I’m just wondering what I should do… I’ve randomly tested while shopping at the mall with a friend and was at 498, a crazy high as I’ve been doing good with my diet and all. I double checked to make sure before I corrected the high and had the same result. I then corrected with 15 units, I have a 1:20 correction factor. I tested an hour later and was 370. Thinking that it would get better I waited and tested at the 1 1/2 hour mark and was 350 then at the 2 hour mark I was back to 400. I’m not feeling sick or anything but it’s been four hours and I’m still in the 400’s. I put in a call to my endo and am waiting but I know he’s going to tell me to go to the emergency room. I thought that maybe it’s bad/ out of date insulin but I opened this vial a week ago and it’s crystal clear. Before lunch my sugar was 152 and then I had 78 grams of carbs for lunch and took 5 units fast acting. I’m not sure if it was walking around shopping that raised me that high, but it’s the only thing that I’ve done “out of the ordinary”. Any suggestions? I’m just not sure what to do!
Similar issues have happened with me after two interesting scenarios:
I’m nearing the end of my infusion set and those little bubbles that I might have missed at initial insertion have become huge interruptions to my basal insulin flow. Sometimes I can confirm that air lines are still in the tubing, which reminds me to change my set.
High fat meals often will spike my BG higher like that for seemingly no reason.
Otherwise, I do share Dave’s thoughts re: infection or bad insulin. I also know that when my sugar is that high, it often takes several hours for it to come down after an aggressive bolus like your’s.
Hopefully by now things are looking better, and you’ve heard back from your endo. Hope all is well.
Agree with the others that I’d open a new vial even if it’s not expired & looks clear. I’ve brought insulin back to my pharmacy & they’ve given me a replacement.
What’s your carb:insulin ratio? Five units is pretty low to cover 78 carbs, especially starting out at 152. Were breakfast & lunch close together? If so, you might have had been steadily increasing from breakfast which contributed.
Hormones play a big role in high readings (as does infection, taking steroids, intense stress), but hormomes don’t usually result in highs that high.
High doses of insulin (like 15 units) don’t absorb easily.
Walking around shopping makes me low.
As Nel said, drinking lots of water when BG is high is important.
Do you have a new vial of insulin at home? When I’m in doubt I give new insulin.
There are many possible reasons for highs, but given that you were diagnosed so recently, it could be that your insulin needs are increasing. Then you need to talk to you doctor about how to adjust them.
Have you seen numbers above 400 before? During my honeymoon, I never did, but then one day I woke up above 450. The honeymoon was over and my insulin needs almost doubled.
I know this is so frustrating, but I promise that you will find your rhythm and this will get easier to deal with!
I feel that your insulin to carb ratio has to be adjusted. Was
there much fat in the meal that you ate ? Certain fats raise sugar
long after meal was eaten. I assume that you’re on injections ?
Hey. Have you checked ketones? Because if you have them, you’re probably also suffering from a insulin resistance, which usually can only be broken be larger amounts of insulin than you would take to correct normaly. (I would take 20% of my daily insulin amount, but you should not follow this advice without talking to a endo or doctor before.) You should definitely test ketones and drink a lot.
There are several things that may have added up to raise you so high. First thing that comes to mind is the fact that large doses of carbs corrected by relatively large amounts of insulin suffer from error factors. Carbs may be exactly what they seem to be according to your information, but they may vary quite a bit. The error factor for carb counts is over 10%, so if there was actually 10% more grams of carb in what you ate it could start you spiking like this.
I trust you weren’t worrying about how to pay for what you were shopping for? Anxiety raises bg, and it tends to stay high. Just kidding, but who knows?
Also, if I understand it you take insulin in shots? If not the following will vary somewhat, but I’ll mention both options. With shots, and to some extent with pump infusions, it’s possible that the insulin was pushed into a bit of scar tissue from a (presumably) recent injection at the exact same spot. Scar tissue builds up over time, but can be a problem for anybody taking repeated shots in acceptable areas. If the plunger seems to resist being pushed down then you are likely injecting into scar tissue. Scar tissue may delay absorption for some hours, but it will eventually work out of the pocket, and you may go low from it later. Same thing may happen with infusion sites. I trust you rotate injection sites?
It’s also possible that the different level of exercise may not have fit the schedule for your insulin correcting the bg level. Tricky to figure out, but it’s possible that after eating your bg level went over 250 or so from the meal, you started exercising and the liver responded to confusing signals by releasing too much glycogen (which immediately converts back to glucose) to support the new exercise level. Hate it when the system gets confused like that.
SO, as has been mentioned it may be safest to drink a lot of water and wait for 4 hours or more to see if your bg starts dropping, and how fast. Taking more insulin now could be problematical if you have insulin lurking in scar tissue.
Also, what variety of insulin are you taking? If it’s Humalog or Novolog the situation is 1 way, if you take R it’s a whole different thing entirely.
It’s official. The honeymoon is over. I got two months of it and that’s all. I’ve been being observed at the hospital this weekend, I’m home now, but my new endo, yes new one, seems much more up on type 1 instead of my old one that knew type 2 very well, has fixed everything. I’m still hitting 400’s but it’s only after crazy meals. I have an appointment with his CDE and she seems really nice. He does want me to start using a pump but I’m not too fond of the idea, but we will see.
Thanks for all of the tips! My new endo is going to be a little more aggressive with my treatment so hopefully I won’t have to go through this again!
My honeymoon lasted about the same amount of time… the positive side of ending the honeymoon is that there are less random lows. One less thing to guess about-- how much insulin is your body producing?? The answer is almost none!
Sorry your honeymoon is over! But very thankful you have found an endo familiar with treating Type 1. An endo used to treating Type 2s and unfamiliar with Type 1 would be of absolutely no use to you. Have you seen the new Solo patch pump? Not yet here; scheduled to be released in January 2010, but looks like it is worth waiting for. Slim, thin, tubless and flexible.
Keep us posted.