What to do?

[britisme]

My husband has Type 1 diabetes. He just turned 30 and has had it since he was 4 years old. Off and on for the last year or so, he will suddenly get extremely high blood sugar readings(high 400's) and will not have eatten anything all day. This happens even if his blood sugar was perfect an hour earlier. He'll take 20 units of insulin and an hour later it will finally have dropped to 375. He'll take 15 more units. Still, hours later he will be in the 300's. He will switch to a new bottle of insulin to make sure the first bottle wasn't bad, but it doesn't make a difference. This is quick acting insulin. Then, after 5 hours or 10 hours (we never know how long it will take) he'll suddenly go really low. Two different doctors have just said it shouldn't do that and they don't know whats wrong. His eyes keep bleeding more because of the high levels, even though he's had laser surgery. We don't know what to do! Has anyone else had any problems like this?

[brucedeen]

How long has he been on the fast acting insulin? I assume he was on a slower acting like R, what was his response time with R?

I've used Humalog, Novolog and even Apidra. With Apidra (pig latin for rapid) the insulin took effect at the end of the life of the Insulin. His body may act differently to different fast acting insulins. Is he on an insulin pump?

[Eddy]

Assuming that basals are in order... what about insulin-binding antibodies? I've heard one person mention that on here w.r.t. her two-year old son...

[xMenace]

and will not have eatten anything all day.

His liver. He needs to eat regularly to keep his metabolism active and to prevent his liver from trying to keep him alive. He doesn't have to each much, just don't go longer than 4 hours.

Understand insulin behavior too:
Index of Diabetes Technology pages: Insulin Pumps, Insulin Pump Comparison, Blood Sugar Meters, continuous glucose monitoring devices, noninvasive monitoring, diabetes software. (http://www.diabetesnet.com/diabetes_technology/dia.php)

He may also have absorption issues, and taking lots of insulin like that can be slow absorbing.

[Eddy]

Doh! Thanks, John! I wasn't thinking about the gone-too-long-without-eating "fun".

Note to self: Read slowly and activate brain before posting.

[lilituc]

What kind of insulin is he on? Is it possible that these highs are the result of a rebound from a low? That's when the liver dumps too much glucose into the blood to try to bring bg back up. Rebound highs are also difficult to bring down with usual methods. Another possibility is that he's on an insulin like Lantus once a day, and it's not lasting 24 hours. In that case, the dose could be too high, and then wear off early, causing both highs and lows.

I would recommend the book "Using Insulin" by John Walsh.