I am at a loss

I would appreciate any advice you could give me. Here is the scenario. I started running higher bg than normal when I didn’t feel well yesterday afternoon. I knew something was up. I am on MDI now. I’m give lots of shots. I ate a moderate dinner and bolused accordingly. During the night my Dexcom woke me up with higher than the set alarms. I had moderate ketones. Drink drink drink and a few crackers. I struggled all night with ketones and they finally went away at noon. I went to urgent care. The verdict was a rattling in my chest and ear infections. An antibiotic has been called in. No Covid, RSV, or flu and no fever. After getting rid of the ketones, now they are back at moderate again. Correction in IM. New pen. What do you guys think? Thank you ahead of time.

An infection will definitely raise BG. Use your sick day protocols until infection is resolved (lots more basal and most likely bolus) or BG starts responding normally. Warning BG may drop suddenly when you start to get better.


Thank you for responding

As T1’s, you (or I!) can have moderate ketones while sick without any real risk of DKA as long as we’re taking insulin.

Now it doesn’t feel good to have bg so high that you’re generating ketones. Some of us when sick causing high bg will very aggressively boost both basal and bolus insulin but our docs might discourage that because of risk of going hypo. Having a CGM goes a long way towards reducing the hypo risk from aggressive dose-boosting.


Thank you for answering. I hardly ever get sick and the ketones are scary. I have been aggressive with the insulin dosage. I’m depending on Dexcom to alarm me,

Did you confirm the higher overnight BGs with a finger stick? How did you measure ketones? Urine or blood? What does moderate ketones mean in numbers? How high was BG for how long?

Smart to take a correction dose of insulin with a new pen. If you’re not using a blood ketone meter, I would strongly suggest looking into a system. It’s a useful tool for safety. I use a Precision Xtra.

It’s possible that you had/have a relatively low-level infection. Congrats on being well-tuned into the various symptoms. I hope you feel better soon. I think that we insulin using diabetics can use our BG monitors as an early warning illness detector!

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Thank you Terry. I have been using urine testing for ketones. I have a blood one do I need to use it. I know one should have extra good and insulin Do you have any guidelines for how much food? It seems like I am going in circles with every tiny morsel of food sends me to the moon. I did discover one thii I my that is helpful was to drink alkaline water with baking soda and water. I started feeling sick on Tuesday night o get rid of the ketones during the day and at night they come back. Thank you for your input

Urgent care on Wednesday with ear infections and a rattling in my lungs. On antibiotic.

I like the blood ketone systems because of its better accuracy and that it detects ketones earlier than urine and the ketones are cleared in the blood sooner. I like that the blood ketone meter gives a specific number instead of a descriptor like negative, low or high.

If small amounts of food are sending your BGs high, it could be explained by not enough insulin being delivered or absorbed or large insulin resistance caused by infection. At this point, a good doctor could be needed.

I just had an issue with new Tresiba pens. As soon as I started a new box of Tresiba pens. The insulin I injected didn’t do anything even after a full day. Took my shot the next day and I kept a close eye on my Libra 2. My sugar didn’t go down after 3 hours even though I didn’t eat anything. I learnt Tresiba goes dead when frozen I never let it freeze as I have done for 2 years. I demanded the pharmacist give me another box with a different batch number. I injected my blood sugar started going down within an hour.
Remember we don’t have control over our insulin before we get it. So I believe it was frozen in transit at some point
I know some other human based insulins can be froze and be pretty good but not Tresiba.

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@Robmcl – Good catch. Bad insulin is seldom the cause of high blood glucose. But it does happen. Since it is winter now in the northern hemisphere it definitely increases the chances of insulin freezing. I don’t know of any insulin formulation that doesn’t suffer if frozen.

I once froze about 20 vials of insulin in a live-aboard boat refrigerator due to inadvertent bumping of the thermostat wheel. It’s made me more aware of the freezing risk with my supply. I never trust hotel refrigerators when I travel.

Congrats on the clear-eyed troubleshooting as well as negotiating replacement insulin with the pharmacist.

I was sceptical at first but when I increased my dose 4 times in 8 hours and still no change. I knew it wasn’t me.
There is no way to know unless you do what I did. Pharmacist got mad but who cares it is my life.

Wow. Terrible spelling in one of my posts. I guess my fingers are sick too. The good news is that the ketones are gone I think. I actually slept last night for the first time since Tuesday. Terry, thank you for the advice on the blood ketone meter. You are always helpful to me. Thank you all who have responded. This forum truly is helpful when we are going through the diabetic battle to know that others are there to help.

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Thank you for the heads up. I use tresiba too

I had same thing with COVID. Along with persistantly high BG’s. All of that makes sense with having an infection. It will pass, just manage as best you can in the meantime (as you are clearly doing). And, as someone else already pointed out, be very cautious about going low w/ the extra doses, b/c when your body does start recovering, your insulin needs will go back down. It’s extra work being sick with T1D, cuz you have to do even more monitoring and management, often. But yeah, just saying, from experience, what you’re going through makes sense (for better or worse). :slight_smile: Hang in there.

Try a new bottle of insulin. And use a different injection site.

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Don’t worry about a few miss spelled words. Sometimes it is the auto correct changing spelling and we don’t always read it again to make sure. Lol

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