Peak Frustration

Weird things are happening to me- and right now I’m feeling like I’ve hit a wall without input from my Endo. Two days ago, I ended up going onto a second day without sleep due to a work scheduling conflict. Well, that day, my morning BG was slightly elevated. I took my morning dose, had breakfast and went about my day. I am testing about every 2-3 hours- my BG is extremely reactive, and the smallest things make it go way off. Well, that day without sleep, I couldn’t get out of hypo. I was hitting hypo (3.8 - 4.4/mmol) every few hours. I wasn’t taking too much insulin, and I even scaled back a unit or two from what I expected to take. My after-meal sugars were lower than my before-meal sugars.

That night, I got a good sleep. My morning sugar was elevated again (I’ve been trying to compensate by adjusting my NPH dose for morning and evening to get my morning sugars down). I’ve also been waking up at 4am every morning to test and adjust if necessary. All day, my sugars were elevated and I couldn’t get them to come down all morning. They didn’t come down until after 9:30 last night (despite taking a dose every two hours all day), when I finally hit 7.7/mmol just before bed. I woke up just before my nighttime dose alarm, in really extreme hypo. I was wet with sweat, shaking really hard, and totally freaking out. I managed to test alright, and my BG was 2.9/mmol. I have never seen my BG that low. So on one hand, I was impressed after being so high all day, but really unhappy that it was so low. I had a few sips of grape juice and went back to bed. When I woke up, my BG was 15.3/mmol. I didn’t drink much juice- just enough to get me out of hypo.

What is going on?! I’m really frustrated that my BG is so reactive for no reason- it’s making getting even BG through the day really difficult. Every time I get within range, I find that almost every time it is offset by a ridiculous high later- even if I haven’t changed anything and am dosing properly. Oh, and the edema I had in my legs last week is back with a vengeance. :S I keep having to keep my legs elevated. I am going to make an appointment with my Endo, because at this point, I’m not sure what it is I’m doing wrong or how to stop the peaks I’m having. I’m working really hard to bring down my A1C and level out my graph. I get so depressed when I peak. :frowning:

Kass

What you’re describing is really not weird. It makes sense, if you think about it. Please forgive me if I’m being too basic in my descriptions, I don’t mean to be insulting.

You hear a lot of discussion on here about basal and bolus, as if they are two separate entities. But NPH functions a bit as both – it covers the bolus for the meal you’ll have about 4-6 hours later, and the basal for the next 12 hours or so. It makes it really hard to figure out how much to take (and how much to change the dose), and is not forgiving when you change your schedule. You’ve likely refined your overnight dose (I’m not sure when you take it or when your meals are) to cover the overnight basal requirements for your “typical” routine.

Since activity is really low when you’re asleep, your basal needs are higher (my overnight basal rate is about double what it is during the day)-- it’s like that with all of us. But when you’re awake and active doing your work, you obviously don’t need that much. Problem is, the NPH is already in your system, working, and continues to work for about 12 hours. This is why you just can’t seem to shake the low; you fix it and then the next bit becomes active and brings you into hypo again. Even changing a unit or two of NPH, over the course of 12 hours, amounts to very little per hour. But when it comes to treating a low, a sip of juice 6 hours after your NPH will have a very different effect than a sip of juice 10 hours after.

Now, if you slept/napped the morning after your night of work, the opposite is happening. Your basal insulin needs could be double what it is when you’re awake. The NPH only did part of the job. That’s why you needed so much more Humalog/Novolog (whichever you needed) just to stay under control. But then that caught up with you. It’s a vicious cycle.

One thing I didn’t know until I started pumping is that a unit is a unit is a unit. 1 unit of regular = 1 unit of humalog = 1 unit of NPH = 1 unit of Lantus. The difference is when they take effect, but throughout the duration, they do the same thing.

NPH isn’t used often these days for precisely that reason – it is long-acting, and has a peak right in the middle. I think you’d find some success going to a separate basal/bolus regimen (using Lantus or Levemir) . It’s still long acting, but it’s more predictable and gives you a bit more freedom. And it’s not as dramatic a change as a pump. If switching off of NPH is an option for you, I’d suggest looking into it.

Does this make sense? I’m a bit tired as I write this, and its a complex topic.

I was actually on Lantus and Humalog, and yes, I found far fewer lows. I had to switch to the generic because of cost. Here the Lilly insulins are almost twice as much. I’m finding my sugars come down quite a bit all day, I hit a low in my sleep and peak first thing in the morning- and the process starts over. I am thinking about switching back the next time I fill my prescription. And thanks for the input. My medical treatment has been sloppy because of moves, etc. I gear so many different things from different doctors.

Poor sleep can play havoc with blood sugar levels.

The lows are a reaction to all the insulin you have on board - you need to check how long it takes to work - for me the slow acting one takes 4 hours, the faster one about 2 and continues to work. Your morning highs are a normal reaction to the night time lows - the insulin that you had on board yesterday is now defunct and also a high is a natural defence mechanism. You were low, your body started chucking out glucose and over compensates for the low, but of course now there is no insulin to counteract it.

I often find that if I have slept through a low (and I sometimes do) I wake up damp with a cracking headache and a “hangover” feeling - and my sugar levels are guaranteed to be high!

I know you are depressed when you peak. It is frustrating, I know. You might be suffering from an infection - you can get infections such as a water infection without even realising. Get to your endo soonest, and good luck. This is just a blip!

I was actually on Lantus and Humalog, and yes, I found far fewer lows. I had to switch to the generic because of cost.

Kassi, reading that makes me sick. You can get insulin, just not the RIGHT one! It’s a real shame that this is the case. My endo usually has sample vials of Lantus lying around (he gave me one on my last visit, just as a backup in case my pump failed), maybe you can get it that way? You do have a doctor after all.

I see from your profile that you live in Canada. I had thought that getting medication in Canada was cheaper and easier than here in the US, but getting appointments with doctors was more difficult. (Many US-citizens actually buy their medication in Canada because it costs less!). I guess no system is perfect. I wish you the best.

Before I qualified for extended medical, I was spending $400 a month on insulin alone. That didn’t include test strips or medfly tips or alcohol swabs… Etc etc. I tried to stay on Lantus and Humalog. The hospital even got me a short term sponsorship for my drugs. I was supposed to get a 6-month supply of each, but only ever got 45 days worth of Humalog and no Lantus. At the time I was ketonic, very sick and unemployed. In the process of getting my sponsorship paperwork to go through, the papers were returned to me several times and eventually the program was cut entirely by Lilly. No more advocacy for me. I ran out of Lantus very quickly and went to my doctor and to the hospital looking for help. I was denied and told “This isn’t a soup kitchen.” I don’t think medical professionals had ever made me feel more worthless. I ended up having to default on bills for quite awhile to get the insulin I needed and even then my EI only paid me enough to get half as much as I should have been taking (or I would gave been evicted). Drugs being affordable here is a misnomer. Things here are slowly getting more expensive. Just to get the paperwork from my doctor to keep my license is $147 a year. I was spending almost $10,000 a year in diabetes treatment and supplies. That was (sometimes) more than half of my income annually.

Now that I re-read what I said below… I meant that the fact you are unable to reasonably get the proper insulin makes me sick. I didn’t mean it as any type of attack towards you. I apologize if the words came out a bit wrong.

But thank you for sharing the story, and telling what it’s really like to try to care for yourself. It’s just not right.

Oh lol no I understood what you meant. No offense taken. I agree.