Feeling desperate

Usually my bloodsugars are predictable and easy to manage. The last few days I have been having ketones and I’ve had to change almost all of my basal rates,especially first thing in the morning and supper. I am feeling really depressed and scared that something bad is going to happen to my health. Tell me it’s going to be okay. Please give me some words of encouragement.

I would give it a few days longer to see if this resolves on its own or if you notice other symptoms. Although on second thought, for us, it would also depend on the size of the ketones. Small ketones, we would give it another few days.

Medium or large ketones, we would call our Endo team.

It is not unusual for us to have spontaneous high BG and then two days later have an illness present. I assume the illness actually started a few days earlier and immediately started playing havoc with the BG but the typical symptoms of the illness do not manifest until it reaches a certain stage.

I also wonder if we sometimes get a high BG for a day or not with no symptoms of illness due to the body fighting it off and preventing the symptoms but the BG still rising from the internal battle of the immune system?

When this happens, we dose whatever insulin is required and wait it out. If anything seems out of the ordinary (for a sustained high BG) then we put a call in to our Endo team and discuss it. At least a phone conversation with the Endo is often enough to give us parameters of what to watch for so as to decide if we need to drive in and see somebody.

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My blood sugar normally doesn’t rise if I get a cold. That is the only thing that is going around in the house right now. My son has a cold. The ketones are usually gone once my sugars turn back to normal. Other than feeling a little defeated I feel okay. I am going to do a supper basal test tonight and see what happens. Thank you for your insight.

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Basal rates sometimes (or even frequently) change just … well, just because. We get older, our bodies change, our metabolism changes, at this time of year we may be less active than in summer, maybe our diet shifts without our really noticing (we eat more in fall, or we lean towards carby comfort foods in cool weather). On a day-to-day basis, work or personal stress or less sleep can increase BG and therefore increase ketones. If you’re premenopausal, your basals probably change a few times a month, and each month may have different requirements. If you’re a man, you could be sensitive to seasonal hormonal changes at the very least (I know I am – my basals change every spring and fall).

You mentioned in another thread you’d had to change your set several times in the same day. Are you using the same insulin? When I see mysterious ketones and I know my site is okay, I start a new vial, in case the previous one was bad for some reason.

Keep us posted!

Hi Dee. I had been having similar problems, and I finally figured out it was not the basal rates that were off so much as my insulin-to-carb ratios. Once I adjusted those, things went back to normal. Still had to tweak the basals a bit, but now things are right. I share your frustration!

Also, I learned a valuable lesson a few months ago and have now (pretty much) learned not to freak out so much over highs. My pump was not working properly (it took me a while to figure out that was the problem) and for a while I was regularly going into the mid-200s. But my A1c came back after that at less than 7.

That is one thing I was wondering about, if maybe my insulin has gone bad. I use fiasp and I keep it on the counter, room temperature. I don’t know how long I have used this vial for. It is still lowering my bloodsugars but not like it was. It might be just me. I ordered more insulin and should get it soon. I hope that this is the case, I am somehow doubtful as I have never had a vial go bad on me before.

Are you using the same basals for Fiasp as you used for your previous short-acting insulin? Did the change in insulin roughly coincide with the nutso BG’s and ketones? Many users of Fiasp (such as myself for a brief period) find they need to significantly alter their basal rates, if not times.

I didn’t have any supper and tested my rates. I figured for sure there would be a rise. I started out at 5.3mmol at 4pm and stayed pretty steady, even going below t arget. I corrected with glucose tabs. I was desperate to know what it was doing during the 5-7pm hours. I now think it was my insulin vial.

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We have thought that in the past. I have recently reconsidered and think our opened insulin vial is most likely always good and that the more probable scenario is the pump infusion site.

An easy way to test that out is to give yourself a syringe injection from the same opened vial you had been using for your pump.

The last couple times, we had followed suggestion from @Eric2 and withdrawn the insulin from the pump itself for a manual syringe injection. (Which BTW was totally effective.)

Yes , I did do that. I was 18.4mmol at 7pm (which is very untypical for my bloodsugar).and took a 1.10unit shot from the same vial I filled my syringe with. I put my bloodsugar into the pump and it tells me how much to give in a syringe. Two hours later I was still 10.6. At 2am I was 11.4 even after overriding IOB. I even did a tempbasal of .150/hr. Normally I am at .125 as I get sensitive past the 9pm hour I figured it would have been on target especially after the shot. The insulin wasn’t acting like normal. For now on I’m going to leave my insulin vial refrigerated and just deal with air bubbles in my cartridge. It won’t hurt anything, just decrease the amount a little bit in the cartridge.

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Dee, I am sorry you are struggling with this. I don’t have answers but I do have a few thoughts. When blood sugar is high, it can drive up insulin resistance. I know that we’ve been taught about insulin sensitivity factor (ISF) or the amount of blood glucose decrease that one unit of insulin will drop us. I’ve found that ISF is not the same across my day and it’s definitely not the same across blood sugar levels, from low to very high.

It’s clear that your 1.1 unit correction for a 18.4 mmol/L (331 mg/dL) glucose was not nearly enough insulin for you. You must be very sensitive to insulin normally. I think you need to add more insulin in these very high glucose situations. I’ve adopted a practice of never adding correction insulin through my pump if my BG is over 16.7 mmol/L (300 mg/dL); I then use a syringe.

When was the last time you changed your ISF on the pump? I know people have a tendency to resist changing the various pump settings. Is there someone who can help you with this, like a CDE or someone at your doctor’s clinic?

I’ve never used Fiasp, but I’ve read several accounts of people who stopped using it when, after initial great performance, it lapsed into poor control. And I also read accounts of people who are doing very well with it over a longer time.

Good luck sorting this out. Don’t hesitate to reach out for some medical help locally. I’ve used Gary Scheiner’s (Think Like a Pancreas author) services with success. You can consult with him remotely using the phone, email, and Skype. Search for Integrated Diabetes Services and you will find him.

My post lunch bloodsugar was 6.0mmol today. I eat pretty well the same foods. The last 2 days after lunch I was running in between 10&11 mmol.

Well, my supper bloodsugars are back to normal, behaving the way that they were before and I’m feeling much better. I am positive that my insulin was bad. This caused me so much distress. The insulin stays in the refrigerator no matter what.