High Blood Sugars-What am I missing?

[zoelula]

Hi all:
I normally have blood sugars pretty consistently in target (around 100 fasting, under 140 2 hours post prandial, around 120 at bedtime). I have occasional isolated higher numbers, occasional lows, but generally ok. But the last four days I've had numerous highs: several 150s and 160s after meals, a 142 fasting (which is unheard of for me, I have virtually no DP), and a 132 and 168 at bedtime (again very unusual). Just now I tested before dinner and I'm at 205!! (I was 151 two hours after lunch. What is up?

I thought of all the things I hear discussed on here: I am eating the same as usual, using the same I:C ratios. I was at the tail end of my 28 day Lantus but started a new one last night. I started a new Apidra on 10/3. It is definitely not hot here. I'm not stressed (although these numbers are starting to get to me..lol) and I'm not sick.

All I can think of is it's the dread LADA unpredictable blood sugar or final pancreas death I hear about (I haven't experienced any noticeable variations so far). Anybody have any theories? Suggestions? What I'm thinking is to start to increase my doses, both basal and bolus by a unit at a time. I'm nervous as I'm pretty insulin sensitive, but if these numbers stay like this it might be time.

[sarahspins]

It sounds like your insulin needs are changing - totally normal :)

While I was still honeymooning as a T1 I almost never had #'s over 200. Now if I am not careful I can be there or much higher FAR too easily.... it's all part of the game.

[Real4]

...and I'm not sick.

Anybody have any theories? Suggestions? What I'm thinking is to start to increase my doses, both basal and bolus by a unit at a time. I'm nervous as I'm pretty insulin sensitive, but if these numbers stay like this it might be time.

How do you know you are not sick? The first symptom of sickness for a diabetic is higher than normal blood sugars. Yo can have elevated levels for days before any other symptoms occur. (I've wondered, in fact, what diagnostic use could be made of this phenomena.)

But it is certainly possible that you are NOT sick. There are many other possibilities.

I, and many other in the forum, see a decrease in insulin requirements in spring with a corresponding increase in the fall. My basal and bolus requirements change about 15% with the seasons (I'm a type II on insulin for years, BTW.)

Changes in exercise, food intake or medication will cause changes in insulin requirements.

Ans then again, some things they just change! For some unknown reason.

I will use corrections, or added carbs, as needed to adjust my levels but if the changes persist for two days, I'll make small changes in my normal insulin levels until I get back "on keel,"

[zoelula]

Thanks, guys. The season has definitely changed here in the last couple days, much cooler and rainy. That's interesting about sickness but makes sense as we incubate illnesses for a few days before we get symptoms. I'm going to do just what you suggest, and increase my basal and bolus a tad or correct as needed and see what happens.

[DeusXM]

I, and many other in the forum, see a decrease in insulin requirements in spring with a corresponding increase in the fall. My basal and bolus requirements change about 15% with the seasons

Bingo. Without fail, about two weeks before the clocks go forward or back, people start coming on here saying their insulin requirements have changed for no reason. Congratulations zoelula, you're the first for this autumn I think! I guarantee you that a lot of people here will be posting with the same problem over the next four weeks. I've been on the forums here since 2003 and it's been the same thing twice a year for the last 6 years.

It's nothing to worry about, it's just your metabolism changing slightly. It'll do the same at the end of March as well.

[Subby]

Well, the seasonal thing is a possibility. Just a possiblity though.

[zoelula]

Interesting. I always like to be the first on my block for something...lol. I upped my basal by a unit last night and so far this morning I'm back on track. Almost too easy!!

[cynthiazinn]

I/C ratios change constantly. Retest it at least every 3 months.

[Paul W]

I hate to sound uncaring, but I would kill to have blood sugar problems like that. Your sugars are so in control it's scary. I think of myself as an expert after 30 years, but my sugars regularly spike up to 300 and beyond if I'm busy and haven't had a chance to make any corrections. Granted they don't stay that high for very long, but they do get there. I wouldn't be concerned about that at all. Like others have said, just make the corrections. You are probably progressing and your requirements changing. Sometimes you'll never know why it happens. One day it will jsy be different for a couple of days and then go back to normal. I do think the seasons can have an affect.

[Subby]

I hate to sound uncaring, but I would kill to have blood sugar problems like that. Your sugars are so in control it's scary. I think of myself as an expert after 30 years, but my sugars regularly spike up to 300 and beyond if I'm busy and haven't had a chance to make any corrections. Granted they don't stay that high for very long, but they do get there. I wouldn't be concerned about that at all. Like others have said, just make the corrections. You are probably progressing and your requirements changing. Sometimes you'll never know why it happens. One day it will jsy be different for a couple of days and then go back to normal. I do think the seasons can have an affect.

I dont think that sounds uncaring... people just have different standards, is all. If I could reasonably keep better control than I can, I would, and I too would be trying to track down the cause of anything out of the norm.

I dont know you as far as what you get up to with your control. Your post just made me think though - you may or may not be interested, but as another long timer with spikes that occur regularly and easily even after many tweaks to my insulin therapy, I have found taking metformin to reduce these spikes and tendency to spike substantially. After this time I am very keen to see the back of that degree of regular spiking, and have been grateful to find this extra tool.

[Paul W]

I dont think that sounds uncaring... people just have different standards, is all. If I could reasonably keep better control than I can, I would, and I too would be trying to track down the cause of anything out of the norm.

I dont know you as far as what you get up to with your control. Your post just made me think though - you may or may not be interested, but as another long timer with spikes that occur regularly and easily even after many tweaks to my insulin therapy, I have found taking metformin to reduce these spikes and tendency to spike substantially. After this time I am very keen to see the back of that degree of regular spiking, and have been grateful to find this extra tool.

I wish I were more abrest of some of these newer treatments and that is part of the reason I have joined this forum. I don't know everything and it has been a couple of years since I sat down with my specialist, but I am curious. I have never heard of metformin. What does it do? Currently I take Novolog exclusively during the day at meals and for correction and 5 units of Lantus at night. That seems to be pretty good for me except for the routine dawn spike from say 120 to 300 in a matter of a couple of hours about 3 hours before I wake up. That is the most frustrating part; that spike which occurs in the wee hours of the morning. Drat!

[Subby]

It seems pretty common to find that dawn phenomenon is one of the more annoying and hard to deal with problems. The best probable solution I know is the pump, which I found to be a fantastic step in treatment for both basal and pretty much everything else. Pumps use short acting for basal needs, like a controlled drip feed, instead of long acting insulin. This means you you can set different basal "Rates" through the day, effective within about an hour, and often pretty much eliminate DP. You can also set a "temp" basal, for example I often get a spike when getting up even if it's a different time, so a temp basal of 120% for 2 hours can really help combat that. Pumps are obviously a big issue to consider in a number of ways. If you haven't looked at them recently though, I think it's well worth looking into it and tossing it up, with an open mind.

Back to the metformin, it's an oral drug that's been around for a long time. Traditionally used to treat insulin resistance, such as seen in type 2s - it's a very popular type 2 drug. There are known precedents for type 1s to take it, but it's just not really mainstream. I gather its gathering a little more steam with doctors and endos recently. My endo was dubious it would help but agreed to let me try it.

One main way it works is to help stop your liver from being overactive - such as may be going on during your DP. It seems to suppress the liver getting a full glut of glucose and releasing it rampantly, causing (for me) big highs during the day and in times of stress. It also seems to help with IR in other ways I am not clear on. For me it has not reduced my dosage much, but I am very happy with the way it has reduced liver/basal/biological spikes. It also seems to help with carb spikes as well.

Here's two threads worth looking at.
http://www.diabetesforums.com/forum/type-1-diabetes/43551-metformin-for-t1.html
http://www.diabetesforums.com/forum/type-1-diabetes/44010-metformin-findings-one-t1.html

Just to put things in context though, as far as I can tell metformin really is not some big answer for your typical type 1, compared to working with insulin dosaging as far as possible. It appears to me to really help curb the excess of large spikes, if they occur, and may help even things out. So a very much "supporting" role for the T1 who is finding some limits to their insulin therapy.

[Paul W]

Thank you. That was a great response.

[DanG]

That is the most frustrating part; that spike which occurs in the wee hours of the morning. Drat!

If you are inclined to try some experimenting with your dosing on your own, you might do something I have been real pleased with. That is - take your lantus in the morning. My **theory** is that the lantus at night is problematic, as it perhaps causes the body to do a liver dump of glucose materials to keep you from diving to a dangerous low blood sugar. Corollary to my theory is that the body does like to have a break from free insulins floating around. Hence, at night, between 2am and 6 am, most likely, I have zero insulins in my body and the body rewards me with a good rest and with careful monitoring, a good morning blood sugar. That is my experience. If you want more information, we can discuss it further. There are a few of us here at diabetesforums that take lantus in the morning. Mind you - I do not speak these things through with the doctor, as I was told 35 years ago when I started this insulin habit, that I would know more about my diabetes than any doctor - so I live with that. You might want to discuss this with a doctor, if you have a doctor that you are confident with. I am not necessarily not confident with the doctor, but I do not confide in a doctor for anything. He can do some stuff, but I take responsibility for all things he doesn't do - which is everything - he writes my insulin prescription.

[zoelula]

An update: I increased my basal by two points and my numbers are back in target! So thanks all. Cynthia, I'm not sure what you mean by "re-test"but I actually re-examine my I:C ratio every three weeks (when I finish a page in my log) by seeing how many days I was out of range and tweaking the I:C by a carb if needed.

[Paul W]

Interesting. I might try that. As it is now I take 5 units of Lantus at night and then another 3 in the morning, because I was feeling like the Lantus was running out after about 20 hours.