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High levels

C

casand2011

New Member
Relationship to Diabetes
Carer/Partner
Hi again, my husband is type 1 and "we"have been coping better with his blood sugar levels being a bit more stable,then over the last week they have suddenly shot up spiking at 17 in the morning. He has the same type of food and is actually really good in his choices. The problem is I think he should increase his basal from 3 units to 4 morning and evening dose but he disagrees and won't spk to the diabetes nurse. I get very stressed by it all and frustrated that he won't ask for help as highs to me must be affecting his health. We seem to have been left now to work it out ourselves which is really hard when he isn't prepared to try and adjust his medication. I feel as if all I do is nag him which in turn gets him wound up and me upset !
 
First thing for him to do is swap to a new insulin cartridges just in case his current insulin has degraded. It does sometimes and then becomes less effective. Once that’s ruled out, he can look for other causes like illness, stress, etc. It might be that his insulin doses need adjusting but rule out obvious things first @casand2011
 
Which insulin(s) is he on? If he is just on a basal (long acting) insulin then he may now need a bolus (meal time) insulin added to his regime. Since he is still relatively newly diagnosed, he is likely still in what we call the honeymoon period where his own body is still producing a decent amount of insulin. This slowly tails off and insulin doses often need increasing (or occasionally decreasing) during this period, so you really do need regular support to reassess and adjust doses from the results that you get.

Is he coming back down into range before the next meal or are his levels remaining higher than usual throughout the day?
 
rebrascora said:
Which insulin(s) is he on? If he is just on a basal (long acting) insulin then he may now need a bolus (meal time) insulin added to his regime. Since he is still relatively newly diagnosed, he is likely still in what we call the honeymoon period where his own body is still producing a decent amount of insulin. This slowly tails off and insulin doses often need increasing (or occasionally decreasing) during this period, so you really do need regular support to reassess and adjust doses from the results that you get.

Is he coming back down into range before the next meal or are his levels remaining higher than usual throughout the day?
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Hi there, thank you for your response. He is on 3 units of levimar morning and evening then has 3 units of trurapi before his evening meal. His level usually still rises to about 12 or even 14 during the evening even after a low carb meal. By bedtime (around 10.30) it has come down to around 8 and is hovering near 7 overnight. This has been quite consistent over the last few weeks which is why I think he needs more insulin but should that increase be with the basal or the bolus? Trying to help him but difficult !!!
 
Hi @casand2011 he really does need to seek advise from an HCP. I've had diabetes for many years but a few months back my BG kept going incredibly high. I'm on long acting morning and evening and fast acting before meals and I tried increasing my fast acting to bring the levels down but this didn't work. I eventually spoke to the Diabetes team who suggested increasing the slow acting and by how many units, monitor results and then modify depending on BG. Eventually all was okay but I still have no idea why it happened🙄 Hopefully your husband will seek advice to get the best course of action. Keep us updated
 
casand2011 said:
Hi there, thank you for your response. He is on 3 units of levimar morning and evening then has 3 units of trurapi before his evening meal. His level usually still rises to about 12 or even 14 during the evening even after a low carb meal. By bedtime (around 10.30) it has come down to around 8 and is hovering near 7 overnight. This has been quite consistent over the last few weeks which is why I think he needs more insulin but should that increase be with the basal or the bolus? Trying to help him but difficult !!!
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So he’s not counting his carbs and adjusting his mealtime insulin? That will probably be part of the problem. The recommended diet for Type 1s is the same healthy diet recommended for everyone. The key is the correct use of insulin (harder than it sounds!). How few carbs is he eating? If he eats too few, he’ll find control harder.

As well as speaking to his team about whether his basal dose is right, he’d find it easier to learn to count carbs. This should give him more flexibility and better control.
 
Does he also take Trurapi before breakfast and lunch or just with his evening meal? Morning tends to be the time when we are most insulin resistant plus our liver releases extra glucose into our blood stream as well as whatever carbs are in our breakfast, so he will likely need more insulin in the morning but he really needs to get support. How often does he get appointments at the diabetes clinic and if he doesn't get appointments then he needs to get something sorted as he is not getting the support that he needs to manage his diabetes well.
 
I completely agree that your husband needs to talk to his diabetes team. However, if his BG comes back down to 7 or 8 and stays there overnight, it suggests to me that his dose it not far out. The problem is more likely to be timing. Does he pre-bolus? The challenge is to match the peak of the insulin activity with the peak of the food digestion and it sounds as if his food is digested, rising his BG before the insulin gets to work.
Carb counting would definitely help as there is no need for low carb (unless he wants), especially as it can make insulin dosing and timing harder.

The other thing to check is whether his highs are really that high. Does he check with finger pricks? I ask because cgms tend to over egg high readings.
 
Hi @casand2011 - I can only echo what everyone else has already said - I too am on relatively low amounts of basal insulin, but this works fine for me (for now!) - but I have to get my mealtime bolus insulin right or my BG sky rockets - and I do take lots more in the morning compared to the evening meal, which might explain why it is going so high in the morning if he is on fixed doses - definitely worth speaking to his diabetes team for more help and 100% ask about carb counting and adjusting doses to compensate for them in food
 
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