What happened

So after a few weeks of really fine-tuned BGs, (80's) they are now constantly in the low 100's. Nothing seems to bring it down.

For example, last night BG was 128. I took 4U Novolog to cover, and my usual 4U levemir for basal. But the morning reading was 110. So what happened?

a) I'm not getting enough basal
b) One (or both) of the insulin pens are old and not effective enough
c) BG was still going up from evening snack (I don't think so.. it was a few hours later when I measured)
d) Maybe BG really did go down overnight, but went up in AM bec of Dawn Phenomenon


I'm still pretty new at this. There are SO MANY unknowns!

To figure that out, I'd ask a couple of questions (*looks @ profile*...hmmm probably not the end of the honeymoon....). I look at fasting as "basal" and post-meal as "bolus" and make adjustments to each on that basis. If one runs high or low, I will kind of roll with it for a couple of days, if it doesn't go away then I'll adjust basal or bolus +/- a notch or two on my pump (.025U/ hr basal, .1U carb/insulin ratio...). Maybe try adjusting a small amount, say 5-10% and see what happens, ideally in a sort of controlled situation, certainly with plenty of medicine available in case you run low!

Morning numbers can be highly variable. If you sleep poorly, blammo, you can wake with a higher numbers. If you go to bed early or late, again, blammo.

If I awake high, I correct if needed and write the number down. Then, I average my morning readings over a week or more and see if there is an average trend. If I am awaking at like 130-150 mg/dl every morning, then I make a change to my overnight basal. I split my basal and take my Levemir at night (dinner) to address morning numbers.

As to your particular numbers, I think your insulin levels are likely in need of adjustment. "Covering" with 4U seems like a lot if your basal is only 4U.

ps. A 110 mg/dl in the morning is actually pretty darn good.

ps. A 110 mg/dl in the morning is actually pretty darn good.

Maybe we need a "total perspective vortex" for bg numbers.

I remember getting chewed out by docs because a spot lab bg when I was sick as a dog (stomach problems), was 110. I thought that was quite excellent (and the result of hard hard work) considering I'd been sick!

We probably also need that for A1C numbers. When I get my lab paperwork back I am always amused that an A1C of 5.7% (my lowest in a LONG time) puts me at "decreased risk for diabetes". Oh, that's a relief, I thought I'd had diabetes for 30 years now :-)

I imagine I need to really run some self-tests to get the basal right etc. BUT I think (b) was true - I started a new Levemir pen today, and using the same amount of it as I have in the past few weeks, when i couldn't get my BG lower than 100 - I just went down to 54 (yikes!)

Your numbers are very good...One thing you will learn with time is your BG is always changing, if you disagree just wait 10-15 min and re-test, I never realized just how unstable mine was until I started using a CGM.

Remember every day will be a new opportunity for success...;-)

Things change over time. The only constant with diabetes is that....nothing is constant. Hormones, minor illnesses (like the kind you barely even notice), weather changes, etc. All have an effect on BGs. I do notice that around this time of year, when the days start getting shorter and the weather cooler, my insulin requirements go up. I have no idea why; it's just the way it has always been.

I have always used a little more insulin during the winter months I think my body just needs a few more calories in cooler whether.

you guys are all awesome for taking care of the newbies!

Me too. At the peak of summer I was around about 13-14 units total for my basal and was still running a bit low. Now with fall starting to approach, and the shorter days, and HOPEFULLY cooler weather around the corner, that insulin need is slowly inching back up.

You have to laugh about that always nice to be told you are at decreased risk for something you already have !

You're probably right about the pen/s being old, since each pen holds 300 units and technically speaking you are only supposed to use it for 28 days - and then throw it out - perish the thought, but at 4 units total a day ? say 2 units for priming that's 50 days for a pen a bit past it's use by date. But also as everyone has said the only thing constant about D is change. So even when you think you've got it right, the slightest thing, hormones, emotions, phase of the moon, weather,exercise can screw it up. So don't get too worried about the numbers so long as they average out ok, without too many lows (54 yikes)you really can't do much better than that, but I do appreciate you are "thinking like a pancreas" in your efforts at control.

Last September/October I suddenly became "insulin resistant" where I was suddenly needing about 70-80u of insulin per day rather than 40-50u. Then, this past April/May it suddenly went back down to the usual 40-50u per day. Now, September, I've noticed I'm having more highs than before despite using higher pump settings ... It will be interesting to see if the "insulin resistance" happens this winter, too, in which case that'll be a first and another MAJOR factor in my control.

Sometimes I just have to shake my head at you newbies as you freak out over readings like 128. That’s not the Type 1 I live with. If I mis-dose my lunch bolus by .1 or .5, my BG goes to 250, not 128.

I’ve been trying to eat lower carb for the last 6 months. All it’s done is make me even more sensitive to carbs, so that eating 4 M&M’s can raise my BG 50 points. I really think that Type 1 is a disease of non-equilibrium. Whenever things seem steady regardless of what you’re doing to get steady, BG numbers will go crazy just because that’s Type 1. I’m not convinced that I’m healthier at 100 carbs per day than I was at 250 carbs a day. I really miss oatmeal and I just don’t like Greek yogurt.

To the original poster, the numbers you’re mentioning are within the 20% accuracy of BG meters and are just not that significant. You’re doing great.

I am with you. It sucks to have to count absolutely everything, protein included now too. But c’est la vie. I wonder if you inject or bolus and wait long enough that you are trending downward that you can use your oatmeal to raise you and get your fix. I’ve been fooling around with this once in awhile to taste something I’m missing. Problem is if you wait too long or misjudge absorption you’ll go low.
Education is everything when it comes to this dx. Keep reading newbies. Don’t freak out. Test, keep a journal, and cut yourself some slack.

i don't understand about going downwards. please explain. thanks

A lot of the folks on TuD have a (CGM) or continuous glucose monitor. It is a sensor that attaches and you can basically get your blood sugar at any time by looking at a monitor that you keep with you. The sensor tests your interstitial fluid not your blood so it can be a bit off, but it can tell you your trend is going up or going down or just staying steady which is what we all attempt to do. Problem is we don't have a functioning pancreas so we have to do the best we can. You can google "Dexcom 7" to give you the full run down on one of the CGM's available.

If your BG is not where you'd want it to be and you are going to eat, you can bolus and wait to eat. In my experience maybe just wait like 15-20 minutes and then eat as if you wait too long, like Molly points out, it can get hair raising the other way with potential to run low. Particularly in the AM, waiting can be a good solution.

Acid, is this the case you mean?: Let's say the BG is higher than I would like it to be before a meal, and I am about to eat. I would take the amount of insulin that is appropriate for the meal + an additional amount to cover the high BG. You're saying in this case to wait longer, or less than usual? (15-20 minutes is how long I usually wait after taking Novolog before a meal).

The biggest factor for me is stress. :) I can go from mid 90's to over 180 without any change in diet or exercise routine. My readings can also go high if I am getting sick as well. I get different readings from different injection sites too. Its just one of those things. :)