Blood Sugar Won't Budge, Need Advice

I have been type 1 diabetic for 6 months. I started on Lantus and Novolog, and my blood sugar numbers have slowly but surely been reigned in. I have consistently been diligent about carb counting and meal planning, although I have an unconventional life and do not always eat at the same time.

With Lantus, I was experiencing a lot more lows and highs than I was comfortable with (at least 1 high in the 200-400 range a day, and at least 2 lows a week). I recently switched over to Levemir, which aside from helping me put a cap on the weight gain that accompanies Lantus (for me at least), assisted in greatly improving my blood sugar levels. Immediately, and for the two weeks following, I as experiencing pre meal levels of 80-110 and post meal of 130-150.

Now, within the last few days, my blood sugar literally will not budge from 130-160. It is really frustrating because I am doing everything the same-eating super healthy, low carb, whole food balanced meals, exercising daily (bike riding, ballet, walking, etc), as well as taking my prescribed dose of insulin daily (4 units of Levemir in morning and again at night, 1:25 of Novolog). Most of my meals are 20-50 grams of Carbs so I generally take 4-6 units of Novolog a day.

My only guess, and my next appointment with my health care team is on June 1st, is that the bottle of Novolog that I am using isn’t working? I opened it on April 13th, so it has been just over a month. I know it is said that they only work for a month, for other bottles that I have used in the past worked for at least 2.

Does anyone have any tips/advice? Thanks a lot!

Sounds like your basal and/or Novolog dosing isn’t right. You come back to 130-160 after meals and your Novolog should be used up. Can you fax your BGs to your endo and ask about adjusting your Levemir and/or your Insulin to carb ratio. I know a lot of experienced people on this site would adjust on their own but you are 6 months out so talking to your endo might be a good idea.

I feel confident enough to adjust on my own, I just haven’t considered doing that because I was just adjusted 2 weeks ago by my diabetes team. I went from 1:20 with Novolog and from 6 Lantus to 8 Levemir. I may adjust my Levemir by one unit each dose (total of 10) and see how that goes. Then, I may change my Novolog to 1:20 again.

Since you have had type 1 for over 6 months now, you may be coming out of your “honeymoon” period. You may need to adjust your insulin levels accordingly.

Good point that is very likely!

I would change the insulin out just to rule out the insulin. Like Alan said, you might be getting an infection or something – my BS usually tells me something is wrong before I know it. It could be that your rates changed and you need a different amount of insulin. Do you know how to do basal testing to make sure you have your Levemir set right? There are so many things that can throw off your BS, you have to be a detective to try & figure it out!

i think you may need to look at your basal rates… if your blood sugars are holding steady thats a good thing you just need them to hold at a lower level your not rollercoasting which is good but in my not soo professional opinion you may want start there.

I find that when I eat low carb that I usually minimize post-meal spikes. However, I also tend to start getting higher base numbers. By that, I mean numbers that are steady after mealtime boluses have worn off. I’ve always figured that was the result of one of two things. Either my basals have always been bit low and have been supplemented by mealtime insulin. Or by eating low carb, I have delayed digestion from eating more fats and proteins. The fix is either increasing basal rates or using more square wave and dual wave boluses by pump.

A non-pumper might consider adding Regular insulin to the mealtime bolus or using a tiered approach to mealtime insulin. Kellywpa uses the tiered approach, I think. That means several smaller shots delivered over a determined period of time rather than the whole mealtime bolus being delivered at once.

This phenomenon is not uncommon and illustrates that going low carb is not always the perfect solution to BG numbers.

If your eating patterns have not changed, it could be your insulin being a bit old. However, there are many of us who use Novolog and Humalog well pt the 30-day mark. Or it could be that your body has been producing some insuin and is slowly starting to produce less.

Type 1 is a never-ending puzzle and most of us do what works “most of the time”. The cure of one problem seems to bring up another problem. You’re certainly thinking of the right things as you try to solve your latest puzzle.

Start a new vial of insulin just to be sure it isn’t that. If the numbers continue, then you may need an adjustment of basal or bolus or both. As someone else mentioned, you may be coming out of your honeymoon period. During the first year or so you’ll hit periods where there just seems to be a big change in what worked before. That’s when you need to tweak. Your 1:25 ratio is a pretty light dose and you aren’t getting down below 130. I would tweak there first. Maybe a 1:22 ratio. See if that little bit makes a difference.

My dtr was dx a little over 6 months ago and I am also new to the whole adjusting numbers, etc… and I have just read “Think Like a Pancreas” by Gary Scheiner and it really gives you formulas to start with so you are adjusting your numbers based on some science that gives you a place to start instead of blind guessing. I highly recommend it if you haven’t already read it.

I took 5 units of Levemir last night and woke up with 114, we’ll see how it goes!

Yes, it does seem that for some people high blood sugar can be an indicator of an incoming infection, but I so rarely get sick and haven’t felt any symptoms yet.

looks like it was the bottl of Novolog. Switched it up with a new one and now I can’t keep up with my blood sugars. Running low all day! Oh, diabetes.

Very interesting Frankie.

While I am not on Novolog (I am using Humalog), I find that the longer the vial has been out of storage in my fridge the less the insulin works. This is particularly noticable right at the end of my current vial and at this point I tend to inject a couple of units extra for the same meal. Switch to a fresh vial right out of the fridge and the insulin/BG drop is back to normal.