High blood sugars

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Evergreen

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Relationship to Diabetes
Type 1.5 LADA
Hi everyone,

I’m back yet again!

After a little period of doing ok with my blood sugars (you might remember I upped my carb intake, so eating 100-150 grams a day now) and even though I was still trailing on the higher side of normal I could see that my ratios were ok.

However in the last couple days everything has gone haywire. I’m wondering if it’s a combination between having a cold, maybe getting to the end of my honeymoon period and I’m due my period in a couple days too. It’s been so sudden though, this cold also doesn’t feel hugely bad (similar to previous colds I’ve had that didn’t push my blood sugar up)

I’ve upped my basal from 9-11 units over the past few days, and taking more fast acting in between, but I don’t get my blood sugar lower than 11 really. Is there anything else I can do or does anyone have any advice? It’s making me feel pretty stressed which obviously won’t help either…
 
Change your insulin cartridges @Evergreen That’s the first thing to do with unexpected highs. It could well be the cold though. I had a mildish cold a week or two back but it caused highs for a few days eg being between 10 and 12 in the morning. I corrected as necessary.
 
I can't remember which basal you are using, but in that situation myself with Levemir, I might firefight for a day or two with corrections and then increase my basal slowly and steadily until it brought be back into range and then be prepared to reduce it again if things swung the other way. With Levemir, you can change it day on day if you wish although I would not recommend that, but perhaps every other day until you get to where you want to be. If you have Tresiba or Toujeo, you need to give any adjustment at least 3 days to show the full effect of the change before making a decision about further changes, so you might need to firefight in between with corrections until the third or fourth day. If it is hormonal due to your cycle, and it is likely to be a regular thing then I would recommend changing to Levemir to manage it if you are not already on Levemir.

If it is the honeymoon period coming to an end, then for me it was just a question of increasing my basal every few days until it levelled out. I remember I had a 3 month period 2.5 years ago, where I near doubled my basal dose, by cautiously increasing it by a unit every few days and then it would level out for a week and then increase again. The most frustrating part was me resisting increasing my basal and firefighting with corrections until I got so chewed off at being a pin cushion, I would increase it again. It was nerve wracking as I was pretty sure I would eventually drop off a cliff edge and have a massive hypo and in fact I did have one day when I was much more active than normal and I had 7 hypos that day, so I dialed back my Levemir by 2 units and I have been pretty stable at that level ever since give or take a couple of units here and there for exercise.
I would be very surprised if it is your insulin become compromised at this time of year unless you left it on a radiator or something pretty drastic like that.
 
Some insulin arrives slightly degraded due to its travels @rebrascora so it already has a shorter life and is more ‘fragile’. Mostly it’s not the insulin, but I’ve had a few occasions when a change of insulin has had a massive effect. In none of these cases did the insulin suffer anything unusual while it was in my hands, but I presume it did somewhere along the supply chain.
 
Thank you both.

I will change my cartridges, just in case it’s that. But I haven’t left it anywhere warm I think.

I think the most likely cause is the honeymoon period coming to an end or the cold (or both). How annoying!

@rebrascora this sounds like a horrible couple months! I must admit I feel the same. I look at my blood sugar and I can see my basal needs to go up (I am on Abasaglar btw). I’m switching between being so frustrated I want to just put my basal up again and worrying about doing too much at once. I’ve gone up to 11 last night, so will try and stay there for a couple more days. Then maybe up it again.
 
Another question, what do you tend to eat on days like this? Anything just makes my blood sugar spike so much (almost regardless of how much insulin I take at the moment), but I’m also worried about ketones.
 
Evergreen said:
Another question, what do you tend to eat on days like this? Anything just makes my blood sugar spike so much (almost regardless of how much insulin I take at the moment), but I’m also worried about ketones.
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Generally I eat low carb but I just keep injecting corrections until levels come down. I simply don't let levels get up to 15 if I can help it at all and personally I will stack corrections half an hour apart with Fiasp if my levels continue to go upwards after the first correction.
I have just come back from a late lunch/tea with a friend and levels were great during the meal and after whilst I did my shopping but heading towards double figures now so I injected a 3.5 correction on 8.8 with an upward sloping arrow and another 2 units half an hour later when it hit 9.6 and still going up. If it means I need a JB or 2 later because I over egged it, it doesn't matter but I simply don't let it go into double figures if I can help it.

I also don't eat when my levels are above 8, so If I was in your situation where my levels were persistently in double figures, I would just keep injecting insulin and waiting for it to come down before I eat. If it takes 2 hours and twice or three times as much insulin as I expect, then then that is what it takes and I just jab it and keep a close eye on Libre until it comes down and perhaps do some exercise to help it if I am able. I have recently found that running up stairs 20 times in a row is pretty good for helping a correction to work and giving your cardio vascular system a workout. My stairs have been getting hammered quite a bit recently!! Obviously not a great strategy if you are feeling unwell, but don't be frightened of using your insulin. It is what your pancreas would do if it was working correctly and as long as you have CGM and can keep a close eye on your it is not unsafe to stack corrections if you need to.
 
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Thank you, as always I appreciate the advice. I did this earlier and ended up in the 7s! Whoop, first time in days…

I notice that my blood sugar is being pushed up in between meals (2-3 hours after a correction it just goes up even without food), that’s a basal issue isn’t it.

I am starting to feel pretty rubbish now, hoping I haven’t caught Covid or flu and hoping this is the tail end of this!
 
Evergreen said:
Thank you, as always I appreciate the advice. I did this earlier and ended up in the 7s! Whoop, first time in days…
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Well done! You are having more success than me! My levels continued upwards despite 5.5 units of corrections and 10x ascents of the stairs at a jog, plus 5 at a walk. Currently sitting at 11.5 and another 2 units correction gone in, so that is 3 stacked corrections in the last 90 mins.
Evergreen said:
I notice that my blood sugar is being pushed up in between meals (2-3 hours after a correction it just goes up even without food), that’s a basal issue isn’t it.
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Yes, that usually tells me that I need more basal.

Sorry to hear you are feeling rough. Hope it's not the lurgy!
High levels make me feel rough which was why I could only do 10 sets of stairs at a jog in double figures as I started feeling sick.
 
Believe it or not, a 4th correction has now gone in (another 2.5u) as levels have gone up yet again and now 12.6!! This is probably because I shared a portion of butterscotch cake which I bolused for, with my friend and my system is not at all happy about all that sugar and flour! We actually only ate 2/3 of it because it was so shockingly sweet. I absolutely hate to leave food but I had to!. No wonder people are obese if that was a portion for one person! I wouldn't normally have cake but it was supposed to be a birthday treat for my friend and I so very rarely eat out, it was supposed to be a treat for me too. Definitely not worth it!

Edited to add....Still going up and a finger prick BG gives me 14.9 so I have hit it with another 3 units of Fiasp, so that is 5 stacked corrections plus the original bolus for main course and then dessert at 3.15pm and 4.50pm, when I was a lovely 4.9mmols!!

This is why I prefer to stick to low carb eating. I have now had 19.5units of Fiasp since 3.20pm for a quiche with salad (I swapped the chips for extra salad) and half a portion of cake with butter icing, plus I have walked round the supermarket afterwards and then gone up and down my stairs multiple times. Part of this is Fiasp being a wimp and turning to water when levels go above 10 as it seems to do with me and part I think because my digestive system gets upset with high carb foods and that causes my liver to release more glucose.
Anyway, I am really just documenting this so that people can see that sometimes these situations happen and for me I have to be prepared to be very proactive with my insulin to get back down and I will inject as much insulin as it takes to do so. 19.5 units is easily 2 days worth of bolus insulin for me in just one afternoon, just because I was tempted to have a half a piece of cake! Just not worth it!
 
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Well, levels came down as far as 8.8 but heading back up again and now 9.7, so another 2 units of Fiasp going in! ie the 6th correction in not quite 5 hours and not eaten since 5pm.
 
Oh dear that sounds like hard work. I love scones but every time I have one my blood sugars go sky high. So I tend to resist them now. I find cakes and so forth okay.
 
rebrascora said:
Well, levels came down as far as 8.8 but heading back up again and now 9.7, so another 2 units of Fiasp going in! ie the 6th correction in not quite 5 hours and not eaten since 5pm.
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Sounds like a Fiasp problem to me, ie “like water”. You’re not skimping on the corrections and unless there’s something else going on like illness then that’s mad. I hope it’s ok now.
 
It's OK, apart from frustrating me a little.... OK quite a bit.... but I really just wanted to document that these situations happen to all of us from time to time, usually when we are just feeling better about our diabetes. My diabetes consultant just gave me a gold star yesterday morning in my yearly review and I was on 90 odd % TIR and feeling great..... and then suddenly and dramatically it all goes horribly wrong, but the important thing is that we deal with it and don't let it get us down.... or let those levels continue to rise. I really just wanted to document, that you have to do whatever you have to do to manage it and sometime that can be quite extreme. My Fiasp is working fine this morning for my typical breakfast, so I am pretty sure it is just something to do with my body, and I am not obviously ill, however my levels have started rising again this morning, so I am guessing I need a Levemir increase.
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Yes it’s very useful for us newbies to see that that happens occasionally and you can still have good control overall! (Although part of me obviously wants to hear that these situations don’t happen anymore after a couple years - I’m aware that’s not rational though).

I’ve so far been managing slightly better than before. Woke up feeling pretty dreadful but my levels were ok (not ideal but better than they have been). I’ve also managed to get my blood sugar in range after breakfast with a walk, so all in all slight improvements today. Fingers crossed it’ll continue to improve!
 
Sorry to hear you are feeling rough. Well done on getting out for a walk. I am just about to hit my staircase again as levels are heading upward fast! Hope you feel better soon!
 
To add to the point that insulin needs can change dramatically, I usually use 18-25u a day (basal and bolus combined).

When I had Covid, I used 38-41u a day for a week and a half.

Even after I started feeling a bit better and my test line was just a faint positive, I was still using 33-38u a day.

I kept a record of my day-to-day symptoms, Covid test results and daily insulin usage so I could remember how aggressive I needed to be at different stages of being sick.

It was my first time being really ill since diagnosis. Luckily I'd just switched from MDI to a pump, so I could adjust things easily. I ended up using extended boluses to give me 2u an hour (in addition to mealtime boluses), cancelling the remainder of the extended bolus when my levels came back into range. My average basal rate is less than .3u an hour at normal times, so this was a lot more than I usually use, but it's what I needed.
 
@rebrascora
Mate - there is no possible way I could now or could ever have tried to live with that sort of messing about, quite frankly! I'm glad you find it OK but how the hell anyone else ever would, beats me.

Finn - I had this when I broke my patella - first broken bone and only one in my life. So Yeah, PITA.
 
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trophywench said:
Mate - there is no possible way I could now or could ever have tried to live with that sort of messing about, quite frankly! I'm glad you find it OK but how the hell anyone else ever would, beats me.
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The only alternative is to let my BG go into orbit and perhaps end up very ill, which simply isn't an option.
The point I was making is that you inject whatever insulin you need, just like your pancreas would have done if you were not diabetic. I have to say, last night was very extreme and I have absolutely no idea why, but this happens from time to time with my body, usually to a somewhat lesser extent and you just have to ride out the storm and do whatever you need to do.
I do think that Fiasp doesn't work well for me once my levels get above 10 which is why I start doing corrections when I hit 8 and stacking is essential if it keeps going up but that was ridiculous last night and I had no idea it would pan out as it did when I started documenting it. 3 or at the most 4 stacked corrections will bring it under control. The other option is to rage bolus 1 big one but that can lead to a crash and I never would have guessed at the start that I would have needed 21.5 units.

Can I ask what you would have done in that situation if you wouldn't "live with that sort of messing about"? I average 93% TIR over the past 3 years, so what I do works well. Sometimes my diabetes behaves impeccably but every now and then it throws a wobbler and you have to be pretty firm with it. I should probably have upped my basal this morning but until I see a pattern I am reluctant and I was on a steady patch of smooth sailing up until I ate that cake!
 
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