Blood sugars won't come down

Type 1 and LADA
1

Hello all! I am new to this site, but not new to type 1 diabetes. I am 23 years old and have been diabetic since I was 10. I was recently on the OMNIPOD pod and that was starting to not work and my blood sugars would always skyrocket. I took a month period off while waiting to get the new Medtronic 630g and could control my blood sugar very well with the injections. I now have had the 630g for a couple weeks and worked great! I am not sure if the following is the pumps fault or what could be the problem. Please help. My Diabetes educator just wants me to increase nighttime basal by .15 from .75 units/hour to .9. I was very sick on Monday with a 24 hour bug but was fine the next day.

Supper:
7:23PM BG 180 CARBS 124 INSULIN 11.4
11:01PM BG 147 INSULIN .5
3:20AM BG 253 INSULIN 2.6
6:42AM. BG 247 INSULIN 4 (gave about 1.5 more than it told me)
9:35AM BG 201 INSULIN 1.3
11:20AM BG 225 Carbs 114 INSULIN 11
This has been the case for at least 7 days where my blood sugar barely goes under 200. I know it is working since after I eat my blood sugar doesn’t spike, but I Give the recommended dose for correction every 2 hours but it stays the same.

2

What is “the recommended dose” based on? Perhaps that is what needs adjustment?
w.

3

It sounds like it may not be a pump issue; rather, a dosing issue. What methodology is behind your dose numbers? Have you basal tested? Are you sure your bolus doses are correct? With the big spikes you’re talking about it sounds like both your basal AND your bolus rates are just off. You’ve been doing this a long time, though! I’m sure you’re fully familiar (and have conducted) with the testing methods. Those tests have told you that you should be using the doses you listed?

Also, the very first thing I learned (well…after I began becoming personally educated) is that before you dial in bolus, your basal has to be right.

Just some thoughts! Definitely don’t want to make you sound like you don’t know what you’re doing because, like I said, you’ve been doing this a long time so I’m assuming you know, and are doing, all the proper tests to come to the right conclusions about the bolus/basal doses?

It could be an insulin resistance issue also?

4

Thank you both for the answers! I definitely assume my basal is off, but I usually just stay in contact with my endo and send my numbers every week. They are the ones that set those numbers. My correction is 1 unit brings insulin down 50. When I took shots for a brief time that seemed very correct, and my “basal” was 30 units of Tresiba long acting. What she did was just divide that by 24 and there lies my basal per hour. I also feel that even without giving those corrections in the middle of the night, my blood sugar stays around that 250-270 number. My blood sugar now is 144 after eating for lunch. I just don’t understand the blood sugar staying high for so long during the part of time (1/3 of a day) that is crucial for A1C control.

5

My son (I’m not diabetic, but my 2 year old son is) is set on the Omnipod for different basal rates for different times of the day. We noticed he is always high between 10:30AM - 2:30PM. As a result, we bumped up the basal rate, and decreased his IC ratio until he didn’t spike over 250 after meals. Before our tweaks, he was spiking over 350 for that time of the day and that single time frame was driving down his daily average.

We don’t have a good Endo team right now, but we’re in progress of getting a good team. I’ve found that OWNING my sons diabetes has been the best result so far for us. I’ve educated (and continue to educate myself every day) myself on what I should be doing, what key indicators I should be looking for, etc., and I’ve just done a lot of “self correcting” myself without the doctors orders.

It may be a case where you need to step outside the recommended guidance from your Endo team (and replace them if necessary) and begin experimenting on your own to see what works for you. That’s what I would recommend…I know most medical professionals probably wouldn’t like to hear that, but my current Endo team never has an answer for us except “No changes recommended.”…all the while our son was over 300 nearly 100% of the time.

We just accomplished a huge milestone with our son putting him into the 6% A1C range and we continue refining as we need too to meet his daily insulin requirement.

For instance, for the past 3 days, he’s been very sick…conjested, coughing, etc., and I know, from my own self-education that when you’re sick your body needs more insulin. Yesterday and the day before he was spiking over 300 with meals and his daily BG’s were higher than usual. As a result, I created a new “profile” with the Omnipod called “Sick” and I have it as the active basal profile. Within it, I “bumped up” all hourly insulin doses by .05 and for meals, I bumped it up .10 each (this is on top of what his “normal” range was.) Using this, today’s first meal went right too 250, but didn’t cross above it. I’ll add a bit more to basal and; if necessary, decrease I:C until I find the right amount to give me the numbers I’m looking for.

Remember, this is YOUR diabetes. This is YOUR health and doing things correctly will result in YOUR long term health…I say this being the case, make the best decisions you need too (Dr’s orders or not) to make your numbers work for you.

6

What’s your average total daily dose (TDD) and what has it been the last few days?

When my son is sick and just won’t come down, I look at the two numbers, figure out how much more he’s been given as a percentage of his TDD, and then bump up all the basal rates throughout the day by that just a little bit less than that amount.

As a completely made up example: let’s say your TDD is 35 units. Your sick basal TDD has been 50. That represents (50-35)/35 = 40 percent increase over your normal. So if you normally have a basal program that is about .75 units per hour, I’d try upping your basal by about 25 to 30 percent…so boosting it to between .9 units per hour or even 1.0 units per hour. I up his basal across the board for all times, with a few periods (say, afternoon) having a little extra if he seems to really rise during those times.

I sometimes still need to make more frequent corrections, but in my experience my son is not running constantly high that way.

7

First of all, welcome to TUD @peteyson2012! Glad you found us!

Looking at your numbers it could be your correction factor needs to be adjusted to a higher insulin:carb ratio, or your basal isn’t high enough to keep up with what your liver is putting out. All those corrections between 3-11 am with no carbs coming in suggest a bit of both. Given the time of day we’re talking about, dawn phenomenon may also be involved. That’s something that can change with time and require things to be adjusted accordingly.

They do tend to be very cautious about basal increases because the pump is delivering continuously and thus it’s relatively easy to pile up too much insulin in your system over time and end up in a dangerous place, particularly overnight. So it’s important to be incremental in making any changes, but you can try tweaking these levels yourself if you feel like you’re not getting to the results you want. I think most of us pumpers on the site have become confident doing that for ourselves. Ultimately it’s your body and your health.

8

Do I read this correctly? 120g of carbs? According to Bernstein this would raise your blood sugar 600-1200 mg/dl. I think you should be pleased to keep your blood sugars under 300 mg/dl. If you want to keep your blood sugars closer to normal you might consider restricting your carbs.

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9

The average American diet is supposed to contain 300 g of carbs, according to our dietitians. So I would imagine the vast majority of diabetics are at least occasionally eating meals that carby.
By the way, our son routinely has meals of up to 60 grams of carbs, and he is 2 and about 30+ pounds…and we are successful at keeping him below 200 and usually even 150 without lows for that entire period. YEs, it’s probably easier and less mathematically complex to manage diabetes without all those carbs, but it can be done.

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10

Ditto. Our son’s typical meal is between 30 - 60 carbs and he’s 2 also.

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11

If I ate 300g of carbs/day I would never ever be able to maintain my current blood sugar targets. I think the advice to eat whatever you want and (hope) that your calculated bolus would maintain a normal blood sugar is really flawed advice. Shame on every dietician who advises anyone with diabetes to eat a high carb diet.

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12

I don’t think Tia is talking about “hoping”. I think she’s talking about testing and honing the basal/bolus amounts and testing adequately enough that you know how much insulin you need to give for the carbs being eaten. Lately, I’ve been under 180, 95% of the time and my son (2 also) eats meals between 30 - 60 carbs each meal.

13

That 120gram meal is just a subway sandwich meal. My daily carb intake is below 250 usually between 200-250. According to most diet and calorie calculators this tends to be a normal amount depending on a diet. I know you should divide it into smaller meals. But that isn’t really a problem and never has been for me. It’s more the fact that when I am fasting my blood sugar stays at 200-250 throughout the night and into 11am lunch time. No matter what I do whether it is wake up and correct or don’t eat it still stays up. I know my carb ratio is in the right zone as I do go down after that but nothing I do, even giving 25-50% more insulin than normal, brings me below 200.

14

I mean, I agree with you that “eat whatever you want” is flawed advice and I don’t personally think most people, on average, need to eat quite that many carbs. I think people need to figure out what foods work for them and what foods don’t. But am also of the firm opinion that the number of carbs is only slightly relevant to BG swings. I think for many people it is easier and more sustainable to develop a mental “bolus library,” that, through repeated trial and error, tells them how they need to bolus for oft-eaten carby foods, rather than dramatically changing their diet to eliminate all these foods.

15

Honestly, if this were my situation, I would just up my basal until you start trending toward low, then back off.

16

It sounds like a basal issue to me.

17

Thank you for that answer. I haven running at 125% all week as well for basal. I honestly think that’s the problem too, along with correction factor. Just wanted to see what other diabetics thought. I appreciate everyone’s help!

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