High temperatures and high blood glucose

[CathyFP]

As a pretty new Type 1 (4 months) over the last couple of days I am having a lot of highs at times I never usually have them. Could this relate to the hot weather? Is this normal and how do people usually manage it. More Insulin before meals? I was even high all night last night (14-16) which has never happened to me before. This has worried me a bit. It would help to hear from those of you with a lot more experience. Thanks

 

[Inka]

First thing to do is change your insulins @CathyFP Occasionally they degrade and become less effective. It’s sensible to rule that out first. Then, consider if you could be ill. Even a cold can cause high sugars.

It could be the weather if you’re not sleeping well, for example, but most people find hot weather causes lows (insulin absorbed faster) rather than highs.

 

[rebrascora]

If you are regularly newly diagnosed then it is likely your honeymoon period starting to come to an end. For me I had 3 distinct phases to mine about 6 months apart where I needed to increase my basal insulin. I would try to fire fight it with bolus insulin(corrections) for a few days and then eventually give in when I got really fed up of being a pin cushion with all the extra injections and increase my basal by a couple of units and then things would suddenly be much better again, but gradually they would start to rise and I would have to increase it again until it levelled out and stabilized.
Of course you should rule out degraded insulin by swapping to a new pen or cartridge and obviously assess if you may be starting to come down with something, but I wouldn't delay too long before taking trying option or if you are not confident adjusting your basal dose then get in touch with your DSN. It is generally suggested that you increase it no more than 10% of your current dose and then give that 3 days before you consider whether you need to increase it again. Obviously make sure you keep a close eye out and Libre alarm set for hypos as increasing basal can be surprisingly powerful. Generally, you are looking at a trend of 3 days of elevated levels and the fact that they are increasing overnight for several nights is usually a clear indication that it is basal insulin.

 

[CathyFP]

If you are regularly newly diagnosed then it is likely your honeymoon period starting to come to an end. For me I had 3 distinct phases to mine about 6 months apart where I needed to increase my basal insulin. I would try to fire fight it with bolus insulin(corrections) for a few days and then eventually give in when I got really fed up of being a pin cushion with all the extra injections and increase my basal by a couple of units and then things would suddenly be much better again, but gradually they would start to rise and I would have to increase it again until it levelled out and stabilized.
Of course you should rule out degraded insulin by swapping to a new pen or cartridge and obviously assess if you may be starting to come down with something, but I wouldn't delay too long before taking trying option or if you are not confident adjusting your basal dose then get in touch with your DSN. It is generally suggested that you increase it no more than 10% of your current dose and then give that 3 days before you consider whether you need to increase it again. Obviously make sure you keep a close eye out and Libre alarm set for hypos as increasing basal can be surprisingly powerful. Generally, you are looking at a trend of 3 days of elevated levels and the fact that they are increasing overnight for several nights is usually a clear indication that it is basal insulin.

Thanks Barbara, Last night I increased my Tresiba by just 1/2 a unit and my BG so far is in range so I will continue like this for a few nights. I was lower on waking but not below 3.9 so no alarms.

 

[rebrascora]

I was lower on waking but not below 3.9 so no alarms.

Pleased you just made a very small adjustment and pleased to hear that you were not too low this morning but if your low alarm is set at 3.9, can I suggest that it might be helpful to set it a bit higher, so that you have time to head off a hypo, rather than have to treat one when it happens.

I have mine set at 4.5 (it used to be 4.2 but I was still getting too many hypos so I increased it a bit) but many people set their low alarm at 5 and some even higher. To some extent it depends on your circumstances and how quickly your digestive system is able to absorb carbs. If you set it too high then obviously you risk the alarm going off too frequently particularly overnight, which can be a nuisance but I would certainly consider lifting it at least a little above 3.9.

 

[helli]

If you are regularly newly diagnosed then it is likely your honeymoon period starting to come to an end.

Four months is a relatively short honeymoon for someone diagnosed as an adult.
As you mentioned, your insulin needs increased over a longer period although there were times when you noticed a need to inch it up.
While this may be the reason for the increased BG, in my experience the adjustments were something, in hindsight, I could have predicted rather than a sudden increase on the hottest day of the year so far, as my BG had been slowly creeping up.
@CathyFP I notice you mentioned that you are using Tresiba. This is a great long acting insulin which was not available when I was diagnosed. It is great because it is very long acting (about 72 hours, I think) and very stable. However, the downside of the long actingness is that it can take 3 or 4 days for a change to have its full affect. Therefore, I recommend keeping a close eye on your BG over the next few days. The reason for the lower overnight BG could have just been the hot weather.

 

[rebrascora]

I agree that a 4 month honeymoon period is a short space of time than you would expect and I am not suggesting her Honeymoon is over, but as I explained, mine started ending in fits and starts lasting the best part of 2 years as my beta cells gradually died off. I believe 2 years is about the norm, but as with diabetes there is a very broad range of what is normal. Having Libre during most of this time enabled me to monitor it perhaps more closely than if I had only able to do finger pricks and make adjustments as necessary.

I also absolutely agree that keeping a close eye on things after a basal increase is really important for the next few days, particularly with Tresiba because it is so long acting.

 

[Proud to be erratic]

@CathyFP, @helli, @rebrascora , just to help with accuracy a bit:

Tresiba's profile is +/- 40 hrs duration, so today's dose is topping up yesterday's dose. From that perspective it makes little sense to change Tresiba doses daily and best left alone for 3 days to allow time for changes to take effect. I usually wait for 4 days of CGM overnight (natural fasting) graphs to confirm my Tresiba needs adjusting, unless there is an obvious explanation (eg unexpectedly sedentary in hospital) when I'll alter the dose and wait (hope!) to see the right outcome.

I am taking quite modest doses - maximum 9u in deep winter when no gardening at all and relatively short walks to shops etc; right now I'm down to 7.5u for this wonderful sunny weather in Berks. For a week earlier in June I really wanted a 1/4 unit pen ..... just couldn't quite get a neat horizontal line through the night and ended up alternating between 8u and 7.5u on odd dates and even dates for several days until 7.5u became the apparent and correct solution. But I would say that is bordering on obsessive! However there is something really satisfying in waking and seeing a very level graph for the last 6 hrs.

 

[everydayupsanddowns]

Thanks Barbara, Last night I increased my Tresiba by just 1/2 a unit and my BG so far is in range so I will continue like this for a few nights. I was lower on waking but not below 3.9 so no alarms.

Hope things have continued to settle for you @CathyFP