Frustrating sugar level patterns

My sugar levels has been a bit sporadic recently. It’s been hard to control and it may be to do with my thyroids playing up.

I’m not sure whether it’s my basal or bolus I need to retune. I wake up with a pre meal reading of 7mmol (about 105mg), my two hour after eating reading is 16.9 mmol (304mg) but by lunch time (another 2 hours) I’ve dropped back down again.

I tried increasing my bolus one day but I ended in a hypo state by lunch time. Im not sure how I can control the spike? What should my sugars be two hours after eating?

I have another issue at night. I’ve ascertained my basal is correct throughout the night as I did a basal test and it was steady. Recently I’ve been getting high sugars before bed 13mmol (234mg) so I do an adjustment bolus. It comes down in the four hour window, but it continues to go down pass the sixth hour where the bolus should have worn off and the basal kicks in. And then I end up with a hypo state. I don’t know what’s going on.

Tedos, see my discussion of possible hormone issues. I am 65 and things have changed a LOT so that my old patterns of GCM and Lantus + Humalog by syringe are not covering my BG well. My Endo suggested testing hormone amounts by a morning blood test which I will do next week. I also increased my morning dose of Lantus and reduced my evening dose which helped some.

My suggestions for the spikes. try pre blousing. start by lengthening the
the time between the time u take the insulin and the time you start eating. This
gives the insulin a head start to meet and be ready for the rise in due to eating
Since you are at 105 in am start slowly. Some wait until a certain number others wait until the number starts to go down. The length of time is individual. I do anywhere from 5 min to 40min, Watch ur cgm or test, I have done both at times. Like I said it is individual. Talk with your endo to see what times are best for u to start with. I had this problem and I tried increasing bolus and I went low like u . Prebolusing worked for me.

Thanks. My endo has already given me a blood test for a series of hormones due in 3 weeks time before I see her again because my thyroids has been playing up - TSH was undetectable and sodium was low. This was prescribed to me before this sugar sporadic-ness started to happen. I’m 39 at the moment.

How does cortisone levels impact to sugar levels out of curiousity?

I also thought of doing that but I’m taking apidra which is a rapid acting insulin. I’m not on cgm as the sensor doesn’t work for me on the Medtronic pump - unreliable results all the time.

Tedos, sound like hormone issues. I have never had any of these issues until recently. Many hormones, in addition to adrenaline, affect glucose levels. Cortisol apparently raises adrenaline which may cause release of glucagon which raises blood sugars. Not too clear on this but here is a good article. https://dtc.ucsf.edu/types-of-diabetes/type2/understanding-type-2-diabetes/how-the-body-processes-sugar/blood-sugar-other-hormones/

Are you able to access a Freestyle Libre or CGM? It will give you a much better picture of what is going on. There are a million variables that affect blood sugar, including hormones, stress, quality of sleep, insulin absorption, etc. It really is different every time you inject, and the only way to really conquer spikes is to adjust in real time using a CGM, rather than rely on dosing and checking 2 hours later. There are times I may only need 3 units for breakfast and other times I need 6-7 units for the same breakfast. With a CGM I just take more insulin if I see a quicker rise than I would expect to stop the spike before it gets out of control. If it’s too much insulin, just correct with fast-acting carbs.

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Big question, what did you have for breakfast?

Its so frustrating that there are so many variables :frowning: It could be one thing and also could be multiple.

Nothing out of the ordinary. A slice and a half of toast with margarine with a light spread of honey and half a cup of milk. This is usual for me and I’ve put more honey before and that doesn’t send my sugars up the roof.

Try adding some protein to ur breakfast…

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@tedos Learning to time a prebolus will help stop that mealtime spike. You have to experiment with what works. If you aren’t prebolusing at all now start with a small portion of your bolus taken say 10-15 minutes before your regular bolus. You can start with little amounts and see how you do. I used to prebolus all the time before my CGM. But just do a small portion of your bolus as a prebolus until you figure out what works.

If you are returning to “normal” you shouldn’t increase your dose as it’s a timing issue.

And possibly you need to adjust your night mealtime carb/insulin ratio so you aren’t taking a correction before bed.

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You mean in addition to the carbs im getting or replacing the carbs?

Will try this. I was told with apidra I should take it just before my meal or 5 mins before which has been what I’ve been doing for the past 20 years.

These sudden changes in my blood sugar does lead me to believe it is to do with hormones like @RLS1 pointed out. It will be interesting to see what my suite of hormone blood test shows particularly with my cortisol levels as it has been a stressful period for the past 10 months and then the Covid situation did create some angst along side a few other things has been lingering on my mind. Perhaps the toll of that is starting to surface. :frowning:

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in addition to the carbs.

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Okay. What’s the reasoning for protein, does it make it more stable with the carbs ?

I was told to do this at a diabetes education class. It may have something to do with slowing absorption of carbs to minimize spikes.

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My night time patterns are a bit of a worry. Every night I’ve hypoed in the middle of the night in the last 7 days. My bedtime sugars (around 10pm - 11pm )are above target and the wizard recommends adjustment but I don’t adjust. Between midnight and 2:30am my sugar does a sudden drop, I have no idea why. No intense exercise in morning. I’ve already reduced the basal by 0.125 before between 10pm and 2:30am and it’s still dropping. What’s going on?!?:confounded: