Having a rough night

Like the title says, having a hard time with things tonight. I have several goals I am supposed to be trying my best to stick with in regards to insulin changes, and I feel I am failing miserably. When my motivation is high enough to try to work on this, my anxiety is too high to make a change and stick with it. Or when my anxiety is at a manageable level, my motivation or energy is just so low that I feel like I don't care where things are going, and then I look back over the logs and beat myself down even further for not having done a good enough job at working to control this. Physically I feel like crap, and I know better control will at least partially help that, and one would think that would be a driving force enough to make some positive change, but I'm finding it extremely difficult to make it more than a few days before I slip back to my old ways. As an example of where my numbers are running (cringes at thought of actually posting this):

2:50am 1:54pm 3:23pm 4:44pm 7:04pm 10:11pm
466 480 509 484 499 449

5:03am 1:16pm 5:42pm 7:18pm 11:51pm
444 506 462 430 394

1:37am 12:08pm 4:18pm 5:44pm 9:33pm
403 445 362 461 434

So yea, that's what I'm up against. My therapist wants me to get a second opinion from another endo regarding how high I could keep my numbers and still avoid any problems due to my extreme anxiety around lower blood sugars. I've been hesitant to follow up on this, because 1) I'm pretty sure I already know what the answer will be, and 2) it is very difficult to get an appt any less than several months out in this area. Any thoughts there?
Ryan (this probably tallies up as another ticked off rant post)

I figured I’d reply since its the middle of the night… Not as many people up.
Here’s my strategy- start with one single meal- I like to pick lunch myself but whatever one you feel most comfortable and work on that time period only each day.
So for example, i do everything the same old way but experiment with more insulin at lunch. I pick lunch because I’m generally awake all afternoon and able to check my bg easier and catch lows before they are problematic. Once I accomplish my lunch time goal I hold onto just doing lunch until its my new normal and I am comfortable with it. Then I pick a different time.
I realize a lot of people will suggest basal changes, but if you are too scared of lows and too tired of trying all the time, I find doing it this way is better than not at all.
Hang in there, you can do this.

I feel for you RyRy.. You HAVE to feel bad with numbers that high....Anyway you can try to get some help from trained medical staff in a controlled environment while you are working on basal/bolus readjustment and emotional desensitization to lows?.. I rarely suggest hospitalization for this,but your numbers are alarmingly,dangerously high ;and you risk DKA if you continue to go many days in this state.Are you checking for ketones?
But these numbers may not show the complete picture..They are just 4 a day it seems; and I am assuming they are preprandials, and the early ams are fasting..Do you have insurance and an endo who would consult with your therapist? You really need to get those numbers into a safer range..even into the 200's..in a manner you are comfortable with.

Will keep you in my prayers.
God Bless,

I agree with both the previous two comments. I know how hard it is when a strong emotional component is added to the sheer volume of physical work and issues we have to deal with. But when you talk about "running a little high due to fear of lows" you are nowhere near that goal. Yes, you are dangerously high and I think you know that. I think that's why you posted here.

As Julianna said you need to pick out one thing at a time to work on. Whether you are more comfortable doing it on your own with the help of people here and a book like Using Insulin by John Walsh or want a diabetic educator to follow you closely, you need to start bringing your insulin use in line with your needs.

I'm glad to hear you are working with a therapist because you mention anxiety and perhaps some depression as well, which your therapist can give you tools to work on. But also don't hesitate to consult a mental health professional to be assessed for possible medication. People are often very hesitant to take meds, but if it can make your life easier, why not? And in this case it would help you both emotionally and physically if it allowed you to manage your diabetes better.

Finally you might want to check and see if there are any support groups in your area - check local hospital diabetes programs and the local branch of the jdrf. Many of us feel isolated and alone dealing with type 1 and if you could connect with others it would really help.

Ryan, when people are at a low point in their lives we often use the trite saying, "You have nowhere to go but up!" Looks like just the opposite is true for you, you have nowhere to go but down...blood sugar-wise. Even if a therapist or an endo can get you on the right track, you know it's ultimately up to you to make it work. I think Julianna's advice to start with a lunch goal is a really good one, you don't have the scary part that you might have at night. Everything you learn from experimenting with that will help you learn. You don't sound ticked off, by the way, you sound very concerned, but either emotion is valid when you're trying to get control of your life. You can do it.

Ketones have consistently been negative. There are days where I check more frequently and they show basically more of the same. You are correct that most of the results here are pre meal.

I have kicked around the idea of hospitalization, but have a few issues with that. At 16 I was placed in a behavioral hospital against my wishes, where everything was locked down and controlled. My sugars were forced down immediately without dealing with any of the anxiety problems until further into treatment, and I really don't desire to go through all of those feelings again. They had told me at check in that I would be able to test as often as needed, which I later found met as often as they deemed necessary, and not always when I was feeling off. So needless to say, I have some trust issues with the hospitalization idea. I was back under control while I was there, but quickly slipped back to where I am now, so I question whether or not it would work out. I do have insurance and an endo on board with all of this as well.

Not really sure how my replies got so out of order but anyway...Yes, I know how dangerously high my sugars are running, and that is part of what makes all of this that much more difficult for me. I am also working through the medication part of the anxiety/depression treatment. Was having trouble tolerating many SSRIs and SSNIs that I had been able to take in the past. Mainly upset stomach and couldn't sleep or sit still this time around with them. Shorter term meds were not doing enough for me. Just this week I started on Ativan and so far it seems to have been the best I have tried. As far as support groups go, I am usually quiet and to myself, so that could be a bit outside my comfort zone. I have found this site extremely helpful though.

Thanks all for your input. Had a somewhat confusing appointment with my therapist today. He constantly reminds me that I know way more about all of this than he does, and his face lights up whenever I pull out the latest round of printouts I brought in to try to help him understand better. As I mentioned, he has been suggesting I look for a second endo for an opinion on how high we could leave my numbers running. After going over a few other things and getting towards the end of the appointment, he said he wants me to try to find an endo that will let me just leave my sugars where they are since I am so uncomfortable in the normal range and on the basis that I have been running my sugars this high for this long now. I absolutely refuse to go that route. He then made a comment that he didn't think I can do this based on how long it has been a problem for me. Normally I am one to challenge and prove someone wrong when something is presented to me like that, but I am so sick of fighting with this, that his comment felt completely out of place and it was most unwelcome. He didn't present it like a challenge, just as a continuation of the conversation, nothing challenging in his voice or anything. I left his office today extremely confused and honestly, right now I don't even feel like going to next weeks appointment. I can't stand the thought of having to look for a new therapist all over again.

I was so incredibly confused when I left. I think the only reason I didn't question it was how shocked I was at the time. As far as today is going...

2:28pm-High (over 600)

2:29pm-High (over 600)

I had done some moderate exercise from 4-8pm the 15th working on my truck, so I attribute the slight drop to that. at 1:26am on the 16th I was due for another shot of Lantus, but I allowed anxiety to kick in and I skipped it and had 5 crackers (10g carb). So I can only blame myself for the high later. I also waited too long to do anything about it, I should have corrected for it when I got the 393, but I went back to bed instead. Multiple poor decisions.

Maybe someone else has asked this, but can you get a CGM or Dexcom insurance-wise? You'd have a way to see what your BG is doing any time you want which might be reassuring? Maybe if you knew the remote would warn you before your BG tanks, you'd be less afraid to ride in the 100-200 mg/dl zone? I sure do understand fear of hypo's. I floated high a lot of my diabetic life too (44 years this fall) for similar reasons. Also MDI couldn't track my odd patterns. A pump changed all that for me.

As to lowering your averages too quickly, it can be a problem in that there's statistical data showing an increase in retinopathy for people suddenly getting into tight control from way high. An Endo might approve of very slow moves towards lower A1C? Not sure. I only see a GP.

I am so sorry you have so much struggle beyond the already rough stuff of diabetes. Hang in there. We're pulling for you.

My worry with trying a CGM is that in the past, along with the anxiety I was OCD, and testing my sugars up to 40 times a day. While I wouldn't be sticking so much as just looking at the display, I fear the CGM might be too much information for me and might push me down the road to OCD again. My NP at the endo's office agreed with me on that note.

My endo is ok with lowering my sugars slowly, and seems aware of the issues, both physical and emotional, with bringing my numbers down too fast.

Currently on 4 units of Lantus in the am and 4 in the pm. Its a pretty low dose compared to what I had been taking before. but I had kept doing less and less as the anxiety problem got worse. The goal right now was for me to be able to get comfortable with 4 and 4 then up the pm dose to 5.

So far the Ativan seems to be working the best out of what I have tried, and I need to push myself to work on my numbers when the Ativan is peaked. I am taking 1mg 2 times a day but the Dr told me if I need to I can step it up to 1mg 3 times a day. I do have hypothyroidism as well, and my numbers were way off. Made adjustments, and I am due to get that rechecked in another week or so. Like you said, I've got a lot going on and everything acts on everything else. To add to my anxiety, I'll be starting back to work this week. It is a job I've been at before, but still enough to throw another wrench in the works.

I have been drinking a ton of water, high sugars and being thirsty all the time is just more of the fun of this. I haven't read the book, but it is on my list of what I need to order. I have heard a lot of good things about it, and as a funny side note, Gary was actually my pump trainer when I first went on the pump about 10 years ago. Very good guy and I have great respect for his knowledge.

So I did it again. Was moderately active finishing up the brakes on my truck Saturday. Let anxiety get the best of me and sabotaged progress again, spiking high this morning.


2:02am-273-ate 10g carb to try to counter anxiety, shorted lantus
1:34pm-565-this is when I finally woke up for the day and took humalog and lantus

Having worked nights in the past, you can see by the notes I added that my sleep is never right either.

Wish I had answers because know you're in pain. I'd be jumping out of my skin & extremely irritable at those numbers. Yes, lowering gradually is the way to go, of course.

At what BG do you become anxious regarding a low? Part of the problem, which you know, is that getting into a more acceptable range will take a bit of getting used to. But, the good news is that we acclimate quickly. You can't remain at those dangerously high readings.

If taking increased insulin doses is anxiety provoking, would eating less be doable?

I am usually ok down to about 300, but if I watch it dropping I can make an anxious mess out of just about anything up to 400. And yes, I do feel terrible at these levels. Even the improvement I feel when I can hit the low to mid 300s feels so great. I know I need to get there, its just such a struggle doing so.

Hadn't really thought about reducing carb intake as opposed to increasing insulin. I think in my mind I will still fight with it knowing that the effect will be the same, but I am more than willing to give anything a shot.

Sorry for how badly you feel. I get pounding headaces from highs & feel like every nerve is exposed regarding being extremely irritable. Hate that feeling.

Hope reducing carbs helps & glad you'll give it a shot. You can do that.