Unexpected and unexplained highs

[Rollercoaster]

Hi everyone,

Been Type 1 for a year and a half and went on the DAFNE course a few months ago, which went really well. I've always managed my diabetes really well from day 1, have never had severe hypos or anything like that and the vast majority of my blood sugar results have been between 4-10 etc.

During DAFNE I was advised to reduce my background insulin (Insulatard) from 12 in the morning and 12 in the evening because my blood sugar level would drop by as much as 5 mmol from evening to morning and I would often have hypos before lunch. I reduced the background insulin and woke up with better levels and would have better levels at lunch.

The problem has been in the last few weeks or so. I've had a lot of high levels (the highest being 17.6) and I can't explain why many of them have been high. Just now I woke up with 8.6. Had a bowl of Coco Pops at 9am, for which I usually do 5 units of quick-acting and I also had 9 units of background. I also did 45 minutes of walking. At 12 I tested and it was 15.9. Another example: one morning last week I tested in the morning and it was 9.6 or something. I did the background insulin and walked for 25 minutes, tested again and it had actually gone up to 11.6 and I hadn't eaten or had anything to drink. I've had unexpected highs in the evenings as well.

I've tested for ketones and don't have any and have never felt ill or anything in the last few weeks. I'm doing everything normally but the highs continue to puzzle and annoy me. Does anyone know why I might be getting highs? Should I increase my background back to 12 and 12? Is it possible I'm becoming more resistant to insulin and should I therefore increase the ratio from 1 unit for every 1 CP to 1.5 units for every 1 CP or something like that?

Any advice would be great

 

[everydayupsanddowns]

Hi Rollercoaster

Here are a few thoughts based on what you've said...

1. You are still quite a 'new' diabetic, and there is a possibility that you have had a few waning islet cells still bravely soldiering on so far. Eventually you may have pretty much zero insulin production, but in the first couple of years I reckon I still had a bit of residual 'home made' insulin helping me out. As these last few die out you may find that your overall injected insulin requirement rises

2. Your basal (insulatard) doses are unlikely to stay fixed for more than a few months at a time in my experience. All sorts of changes - level of activity... stress... busyness/illness... even the weather/general temperature can affect precisely how much basal you need from one week to the next.

2a. Basal is the bedrock of your control, and unless you keep your basal doses tweaked correctly (or as near to perfect as you can get them on MDI) it will be *very* difficult to get mea ratios/corrections to behave becaseu you won't be starting from a level playing field. There's a good writeup about basal insulin, hwat it's meant to do and how to test it for yourself here: http://www.diabetes-support.org.uk/info/?page_id=120

3. Watch out for your liver - especially in the mornings. Our BG levels are not only affected by insulin/food and activity. We also have a significant amount of glucose stored away in muscle tissue and organs. Very sensible, as otherwise we'd need to eat something every time we had to run for the bus. As an additional complication, most people (D or not) have a 'fire up the burners' response in the mornings where the liver releases glucose into the blood stream known as 'dawn phenomenon'.

4. Be careful about your ratio tweaks. Your suggestion of changing from 1:1CP to 1.5:1CP seems to me to be a HUGE increase. It might be easy for the maths, but you are suddenly talking about 50% more insulin. Most meals will consist of more than one CPand all those additiobal 0.5us will soon add up. I would be much more cautious in your shoes, making changes of perhaps 10% up or down. It might not be so easy to do the maths in your head, but it will be less frustrating in the end. Perhaps use the calculator on your phone, or ask your DSN for one of the 'smart meters' (that do the calculation for you then round-up or round-down to the nearest whole unit). There are also smartphone apps that offer bolus calculators.

Hope you manage to fix your highs soon. I'd start with basal and work from there 🙂