Random High BG's that Don't Respond to Insulin

Hi All,
For the last year I have been having these ridiculous random high bld sgrs. There’s no pattern and no reason for them (as far as food or illness…). I have not been able to find the kind of help that I need. I have a GREAT Endo but still… Really no answer or way to avoid this from continuing.

My background: I am 41 yrs. old. Have had Type I Juvenille for about 30 yrs. 10 yrs on pump. And…10 yrs ago had a heart attack that led to an angioplasty w/ 2 stents placed in my arteries. The heart attack is irrelevant other than the fact that psychologically I think I kinda freak when my D is outa my control. Oh, by the way…when I had the hrt attck my HBA1C’s were in the 6’s and Ive always had good cholesterol, normal weight/BMI, very low bld pressure, am a vegetarian, and was a boxer! Yikes, huh!!!

When these random highs occur (in the 300’s) they are unresponsive to insulin. I’ll change my pump sight and always inject w/ a shot. My blood sgrs continue to rise even after a shot… this goes on for hours. I feel so sick from the highs. There’s no rhyme or reason & I feel like I have no control, my D has taken over my body temporarily like a monster. I’m sick of “making excuses” like…maybe the insulin wasn’t fresh (I change pump sight every 2 days), or maybe its where I am wearing my pump sight… Always looking for that “magical” explanation. =(

I talked to some other Diabetics in a group setting and 2 said that they’d been hospitalized for this. They were senior citizens & I am assuming they’ve had the disease for a long time like I have (?). They said that there’s a theory that it is the liver putting out extra glucose. Don’t know why or what to do about it. I would really like to avoid another hrt attck and/or other huge complications.

Does anyone have any thoughts or advice about this? Thank you!!!

Have you ruled out dawn syndrome? Don’t know what else to say or guess at. My mother has the same issue I have been over at her house all day and watcj her shoot up to 350 with out touching food.

Sometimes I notice the last ‘load’ of insulin in a bottle doesn’t seem to work quite as well as the fresh insulin when I first break one open? Since I’m pumping, I’d then have bad basal plus bad boluses sort of adding up. The thing is it will still work but much more slowly, apparently in both applications so I get a lot more rollercoastery when this happens. Usually I’ll just swap it out but sometimes I’ll get embroiled in things. Your liver can also dump glucose or hormones that raise BG but you’d pretty much have to have seen a catastrophic type of low for that to happen? If you run higher, it might work that if you had a precipitous drop it might cause that to kick in too?

If you are boxing, that is likely a huge shot of adrenaline too?

If the highs were due to something wrong with the pump operation or effectiveness, like scarring, you would expect an injection to work. After 30 years at this, I presume you have a pretty good idea how your body responds to corrections. Have you closely looked at the insulin? Did you use the same insulin to correct as was in your pump? Is it possible that the insulin has gone bad? One way of testing that is to correct with a different insulin source.

  1. Ask if an MRI of the pancreas might turn up insulinomas.
  2. A 300 blood sugar will always require insulin in greater than the usual algorithm because there is resistance present, as you well know. Giving extra insulin from a new vial to get it first down to below 200, then letting the pump do it, is just a suggestion.
    You have to be careful in choosing the amount to give and have extra glucose around to treat yourself if you give more than needed.
    It’s as if there is one insulin sensitivity table needed for below 180 and another above 200.
  3. Suggestion 3 is that your pump is needing a different site in which to put its insulin. A place totally without scar tissue.
    Best wishes as you work this through.

Nope, I stopped boxing a few years ago. Yesterday I had the crazy highs though remember using a relatively new bottle of insulin. Great suggestions though. Years ago I did have some issues while boxing so that made sense.

Yes it is odd that I am not even responding to the injections isn’t it? It is so frustrating! And you are right, after 30 years…this screams “ABNORMAL”, it makes no sense. This never happened all the years prior and there’s no rhyme or reason.
I usually use the same insulin bottle to correct (if its pretty new) but I have changed bottles before too. Plus, this has happened too many (random) times now, so I struggle with the idea that it could be the insulin. Only because what are the odds that I’ve encountered soooo many “bad batches” of insulin (bottles)? Hmmm… Ughhh!

Thanks! My Dr. checked for scar tissue and feels that i am ok. I did have an MRI of my pancreas, my Dr. was looking for Pancreatic Cancer but it was negative. I wasn’t aware of Insulinomas. What is that? Should I ask my Endo about it? And yes, I always change my pump sight. So odd isn’t it? It really doesn’t make sense why my BG would keep climbing…

Ahhhh John, you are describing how I feel! I know that after so many years we just become “brittle” but I struggle w/ insulin resistant. That is new I suppose, it wasn’t addressed for Type 1’s years ago and I hear about it so much now. I did ask my Endo if I were becoming insulin resistant and she said “no”. Hmmm…could she be wrong? What you say makes sense. I wish I knew what triggers these episodes or how to prevent them, they are so unpredictable and unjustified.
I am going thru a divorce (I handle stress well though) & need to find a full time job so that I will have health insurance when the divorce is final. Some days I am so sick from these highs. I can go a month or two or only one week between episodes. How can I look for a regular job if I can’t get this controlled? I was so controlled prior to this… Seems that even the Dr.'s can’t help. So very frustrating…

Yes, have experienced these huge spikes, jump of 80 to 100 points in one hour’s time with my niece since puberty and she is now early teens. Attribute this to growth homrones and increase insulin by 100 percent basal (if 100 point increase) plus correction and leave that huge temp basal increase on until blood sugars return to normal. Usually takes four to five hours an evening. Can exercise to help the insulin resistance or just get up and walk, shop, keep moving. Don’t know what else to do for insulin resistance; this is temporary, temporary insulin resistance, and she does return to normal baseline use, usually the same evening. Wish I had advance notice for this, as it does take hours to get highs down.

Yes, exactly Jan! Takes hours…

There are medications that may be the cause of this as well. Are you on any kind of steroids for something else? I had the same problem a few years ago and the question everybody kept asking me what medications I was on. They were convinced that was the cause until I told them the only medication I was on was insulin. They finally thought it was my liver releasing too much glucose. I ended up riding it out because i think at that point they were just guessing which was doing me no good. Hang in there and do the best you can until they figure it out…

Thank you!
Nope, no roids. :wink:
You are right, they just guess. And being such an unusual and somewhat isolated type of thing, blame is involved or it is just pushed aside. In the meantime, I feel like it is slowly killing me (?) and I can not move forward in life. Bummer.

I can’t say much about the high BG thing because the only time I was truly unable to get it down (over a period of weeks), I ended up in a coma. The only idea that makes sense to me is that as the BG goes higher, insulin resistance increases, and you need MUCH more insulin to bring it down. It’s really hard to know how much – when I was trying to bring down BGs between 400 - 600, I was just not taking enough insulin, and I had no one to guide me in what to do. Ideally, my endo should have been doing this, but he had no ideas, and just let me slip into the coma. So I fired him, and got me a new one, and I just hope this never happens again. I almost died.

BTW, metformin would not work in this case, because it’s temporary insulin resistance, not permanent insulin resistance like that seen in Type 2.

I also wanted to tell you I know about the anxiety of heart problems – I had a coronary artery spasm (like a heart attack, but the arteries weren’t clogged) when I was 44 (I’m now almost 63), and have apparently had another one since then. I do show damage on my EKG. I don’t know what the state of my arteries is, but I do have that fear in the back of my mind that maybe I will have another one and not feel it, and just die in my sleep some night. Which actually might not be such a bad way to go, except that I’m really not ready for it!

Awww Natalie I am so sorry to hear about your ruff tuff times with this disease. It can be a real drag…what helps me is a really quirky, silly, twisted sense of humor! Though lately it’s been tuff with this high BG thing.
The heart attack was crazy. What’s worse is that about 6 months prior I had had the exact same thing happen, same feeling, same EXACT symptoms. But I was brushed off because I didn’t fit the profile and I was told by RN (I called my insurance’s after hour care) and the next morning my Dr. that the weird feeling in my chest was just a cold - they didn’t address that pain in my left arm… It went undiagnosed! Months later same exact thing happens and I go to ER. After angioplasty I am told that there was a 99% blockage!!! Whoa!
That was 10 yrs. ago. I have handled it well. Have lived life to the fullest (always have) and kinda joke about it… BUT, I do worry about high BG’s because if I had the hrt attck when I was in good control of my BG, its gotta be way worse if I’m outa control. Yes, there’s a hint of subconscious anxiety I think. we can’t help but have that when these awful things just “sneak up” on us, right? So we do the best we can to be preventative. But geez it sure is frustrating when even that power has been stripped away. Like the disease is deciding what it wants to do! The only way I can try to fight back is to think positive…its a daily challenge.

Thanx Fly guy! I will ask my Endo… funny because way back in the day used pork & beef…that’s all there was! :slight_smile:

I find the higher the glucose the less the insulin absorbs, your bodies cells become dehydrated. When I have a stubborn high, that won’t come down after a site change and Subcutaneous injection, I will inject into my shoulder muscle. This has always worked for me. The endo and physicians usually won’t recommend it because it’s not evidence based. I consider myself a lab rat and its worked for me. As for the reasons why you have unpredictable spikes, thats a good Q, and you have thought of the obvious reasons. Hormonal fluxes? Well I hope you figure it out. Cheers from Three 2 Treat

Thank you Trev! It seems like there aren’t enough people out there with this same rare problem so it isn’t something that will be figured out anytime soon for sure! Kinda like the studies that are done. Most are done on Type 2’s. Type 1 (especially Juvenile) are more rare. Makes sense I suppose. The focus is always on the masses so the minority are on their own??? I’m ok w/ that, I am just a bit tired of being a minority.
Its admirable that you are so experimental. I hope that it helps you & your family in a great way. :slight_smile:

When I was taking R, one thing I did was to run up and down the stairs after injecting into my leg. I’d also used IV R (Cheap-a-log?) that would drop my BG from 350 to 70 in about 1/2 hour but, of course, is extremely risky?

Well, some endo’s do suggest intramuscular injections for corrections. Dr. Bernstein does, he even has a video on how to do it. Intramuscular injections absorb faster, don’t require stair running and avoid some of the absorption problems that may occur with dehyrdation. And I would also like to point out that low carb diets for diabetics are not evidence based either.

Medical Science definition of evidence based decision making:

If something is so blatantly obvious that nobody will study it, then you won’t have evidence and you shouldn’t do it.