Hello all! I wasn't sure what category this should go in, so I thought I'd put it on the general T1 page.
Lately my BG's have been literally skyrocketing as soon as I eat. It doesn't seem to matter when I bolus, they will still jump 150ish points. Obviously this is not ideal. But what could be causing this?!?
I am not eating anything out of the ordinary. My meal for lunch just now was 25g carbs and my I:C is 1:2 right now (just changed it from 1:3, thinking it would help, but it doesn't seem to be doing anything). My BG was 139 before lunch and jumped to 300 {per my Dexcom} a few minutes after I started eating.
I've just been really frustrated overall with all of this lately. Too much to go into right here, but does anyone have any other suggestions??
Can't help on what's going on, but something's changed. Have you gained weight recently? More than 1-2 lbs, like 5-10+?
That can increase insulin resistance, and carb sensitivity (a double-whammy).
I'd advise consulting your endo, and if nothing looks amiss, talk about the possibility of adding metformin to your treatment regimen. Although it generally isn't used by T1's, it is sometimes to help with large BG excursions when the liver is just being funky and pouring glucose into the bloodstream for God-knows-what-reason.
If you're getting this high of readings for sure with a finger stick confirmation? Time to call your doctor, and have a talk about what to do here. Maybe you need to try a different fast acting insulin? (this might be way off base but I've heard of people having this kinda issue , even DiabeticDanica did with Apidra and had to switch to Novolog) Maybe you need to try metformin ?
According to Bernstein each gram of carbs will raise your blood sugar 5-10 mg/dl. Thus 25 g of carbs would raise your blood sugar 125 - 250 mg/dl. Without a bolus it would not be surprising to find your blood sugar over 300 mg/dl. Is it possible that your meal bolus is mistimed? Do you wait until you eat or after you eat to bolus? Some of us find that advancing the bolus to 15-30 minutes before eating really helps.
This!
Last week, I was on antibiotics and had to reduce my basal by 25% to keep from crashing. I completed the meds on Friday. This weekend, my numbers were sky high - I had to increase basal by 200% to compensate! And if I was a betting man, I'd wager that I'll need to reduce some tonight. Another day or two and I'll be back to where I started. Or not.
ETA: I spoke too soon. Pump just gave me a low alarm and as I was checking BG, it went into Threshold Suspend!
My first thought was that your basal insulin may be deficient. Too little basal will result in big BG rises after eating. But then I checked your profile and noticed that you use the Omnipod patch pump.
I used an Omnipod for five months back in 2012. I've been a pumper for decades. I stopped using the 'pod due to excessive high BG excursions caused by bad site absorption and occlusions. Not everyone that uses pods has this experience but I've read many accounts about this online.
The nature of the Omnipod is that the cannula insertion angle and depth is fixed. I eventually fixed my problem by experimenting with various infusion sets that are compatible with my tubed pump.
If you've been using the pump for a while, your favorite sites may not absorb like they used to. Sites that resist absorption will also lead to post meal hyperglycemia.
I am simply speculating about your reported symptoms but it may help you to consider my poor experience with the Omnipod. I also realize that there are many happy well-controlled PWDs using the Omnipod system. I wasn't one of them.
I wish you luck in discovering what is going on so that you can take appropriate action to fix it. Sometimes doctors, CDEs, and pump manufacturers provide little, if any help to fix these kinds of things. It often falls on our shoulders since we have skin in the game.
I assume your numbers after eating have been in the region of 200 mg/dl. Now after your treatment with antibiotics they are higher than 250. The exact level is hard to determine because most meters get very inaccurate above 250.
To me this development is not surprising. As you might know we live in symbiosis with millions of gut bacteria. They have this relationship with us and with other gut bacteria too. In a well balanced system. They produce and transform our food for our benefit and for their mutual benefit. We pay these little fellows with carbs to fuel their activity. I can only guestimate that they consume 20% of the carbs we eat. Now with your antibiotics treatment you have successfully obliterated this well balanced system. It will take time for the bacteria to reclaim their ground. Even more time is necessary to establish the previous, very well balanced relationships. Until this has been established you might experience that more carbs are reaching your blood stream as you have been used before. Ask your endo for an insulin like Apidra or NovoLog. They might work faster than Humalog. Perhaps their speed can compensate your current problem. Your endo should have vials for testing available. Perhaps you just need one vial and later you can return to Humalog when your gut is working normal again.
Holger, If you are referring to my situation, I would agree that is the 'normal' situation with most antibiotics. However in my case the antibiotic was Bactrim DS, aka Trimethoprim-sulfamethoxazole. And I've recently discovered that Trimethoprim increases the effects of Metformin (which I'm taking) and sulfamethoxazole increases the effects of insulin...in rare cases....well, I guess I'm rare :-)
I started with the hypos about 36 hours after starting treatment on Bactrim. Which matches up quite nicely with the literature. I had that solved with a basal reduction. However after stopping it Friday, I started going through a transition period that required me to chase my BG. Screaming high, then normal, then low all within a couple hours. Seems like a reasonable deduction...combing the routine effects associated with the cessation of antibiotics and the unique chemical interactions at play in this case.
As for Monday evening, I have come to the conclusion that the events were a result of my body trying to return to stasis, however my pump settings were not changed quickly enough to compensate and the sensor had no hope of keeping up with the rapid changes in glucose levels! So I just shut all alarms off, turned off threshold suspend, and poked my finger a dozen times!
Today, I'm back to 'normal' after returning my settings to pre-antibiotic settings. Woke up to a nice 82 and the high so far today has been 98.
My doctor has always said "You're a little different than most of my patients." I suppose this is just further proof of that sentiment.
I'm going to add Bactrim DS to the ever growing list of "Stuff to keep in mind when doctors want to give me new/different meds."
no significant weight gain--been trying to lose for several years now but nothing has really worked. i'm not willing to go on metformin. i prefer to do things as naturally as possible and don't want to risk the side effects of such a drug.
Thanks Terry. I know that I have this problem sometimes, depending on my site. This is one reason why I went into DKA back in April. My stomach sites have bad absorption & there are limited areas, my arms have always absorbed really poorly so I finally switched to my outer thighs a few months ago and now those sites are starting to suck.
I can usually tell when it's my basal insulin, because I will flat line on my Dexcom, but I will be at, say 220, instead of 120 or so.
I think this is one of the biggest pitfalls of the Omnipod system. I've never been on a tubed pump and really can't imagine it {can't afford it either, lol}. But being able to change the angle and depth of insertion depending on your skin/body preference seems like a huge plus.
I'm seriously considering a pod break or a semi-break {wear my pump for my basal but use a syringe for boluses - actually the other way would probably be better for me...is that even possible??}.
This interaction between the drugs is good to be aware off I fully agree.
With a stomach flu I had the opposite effect in the last year. From one hour to the other the processing of carbs was totally blocked. The injected basal dragged me down for hours. I had to eat glucose tabs, waited 10 minutes to finally throw up and started to eat tabs again. No fun. It would have been easier to use the outdated glucagon I still have. But somehow I have not thought of this helpful drug. Another example of not connecting the dots when you need it the most...
I'm taking so many medications that interact with one another that I have to be fully aware of who, what, where, and when. Certain ones cannot be taken at the same time as others. Certain ones have to be taken at specific time of the day based on the body's metabolism, etc.
I spend lots of time talking with my Pharmacist and doing my own research. Heck even in the ER, I'll ask many, many questions. I'll even whip out the phone and research for myself. Some (fewer and fewer these days) doctors don't like informed patients. I don't have any of those on my team anymore. I just got lazy this time :-( That won't happen again!
Case in point, when I was in the hospital earlier this year the attending physician was going to put be on Levaquin for bronchitis, but it likely would have killed me. Yeah, yeah, I know their system should (might) have caught the conflict, but I'm not the trusting type. :-) He had an attitude when asked about this. Told me and my wife (huge mistake!) that he had not read my chart yet! I fired him and they brought in a infectious disease specialist to talk to me.
Currently I'm suffering from a diabetic pressure ulcer on my foot. The Wound Center's Director suggested I go into the hyperbaric chamber (which would have also killed me) I told her I read something (I could not recall at the time) that it was not possible for me. She told me I was mistaken. I wasn't. Funny story: I was relaying this to my cardiologist the other day...his reply "She does not know you very well, does she?" :-)
