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High BG after insulin

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ky333

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Relationship to Diabetes
Parent of person with diabetes
Another query that I cant work out!

Has anyone have any suggestions... my daughter ate tonight at 1900 ( we had a lazy day) Her BG was 5.6, injected 25 min pre meal. Her BG stayed constant at around 7-8. At 2300 when her insulin had worn off her BG spiked almost immediately to 18. Has stayed there and I suspect will continue to do so for a few hours.

Any ideas on what to do to avoid should this become a pattern?

( she had a common tea which she has had plenty of times before, eggs, beans and hash browns)
 
maybe her insulin doses are needing a slight tweak xx
 
Hi @ky333

Diabetes can be very irritating at times and just not behave.
We’re you able to do a correction to bring her back in range.
(I am not sure how your daughter manages her diabetes (Injections or pump)

The sudden spike does sound strange especially as this is a meal that she has had often with no problems. Having said that I still remember from my carb counting course that they talked about baked beans being a bit of a bother, as the beans take time to release and the sauce gives an immediate rise. We were told to split the dose and give half before the meal and the other half about an hour later. If your daughter is on a pump this is easier as you can just tell the pump to sod this.

The only other suggestions that I have are:
  • Were they a different brand of beans. There can be a big difference in the carb content.
  • Some forgotten extra carbs consumed. I had a chocolate bar the other day and got distracted and just forgot to Bolus
  • A missing background insulin dose. Does she do this am, pm or both
  • Some sort of illness brewing (I tend to get raised levels the day before I have a cold)
I hope that there is something in there that helps.
 
How frustrating for you @ky333

Interesting that the rise all came after the initial dose was beginning to fade.

I wonder if she needs a basal tweak?

Or perhaps it was related to the lazy day, and a lower level of activity and energy expenditure than usual?

It’s particularly annoying when it happens with a meal you’ve successfully dosed for many times before I find :(

If it begins to be a pattern with the meal, perhaps splitting the bolus with most of it up front and the rest trickled in over 1-2 hours might spread the action of the insulin? Though to rise like that does seem to me like for some reason she needed more insulin yesterday.
 
I have just realised that your message was in the pumping thread!! Sorry.

As others have said some tweaks to the basal insulin might be needed.
I also find that if I have a very lazy day, or a day of being a passenger in a car, I use a temporary basal increase as I am just not using up as much glucose.
 
A basal issue - or a cannula site issue. What you’ve described happens to me when I have a poor site. I also find that eating ‘late’ makes my blood sugar higher but not that high. However, it might be contributing.

The other possibility is impending illness so keep an eye on her. I hope you get it sorted soon.
 
Looking at OP's profile it appears her daughter is newly diagnosed (sept) and she is on injections.

It just sounds to me as if it's adjustment time again due to the pancreas playing silly B's. Having a lazy day (sounds good 🙂 ) would also have an effect by the end of the day as well.
 
Thanks everyone. She is still on injections... wrote it on the wrong thread.

I asked the Diabetic nurse about correction doses and she said not to correct at night time no matter how high it gets. She stayed high till around 5 this morning.
We did actually reduce her basal this evening, only by 0.5u as she has been having hypos every night for past 2 weeks, sometimes twice a night.
 
I can’t remember what you said about pumps (whether she wants one or when one would be available) but that’s where a pump would be ideal.

For me, no basal matched my needs. I’d have nocturnal hypos, lower my basal - then go high. The pump sorted all that instantly.
 
she has at least 2 hypos every day. At least 1 during the night or just before bed.(She uses tresiba). Started on 11 units, now down this week to 5u. Just when I think we are getting the hang of it something changes. She never, up to 4 weeks ago had any hypers... they are increasingly common now
 
Apologies if this has already been mentioned in another thread, but would Levemir be better? Two injections a day but more flexible (because you can have less at night, for example, if hypos then are a problem).

The early days are hard because there’s probably still a few of her own beta cells working erratically. All you can do is test and keep an eye out in order to ward off lows or highs before they become too bad.

How low is she going with her daily hypos?
 
Thanks everyone. She did the same again last night... a very high HI... and she had eaten beans again. Thinking this could be the cause. Will do a trial test again later in the week.
The only problem we have is her DSN has said not to correct a HI at night time. This results in her staying high till the next morning. I do understand her reasoning but surely 1/2 unit wont hurt especially if given 4 hours after the tea time dose (i.e 2000) so I can still monitor her before I go to bed?
 
Inka said:
Apologies if this has already been mentioned in another thread, but would Levemir be better? Two injections a day but more flexible (because you can have less at night, for example, if hypos then are a problem).

The early days are hard because there’s probably still a few of her own beta cells working erratically. All you can do is test and keep an eye out in order to ward off lows or highs before they become too bad.

How low is she going with her daily hypos?
Click to expand...
Her lows are becoming lower! Libre read 6.2,,, BG read 1.9 and completely asymptomatic. ( only noticed as we were testing her blood to get ready for bed)
 
I think it’s sensible not to correct at bedtime, especially if she’s newly diagnosed. I’m very wary of correcting then even now and always aim to correct to a higher number than during the day.

I keep saying it, but I’d be looking at a change of basal so you can control both day and night more easily. You can then try to get her doses right. Her blood sugars are swinging up and down, and the fact she didn’t sense the 1.9 hypo is a little worrying.
 
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