetes a little bit tricky. When was the last time your daughter spoke/seen her diabetes team? Maybe it's worth giving them a ring and see if they can help her manage her diabetes when stressed.

 

[Inka]

Hi @lilly the pink I found I had a step down in my own insulin production a few years after diagnosis. Things became harder to control. However, stress is an issue too, and can cause both highs and lows.

To me, it sounds like your daughter has got stuck on the horrible rollercoaster of highs and lows, which is exhausting and stressful in itself. You say that the highs are rebound highs from treating the hypos. My plan would be to try to reduce the hypos and then treat any I did have moderately to try to avoid a rebound high. You say she has a Libre - I’d raise the Low Alarm a bit so she can catch hypos before they happen.

How high is she going? Although you can correct highs, sometimes you get into a vicious circle of corrections, hypos, then rebound highs. You say her corrections aren’t working - has she changed to new insulin cartridges? Is she leaving them long enough to work? With a high sugar, a correction can take 3+ hours until you start to see a shift.

 

[Proud to be erratic]

Hello @lilly the pink ,
As a relatively new T3c with no pancreas and very brittle diabetes, I can identify with everything said by @Inka in her post.

I spent weeks during 2021 constantly on the 'rollercoaster', becoming increasingly frustrated and anxious about the total lack of control. So I made a decision to cause it to stall by reducing my hypo response.

I knew that when hypo and particularly low, I felt horrible; but I also knew that it would end, wasn't causing me any internal damage other than potentially reducing my hypo awareness (which can be corrected) and I was sufficiently alert to be unlikely to get to coma stage. So, first I always checked by finger pricking that I really was hypo and not being misled by Libre. Then, instead of the 15:15 rule, I treated with 2x JBs (10gm CHO) and waited - monitoring with my Libre - all the while determined to remain calm and sitting quietly. After 15 mins if still going down I'd take another 2x JBs and repeat. As soon as I levelled out I did nothing and waited a bit more. If totally stalled I'd take another 5gms, but resisting the panicky urge to eat more! Difficult for anyone but particularly for me; I habitually graze on snacks and when hypo that becomes a pressing issue. As my recovery became obvious, thanks to Libre, I would eat a small amount of low GI carbs, such as a cookie of 10 gms (but no chocolate at this stage); this (for me) consolidated the recovery with more enduring carbs. Hence the empathis on moderate (minimal?) response.

The recoveries became increasingly controlled and the hypers reduced. They've not disappeared, but are rarely over 13 and those are usually because I broke my own rules! The first success with this method gave me the confidence to regularly use this process and that, with rapid responses to a low alarm set at the highest level (5.6) by taking a modest snack seems to have intercepted and so stopped the hypos.

I really do feel the rollercoaster era has passed and I have a way of managing if it should return.

I also, as Inka says, find that when c.12 or above my bolus corrections can take a very long time to take effect. I now never eat until my prebolus correction has brought me back to below 8 and heading down; sometimes this means a 90+ minute wait! If I don't do that the correction simply doesn't 'stick'. I do have the advantage of age (72), being retired and thus time to treat hypos in a measured way. I appreciate that University life (and probably some peer pressure) makes everything that little bit more frantic!

 

[helli]

Fantastic advice above, especially about trying to minimise hypos to avoid the risk of overtreating them.
However, they do happen but it is important to understand how low levels really are.
Libre is a fantastic tool but it is not perfect. It is calibrated to be most accurate at "normal levels" (between 4.0 and about 8 or 9 mmol/l). Therefore, it is always advised to check a high or low before treating it. Something like a 14mmol/l on a LIbre may be more like a 9.5. If you give yourself enough insulin to reduce a 14, you are likely to rebound to a hypo.
Furthermore, the Libre graphs may look worse than things really are - it looks as if you are bouncing from 2.5 to 14 and back again when you are really bouncing between 3.5 and 9.5. But the stress in seeing these numbers without understanding their limitations makes managing diabetes even harder.

So, what I am saying is Libre is great but make sure you understand its limitations and always check a Libre reading before making any corrections.

 

[helli]

I now never eat until my prebolus correction has brought me back to below 8 and heading down; sometimes this means a 90+ minute wait! If I don't do that the correction simply doesn't 'stick'. I do have the advantage of age (72), being retired and thus time to treat hypos in a measured way.

As I do not have the privilege of retirement and work does not allow me to wait 90 minutes before eating, my target "consumption level" is 10 mmol/l. I glance at Libre half hour before I plan to eat and, if my levels are in double figured, pre-bolus at that point. This, usually gives them a chance to start coming down to 10mmol/l by meal time.
If I don't know what I am going to eat (e.g. I am going to a cafe and don't know what they have on offer or how big the portion is going to be) , I give myself the correction when I first glance at Libre plus a minimum carb dose - I know I will eat at least 30g carbs so dose for that as a pre-bolus and top up when I know what I am eating.