[tmkain]

Hello,

I'm a 26-year old male, diagnosed with Type 1 5 years ago. My blood sugar control has been quite good, with HbA1c always in the 5.9 to 6.3 range.

However, lately I haven't been able to get any control at all. The problem is ineffective corrections and astronomical morning numbers.

Last night before dinner (8 PM) I was at 86. I ate a relatively large meal and gave an appropriate dose. 2 hours later I checked again, and I was at 256. I gave 2 units of Novorapid to correct, but 2 hours later (before bed) I was at 286, so I gave an additional 4 units of Novorapid and my normal dose of Lantus, thinking I would be fine in the morning. Then, this morning I woke up with a 295 - it's almost like my Novorapid just completely stops working at night. I don't get it, and it's been happening semi-regularly for a week or so. I know that inactivity can keep sugars elevated, but this high? Even with corrections?

This is starting to kind of drive me crazy, and my mood is awful. Does anyone know what might be happening? Does it sound like a pre-illness thing?

Thanks for the feedback,
Tom

[Joeprep4820]

Originally Posted by tmkain

Hello,

I'm a 26-year old male, diagnosed with Type 1 5 years ago. My blood sugar control has been quite good, with HbA1c always in the 5.9 to 6.3 range.

However, lately I haven't been able to get any control at all. The problem is ineffective corrections and astronomical morning numbers.

Last night before dinner (8 PM) I was at 86. I ate a relatively large meal and gave an appropriate dose. 2 hours later I checked again, and I was at 256. I gave 2 units of Novorapid to correct, but 2 hours later (before bed) I was at 286, so I gave an additional 4 units of Novorapid and my normal dose of Lantus, thinking I would be fine in the morning. Then, this morning I woke up with a 295 - it's almost like my Novorapid just completely stops working at night. I don't get it, and it's been happening semi-regularly for a week or so. I know that inactivity can keep sugars elevated, but this high? Even with corrections?

This is starting to kind of drive me crazy, and my mood is awful. Does anyone know what might be happening? Does it sound like a pre-illness thing?

Thanks for the feedback,
Tom

Could be a variety of things - you could be getting sick, your insulin could be old and/or losing potency, you simply could require more insulin, or it could be how the carbs in your dinner affected you, and there are more than likely other reasons.

[poodlebone]

Originally Posted by tmkain

Last night before dinner (8 PM) I was at 86. I ate a relatively large meal and gave an appropriate dose. 2 hours later I checked again, and I was at 256. I gave 2 units of Novorapid to correct, but 2 hours later (before bed) I was at 286, so I gave an additional 4 units of Novorapid and my normal dose of Lantus, thinking I would be fine in the morning. Then, this morning I woke up with a 295 - it's almost like my Novorapid just completely stops working at night. I don't get it, and it's been happening semi-regularly for a week or so. I know that inactivity can keep sugars elevated, but this high? Even with corrections?

What did the meal consist of? If it had a lot of fat and/or protein that can cause very prolonged highs. Also, I've found that if I have a lot of carbs my normal I:C ratio isn't good enough, and I actually need more insulin. When you add a lot of carbs with fat and protein it's gets trickier trying to calculate the right insulin dose. I also find that when my BG gets very high my normal coorection no longer applies and I need more insulin as well. To correct a BG of 200 my normal correction will work. To correct a 350, I probably need a little more.

I vaguely remember the endo telling me that after X years, my numbers might go crazy and I would have to evaluate everything again. I forget the number, maybe 7 years? Of course that was back in the day of only two injections a day... Still, you may have to do some basal testing and tinker with your numbers, as your needs may have changed.

[DanG]

Yep - it is about this time of year that I go in to a slump like you describe. Somehow, the insulin seems ineffective. I take my daily insulins and essentially do not eat - nothing happens. It takes about two weeks to get back out of the slump. Either that, or it is a sickness coming on and the high readings happen then also. Two thoughts: wait it out for at least 2 weeks, taking whatever insulin you need to keep the numbers down, and eat very very small meals and watch what your numbers are. Thought two: when animal derived insulin was available, I never had this type of problem. It is the ecoli derived insulins marketed today that have caused the problems of cyclical or seasonal ineffectiveness. That is my experience of 35 years with insulins. But, alas - the money-stealer pharma industry sees fit to not allow animal derived insulin in to the country - unless you are a known terrorist, or something like that. There are people that spend 6 months acquiring permits and purchase animal derived insulin from Argentina. Seems odd - but we are all terrorists until proven otherwise. Oh, well - what a country! (in russian accent Borat style).

[tmkain]

Originally Posted by poodlebone

I vaguely remember the endo telling me that after X years, my numbers might go crazy and I would have to evaluate everything again. I forget the number, maybe 7 years? Of course that was back in the day of only two injections a day... Still, you may have to do some basal testing and tinker with your numbers, as your needs may have changed.

Interesting point about the whole "re-evaluation" idea. I think I might be getting to that point, since what's happening right now is both prolonged and entirely out of the ordinary. I live in Japan now, and the doctors here don't even emphasize carb ratios, etc., so it's tough to get good, on-point advice. Would you say my best (safest) bet is to slowly increase my Lantus?

Thanks,
Tom

[tmkain]

That sounds like good advice, too, DanG. I'll keep my meals small and see what I'm like on an empty stomach. I totally get what you mean about temporary ineffectiveness - just wish I could tell when it's coming or how to combat it best.

Tom

[Lilly164]

I suggest that you check two things. 1. How long have your insulins been opened? Four weeks is the recommended time to use each one. (I myself have been known to bend this rule.) Hold each bottle up to good light, see if you can see any floaters. Insulin should be perfectly clear and about as liquid as water. It doesn't often go bad early, but it can happen.
2. Tighten up your carb counts. It is very easy to relax here and for additional carbs to creep in. So I agree with the advice to cut back on food somewhat to see if it makes a difference.

Good luck to you. Highs are frustrating.
Lilly

[xMenace]

Originally Posted by tmkain

That sounds like good advice, too, DanG. I'll keep my meals small and see what I'm like on an empty stomach. I totally get what you mean about temporary ineffectiveness - just wish I could tell when it's coming or how to combat it best.

Tom

Keep meals at a standard size and composition for awhile. It's hard to figure things out when one day you eat a chicken sandwich and the next a chinese buffet.