Help I don’t know what’s going on

So I’m 27 Iv been diabetic for 20 years and ever since March Iv been using a cgm. Iv noticed things that make absolutely no sense about my blood sugars. Iv noticed lows after eating then strange spikes hours later. Iv read about Gastroparesis and think it maybe this. I don’t understand some things tho. Like I’ll eat and cover what I think I should take and sometimes I get way higher then I think I should and it takes hours to come down. I use at night and humalog I just got the pump and haven’t been trained on it yet. I am so nervous to go to the gi doctor because of all this COVID-19 and my numbers being so out of whack. I just have no idea what todo and my endo is kinda helpful but not that much. I’m home from work till the end of the month and I’d hope to get things kinda figuared out before then.

I know it’s tough when you get a cgm you see how all the weird trends and ups and downs you never knew existed.
I doubt you have gastroparesis Unless you also have the other symptoms of feeling bloated after you eat or fullness that doesn’t go away.
I have problems with certain folds like pizza and Chinese food where my sugars just never come down for hours and hours. Your cgm will help you figure out if certain foods are causing you trouble or where you need to use ore insulin. Also waking up in the morning cans cause spikes in sugar. Menstrual cycles and exercise. When I run my sugar actually increases and then drops out.
So if you are having all the symptoms you should see your doctor there are some meds that can help.
Otherwise just tighten your control with help from your cgm. That will help with gastroparesis too If you have it, but it will take a while for the nerves to repair.
I’m 33 years in and I’ve never had it, luckily.

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I should clarify I have had the cgm for a few years. Haven’t worn it in some time. Since covid started I started using it more to tighten up control. I have been trying to figure out for 4 months now what is going on. The same meal one day will have me drop low after eating and not raise for hours then the next day it’ll have me go up to 300 for hours and not come down until another correction. I also have become full early on the past. Although it’s strange that isn’t happening right now. My bowel movements are very small and almost hard to pass as well. Not that anyone wants to hear about this. Iv just wondering if others have experienced the same type of things with Gastroparesis. It almost seems like the meal I have prior to the meal I’m eating plays a big part in what my blood sugar will do.

This was likely also happening before you had cgm, unless you did lots of bg checks after meals. Typically we do before meal check to help determine insulin dose, but rarely check after. I agree with @Timothy, not likely gastroparesis, but do check with dr if concerned.

I started cgm many years ago, and was surprised at what bg was after meals, during sleep, excerise, etc. Even stress and anxiety can impact bgs. With pump you will have ability to fine tune your food, insulin, etc, and depending on pump, it may do some adjusting for you.

Take your time, learn and ask questions.

There are a few good books,

Pumping Insulin by John Walsh,
Think like a pancreas by Gary Scheiner,
Sugar Surfing by Stephen Ponder (more about using cgm data to make decisions).

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Could be gasteoparesis, but its most likely not. Everybody goes through this when they try to tighten up control. If you had really poor control for a decade, then gasteo will be more likely. We (and you) need very detailed records to tell if there is anything odd going on. This will take a month (at least) to sort out, if your records are top notch.

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Different types of food digest differently. For example, if I eat a big steak my blood sugar will go down, I will eat something to big my blood sugar up. When the carbs kick in from the steak meal then my blood sugar will go up quite a bit due to the carbs in that type of meal and the food I ate to bring my blood sugar up will also kick in causing high blood sugar.

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I agree with the other responders. I also was shocked at my numbers when I started on a CGM. It takes time and diligence to understand what causes your body’s reaction to all of the variables that effect blood glucose, but with good notes, and especially use of the new technologies (graphs from CGM and Pumps), you will be able to make changes for the better. It is a hard disease to control for sure. This is not to say you don’t have gasteoparesis, and you should seek a Dr’s diagnosis if you continue to have issues.

I also second the recommendation by @MM1 on these books. I’ve read both and frequently referenced them as I tried to understand my body.

Lastly, I searched TuD and other online resources to better understand how to control the lows and spikes. I was like you, I’d have a low shortly after eating and then would spike hours later. I learned here at TuD that fat and protein effect blood sugar, too, but just much slower, hence the spikes hours later. I also learned about pre-bolusing to head off a post meal spike. When I couldn’t find an answer, I posted specific questions here at TuD and other resources, with charts of my BGs and carbs to ask for help. I learned so much from the other T1Ds who so selflessly gave their expertise, experience and time, and I think you will, too. I only mention this as I see you are new here to TuD, and wish to welcome and encourage you to participate in this community!!

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Thank you so much. I’m very nervous and I have been extremely stressed from this covid thing and I lost weight and I’m just all over the place. Yesterday was my first day out and it was a new gi doctor. Waiting for a call from them to schedule a gastric emptying test. But I also ordered one of those books surfing sugar. Hopefully I can make it through this whole covid thing and learn more about my diabetes and control as I navigate through. I just feel so hopeless getting through this with not so well controlled sugars and underweight. I’ll most likely have to be back to work at the end of the month and then it’s much more likely of being exposed but I’m trying to stay hopeful. Thanks again I’m going to keep trying.

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There’s no way that you can work remote? Did you ask if they could move you to a different position temporarily?

One day at a time. Don’t worry about fixing it all and it being perfect right away. For one it will never be perfect.

So my standard response because timing and proper dosing is usually what the problem is…

How high you go up after a meal is a matter of timing. And that timing is a matter of learning how you respond to different foods. High fats delay absorption so some or most of your carbs. BG can spike later, how much later kind of depends on how you personally react. And you have to read labels if buying prepackaged food as there are higher carbs in things than you expect sometimes.

So a potato for me is simple, I dose half my bolus as a prebolus a half hour before I eat. If I put margarine all over I will split that dose into thirds. A third before, a third when I eat and a third a half hour after I eat and if I am having a bad day, maybe I didn’t sleep well the night before, maybe a correction dose later on. And that can vary person to person.

So you have to learn what effects you, I suggest a food diary with what you eat, just in case you are eating something slightly different and make a note of the day. High stress day, lack of sleep the night before. It’s a pain but when things are way off sometimes it will help you see the trends that are going on.

Non standard response…

Can it be gastroparesis, sure it could be. But it’s not just gastroparesis that can cause an issue. There are other IBS or IBD problems. Not to compare you to my dog, but my dog has digestion issues and she’s diabetic. She had the digestion issues before the diabetes. She has very slow stomach emptying, but hers they have diagnosed as being caused by the inability to digest proteins well and food allergies. She was put on steroids initially. The dose was lowered over time but she has to stay on it. Her stomach issues cause huge irregularities in blood sugars and very slow digestion of her foods. Carbs take 2-3 hours to hit, even very simple sugars seem to take longer, we rub it on her gums when we want a faster reaction. They had to scope my dog and run several tests to know what was going on. It is considered well controlled stomach wise, but plays heck with her blood sugars.

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Did the night shots work better for you than the pump? One thing I do sometimes when things are out of whack is give myself my standard night shot of 14 units of Lantus and then set my basal to 0.1 per hour.

It at least insures that I have some insulin in me. A lot of the times that I am totally all over the place, the insertion set isn’t proper or for some reason my body just isn’t responding to the pump in a moment.

These things you’re going through totally suck and we’ve all been there, I’m sorry to hear it’s so stressful. Good luck and know that it will get better soon.

I just got the pump haven’t started using it yet

Unfortunately no I’m a linemen and can’t work from home. With these out of control blood sugars I may not be able to work at all

Its that bad, huh? Can you post the data for everybody to put eyes on ?
It will be faster if we just walk you through the process. we want detailed, complete data in order to set you up to be successful.

I’m not sure how to post the data? Like take pictures of my cgm graph? I’m open to anything really at this point. My problem is one day I’ll take a certain amount to cover a tunafish sandwich for lunch and I’ll get low after eating have to have some juice then never see a blood sugar spike Until I eat dinner (dinner was carb less) then the next day I’ll do the same thing and I’ll be high for 3 or 4 hours after eating the same sandwich. Like it makes absolutely no sense to me I don’t know how to recreate the situation or what but the only explanation I have is that some foods digest and some don’t and sometimes foods stay in my stomach until I eat the next meal weather it be dinner after lunch or breakfast the next day.

I dunno if anybody ever walked you through this, so forgive me if I’m telling you something that you already know…

You always test your basals (long term insulin) before you test your bolus (short term meal insulin) dosages. Otherwise, nothing will ever makes sense.

Now, because I think you are still on manual injection, not a pump, your basals are gonna be a little more erratic than if you had a pump tuned up to do this well. So, this might take a little team work from the forum.

I assume that you are taking one shot of long term insulin per day and various bolus shots of short term for correction and meals.

We need a spread sheet showing every time you take insulin or eat and your corresponding sugar level.

But, what we will mainly be looking for upfront, in order to test your long term insulin dosages, is periods of time where you have no food or insulin on board - ONLY the basal insulin running in the background.

Those periods of time will exist anytime you have:

  1. Not eaten & taken insulin in 2 hours. AND,
  2. Not taken any correction insulin within 4 hours.

Needless to say, this data is a little tough to come by. But, that’s how it works. Its a pain.

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The best place to test your basal will always be to take a sugar before bed and a sugar in the morning because you have not eaten or taken any insulin while you where sleeping. That’s a good starting point.

But, after than, it will also be nice to see a period of a few hours during the day where you have no insulin in your system and no food. If your blood sugar doesn’t change, then your basal dose is correct.

After that, you can test the short term dosages like this:

Let me show you an example.

Here, you can see that I am taking so much insulin all day long, there is no opportunity to see how my long term dosages are doing, but lets assume that I already decided that those were correct and started to test the short term (bolus) dosages.

A 8am, I take some correction insulin. I need a bloodsugar right before I take it, and 4 hours afterwards (with no other stuff going on in between in that 4 hour period). If the blood sugar is the same, then my correction dose is correct.

Now, in this picture, I mess up this test. This is not a good test because I also take bolus insulin and eat food (because I get low BG) around 10:30am.

I would have had to make it from 8am until 12:00 with no food or insulin events in between in order for this to be a good test.

I kinda get why your saying. I haven’t been walked through it before. You are correct I take one shot of long acting insulin a day. I have just recently lowered it because I kept going low through the night. Although I don’t think that the long acting is the problem I could be completely wrong. I’m willing to try anything. I could not eat breakfast tomorrow and try and do this.

Give it a try. Bring us your before bed BG, morning BG, and anything you eat in that time period of testing. Eating or taking insulin breaks the test.

Your basals are going to be a little erratic because your not on a pump. We just get them as good as they can be. That will help if you start on a pump because you will have a rough point to jump off from.

Okay