Mysterious highs... please help.

[ohcarolina]

Hi everyone, I have been extremely independently managing myself for the past six years (no insurance, so no regular doc relationship) and have finally arrived at a situation that I haven't been able to solve myself. Over the past two weeks, my BG's have jumped from my normal 80-120 range to 180-300 even in the morning. I have actually been exercising a lot more, since the bike/triathlon season is starting. I'll be out riding for 2-3 hours, which in the past meant I had to cut insulin in half! I haven't changed my carb/food intake, my insulin has been in the fridge and looks totally clear, I just went to ,my dentist to rule out my teeth...
I know I need to see an endo but can't get in for two weeks. Is there something I'm missing? I feel like I have a slight cold, but being sick has never done anything this dramatic. Usually if I'm sick I will up my Lantus. I've doubled it and nothing. I know, I know, I should have a doc to call, but right now I've got no one who knows me. I'm so frustrated! Any thoughts?:confused:

[Coppernob]

Carolina, I think it could be the slight cold, perhaps. Sometimes viral infections just hit us harder than we expect. About 10 days ago, I didn't even think I had an infection but my blood sugars soared and I ended up in the ER because I was spilling ketones. Next day I had a sore throat - it affected my BGs for more than a week. This has never happened before.
I have also found that my diabetes changes every little while - it and I are not on the same page any more. Then I have to rethink and readjust.
Consider changing to a different vial of insulin - at least then you'll see if its that - if it doesn't make a difference then you can still use up the original.
Finally check in with the endo - if you cannot see him/her for 2 weeks, would he/she or a PA or NP in his office talk with you. I think you'd feel reassured if you could talk with a medical professional. Good luck.

[ohcarolina]

Thanks so much fo r responding! In the past two hours I have started to get sore throat, dizzy, and sinus pain. Guess I was sick after all. I think I will try to talk to someone. It can be scary to feel out of control. Just reading everyone else's posts has helped me feel a little better.

[UpNorth]

I really hope you'll feel better real soon!

I've just recovered from a tripple infection which was a combination of both virus and bacteria. And while i was really sick and for a couple of days more, i'd run high constantly... Now i feel well again, and my sugars has been down to normal for a few days, even been having some hypos:eek: I've just hooked up on the pump again too, so that makes my sugars a bit more unstable than usual until everything is set correctly again...

[xMenace]

Doubling Lantus? That' screams no control to me.
Required reading: Getting Down to Basals :: Diabetes Self-Management (http://www.diabetesselfmanagement.com/articles/Insulin/Getting_Down_to_Basals)

Rising in the evenings ...

- do you rotate sites well? Scar tissue may be at work. Try some differenst spots?

- your post suggests changes in dosages. A lower than needed dose can run out early in basal insulins.

- basal insulins can run out early anyway. Many split their doses to compensate.

- as we age our basals tend to change. I actually now increase much more in the evenings than I used to. We call it the dusk phenomenon. Of course you know about the dawn phenomenon. This seems to behave similarly but is not as intense. I've found no explanations, but my endo says he sees it often.

[Coppernob]

Thanks so much fo r responding! In the past two hours I have started to get sore throat, dizzy, and sinus pain. Guess I was sick after all. I think I will try to talk to someone. It can be scary to feel out of control. Just reading everyone else's posts has helped me feel a little better.

Glad to respond - I know how unnerving it is to feel that loss of control. Feel better :)

[Eddy]

Doubling Lantus? That' screams no control to me.


I've [fortunately] not fallen ill since DX, so I can't comment.

Question: When one is ill, how quickly do basal needs return to normal? Being stuck on "extra 1.29 U/hr" (for me) for a day sounds scary. I think I'd rather shoot regular every few hours...

[ohcarolina]

Doubling Lantus? That' screams no control to me.
Required reading: Getting Down to Basals :: Diabetes Self-Management (http://www.diabetesselfmanagement.com/articles/Insulin/Getting_Down_to_Basals)

Rising in the evenings ...

- do you rotate sites well? Scar tissue may be at work. Try some differenst spots?

- your post suggests changes in dosages. A lower than needed dose can run out early in basal insulins.

- basal insulins can run out early anyway. Many split their doses to compensate.

- as we age our basals tend to change. I actually now increase much more in the evenings than I used to. We call it the dusk phenomenon. Of course you know about the dawn phenomenon. This seems to behave similarly but is not as intense. I've found no explanations, but my endo says he sees it often.

This haven't been an evening thing, just a whole week thing that I didn't think was illness. Now I'm sure I am sick, it hit me hard, so case pretty much solved....

Um, I have to say your "No control" comment felt a little judgemental to me. I think anyone on here is doing the best they can, and my A1c is normally around 6.0, so I'm not sure where you're coming from.

I actually change my Lantus reguarly based on my level of athletic training, and this has given me really good results, so for me that is a logical thing to do when illness or other things prevent me from my normal lifestyle.

[xMenace]

Um, I have to say your "No control" comment felt a little judgemental to me. I think anyone on here is doing the best they can, and my A1c is normally around 6.0, so I'm not sure where you're coming from.

I actually change my Lantus reguarly based on my level of athletic training, and this has given me really good results, so for me that is a logical thing to do when illness or other things prevent me from my normal lifestyle.

I try not to judge, please don't take it as such, but I suppose it was my initial judgement. I don't hesitate to question though.

Most of us do not have much if any variation in our basals except when extraordinary conditions warrant. Variations are common for exercise, sickness, and other known triggers, but typically not such big ones, especially for such a long term insulin. My first thought was lack of knowledge of what basals are about. Typically someone making such a change is behaving dangerously. Obviously you do understand and you understand your own body's behavior, and that's all that counts. Frankly, what you do is awesome. I wish everyone was taking control like you do.

[Eddy]

And you both have sweet A1c values, so this could prove to be an excellent argument. :)

(Note that I use "argument" in the sense of "debate", not "verbal fight".)

ohcarolina: If you feel like sharing your exercise/dosage experiences, I know that I'd be interested in reading. I've not yet started training since DX, and would love to gather more information from those with first-hand experience.

But that certainly can wait. First things first. Get better!

[ohcarolina]

Well, had no idea I would start a debate here, but I am glad to trade stories! I definitely acknowledge that since I spent the first five years of my diabetic reality with no medical care due to a new community, no insurance, and maddening free clinics that were a waste of time blah blah ...I do things unconventionally. I have figured out what works for me by experimenting on myself and reading a lot. That approach could probably be a really bad idea but here I am. When I am in active season (2-3 hours/day strenuous exercise, mountain biking), I can't take more than 8/units of lantus without running constantly low- horrible nighttime and afternoon lows. When it's winter and I just go to the gym for under an hour, My BG's are stable and good when I take 15. It's like having two different bodies, even though my weight doesn't fluctuate by more than 5 pounds. Changing my basal works way better for me than trying to adjust my humalog or eating extra snacks or something. It just works for me in a stable and predictable way. I've had to go to doctors to get presciptions and they always get mad at me, but when I get my labs, they just say "well, I guess it's working for you" I am more active and vital than most non-diabetics I know. I have never been to the ER or been unable to help myself since DX, and this sick spell is the first time I have had unexplained highs like this. I hate having to stay home sick! :eek:

[HelenM]

When I am in active season (2-3 hours/day strenuous exercise, mountain biking), I can't take more than 8/units of lantus without running constantly low- horrible nighttime and afternoon lows When it's winter and I just go to the gym for under an hour, My BG's are stable and good when I take 15.
This fits is with my experience. When I was training for the marathon and weekly distances became longer so I gradually reduced the lantus. But when you're marathon training,even at my slow speed, you normally only run for more than 2 hours on one day a week.
During a weeks backpacking, fairly hilly terrain with 6-8 hours walking every day. I cut my lantus by the normal couple of units and halved the boluses but was still fighting frequent lows and having to eat frequent snacks which I didn't want to do.
When I discussed it with my doctor she told me to half the lantus next time.

(Although next time I'll be on a pump so that will bring a whole different set of problems)