So I woke up this morning to find my fasting blood sugar quite high. I gave a correction with my breakfast bolus, but before lunch, my sugars were still in the 17 range. I gave another correction with my lunch bolus, but alas, 2 hours later, and still too high. I bolused yet another correction and my numbers held steady. By dinner, I was still in the 17s, so I bolused for food and another correction. Two hours ago before I was supposed to go to bed, my blood sugars hadn’t budged, so I thought maybe there is something wrong with my meter. I tried 3 other meters (3 different brands, 3 different lancets, and used rubbing alcohol on my fingers all three times) and still got 16s to 17, depending on the meter. I haven’t had to give a correction before bed before, but I did tonight 2 hours ago, and yet still my blood sugar isn’t budging. I just corrected again, and am afraid to go to sleep because it’s all of the extra humalog I have taken this evening, I’m afraid of going hypo in my sleep. What gives? And what do I do? Experienced diabetes, do you have any suggestions? Thanks!
Open a new vial of insulin. If you have a pump, change your infusion set. Also, drink three or four glasses of water.
I agree with @Timbeak48. My personal guess is that these types of stubborn elevated BGs are more likely down to problems with basal than with bolus insulin. If you are on MDI, try an new vial of Lantus (or whatever your long acting insulin is). On a pump put in a new set - that is more than likely the problem) and perhaps put your basal up (?50%) with a TB.
My 11 year old and husband have been doing this a lot lately too. For my son I changed his long lasting injection site and increased the dose. It’s helped but think we still are going to have to up it a little more. Possibly even change his insulin to carb ratio. My husband has increased his long lasting too but honestly he found that if he drank a little alcohol before bed it helped him not to wake up super high. It seems like if he can avoid waking up high it helps his numbers to stay within range better through out the day. Early morning to afternoon seems to be their worst times. It makes me wonder if it’s something like seasonal changes or something else like that, that is affecting them lately. Best of luck to you.
What is it, phase of the moon or something? Because I’m having one of these too. So ok, my wife’s b’day yesterday, took her out to dinner, ate some carbs, thought I’d bolused more than adequately but apparently not. Did a correction, but still spiking over 200 at bed time, boosted my basal up 1/3 over normal. Still high this a.m., 180 and trending upward, did a correction + bolus but over the next hour it’s up into the 200s again, another correction, still 240 an hour later and not budging… finally hit it hard about an hour ago and it’s finally down <200 but damn… And this is like the third time I’ve had one of these in the last month.
I dunno, seems the older I get the harder these things are to reign in. Plus my regular exercise routine is off (bike riding) due to a nasty cold followed by a couple weeks of bad weather, so that’s not helping. Probably the most effective thing for me is to get out for a fast-paced walk but in the middle of a workday morning with meetings and whatnot that’s not so easy. If you can get out though, that one always helps, especially if you have insulin on board.
Depends if you’re on a pump or MDI.
On a pump replace the infustion set, a bolus into the deltoid with a 12G needle drops me fast.
Try a new vial of insulin or pen.
What is your basal protocol? Since you talk about giving a “bolus” for a meal, I suspect you’re on a pump. I would try increasing all your basal rates. You may do this using a temp basal setting if you wish.
Basal rates are not a “set it and forget it” parameter. Your symptoms of a continuous high BG all day long makes me think you have a significant basal deficit. Is your site working? Do you have any site pain? If you disconnect the infusion line at the site hub, can you see if insulin is coming out of the set when you deliver a bolus?
If you’re filling the pump from an insulin vial, how long has that vial been out of a refrigerator? Twenty-eight days is often the max specified time outside of the refrigerator, but extending that time has never been a problem for me.
If you’re on a pump and blood sugar rises to above 16 (288), take all corrections with a syringe. At this point, the risk of DKA goes up a lot. You want to be absolutely sure you’re getting insulin.
Have you called your doctor? S/he should be aware of these kind of episodes when they’re happening. Good luck and please report back.
Yes basal fasting tests after episodes like this that cannot be attributed to a blocked infusion set or carbohydrate intake, illness/stress are always a good idea.
I quickly rose to 17.4 within four hours from 5.6 at the beginning of the week because I had a large amount of air in the infusion set. I’d also silenced alarms as I was in a work meeting and rushing around.
It was only upon the feeling of early DKA in my chest (cannot articulate it but I can recognise early DKA quickly, (a peculiar tightness in chest and metallic taste in the mouth) ) that I checked my pump and my BG and quickly corrected. If I’m extremely high I have to double my typical correction factor to get down to a normal range within 2 hours.
If you’ve been high for a long time also check your ketones and consider seeing a Dr.
God do I hate these mysteries. As I posted above I’ve been going through the same craziness since last night into today including doing scary correction boluses I’m afraid are suddenly going to kick in and crash hard.
@VikaPlume I think we’re mostly assuming you’re on a pump. If so, I don’t read whether you have checked your infusion site. In my case that turned out to be the culprit. I’d just started a new set yesterday and most of the day everything seemed fine, regular numbers, no pain at the site or anything. Which made me think that couldn’t be the problem, but when I finally decide I needed to just swap the whole thing out and start afresh I pulled it off and lo and behold the cannula was bent flat. Now that I think of it I recall at some point catching a finger on it and checking that it was still sealed against my skin, which it was, so I didn’t give it another thought. Still looked perfectly fine from the outside when I finally decided to yank it this afternoon, but as soon as I got it off I could see it was crimped.
Lesson: It’s pretty rare but you CAN yank the cannula out of your skin without the sealing patch actually detaching. In the past when I’ve done that the telltale is it feels wet due to the insulin dribbling out, but this time that didn’t happen. I can only conclude the cannula must have remained inserted part way so I was getting something but it wasn’t getting into my system. Maybe the real lesson is that no matter how experienced you are this sh** can still trip you up. I was sure I’d checked everything…
I agree with all the troubleshooting. I’d run through: site issues with pump, insulin bottle swap, and would probably bolus with an injection instead of the pump - and more than my ratio would dictate, but during the day so I could monitor and treat lows. One additional question - any chance you could be pregnant? That was my first sign that I was pregnant… my bgs were all of a sudden much higher than they should be and required aggressive adjustments to bring everything back into normal range.
I thought I’d update all those of you who took the time to respond to this. I had been feeling so crummy that writing a long response sounded like too much work, but I’m feeling much better now. I’m not on a pump, I’m on MDI. I checked the expiration date on both my lantus and my humalog, and they were both fine, but I opened up a new cartridge of each from a brand new box as many of you suggested. The high number only got worse the next day (my fasting reading was 22.6 mmol/L ; 406.8 mg/dl). I uped my Lantus dose a lot, but no change by the next day. At this point I was feeling really nauseous and dehydrated so I decided to use a ketostix and it turned a lovely shade of purple so I went to the ER. They admitted me 5 days ago and hooked my up to IV insulin and some saline for the dehydration. It turns out that you were right @Pipli - I’m a little bit pregnant (just barely pregnant? 4 weeks). Being in the hospital sucks because it means I missed my appt with the community based endo and will have to wait now another month to see him, and once discharged will have to come back to hospital to see the endo until then. On the upside I feel much better now and my numbers are much better, so hopefully I’ll get to go home again soon 
Ah! Congratulations! Hopefully they were able to address the ketones quickly and everything will go smoothly with the pregnancy. I’m glad you feel better! I’ve found that pregnancy requires regular and aggressive adjustments to my basals, with a healthy collection of glucose tabs for treating lows.
One aspect you might want to check quickly with your medical team - I pump so I only have Lantus as a back-up. My endo told me that Lantus isn’t approved for pregnancy, so she gave me a prescription for Levemir.
have you considered opening a new vial of insulin. if you are continuously so high, i doubt it would have anything to do with your meters being correct or not; you would feel a significant drop in your BGs physically with all those corrections. i am so sorry to hear that you are having such a frustrating time of it. i find when i have similar issues, my problems go away when i open up a fresh vial of insulin ( and, FYI, if you call your insulin company and report it, they will replace the bad insulin, just don’t throw away the bad vial/pen ; the company will want your pharmacy to return it)
best of luck.
Daisy Mae
@Daisy_Mae Thank-you for the suggestions They were excellent and I tried them all. If you look above for the update, you’ll see that I am in hospital now, on an insulin drip (I started producing ketones from the elevated number). It turns out that I’m pregnant and that is what caused the high blood sugars.
@Pipli Thank-you! I’ll definitely ask them about the lantus before they discharge me! I’m sill on the insulin drip (thy tried removing it and giving me shots instead, but my sugars sky rocketed). We’ve been talking about maybe getting me a pump (I can sample the omnipod, as they have some here) depending on how things go. If they decide against it, I’ll make sure that we talk about switching to Levemir!
dear VikaPlume,
congratulations on your pregnancy !!! 
hopefully the hospital doctors and staff will be able to regulate your BGs and get you back into a safe and healthy range. personally, i prefer the Medtronic Pump. i love the company and have worked with them for over 17 years. my girlfriend is on the Ominipod and i am not the biggest fan of theirs, but to each his/her own.
all the best of luck. have faith and hang in there.
Daisy Mae.
Stress hormones–there’s the culprit! And elevated cortisol in particular I bet, since that seems to be a pretty common effect of pregnancy, or so Dr Google tells me. I’ve never been pregnant (obviously!), nevertheless I’ve had a run in with this. Back when I was on R/N regimen I started having one of these outrageously high episodes that went on for days even though I kept upping my dose to scary levels to no avail. It was about a week of going crazy with it when I finally found out it was due to a cortisone shot I’d received when I’d seen an orthopedist for shoulder pain. Took about 3 weeks for it to finally clear.
Your situation is more challenging but I expect you’ll find a lot more information on how to handle this now you know what you’re actually dealing with. Takes some of the anxiety away to find out what the problem actually has been. And congratulations!
dance around or go for a good walk for 15 minutes. seriously.
I think this pregnancy is going to kill me before I get to even start my omnipod trial.
This morning my meter simply said: Blood sugar over 33.3, please wash hand and repeat with a new test strip. I did, and got the same message.
I guess that means I get to go back to the ER. This is getting really frustrating. I really only needed to make it to Wednesday it hour going back to the hospital, as that is when I get to start my omnipod trial. That has got to help this fasting sugar going from 8.0 when I go to bed and then skyrocketing over night. Sigh 
So sorry to hear this! Please let us know how you are when you can. All the best.