What could have caused this? (Oddly high glucose readings)

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BenjaminRWT

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Type 1
I just made an introductory post elsewhere, this is all stuff I'm getting to grips with so please bear with me.

Ive known I was highly likely to be diabetic for over a month (I told the story earlier in my introductory post), was told I had type 1 diabetes last week. Frankly given my shockingly bad diet (which I'm trying to work on) and my late mother was diabetic (unsure of what type but she was injecting multiple doses a day so I assume it was type 1), this shouldn't have been as much of a shock as it was.

Anyway, I'm rambling a bit, I'll get to the point. For the past few days I've been asked to start keeping a record of my blood glucose, and have started taking insulin. 6 units of Lantus. I've been prescribed novorapid, but have been instructed not to take that yet as they need to see what kind of dose I will need. I have to ring the hospital on Tuesday after the bank holiday with these readings and I have a few appointments coming up. I would think this will be determined soon.

So, yesterday evening, I took a reading just before dinner. 13.8, my monitor went off and told me I'd need to test for ketones. Which I did. 0.1, which I gather isn't anything to worry about. But I knew I'd need to take another glucose reading in a few hours. 16.2.

Between those two readings, I'd taken my daily dose of Lantus (as explained above, I'm doing it on an evening because I don't have much time between getting up on a morning and leaving for work I was worried I'd forget or rush things and mess it up somehow).

What made this one worry me even more, was that my morning and pre-lunchtime readings were 8.3 and 8.4 - stil higher than they need to be, but the morning one was actually the lowest yet for the time of day, and the lunch one was about the same as it had been, it hovers in the 8's.

I also need to explain, Friday (28th) wasn't a normal day either. There was a works leaving do because most of the people I've been working with for the last 17 years have been made redundant. I did seek advice on taking insulin that night and the diabetic nurse I'd seen in the week said I'd be okay taking it a bit later for one night. I didn't want to miss out on this for the world.

There was a buffet in work and we were all going out afterwards. I didn't have any "dinner" that evening but had a little something to eat and took my insulin as soon as I went home. My final reading that night was a bit lower which I put down to not eating as much that day, and as mentioned, the next morning and lunchtime ones were a bit down which I was fine with. But for it to go up like that made me worry. There were also a few things that I wonder contributed to that high reading:

1. I had a chippy tea. Even after the 13.8. I didn't want to cook, and was feeling a bit crappy anyway.

2. I did have a bit of a kip a few hours earlier. Not typical for me, but not like I lost consciousness or anything. The previous day was a long day, I just assumed it finally caught up with me.

3. I was late taking blood pressure medication I'm also on. 5mg of Amlodipine. I usually take it on a morning but I'd forgotten and took it early in the evening.

The 16.2 reading panicked me, and I dialled 111 because it's the weekend and there was nowhere else I knew I could go for advice (I tried signing up here but for some reason the confirmation email didn't come through). So an out-of--hours GP was able to talk to me and I explained ALL of the stuff I've just explained to you here.

He basically told me that while the readings are high, I'm feeling okay generally, and it's not high enough to worry about. The fact the ketone reading I did was okay is also a "good" sign.


Apologies for this huge, rambling post, but I really wanted to get some feedback from people. I suspect the chippy tea was the biggest culprit. Chips, full of carbs, not exactly the healthiest thing in the world (I swear my diet is something I need to work on and undoubtedly the hardest part), seems the likely thing.

Like I say, this is all still so new to me.
 
No problems asking at all.

The chippy tea will have been high in carbs which will turn to glucose and impact your levels. It might be worth finding out a bit about carbs and starting to know what is high or low in these. Eventually you will be able to eat what you want once you have learnt how to match your Novorapid insulin, which I suspect they will start you on soon. Whilst you wait for your next appointment (how far off is that) you could try to reduce your carbs which will reduce your levels.

They have asked you to keep a record of what you eat and your levels as this will help them to work with you to get the right doses. knowing the cabs in your meals is the basis of what you will be doing in the future, so if you can start to find out about that it will help you. You could try to add that to the info your are writing down for your team.

keep the questions coming.
 
SB2015 said:
No problems asking at all.

The chippy tea will have been high in carbs which will turn to glucose and impact your levels. It might be worth finding out a bit about carbs and starting to know what is high or low in these. Eventually you will be able to eat what you want once you have learnt how to match your Novorapid insulin, which I suspect they will start you on soon. Whilst you wait for your next appointment (how far off is that) you could try to reduce your carbs which will reduce your levels.
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I am going to be contacting the diabetes department at my hospital on Tuesday morning to tell them my readings. I was going to bring this up with them, actually. I need to get more testing strips for my monitor as well - I've wasted so many because I've messed it up so many times in the last few days, not getting enough of a blood sample onto the strip!

Apart from that, I have an appointment to be seen on the 17th, and another on the 15th of June (had letters in the post yesterday for these)
 
Your high levels are exactly what i would expect with no novorapid (bolus / rapid acting) insulin. I'm sure they know what then are doing (ironic) but i was started in insulin it was basal (long acting) and bolus from the start.
You said you levels were lowest after the night out? You ate less, from the sounds of it, which will have helped, and was there alcohol? That can reduce your blood sugars too (by distracting your living from producing glucose)
Eating lower carb til you are on novorapid is a good idea...avoid bread, potatos, biscuits, cakes, pasta, but egg, cheese, meat, most nuts all good...look at the carb count on lables. Mushroom omelette with salad, green veg etc is very low carb.
Re having a kip...well, activity/ excercise tends to bring bs down, so inactivity will have opposite effect. Though i find a short nap brings bs down....probably by reducing stress
Ask for a cgm like libre or dexcom ASAP. This will alert you if you go too low and will be really helpful and save you from fingerpricking.
As soon as you feel confident, take control of your doses. My bs control got so much better when i did this rather than relying on the 'experts', who, in my case, weren't too good. But even with the best team in the world they aren't going to be making your day to day decision.
And you will feel rubbish if you are over about 10. I know i do. But i rarely get that high now.
By the way when you have got the hang of novorapid you can definitly have chippy teas! The fat content will reduce the bs spike of the potatoes and any bread if you have chip butties. Took me a while to deal with sarnies, but now i have choccys and everything!
By the way, it does get easier!
 
Tdm said:
Your high levels are exactly what i would expect with no novorapid (bolus / rapid acting) insulin. I'm sure they know what then are doing (ironic) but i was started in insulin it was basal (long acting) and bolus from the start.
You said you levels were lowest after the night out? You ate less, from the sounds of it, which will have helped, and was there alcohol?
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I don't drink. I was on diet/zero sugar soft drinks if I was having anything. It's not even for my health, alcohol has never appealed to me.

I did used to drink the full sugar stuff almost all the time. I'd actually made attempts to cut down last month just beforeI found out there was a strong possibility I was diabetic. Just because I'd started to realise how bad I'd become with sweet stuff (soft drinks and chocolate, mainly). Funnily enough I was reading last night even the zero-sugar stuff isn't exactly the best, so I'm rethinking that now as well!

I didn't have as much to eat as I normally do that day, partly because I wasn't keen on the sandwiches in the buffet, so mainly ate chicken and a few sausage rolls.

I just had a bit of toast when I got home, because I didn't have anything else in the house - I do my weekly shopping on a Saturday morning.

Like I say, it was the fact that over the course of yesterday, they started lower, but then went high enough to need to test for ketones had me worried.

It's amusing that all the stuff I'm told I need to avoid, food-wise, that wipes out most of my diet these days! Never did eat "properly"
 
With no Novorapid, those levels aren’t too bad. Basically, your Lantus is supposed to keep your blood glucose controlled in the absence of food.

It looks like your team are getting you to eat without Novorapid to get an idea of how much you might need for x amount of carbs. As said above, if you can roughly record your carbs that will help, or even just an idea of portion size or weight, eg if you have a sandwich look at the bread carbs per slice and jot that down in your notes along with any other carbs in your meal. That information will help give a reasonable starting point for your Novorapid to carbs ratio.

Most Type 1s are started on both basal (background) and bolus (meal/fast) insulin straightway. So, don’t worry (apart from watching for ketones) as you’ve only been given half the tools you need to control your blood sugar. Once you get the Novorapid added, you’ll find it easier to balance things. It’s best to bring your blood sugar down gradually, both for safety and because it’s less of a ‘shock’ to your body, so don’t focus too much on the figures long-diagnosed Type 1s are mentioning or that are on the internet. Your targets will be higher initially. I can’t remember my targets but they were gradually reduced over a few weeks.
 
First of all, thanks to everyone sharing their experiences and feedback on this. It's been helpful.

I've done two readings today as usual. Morning pre-breakfast (which was 2 weetabix, semi-skimmed milk, been my usual most mornings these days) came back 9.6, which isn't out of the ordinary for me based on the last few days, which has been 9.7 or 10.7, yesterday being lower than that at 8.3 for reasons I've talked about already.

Just took one about 5 minutes ago, 8.3. This is bang in the middle of the last few days. In the eights, 8.6 being the highest.

I'm going to go out for a Sunday dinner, which is my typical Sunday afternoon - I live with my stepfather, we both like a sunday dinner, but cooking one just for the pair of us is a bit too much hassle. He's actually away for the weekend, but I still fancy one. I don't have anything else with it. Will probably go out for a walk or something later, too.

I've been a bit out of sorts between the works do, last night and the general starting on insulin and so on. I need to just clear my head a bit and maybe being a bit more active today might actually help.
 
@BenjaminRWT when I was first diagnosed last year I was also only given long acting insulin to start with, probably got novorapid for one meal a day about a month in and then with all meals about 8 weeks later. As others have said, it's probably to avoid bringing down your levels too rapidly as that can cause problems (my eyesight became affected for a few weeks even on background, so probably a good job there wasn't bolus too!), as well as to probably assess how much insulin your own body is still making if you are newly diagnosed and in the "honeymoon phase". But I know this approach did make me feel frustrated to begin with, as @Inka says, you are only given half the tools you eventually end up needing. But it will all come good in the end - I eat takeaways now without seeing overly high numbers 🙂
 
Hi and welcome from me too.

Those readings you are getting are mostly really stable and your body is almost certainly still producing a decent amount of it's own insulin. Even the trip up to mid teens is not bad at all after a fish and chip supper and I would expect a similar reading after a typical Sunday lunch, so don't be surprised if that happens, although if you can fit a walk in afterwards, that will help. If you can keep a note of how many potatoes (roast, boiled and mashed) and Yorkies you have, it will help your nurse figure out what is going on and how much NovoRapid to start you on.

It is really important to understand that BG levels are very variable, even for not diabetic people but those of us who are diabetic will see much greater peaks and troughs sometimes too, if we are also using insulin. I was shocked at how frequently I hypoed as I thought they maybe just happened once or twice a year but for me they were almost a daily occurrence, despite my best efforts and my levels went up to 15 every morning after breakfast before they came crashing back down again. I really had no idea just how clever my pancreas had been when it was working properly, but you really come to appreciate what a great job it had been doing, once you have to take over that very tricky task of BG management manually. It is a steep learning curve in the first few months particularly, but it really does get easier and often we liken it to learning to drive a car.... It all seems incredibly complicated at first and there are so many things to think about all at once, but gradually you start to do a lot of those things automatically, so you don't need to think about pressing the clutch when you change gear or looking in the mirror and indicating when you are making a turn etc. They just happen in the background. Some of your diabetes management will become like that. It still amazes me that I can wake up from the depths of sleep in the middle of the night if my high or low Libre alarm goes off.... calculate how much glucose or insulin I need, administer it and be back to sleep within a couple of minutes, without even putting the light on or sitting up in bed. I am 4 years down the line and feel reasonably confident I can handle most situations now but I have spent a lot of time on this forum picking people's brains and experience and then experimenting on myself to gain the knowledge and confidence I need. I would certainly encourage you to come here regularly and ask questions and read other people's posts as you can learn a lot from others, even though diabetes is quite individual and what works for me may not work for you, we can suggest things to try that may help or give reassurance that what you are experiencing is normal and not to panic.... or very occasionally we may say it isn't normal and you need to push for more investigation or support.
Anyway just wanted to say hello and that whilst it is tough at first, it will get easier and we now have wonderful tech to help us manage things well that diabetes should not negatively impact our lives, providing we take a bit of time to learn, plan and manage it.
 
I think hink the walk did me good yesterday. I was out longer than expected. I took my blood glucose at my usual times later on in the evening, and it was down. It's actually stayed at 8.3 since then. Before evening meal, before bedtime, and 1st thing this morning, all of them came back 8.3.

I think I will plan things a little better, but this might become my sunday/weekend afternoon routine...
 
BenjaminRWT said:
I think hink the walk did me good yesterday. I was out longer than expected. I took my blood glucose at my usual times later on in the evening, and it was down. It's actually stayed at 8.3 since then. Before evening meal, before bedtime, and 1st thing this morning, all of them came back 8.3.

I think I will plan things a little better, but this might become my sunday/weekend afternoon routine...
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Yes indeed-- moderate-intensity aerobic exercise, like a reasonably brisk long walk, reduces blood glucose! It triggers an 'insulin-independent' mechanism in your muscle cells which enables them to absorb glucose from your blood without relying on insulin; and they will go on absorbing more glucose than usual for hours afterwards, so the BG-lowering effect will go on for hours. (By the way, high-intensity aerobic exercise and resistance exercise tend to increase BG; so avoid sprinting or weightlifting for the time being ...)

So, while you're waiting to start mealtime 'bolus' insulin, going for walks is definitely a good thing to keep your BG down-- while also of course being a good thing in loads of other ways!

When I was first diagnosed, 9 months ago, I was on only basal (Tresiba) and 2 units of bolus (Fiasp) per meal. That was of course not nearly enough bolus! So, between then and when I started a proper bolus regime, I used walking and slow jogging to help keep BG down. (I was already a regular walker and jogger, which helped.)

Once you do start your bolus insulin, you will have to learn how to adjust it for exercise; for example, if you're planning a walk after lunch, you will find you want a little less insulin before your lunch. As you'll have gathered from other people, managing T1 is rather trial and error; all you can do is get as much information as you can, and then experiment on yourself!

Finally, Tdm makes a very important point: Do ask your team to give you a CGM ('continuous glucose monitor') as soon as possible!

NICE now recommends that *all* people with T1 should be offered a CGM, either a Libre 2 or a Dexcom One. This will make your life much easier (much less fingerpricking), and it is reassuring (because you can set it to set off an alarm when your BG goes too low or too high), and it will give you a lot more information, which will make it easier for you (and your team) to work out how best to manage your T1.

Anyway, in the next few weeks you should be getting a lot more help and information from your team; and over the next few months you'll be gaining more understanding and more control of your T1 management; and it will sometimes be confusing and/or overwhelming-- like a tsunami, I thought!-- but this forum is always here to help. (I discovered this forum within a few days of my diagnosis, and it has made a huge difference.) Fingers crossed, and all the best!
 
So, since Sunday, I got into a habit of going for a walk on an afternoon or evening after I eat (time depends on whether I have work, even then I have a bit of a walk to get there after getting off the bus).

That's been helping. The rest of Sunday my readings stayed at 8.3 the rest of that day, and have been coming down a bit since then. Monday night & yesterday morning were more 6s and 7s, and today's were 5.7 and 5.0.

I relayed a lot of these to the diabetic department at the hospital yesterday (obviously not the lowest ones this morning), and they seem to be happy, even explaining the 16.2 over the weekend. They seemed happy with that, to the point they're not asking me to start the novorapid yet, but did ask me to bump my Lantus dose up from 6 to 8 units.

As for today,It did jump up to 6.9 before dinner, but I think the egg & bacon sandwich and bag of crisps for lunch had something to do with that. Still on the lower side of what they have been so far.

I am, as expected, struggling with food, as someone who previously had a limited diet. Stopping snacking so much and cutting a lot of sugar out (chocolate and full-sugar coke & pepsi mainly) was easier than expected, carbs are another thing entirely.

The walks are helping me manage stuff a little for nkw, just got back a few minutes ago, been out the best part of an hour and quite a bit of that was uphill.

I'll see how things are later tonight as usual, but it's a start!
 
Great to hear you are getting some nice in range readings now, but a little concerned that they have increased your Lantus dose, not knowing those latest readings. Please make sure to keep hypo treatments with you at all times and particularly when you head out for a walk AND by the bed along with test kit and don't hesitate to test if you feel a bit wobbly.
 
That is something I need to do now, if my readings are going down like that.

I'm expecting them to go back up tomorrow. I have to stay at home to retake a test from the hospital - a cortisol test I did after the hospital appointment that ultimately led to my diagnosis. A thing where I need provide a sample taken over 24 hours. Last one got rejected for some reason. I could probably squeeze something in, but I'm reluctant to because I don't want to stray too far from the house, just in case.
 
BenjaminRWT said:
That is something I need to do now, if my readings are going down like that.

I'm expecting them to go back up tomorrow. I have to stay at home to retake a test from the hospital - a cortisol test I did after the hospital appointment that ultimately led to my diagnosis. A thing where I need provide a sample taken over 24 hours. Last one got rejected for some reason. I could probably squeeze something in, but I'm reluctant to because I don't want to stray too far from the house, just in case.
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As someone using insulin, you ALWAYS NEED to carry hypo treatment with you. A hypo can happen at any time but will usually happen when you least expect it, so please make sure you are always prepared.

Do you know the rule of 15 for treating hypos? ie. If your levels drop below 4, you have 15grams of fast acting carbs.... this might be 3 Jelly babies or 4-5 glucose tablets and then test 15 mins later and if you have not come up above 4 at that time, you have another 15g fast acting carbs and test in another 15 mins. When you get above 4, then some people find it helpful to have 10g of slower acting carbs like a digestive biscuit to stabilize things.
 
I am, as expected, struggling with food, as someone who previously had a limited diet. Stopping snacking so much and cutting a lot of sugar out (chocolate and full-sugar coke & pepsi mainly) was easier than expected, carbs are another thing entirely.
The walks are helping me manage stuff a little for nkw, just got back a few minutes ago, been out the best part of an hour and quite a bit of that was uphill.

@BenjaminRWT I too think it’s strange to up your Lantus. I don’t understand why they do this - treating a Type 1 more like a Type 2. If you’re having to limit carbs and go for vigorous 1hr walks to stay in range, then that’s not right. Lantus is a background/basal insulin. It’s supposed to keep your blood sugar in range in the absence of food. Your Lantus is probably covering some of your food. So, what happens if you don’t eat for a day, miss a meal, or eat fewer carbs? A hypo - and they can be bad. It’s far better to have less Lantus and small amounts of Novorapid (or other bolus insulin) for one, two or three meals.

Type 1s can eat a pretty normal diet, including carbs. Type 1 is all about the insulin.
 
To be honest, I've been doing this as a temporary thing UNTIL they start me on novorapid. I'm not really able to do much today anyway.

I have an appointment coming up in 2 weeks. I may bring this up, actually, along with some stuff I have coming up (a couple of concerts and things I plan to attend and might need to adjust how I do things for those days).
 
Yes, forget it today (but don’t forget the hypo treatments!) However, once you’re settled with the other stuff, you could try just eating normally and not walking, and see what your blood sugars do. Obviously if they go high, get straight on to your team. Novorapid makes things easier because you can then eat what you want within reason. You might also be able to reduce your Lantus dose. Novorapid comes in pens that can do as small an amount as half a unit. That’s great for the recently diagnosed, in particular, but useful for most people as you can fine-tune your dose better and potentially reduce both highs and lows.
 
I've stocked up on hypo stuff. Also decided to stay at 8 units for now and see what happens.

Staying at home on Thursday hasnt really made much of an impact, all largely within range.

Anyway, I went into Boots today, and bought some chewy glucose tablets. They had them in tubes of 10, and jars of 50. Got one of each, felt the tube would make them perfect to keep in my pocket at all times, and the jar for refilling as required.
 
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