My Daughter's Blood Sugars Run High

Sarah -
If you are 180 and stay 180 WITHOUT corrections your basal is probably OK. If your corrections bring your blood sugar down to target for 3-4 hours and then you start to go up again without eating, your basal is too low.

Thanks, Maurie. That's what I thought, if one keeps going back up to high after a correction bolus wears off, then basal is too low. Thus, we take basal to stop the liver dumps and the goal is take enough basal whether pumping or MDI, to, hopefully, get a somewhat 'normal' (cough, cough) fasting blood sugar. But then there's DP and all kinds of other stuff too. ugh!

Sugar Bertie: When her bg's have been a lot better with her on her pump, until recently. She has an Animas pump, with a short infusion set length. I'm not sure what it is made of, but I do know it isn't metal. Is there any particular reason you suggest a longer set?

It wasn't my intention to come across as being worked up or needing to dial anything down lol. I was just explaining what was going on, and other things on my mind that go along with it, hoping to get some advice, which a lot of wonderful people on here have given to me. I understand that my concerns with her kidneys and other issues aren't immediate things. But she is my daughter, my only child, and of course I'm going to worry. Even if my fears aren't for things that can immediately effect her. I worry. Thank you for taking the time to comment :)

Your comment about the damage starting years prior to diagnosis, that is exactly what her neurologist told her. Some people think that, "oh she was diagnosed Dec 2012, she couldn't possibly have complications yet." But they don't take into consideration how long she had it before her diagnosis. She has diabetic neuropathy, and like you said, she is in a lot of pain sometimes. She's actually in physical therapy to help, so we're hopeful that it does :)
I've talked with her, and she's going to do as Maurie suggested and test the basal.
I have told her about this site, and she's going to register soon.
Thank you for your help :)

"If you are 180 and stay 180 WITHOUT corrections your basal is probably OK"

For me that wouldn't be true. My insulin needs are significantly higher once I get up to 180 vs 85-120, so I'd want to be stable within my target range.

I wish I had decent doctors in the years prior to my diagnosis....a lot of damage was done.

More thoughts...
1. A pump company rep might also be able to help.
2. She (with your help) is ultimately responsible for her BG management, so read some books and do research. My endocrinologist is the person who gives me an Rx for my Dexcom, insulin and test strips, but I run the show.
3. Don't be afraid to syringe bolus if the pump insulin isn't absorbing. If she can't get the pump to work for her, she might try syringe (MDI) basal/bolusing for a while. I dont have a pump, and over the past 24 hours I've been below 130 for all but 2 hours while going a bit low once for 1/2 hour (injecting before a meal).
4. She will get there. It stinks right now, but you'll figure it out and find out what is wrong. It's just tough in the beginning.

i think the point was trying to determine if basal is enough or not. i can't imagine any T1 wanting or embracing a 180, I like fasting to be around 90 and my target range is 80 - 140...but if i'm 180 and take a correction and it comes down and stays down, basal is good, if it doesn't come down w/corrections or continues to go up after correction(s) burn off, as maurie indicated, basal isn't stable. 1 unit drops me 100 points, I notice I need more once I get to 200's and it depends what time of day, ISF's change throughout the day, night too.

I think Scott is saying that at different levels his needs would differ as well, so the best test of basal stability is done when in range.

what's in range, i think when one basal tests, it's recommended one shouldn't be above 200 or below 70. on MDI, not much one can do about different levels or different needs, there's no way to really adjust that much.

As Zoe says, my basal needs are different at different levels, Enough basal at 180 is probably 50% more basal than I would need at 100. So if I tested at 180 and then tried keeping my BG steady at say 110, my BG would constantly drop because my basal rate is too high. I think the purpose of having the right basal is to be able to safely keep my fasting BG somewhere close to 100.

For me I'd want to be around 100 for basal testing, certainly below 130. Im on MDI (with Levemir twice a day) and my numbers are that stable. I had a good day today, and my numbers (per Dexcom) were between 145 and 70 the past 24 hours.

Hi Leilani,

Her basal needs may be increasing, she may be coming out of a honeymoon. Popcorn isn't high carb, if you make it yourself with an air popper and add butter it's only about 4-6g per cup I think. Crackers and tacos could be spiking her too, some people don't do well with grains. I've eliminated most grains now although I occasionally have some toast or a very low carb fiber cracker with cheese. I eat berries and don't have a problem with them either, they're relatively low carb, but I would eat small portions only probably.. it really depends on the person.

And yes with type1 there are many times I spike for no reason and go hypo, this is typical of many type 1 if you tend to fluctuate a lot.

My endo does the fructosamine test also and the glycomark which shows how high you spiked in the past 2 weeks or so. Even though I have a low a1c I spike high at meals it seems according to that test anyway, not sure how accurate these tests really are, I tend to spike a lot it seems no matter what so I try to limit the amount of carbs per meal. It could also be showing my spikes when my basal shots run out too.

My A1C is not high though. 11.2 is way too high imo so I think she needs to bring it down more, at least 4-5 points, slowly because doing it too quickly can cause retinopahty in some people, with either a higher basal dose and more bolus for meals if she is spiking a lot after meals and pre bolus if she doesn't do that. A lot of people say if they exercise more it keeps them lower too. I tend to go hypo a lot so although I'm quite active I go easy on the exercise. Today I was in sick with a bad cold and I've been going low a lot with almost no activity so I never know what will happen.

My endo recommends an A1C of 6 to avoid complications.

Her current A1C if it is accurate means her average bg is in the 270's which is very high. I was already in dka at that level. Mine was 13% at diagnosis.

If she gets her A1c lowered there is a good chance her neuropathy symptoms will get much better or reverse as can any other damage that has been done.

A somewhat left-field possibility is that the insulin has denatured. I understand that insulin starts to denature at around 82 F. It may be worth trying a new batch and making sure it is kept cool.

She doesn't have grains much at all, maybe once a week, and we're really careful with how much. It's always whole grains though. Honestly the only reason she has them at all is because her endo said she needs them. She gets most of her carbs from vegetables though, and some fruit, although she avoids ones that are high in carbs.
As far as her A1C goes, she was 15% when she was diagnosed, she was in ketoacidosis, and I will spare you the details, but it was bad. She was in the ICU for 5 days. I know 11.2 is bad, she's trying her best to get it down to under 7. She was at around 8 last April, which was great. We're obviously determined to get it down again. :)

She's already tried a new batch of Novolog, and we always keep it where it's cool. :)

Hi Leilani, I think it sounds like insulin levels that need to be adjusted since her diet is good.. she could have celiac and react to any type of gluten too. I'm so sorry she went through all of that, I don't know how long ago it was but it takes time to recover. I guess the question is what caused the jump back to 11.2 which I think you will figure out soon. Another thing I forgot to mention is that I take losartan to help prevent kidney damage, my blood pressure is good, but this can help prevent any damage that comes with higher bg and bg fluctuations. I'm sure she will get it back down soon :)