How to treat high that won’t come down!

[Caroline1967]

Hi I am
I’m the middle of the Mediterranean in a cruise otherwise I would contact my nurse!
I woke up this morning with blood glucose of 14.7. I took 58 units of Tresiba ( as instructed). I am supposed to take 1:10 of Trurapi with meals. I didn’t have breakfast so didn’t take any. Half an hour later it had risen to 16 so I had a yogurt and took 2 units of Trurapi. Now an hour later I am in The Thermal spa (very nice) but my glucose is now 18. Should I take more Trurapi or just kind of hope it comes down? I am
Not sure that starting this just before I went away was such a good idea!!
Thank you for any suggestions or help.

 

[rebrascora]

Sorry to hear that your levels are worryingly high and not coming down.

Do you have Libre or other CGM to monitor your levels or are you relying on finger pricks? The reason I ask is that if you have a CGM then you can be a little more assertive with the insulin than if you are relying on occasional finger pricks.

Were you given a correction factor to use? This is where you are told that 1 unit of insulin will drop your levels by a certain number of mmols. The standard starting advice is usually to assume that 1 unit of fast acting insulin (Trurapi in your case) will drop your levels by 3mmols. Some people who are very sensitive to insulin find that half a unit drops them by that much, but I think by the sound of your Tresiba dose, you are quite insulin resistant, so 1 unit dropping you 3mmols would probably be a very safe starting point and you may find that it only drops you 1 or 2 mmols in reality, but start conservatively with 1 unit dropping you 3. If your levels are currently at 18 then ideally you want to be down to about 6, so you want to drop from 18 to 6 which means that you want to lower your levels by 12mmols. If 1unit drops you 3mmols then you will need 4 units to drop you 12 mmols. Generally they like you to add a correction to your next meal bolus rather than in between meals but at 18 and rising I would be reluctant to eat any carbs when levels are that high, so I would inject that calculated correction and go for a walk around deck to help it get working. Make sure you have your hypo treatments and testing kit with you and a companion if you can and keep a close eye on your levels. As I said, this is easier with Libre and in fact double check with a finger prick before you inject a correction because Libre can exaggerate highs and adjust the correction if necessary.
Generally they suggest that you don't stack corrections Take two corrections within 4 hours of each other and you already took a very small one with the yoghurt, so taking another one now would be frowned upon but considering that your levels are so high and that insulin resistance increases significantly with high BG and provided that you keep a close eye on your levels and be prepared to treat a hypo if it happens and that your previous correction was so small, then that is what I would do at this stage.

Do you have a means for testing ketones? Ketostix perhaps that you dip in your urine or blood ketone strips to do in a dual purpose BG meter? I appreciate that you have plenty of insulin in your system with 58units of Tresiba but it would still be some peace of mind to know that you are testing for ketones and they are not developing. High BG levels are not a major concern over a period of a few days or even weeks but if ketones develop with high BG then they can make your blood toxic and lead to a medical emergency. Generally they only develop if there is not a decent amount of insulin in your system which is why I say that the 58 units of Tresiba should be protecting you from that concern, but worth checking if you can.

Let us know how you get on? Maybe just have some meat and coleslaw and salad for lunch if you need something but avoid carbs, so that you don't need another Trurapi jab and see how that correction works as that will give you an idea of how that correction factor works for you and tell you if you need more or less next time. My guess would be more, but play it safe and see what happens. The Trurapi correction will be active for at least 4 hours, so whilst you should monitor your levels during that time, you can't draw any obvious conclusions until the end of that time. Let us know how you get on. Gentle exercise like walking will help it to work.

 

[Caroline1967]

Thanks for your advice. I do have a libre but am checking with a finger prick too. They measure about the same. I have been for a walk and will follow your advice re injecting and lunch and hopefully things will
Improve. I have checked for keystones and they are fine. I only have limited internet access but will let you know how I get on.
Thanks again

 

[Inka]

@Caroline1967 An hour after eating a yoghurt with a blood sugar of 16 and only being 18 is fine. I find missing breakfast, even with a high blood sugar, just means that my blood sugar stays stubbornly high all morning. Next time you wake at 14 or whatever, do a correction dose either before or with your breakfast and bolus and eat a moderate amount of carbs.

 

[helli]

Every 1 unit of fast acting insulin should reduce your BG by 3

We should not be offering medical advice on the forum, especially on dosage for something which varies from person to person.
The suggestion you have made is often used as a starting point by HCP but entirely depends upon insulin resistance.
If I was to use this correction factor, I would be likely to be hypo as I am very sensitive to insulin.

 

[DaveB]

Hi. It's normal to do correction doses with your fast-acting insulin and not the long-acting although very occasionally I will do the latter if it makes sense to me. BTW was the yogurt a plain one or the more popular ones that can be loaded with sugar?

 

[Inka]

I think @Caroline1967 meant she just took her normal basal in the morning not that she corrected with it @DaveB ?

 

[Caroline1967]

I am down to 8.4 now which I am much happier about.
Thsnks

 

[helli]

BTW was the yogurt a plain one or the more popular ones that can be loaded with sugar?

Sure, fruit yoghurts (especially low fat ones) have more sugar than plain yoghurt but my definition of "loaded" is far more than 13%.
Reminds me of a comment of another forum than bananas are "full of sugar" which could suggest 100% sugar rather than 23% carbs.
I try not to use such emotive terms because someone newly diagnosed with Type 1 may incorrectly assume they need far more insulin based on such comments.

 

[rebrascora]

I am a little concerned that you are down to 8.4 so soon. We are probably not quite 3 hours from you doing that correction so do keep a close eye on your levels for the next hour, as I would hate for you to have a nasty hypo and there may still be enough activity left in that correction to bring you down further, so please do be careful, but..... well done on dealing with it so far and hopefully it will level out and you will have gained some valuable experience from this.

 

[trophywench]

Thermal Spa!!!! We have a hot tub (not been used for ages but of course it's still there in the back garden) and assuming BG is between 5 and 9 when I get in, I can only do approx 10 -15 minutes before my BG's reduced to 4 or below, so have to make sure I get out after 10 so I can a) get out and b) get back in the house where I can test properly ie fingerprick and do whatever's appropriate at that time. It was a ruddy nuisance that cos when it was new and still a novelty, friends visiting would expect to join us in it, then I'd have to get out and leave em to it.