Suddenly my BG keeps going up

Type 1 and LADA
1

I suspect that my honeymoon phase is beginning to fade. A few days ago, I began to notice that the BG in the morning rose quicker. Breakfast caused unusually high BG spikes (that is, high for me; I do a long pre-bolus in the morning, and usually get 120 at most, but yesterday I spiked at 137, the day before at 145). Then I began to notice that once the bolus insulin was out of the system, the BG began to rise again, reaching 120-130 (starting from about 90). I had to administer multiple corrective boluses to bring it down, only for it to go back up again once the bolus was gone.

I heard an interesting explanation, and that is that slightly insufficient basal can cause insulin resistance due to too many fatty acids in the bloodstream that “clog up” insulin receptors. This is why when you are in ketoacidosis, you need tons of insulin to bring things back under control. So, in my case, apparently the beta cell function is now further diminished, and as a result, I am in that situation. Clogged up receptors means that bolus doesn’t work as well either. So, the solution is to crank up basal.

But, perhaps this is just an intermittent period of the honeymoon phase. A few months ago I suddenly had a period where the insulin sensitivity skyrocketed. I:C ratio shot up from 1:12 to something like 1:25. Hypos abound. So, maybe this is something similar, but in reverse, and the beta cells may someday become more active again … ?

Either way, these past few days have been hugely frustrating. I am very focused on tight control, and having days with an average BG of 110-120 is terrible for me (I do low carb and usually achieve FBG of 90). I know 110-120 is objectively not bad, but I have to run a tight ship here, because if I slack off and let the FBG go up to 180 or more, then bringing it down again is much harder.

So, perhaps I am venting here. But it is damn frustrating. All I can do is wait until the increased Tresiba dosage takes effect, and eat very few carbs until then. I sure wish I had a pump right now…

2

Honeymooning or not, it is normal to go through periods where basal requirements increase significantly. Sometimes it happens for a few days, a week, a month or just a few hours. I’m sure there are a million explanations for it (stress, hormones, the weather, sleep, the immune system, etc). This is definitely an advantage of pumping, but also a reason a split dose of Levemir has an advantage over Tresiba, since the dose can be changed every 12 hours at least and without lasting effect. Like you said though, your increases aren’t that big. Even if I’m eating as low carb as possible it is still difficult to avoid BGs of 180 and higher sometimes. There are just too many variables to account for.

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Well, to be precise, they haven’t been big because I acted early. I suspect they would have gone way higher otherwise. Today it seems to be a little better though. I’ll see how it continues.

4

[/quote] All I can do is wait until the increased Tresiba dosage takes effect, and eat very few carbs until then.

I know a correction can take hours and may not even bring down a high BG. When I am high I put in the correction bolus and a meal bolus and then I wait for BG to come down to target. The two boluses will first act on the high Bg and then when it is near target have your meal. Much better than waiting for hours.

5

Hello all.
I also appear to be having daytime BG increases despite increasing my premeal Novolog. Newly diag 1yr ago T1DM. Past few days my levels which are around 90-110 pre meal, now have increased sig to 130-180? This is driving me crazy. The bolus insulin appear to be adequate to lower within my range however within 30 min after this (I use G6 CGM), it starts to raise gradually and peaks around near 180 3-4 hours after. Scary stuff. I also notice that (I have tinnitus) my ringing gets louder when BS rise. Im assuming that I may need to increase basal? Have to call my Endo tomorrow however wanted to know what others are doing? Is this an indicator that I may need more basal insulin? TIA

6

Your honeymoon is probably wearing off and you are experiencing the unfortunate BG spikes and swings that come with being a type 1. It could be that you need more basal, but it’s also likely you need to pre-bolus earlier, if you aren’t already, or modify your diet to avoid foods that are causing you to spike. Some spikes are near-impossible to avoid when eating certain things, and it is very difficult to stay in a tight range as a type 1 unless eating an extremely low-carb diet. 180 isn’t that big of a deal btw. I try my best to avoid going high and take more insulin when I see I am, but again, it is very difficult to avoid ever going that high unless you stick to a very rigid low-carb diet.

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7

In case this was directed to me: Oh I’ve been having spikes and swings already. Honeymoon is not THAT strong in my case. I’ve always had to pre-bolus 10-15 minutes, otherwise spikes are guaranteed. With pre-bolusing (and with certain foods: slow eating), I usually manage to stay below 140 mg/dL.

Also, I know some veteran T1s who, with careful pre-bolusing, regular exercise, and smart food choices, also manage to stay below 140 mg/dL almost always. Carb reduction is key in most cases. Not necessarily low carb, just reduced compared to the standard western diet (which means 200g of carbs, or even more). So it is doable!

I’ve also learned that the truly difficult meals are the ones that combine high amounts of fats and carbs in a complicated intertwined fashion. I don’t mean meals with, say, chicken, potatoes, and some fat on top (fat on the chicken, or fatty veggies like avocados). I mean stuff like pizza, lasagna, gnocchi, french fries etc. As I’ve learned from various endocrinologists and nutritionists, our bodies - no matter if diabetic or not - are not made for digesting that kind of food, since it does not occur in nature.

Think about it: In nature, you either encounter high carbs (fruits), or high fats, or high proteins, or high fats & protein, but never high fats & carbs. So, our digestive system has a hard time digesting that stuff. No wonder it is so difficult to bolus for it! So I try to stay away from that, and it helps a lot.

Also, most of that stuff is anyway unhealthy. The best example are french fries: Next to zero nutritional value, and instead, concentrated refine carbs encased in layers of trans fats (which are the one type of fat that is completely unhealthy). I no longer eat them, and I don’t miss them. I usually preferred regular potatoes, or even better, Polenta, anyway.

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8

It wasn’t directed at you, it was a reply to the last commenter. I’m not saying this is impossible, but it takes a lot of work and there are still variables other than food that make it difficult. I do very well myself, but it is still a struggle unless I am eating low-carb or paying a lot of attention to my Libre and correcting. Also, I find any big meal will give me problems hours later, even chicken and potatoes.

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9

Thanks Scott.
By pre bolus you mean bolus rapid acting say 10-15 min prior to meal? I usually bolus 5-7min prior to my meals. I do watch type of CHO and fat content as may delay digestion. I am a Registered Dietitian and am keeping meals clean and mostly healthy. Good fats, no refined CHO, good fiber and plenty of water and occasional glass of red wine or dark chocolate 90% cocoa. Diet is pretty tightly controlled.

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Pre bolus varies, and may be 30-60 minutes or more. Depends on what pre meal BG is, whether you have recently exercised, whether you are during a hormonal cycle, whether you are stressed, sick, or many other things.

For you personally, 5-7 minutes may be just right.

11

I’ve found that in the morning, a long pre-bolus may actually be masking a natural feet-on-floor phenomenon. So, what can help is to administer a bolus before standing up, which includes bolus for both the feet-on-floor phenomenon and the breakfast. That way, you wait your usual pre-bolus period (10-15 minutes in my case), and the insulin is already active for both the feet-on-floor phenomenon and for your breakfast. I also keep the bolus for the feet-on-floor phenomenon separate from the breakfast in my bolus calculation, so I do it like this: total_bolus = feet_on_floor_bolus + estimated_breakfast_carbs / IC_morning_ratio. That’s because this morning rise is not driven by carbs, and yet I can still factor in the higher I:C ratio in the morning.

Of course, this means that you have to know the carb estimates for the breakfast before you get out of bed, so perhaps preparing it the night before can work, or you eat toast slices that all have very similar amount of carbs.