Since about 2 months I have been getting very high glucose levels, in the 300 range after eating lunch and dinner with little carbs, 25 gram range(breakfast is mostly protein). Correcting it takes a lot of time for the glucose to come back down which means that from about 1pm -9pm I run extremely high. Sometimes all of a sudden I start dropping very fast and risk very low glucose levels around 5pm. It has been quite an exhausting time trying to figure out together with my endo what it could be and we have not found it yet. I changed from novolog to Humalog, changed pump manufacturers, infusion sets but it has not made any difference. My stress levels are not very high, I exercise a lot (running, biking, swimming) and have used a CGM to monitor my levels for the last 5 years. I have been a type 1 for 14 years.
Anyone any suggestions? Could Symlin help?
Sounds like you should go back to the drawing board and test your basals and then work on revamping your I:C ratios as well as your ISF. Have you done this?
Thanks Zoe, no I have not done so but the changes are pretty dramatic and all of a sudden, could it be age? Hormones? I am 45 years old
Those are definite possibilities, Valerie. But personally I would be less concerned with the cause as with working on tweaking doses to get my blood sugar more in line.
It could be your age and it´s easy to find out,- just a few blood tests. Then you would at least know what´s causing this. Either way it could be wise to follow Zoes advice. What you do today doesn´t work. Do the basals, I:C ratios and ISF all over again It seems like it has to be done no no matter what causes the dranatic changes you experience.
I would guess that if it's just your post meal numbers that are off, it might be your carb-insulin ratio could be decreased (i.e. more insulin/ food...). Another potential culprit could be the protein. I usually try to "cover" some protein, in a very primitive manner. I've read here that 53% of protein is "converted" to carbs so if I have a couple of eggs, I figure maybe 5-7 "bonus" G of protein and cover that with my bolus. I would play around with insulin amounts before I would bother with Symlin but I am very comfortable making changes. If you can post some more specifics (numbers...) we might be able to help you identify the "culprit" here. I am never satisfied working at "endo" speed which always strikes me as sort of plodding.
My wife would regularly have blood sugars in the 300 mg/DL range after meals until she switched to a ketogenic diet.
You said you ate very little carbs -- 25 grams. That's not very many grams of carb compared to the typical American diet, but it was certainly more than Nicole could safely compensate for.
It left her open for a very wide error margin.
Nicole would either end up giving too much insulin, or too little, with a meal of 25 grams of carbohydrates. Since she wanted to avoid lows, she'd usually would end up high. She also settled on a higher target blood sugar. All of which made her quite sick (e.g. kidney failure).
She now has 2-5g of actual, digestible, carbs for breakfast and lunch (per Dr. Berstein's instructions in Diabetes Solution).
Funny thing is, even a 2g meal will act upon her blood sugar as if she ate 12g ("Chinese Restaurant Effect" is certainly applicable for her).
Hence why we don't even bother counting carbs -- we just avoid them as much as possible. We just measure out 2 cups of low-carb vegetables for each meal (which we then cook) and add 4+ ounces of protein and lots of fat.
On the pump she was taking 1.3 units of Humalog to cover this. Her blood sugars would never jump more than 36 mg/dL (2 mmol/L) -- most of the time only 18 mg/dL (1 mmol/L). She's now switched to needles, and is taking 2.5 units of Regular.
Which brings up another point -- remember to count the protein. I don't think it's so much a matter of gluconeogensis. It's more so that it expands the small intestine and triggers the release of glucagon. Nicole still needs 3/4 unit of Regular to cover 1-1/2 cups of zero-carb homemade yogurt. We ferment it for 36-hours. There's no carb left in the yogurt, but it'll still raise her blood sugar 36 mg/dL.
But the big player is the carbs. When we minimized the carbohydrates it really took away 80% of the challenge. Fat has no direct effect on blood sugar levels, yet is supplying all of Nicole's energy needs quite fine.
I hope that helps.
Thanks all for your advice. I am wondering if anyone else has sudden changes in insulin requirements like this. I am going from and I:C ration of 1 unit for 12 grams to three of four times as much.
My night time basal rate is the same and seem to work fine.
So you need 3x to 4x as much insulin for meals than you did before?
A few things that come to mind, based on my research and experience:
1. You are developing insulin resistance (type 1 diabetics can also become type 2 from too much insulin).
2. You are absorbing food better.
3. You are having an allergic reaction to food that is causing a cortisol response (driving glucagon).
4. Something is wrong with your insulin. Make sure it isn't cloudy (compared to a new bottle). A bad or spoiled vial will be a lot less effective. Trying a new bottle can eliminate this possibility.
Interesting suggestions, thanks!
I passed the suggestion of insulin antibodies to my endo but he said the only way to treat that is with more insulin which I am already doing, he said it was hard to test for.
1. type 2 seems unlikely as my night basal is fine but I am only seeing this with food. But I am no expert on type 2.
2. food absorption faster; however with type 1 I can only think of delayed gastric emptying which would give an opposite effect
3. I think the allergic reaction is interesting and will discuss it tomorrow with my endo, as I do not always have this reaction and therefore it makes treatment so difficult (over-bolusing resulting in lows...)
4. I changed vials and brands, pumps brands and back to injections, the only thing I did not do is go back to Lantus but my basal is not the issue I think.
I still stand by my comments about the liver and metformin. Anytime one sees fast shifts of glucose high; that shift is usually do to unexpected liver glucose release - I call liver dumps.
I have had those and found that only metformin can stop that.
These large dumps can cause the musscles to get overloaded with glucose and see the insulin resistance jump up and excess insulin needed. I have never seen normal digestion able to cause fast humps in glucose - yes slowly raising but not fast jumps!
When my BG runs high, I figure that I don't have enough insulin, adjust something and, so far, it's gone away. I'm sort of dismissive of the "liver thesis" but drink a lot to keep my liver (among other things...) in line...
I think liver dumps are a characteristic of T2 more so than of T1. This is another manifestation of insulin resistance, the liver receives a signal to release some glucose but then fails to receive the signal to shut off.
Look, T1 and T2 are not separate orthagonal separate diseases
but varients of problems in a multi-organ-multi-hormone digestive chemical plant encompassing pancreas, liver, kidneys, intestines, thyroid et all.
when some one says they see their Blood glucose levels hanging high, slowly rising to 300; yes I agree much of what has been stated seems valid.
The original post talked about fast rising levels to 300. The only thing i know and observed on cgms that can do that is the liver and it is banging the levels up that high in minutes.
Yes, I am type 2 - great but: every time I let my blood glucose drop sub 70 my liver would shoot up the blood glucose to 511 and slide back to 278 to 311. My cgms could not follow that jump and only show the average up to 300 while the caveman fingerprick could follow the instantaneous level up to 511 max.
When I used to eat a snack as my blood sugar was falling after a digestion end cycle ( BG was 140 to 200) I would watch my blood glucose stop falling and after a few minutes accelerate thru the roof to 311 average. THe only thing that would stop that monketshines was to ensure metformin up to strength in the blood at the time this event was likely to happen. ( 1 hour met dose before eating meal.)
Its the same argument that metformin is a type 2 drug. Nonsense, it is a liver drug stopping excess liver glucose release and some type 1's are now using via their endo's.
Having watched and solved these issues with my Doctor, on a cgms many months, I am tired of these arguments of sophistry versus what the test equipment is logging and showing!
Best wishes and good luck!