So about 4 weeks ago, I posted here how my nightly BGs kept running up in to the 250s by 5am (for like 3-4 months). I could not figure it out. One of the members suggested upping my basal at night, and lowering it in the morning to a 33/66 split, vs 50/50. This worked great for about 4 weeks. I would go to bed and wake at 7am, almost totally flat.
Well here I am 4 weeks later and I'm totally out of control again. Literally over the course of the last 6 days, I went from flat to 220, 220, 220, 260, 265, 220, mid-nightly numbers. Monday I went to bed at 118, 4 hours later I was 265
I'm so mad, because I justed upped the nightly, now what? Even adding two extra units at night, has done nothing. I suppose, I'll just keep adding, until its gets level again. I guess what I don't understand is for 4 years, I was relatively flat on 24 units per day, now I'm at 35, and now, again, I need to add more. No slight rise, just straight back in to the mid 200s.
Sorry you're having problems! I'm a little confused by what you mean when you say you "lowered it in the morning to a 33/66 split vs 50/50". Are you talking about your basal and bolus ratio? If so, that's pretty much irrelevant. That ratio is based on lots of things like how much carbs we eat, for instance. What's important is that you have the basal you need at the time you need. How many different "time zones" do you have? If you have figured the period of time when you start to go high (sounds like the first four hours after you go to bed?). Then create a time zone for that period and raise it slowly until you get where you want. Keep experimenting and testing during the night until you have created time zones with the right hourly rates. Just FYI I have 8 different time zones over the 24 hours. It isn't just "raising at night" and "lowering in morning" but breaking it down to hourly rates. Remember that you have to change the time about 2 hours before the problem. So let's say you start going high at 2AM, then you up the basal rate at midnight.
Finally if you eat late and/or eat high fat foods, you may be seeing a late peak from your dinner. What you can do about that is use a combo bolus or eat lower fat meals. The worst offenders for delayed spikes are high fat and high carb meals like pizza or lasagna.
Thanks Zoe, Yeh, the 33/66 thing is my basal split - 12units at 8am, 23 at night. I'm not using a pump, so its harder for me to split the basal rate in to time zones. The thing that is the most frustrating is for 4 weeks, I was flat, now its back to out of control numbers. Anyways, I'm going to keep adding to the basal until it flattens again.
You know, on the delayed response, thats what I thought it might be for the first few nights because of the holiday foods. But then like last night, I had, baked chicken, green beans, and a little stuffing. After wards I was 210 which aggrevated me, but took a correction, which generally knocks me don 70-80 points at night. Not last night, 230, 3 hours later. This is the same thing I was experiencing before, where nightly corrections did little to nothing.
Sorry, Jason, I gave you totally irrelevant information..lol. I thought when you were talking about "more at night, less in the AM that you were on a pump. Yes, it does make it harder to get a smooth basal. If you're taking the night time dose close to bed, you might try taking it earlier, say at 8PM (12 hours apart) so it's "Peaking" in those late night hours when you most need it. And yes, all you can do is keep adding a unit at a time until you get better results. I would suggest staying with each change for 2-3 days to see a pattern. If you still don't get results, you might want to consider switching basals (I found, as many do, that Levemir was smoother than Lantus, some people seem to find the opposite). Bottom line too is to consider a pump. It really helps with basals.
I agree it's totally frustrating when things are going along smoothly and then they go all to hell. At four years you might have lost your last production of insulin, or it could be something temporary you're unaware of like fighting an infection of some kind or added stress...anything. I've learned (keep learning) that getting hung up trying to understand why is useful only up to a point and beyond that it helps to just "treat what is". Hope it resolves soon.
Oh yes, and you might want to see if your ISF needs changing as well. For me, when my basals change my ISF often does as well.
Jason - Has your weight changed during the last four years? Even a little. My experience my not be relevant at all to you, but it does affect many of us.
I was going along for many years with decent BG control but then it started slipping. My A1c numbers started increasing and I couldn't figure out why. Looking back, it seems clearer to me now. Slowly, over the years, I had been gaining a few pounds a year. With that weight gain I started to become more resistant to the insulin I was taking. What alarmed me the most was taking a correction dose and not seeing any effect on my BG, something you also reported.
Once I started exercising more regularly (walking 30-45 minutes every day) and losing just a few pounds I saw an improvement in all my numbers. I also failed to change my ISF, as Zoe suggests, while I was gaining weight so my corrections were not aggressive enough. Insulin sensitivity also affects basal insulin needs.
For some reason, being a Type 1 diabetic, I did not realize that, like T2's, we could become insulin resistant too.
I don't know if any of this applies to you but thought I'd raise it in case you share some of my experience. It's easy for T1's to gain weight if they are closely observing their BG's. Correcting high BG's can sometimes lead to low BG's and extra carb consumption.
Finally, I hope that you are logging all of your insulin dosing, timing, and any other pertinent info. Being too close to all the data can sometimes blind us to the larger picture. Good luck with this!
With my daughter got a situation smilar to yours these weeks. It came out her daily basal ended a little sooner than before, so doing the night basal at midnight left an uncover period and her BG rose quickly. Now we do the nightly basal at 21:30, 2 hours after last bolus and she's "flat" again.
Try taking you nightly basal a little sooner.
I whish you good luck !
Hi, Thank you for your response. I am going to try this tonight. I usually take my nightly does at 11, but tonight, I'm going to try 9:30. I've heard that it can take an hour or two to peak, and you're right, if my morning does is done by 8-9pm, I could be going with no coverage for a afew hours.
I could be wrong as it's been awhile since I used long-acting, but I actually believe the peak is at 5 hours, though it does begin to work after an hour or two.
Do you think you might have an infection or otherwise be sick? That can cause a dramatic change in basal needs. Even if you feel fine, there might be something lurking, like a periodontal infection.
I know the standard response is to just keep increasing your basal.
However, there is one situation you need to be aware of - that if you have TOO MUCH basal, then you could be getting low at night and getting a rebound, waking up high, then knocking this down with extra breakfast insulin.
The best way to check for this is to lose some sleep (dammit!), I recommend testing every 2 hours overnight, to see when the rise occurs. For my daughter, when we found her high in the morning, the doctor's suggestion was ALWAYS to increase basal. But instead, I found that her dinner time Lantus given at 6pm was making her very low at 8:30pm, and us testing at 9pm, 9:30pm, 10pm would only see her 'on the way up', but not high enough for us to suspect anything.
This seems weird about the Lantus. It is not supposed to peak for 5-6 hours. It seems odd that your daughter would have a low from a basal injection so quickly after injection.
Welcome to basal insulin variability...many of us had a love/hate relationship with it for years our body's stopped absorbing it the same way each day, one day utilizing 90% and the next day 60%. The main reason for using a pump is to correct the absorption problem and supply the correct amount of basal insulin throughout the day and night.
I always use more insulin during the winter, and my requirements have doubled in the last 20+ years, I'm not fat but I do weigh 40 more pounds than I did 20 years ago and my activity level is probably 75% less...I'm confident that this adds up to needing more insulin. I also use 50% of my basal insulin between 3am and 11am.
If the Bete's was predictable we would not have a need for a DOC....how boring is that..;-)
From the scenario you're describing last night, reasonable food but a post meal spike that kept pounding, I'd speculate that at the 210, you may still have had "protein on board" (baked chicken, my favorite but I've burnt the family out on it a bit!) that had yet to deploy so the 210 + CB didn't cover both the high and the subsequent proteinapalooza. It may have been more of a bolus issue than basal as a lot of times there's overlap? I've tried to get better about including big hunks of protein as 5-10(+)G of carbs in my bolus estimation and it seems to help.
Interesting idea, I have never thought about the protein continuing to cause a sugar spike. My basal bolus does have a little overlap, I usually do my dinner bolus at 8pm, then my second basal shot at 11. Last night was a little better where I moved my second basal shot to 9:30. At 11pm, I was 110, at 3am, 150. Took a unit at 3am, but was still 210 at 7am this morning.
Here's an idea that I've been aware of for 10 years. The body does notice foreign invaders and slaps cholesterol over them. That is evident from the fact that in the USA they designed a stent with medication over it to help dissolve the cholesterol the body immediately tries to throw over it. That's why so many people become all blocked up again within 6 months to a year after an angioplasty.
Dr Bernstein suggested never injecting more than 7u if insulin in any one place (chap7 of 3rd edition). That makes a lot of sense, but he didn't give a reason. He just said there is such variability of effectiveness for large injections. So, I propose that the body is more or less wakeful in sending out the defence mechanisms. After all it expects insulin in the blood stream and not as pockets in fat and the analogue long term insulins are not truly human insulin. So the smaller the pocket in one place the better. It is easy to draw up the full amount you intend to take, but inject 1/3 in one spot, pull out and inject in another spot, and then a third time. BUT notice that as less is going to be destroyed, it behoves you to take less or else you will get a low blood sugar reaction.
I tried suggesting this to a woman taking 30u before bed and she found 3x7u=21u worked just as well. Given that people who change to using a pump end up using 75% of the level of total insulin they used before, it seems to show how much used to be destroyed by the body. Large sized injections also contributes to lumps forming under the skin. So the smaller injections are getting it "in under the radar" as I call it. It would explain why I have not had to increase insulin in so many years as I have always taken very small but frequent injections. Please don't think the body is unable to notice. It does. It's trained to use cholesterol to patch damage. Too bad we can't just tell the body that this is injected for a good reason. When people talk about absorption problems this could factor in. It's only slightly more complicated, but it does reduce lumps forming, so it is well worth it. I use a syringe up to 60 times, so each injection does not require a fresh syringe. So pulling out and reinserting in another place can easily and quickly be done.
I think you can't ask a person to split one injection into 3, that's not living well. As for the explanation it doesn't match: as you say insulin pumps inject all the insulin into one place for 3 days, nevertheless the total amount of insulin is lower than when in MDI.
You have to consider that the needle itself "hits" the skin and causes inflamation, so 3 times the injections are not good for lipodystrophy.
I have friends using pumps which found helpful to ease the "infusion" of insulin through the skin by doing a small bolus followed by a very short square wave. Sometimes, for big boluses, they felt pain. Doing so seemed effective too about kicking in sooner, as if insulin flowed easier toward the capillary blood.
I don't have a direct experience myself about that.
With a pump, the amount going in is a much smaller volume at one time and the short acting insulins are closer to human insulin. What is your explanation of the smaller amounts needed once on the pump? What's your explanation for why the medical industry felt it was useful to dissolve cholesterol that is immediately "plaqued" over a stent? Your consideration of piercing the skin as cause for lipodystrophy does not impress me as much as just having too large injections of a foreign substance into one place over time as being the cause. That is why rotation of sites is also recommended. Are you going to insist that all acupuncture be done away with? My GP informs me that a pin prick does draw the attention of the body to a location for healing and whatever it feels it needs to do. Small 7u injections of insulin is Dr Bernstein's idea and he suggests the balance go in another location at the same time. Are you going to write him and tell him he is wrong? I don't have any sign of lipodystrophy even after 31 years because of needing so little insulin. This would happen from re using the same site over and over. I still have had no problem even though I have used just around 240 syringes since 1986 and I use separate ones also for B vitamin injections and still no sign of lipodystrophy. So reuse of syringes that are kept clean has not caused me a problem in all these years. I'm not going to discuss the details of being on a pump as I have no experience.
I thought you might make a comment, just as you shot down supplements with an example of someone overdoing synthetic vitamin E which I would not recommend anyway.
You've been studying diabetes since 2009 and I have been doing the same since 1981. I stand by what I said. Syringe pricks are not as damaging as large injections of analogue insulin into a single location repeatedly. I did not say inject three times into the same location. The best idea is to always rotate.
I can't claim credit for this but learned here that 53% of protein converts to carbs. There's a group, TAGers or something like that (total available glucose) here and I'd seen people talking about it and have used it. If a burger bun is 12 G (the "light" ones, I think they are airier...) and the meat is 25G of protein, bolus for like 23G of carbs and it should work fairly accurately. You have to have your meter handy to check and all that, particularly the first few times, but the food will be working and maybe hard to get rid of if it's not covered.
