High BG

[CathyFP]

Hi over the last week my BG is remaining stubbornly high mostly between 10 and 14. I’ve been taking my normal insulin doses and eating as I normally do but it only goes low in the evening often just as I’m going to bed. I just don’t know what to do and am getting very worried. I don’t feel I’ll but have been under a lot of stress.

Any suggestions especially how to adjust my fast Novorapid insulin which I generally take three times a day before meals using carb counting. I am also high at night which I have never been before. I am doing finger pricks to check my Dexcom CGM and it sometimes is a bit higher than blood but blood is still high. My time in range has dropped from a consistent high 70s to just below 50.

Any help very much appreciated.

 

[gail2]

do you have a DSN try them or your GP if they are any good
gail

 

[Inka]

First thing is to change your insulin - ie start a new cartridge @CathyFP Occasionally insulin degrades and becomes less effective. Any prolonged, unexplained highs need fresh insulin. Once you’ve done that, stress can impact blood sugar a lot, so it might be you need a little more insulin temporarily while it persists.

Note - I’d change both your basal and your bolus insulin cartridges just to be sure.

 

[helli]

In addition to the stress you mention, I wonder if a few more insulin producing cells have died off so you are producing less insulin yourself.
Given your BG is lower in the evening but high during the night, I would definitely look to increase your basal. and I would do that before making changes to your bolus. Basal is often described as your foundation - if this is unstable, you don't want to build your bolus on top of it.
With the caveat that I have no medical training, I would suggest increasing your basal by no more than 10% and seeing whether your BG stays more stable overnight.

 

[CathyFP]

do you have a DSN try them or your GP if they are any good
gail

Thanks Gail,
I can only email DSN which I have done. Could be days before they contact me. It’s a terrible service. Not their fault they are seriously “over capacity “.

GP hopeless can only make contact first thing in the morning online and anyway they won’t do anything for T1 diabetes it is all done by the diabetes clinic that the DSNs work in.

 

[CathyFP]

In addition to the stress you mention, I wonder if a few more insulin producing cells have died off so you are producing less insulin yourself.
Given your BG is lower in the evening but high during the night, I would definitely look to increase your basal. and I would do that before making changes to your bolus. Basal is often described as your foundation - if this is unstable, you don't want to build your bolus on top of it.
With the caveat that I have no medical training, I would suggest increasing your basal by no more than 10% and seeing whether your BG stays more stable overnight.

Thanks @helli I had been thinking along those lines. I will try that

 

[CathyFP]

First thing is to change your insulin - ie start a new cartridge @CathyFP Occasionally insulin degrades and becomes less effective. Any prolonged, unexplained highs need fresh insulin. Once you’ve done that, stress can impact blood sugar a lot, so it might be you need a little more insulin temporarily while it persists.

Note - I’d change both your basal and your bolus insulin cartridges just to be sure.

Thanks @Inka I really hadn’t thought of that as my insulin has all just been sitting in the fridge. I will change my cartridges. Although I did travel to Spain and back recently and my basal cartridge did do that journey. It was in a frio wallet though and didn’t get hot?

 

[Inka]

It doesn’t have to be anything you’ve done @CathyFP The insulin has often travelled via a number of countries before it gets to you so you’ve no idea of the conditions on the way.

 

[CathyFP]

It doesn’t have to be anything you’ve done @CathyFP The insulin has often travelled via a number of countries before it gets to you so you’ve no idea of the conditions on the way.

Oh dear more things to worry about! Do I need to get rid of all the cartridges in the box?

 

[Inka]

Oh dear more things to worry about! Do I need to get rid of all the cartridges in the box?

No, keep them and maybe make a note on the box so you know which one it is in case you have further concerns. If you have a new box,I’d take a cartridge from there.

The insulin might be fine but when you have unexpected highs, changing the insulin is the first thing to do because it’s simple.

 

[CathyFP]

In addition to the stress you mention, I wonder if a few more insulin producing cells have died off so you are producing less insulin yourself.
Given your BG is lower in the evening but high during the night, I would definitely look to increase your basal. and I would do that before making changes to your bolus. Basal is often described as your foundation - if this is unstable, you don't want to build your bolus on top of it.
With the caveat that I have no medical training, I would suggest increasing your basal by no more than 10% and seeing whether your BG stays more stable overnight.

Hi @helli ,
I tried increasing my basal last night. Only by 1/2 unit and went low in the night. In fact my BG fell all night. I feel like nothing I can do is right.

 

[dannybgoode]

Hi @helli ,
I tried increasing my basal last night. Only by 1/2 unit and went low in the night. In fact my BG fell all night. I feel like nothing I can do is right.

How low is low and did you verify the reading with a finger prick?

In my time testing Libre I found it was a bit dramatic at high or low readings and oftentimes when I verified a <4 reading with my BG meter I was safely in the 5's.

 

[CathyFP]

How low is low and did you verify the reading with a finger prick?

In my time testing Libre I found it was a bit dramatic at high or low readings and oftentimes when I verified a <4 reading with my BG meter I was safely in the 5's.

It was 3.7 and I did check with a finger prick. I’m no longer using Libre I’ve changed to Dexcom 7 and it is a bit more accurate