Aging, High BS, and Type 1

I am hoping that the collective wisdom and experience of fellow Type 1's can shed some light on a problem I've experienced recently, specifically the effects of sustained high BS.

A bit of background. I've been Type 1 for 12 years and on a pump for 11. My A1C's have fluctuated between 6.8-7.5 over that time (not well controlled, but not wildly out of control either). In May I experienced my first real episode of DKA-a bad combination of 2 failed insulin sites, a bad vial of insulin, and a slow reaction on my part. I had the classic symptoms (irregular heartbeat, vomiting, high ketones, confusion, etc.) It was super scary and forced me to reevaluate my management of our disease. I changed my approach (low carb diet and new insulin pump) and have seen a marked improvement in my care.

Even though I work harder at control I still have days with high BS (mostly related to insulin pump problems). Yesterday was such a day. I was on day 2 of my Omnipod and it started going “bad”. I was over 300 for 6 hours before I decided to change it. My BS levels evened out post site change but the effects of the high BS (lethargy, headache, thirst) are still plaguing me this morning.

Here is my question-does the effect of high BS get worse as we age/the longer we’ve had the disease? Am I more prone to feeling these effects because of my semi-recent DKA episode? I recently dropped my A1C by .6 points (go me!)-could the more stable numbers before a high make the high BS harder for my body to accommodate? In the early days of my care, before I had semi-good control, it wasn’t uncommon to be above 250 all day. I don’t ever remember feeling as awful then as I do now when I have those numbers for longer than 4 hours. Is this just a function of a faulty memory/viewing my past with rose covered glasses or was it easier to handle bad BS 5-10 years ago? I am really hoping for some personal experience on this matter-please share what you’ve noticed in your management of our disease-thanks in advance!

Congratulations on your efforts to improve your A1C!!

I'm not sure about the answer to your question about the long-term effects of higher BG as I avoided that, even during a lengthy period (maybe 5-10 years?) of not going to the doctor, like at all. I would suspect that as we get older, they symptoms might be harsher. It may also be that if your numbers have improved, a number that wouldn't have been all that bad is more different than your "usual" (now) numbers and feels worse becaue the difference is greater? Kids can do a lot of stuff (e.g. drinking) without ending up as miserable as someone who's older so perhaps DKA might be like a diabetes hangover or something like that.

One thing I picked up in a discussion on FB is to turn up your basal when I have site changes. Inserting a site causes some trauma at the site area that can interfere with "clean" absorption so, to offset the rise, I input a basal boost. I usually use 200% and just wait to see the crash on my CGM/ meter. I tried 150% yesterday and it worked pretty well with a bit less crash, go figure!

I am 60 and have had Type one for 50 years. I rarely have high blood glucose levels, mainly because I am very OCD about my readings. Sometimes, though, it just happens, for whatever reason. I don't feel any different with high levels, and I take fast decisive action to bring them down quickly. One tip I learned here is to take the correction with a syringe, instead of the pump. If your pump is problematic, that is a good option to try.

Keep up the fight!

When I started to used a CGM and eating signifigantly lower carbs 2 years ago I noted some changes. I almost always keep my BG under 200 and hopefully under 160. Now if I have a problem and my BG spikes over 200 I feel horrible. This was not the case before I kept tighter control. I think your body adjusts to the new average BG and this is a completely normal and good response. You can sort of compare it to people that are sky high for a long time and then get a "false hypo" at 120 or so.

I think what you are seeing is the difference between pumping and MDI. When you are on injections including a long-acting insulin such as Lantus, Levemir, or even NPH, you are never without some insulin in your system. You may not have enough insulin, but you have some.

When you pump, if you have a bad site and don’t fix it right away, you can quickly become absolutely insulin deficient. How quickly that happens depends on how long your short-acting insulin lasts in your body. For most of us that is 3-4 hours. Becoming absolutely insulin deficient very quickly leads to ketones which means nausea and feeling like crap.

So I do think that what you’re seeing is a pump vs. MDI issue. That may not explain why you feel so crappy today unless you were farther into ketosis than you realized. Or maybe it just one of those Type 1 things that never quite have an explanation.