I sort of know the variables to consider when you have a stubborn high, but I know you guys often see something I've neglected when I ask a question on here.
I've been running high all morning and since I was due for a set change I figured that was it. I was rushing around doing some stressful things though nothing particularly physical. I went to a potluck lunch which is never easy. I never overeat but all the items were highercarb than I'm used to. I bolused for 30 carbs which was probably way low. We ate around 2:30 and around 4PM I tested at 293 - yikes! I corrected and when I got home at 5:00 I tested again: 334! Double yikes! At this point I wasted the 3.25 correction to have it in my IOB and took a shot. I then changed my set again on general principal. I tested at 6:00 and was 414. At 6:45 just now I was 425. Huh? Oh, and when I "wasted" the dose I could see the insulin come out fine. I have no illness (am rarely sick). I am now going to correct again. 7.60 which is a huge amount for me! I'm thinking better to do a shot. (Just did it).
I know it takes more to get numbers down when you get in the stratosphere but it scares me I keep going up! this is as high as I've ever been! The insulin is the end of a vial I've used for three weeks. It visually looks fine. I'm battling with Medicare and Calpers about my coverage and am stalling so I don't have to lay out money but will do so tomorrow if this doesn't improve. I'm scared I will all of a sudden start dropping which has happened to me before - just in time for bed!
This doesn't account for the morning, but as far as the rest of the day…. Maybe it was the fat level in addition to the carbs - people seem to bring their most decadent items to potlucks. For me, a high amount of fat can throw off my numbers for about a day even when the carb estimate should be close. For tonight - maybe it might be worth setting the alarm clock for the middle of the night just to make sure all the insulin doesn't hit you at once. Hope tomorrow is better for you.
Thanks, roodgirl. I just took my blood sugar again and it was 313, down from 425. Never thought I'd be glad to see a number in the 300s! Thank god it's coming down. The hill to town is icy which scares me and the thought of going to the ER was worse than the thought of DKA! LOL. Actually the food wasn't really high fat, it was pretty delicious, especially for a vegetarian: tabuleh, crunchy bread with a spinach and other vegies spread, a tad of squash and my own contributions a delicious artichoke dip and spicy nuts which I just had for dinner as it's no carb.
Yeah, you're right, I worry about all the insulin I've taken taking me down later. But it's only 8:00 so I have awhile to watch. I can't believe that amount of food - a plate that wasn't greatly filled - would do that to my blood sugar. I hate being that carb sensitive!
I often find I go up after a site change (although less so with metal sets), and if I've recently done a correction some of the corrective insulin can leak out. Is it possible the combination of correction and set change combined to make you super high?
I also find carbs from things like potlucks can last for hours ... and insulin (at least for me) is pretty slow to kick in, even with Apidra. (I have my DIA set to 4 hours.) So I wouldn't be too surprised that you're still high. And your right, the big drops always come just in time for bed!
Probably a good idea to do a shot, as you did. I'd personally also check ketones to see if there might be something up with the site or pump.
Thanks, Jen. I don't usually go high after a set change; if there ends up being something obstructing I often come down. I did notice some insulin leaked onto the pad when I did the second change. After the 100+ point drop in the first hour I only came down another 10 points in the last hour. But down is good. I don't have ketone strips; I can't afford to buy something that I use so rarely and that expires. As long as I'm coming down (and feeling ok, just tired) I don't really worry about it. I don't quite understand how ketones would show if there was something wrong with the site or pump. I'm just thinking, "down, down, down!"
will it work to put your pump on temp basal ...say 165 percent ?? ketones may not show , if you don't have evidence of illness ?? ...sadly keep on poking :( Zoe
I often find that when I'm high (200+), I'll take a correction and the numbers don't move during the first hour or two and it's only after the second correction that things start coming down.
I'd guess you're now (around 9PM) under 200 with about 2 units still on board. You might actually go to bed with a reasonable number and little or no insulin on board. I hope so anyway.
I doubt that the food was the entire problem. When I have sticky highs they've often been related to mechanical (bad site, bad cartridge) sorts of problems.
For me, if I'm getting little to no insulin from the pump (i.e., some sort of absorption problem, disconnected for too long, etc.), I start showing ketones after a couple hours. If I'm just high from miscalculating carbohydrates, I don' show any ketones. If I have ketones I tend to change a site right away, even if it's a new one; if I don't have ketones, I'll leave it and correct, even if it takes a few hours to come down. Maybe this is different for people with adult-onset/LADA?
I buy the ketone blood strips, which don't expire nearly as fast as the urine strips, but I hear they are extraordinarily expensive in the U.S. compared to here. I've heard you can get foil-wrapped urine strips so that you don't have to toss all 100 strips three months after opening them, which is what I'd get personally if I used that type.
Hi Zoe, I'm glad you have started coming down, hopefully you won't need another bolus? Maybe you will just keep coming down and you can go to sleep without worrying about crashing?
I spiked today too to 249, which is very high for me and I'm not even sure why. I only ate my regular brunch around 15g maybe and bolused 4.5 units. Then it took lots of water, a 2 mile walk, a 2 unit correction and shopping to get me slowly back to normal. But I would rather get there slowly, I think it's better for us than too fast. At your numbers yes I would be thinking dka. I wasn't feeling well and I was stressed so that could have been a factor too, or maybe an insulin malfunction too. I did drop hypo a bit when I was out but I ate 3 sweet tarts and was 82 when I tested and up to 90 before dinner.
The scary thing was I didn't even really feel I was that high for some reason, but when I tested I did feel some of the usual symptoms but had ignored them maybe.
Thanks, everyone; I just tested again and I'm down to 230. That was actually nearly a record for me - 425 - I don't remember for sure but I think 426 is my record back when I was overdue to start insulin!
It's 10PM here now and I only have .25 IOB but I'm not going to do another bolus - not yet anyway. I do have that pattern, Maury, of coming down only after the second bolus and often go right past the mark. But this timing may be perfect. I'll go to bed a bit high rather than take more insulin. Those two boluses were over 10 units which is an outrageous amount for me. I think you're right that it was more than the food that got me that high. I didn't eat THAT many carbs! I think I didn't get any insulin for some reason, so that and the carbs took me to the stratosphere!
Now since I've corrected with shots I have to hope that tomorrow all is well with my pump action!
Nel, with a two hour delay, I don't usually find temporary basil rates too useful for problems with immediacy, like extreme lows or highs. Meee - the only real symptoms I get even from super highs is fatigue, that's all!
Thanks everyone, it helps just to "talk" to you guys when I get a bit overwhelmed!
I'll correct and crank up my basal. It seems to help with the absorption and, when it rolls over and starts dropping, I can "untake" the high bolus. I haven't hit the 400s in a pretty long time and would probably revert to an IV shot if I did, just to get rid of it faster. I am very impatient with highs.
I had this problem for many days last fall. Nothing was working--and I was on vacation (of course) and had limited supplies for change out.
You know what finally did it--Temp Basal. I set the thing for 1 unit per hour (normal basals are from .3 to .6 per hour) and let it ride. It took most of a day, but the stubborn high finally went down.
My normal pattern is a syringe if it is over 150. It let that ride for four hours. If it has not gone down, infusion set change, another shot and a temp basal for a while.
I have to stop my twinning behavior. Went to bed last night at 72 with a 5 carb yogurt snack and woke up around 5AM at 200. Corrected and bumped my basal up 30% and 3 hours later was still 200. I've changed my site (it was due for a change anyway) and corrected again. We'll see how it goes.
Glad you've started back down and I hope today is a better day.
Yep, twins should share good qualities, not bad! Hope yours starts coming down soon too. Sorry you too, Andrea have been having similar problems. How high has yours been and what have you done? Is it starting to come down?
Well I went to bed last night at 156 without correcting as I would normally do. I woke up this morning at 155 and of course corrected. I'm going with some set/absorption problem that in combination with the higher carb foods meant I was not getting much if any insulin which jacked me up to those outlandish numbers. Thanks again all!
I'd guess what happened is that you first site was getting "stale" and was not absorbing well. Your second site leaked as you observed. I'm thinking that the combination of these two events led to your very high BG.
You were smart to take your correction doses via a syringe. I always use a syringe to correct when I'm over 300. Another thing I'll do is a second fingerstick and use the average of the two to calculate my high BG correction. I've found some fairly large variations in meter BGs when 300+.
So, if I understand you, when you took a shot to correct and wanted your pump to track the number, you just disconnected and did an "air shot." Clever. I've not done that but it seems useful. When I'm high my brain gets foggy and my arithmetic skills degrade.
Thanks, Terry. Yes, I can't remember where I learned that, but it definitely helps keep the IOB straight when you're in perilous waters with multiple corrections. I also just realized when I did it last night that it's also an opportunity to see if the set is dispensing insulin; the more data you have during a problem, the better! I think you are right about your reading of my issue and the higher carb food just added to it.
Just a postscript on what caused all this. This morning after waking up at 155 I corrected, bolused and ate breakfast (8 carbs) and now two hours after breakfast I'm back up to 190. Awhile back I wrote about how after using my steel sets for several weeks in my stomach (rotating spots of course) they seemed to stop working and I had persistent highs that went away completely when I switched to my arm. After using my arm for awhile I went back to my stomach a few weeks ago (unsure exactly how long). It dawned on me that the same thing may be happening again and that I may only be able to use my stomach for just so long with steel sets. So I'm going to switch body part and see if that is in fact the case.
Meanwhile I'm fighting with medicare and am within two days of being out of strips and a few more days to be out of insulin. Incredible how anxiety producing that is! Fortunately I have CalPers to advocate with Medicare. I am very fortunate insurance wise. And so it goes.
I know you are worried about being low on insulin, but it seems the only variable you haven't altered is the insulin vial. If shots aren't bringing you down you should try a new vial. After several episodes of dropping & smashing a vial I never go without at least 1 spare unopened vial in the fridge.
I should have been clearer ?? "will it work to put your pump on temp basal ...say 165 percent ?? ketones may not show , if you don't have evidence of illness ?? ...sadly keep on poking :( Zoe " ...I correct by needle if over approx 11 or higher ( x 18 = close to 200 ) and by disconnecting from my pump and let the correction flow out of tubing , so I have a record of insulin on board ...Then I add a temp basal of 165 percent ( approx ) and find the HI come down faster ...we are all an experiment of one as heard from a Doc living with diabetes for over 53 yrs !
