So background: type 1, using humalog in an Animas Ping since April 2011. The past 3-4 days I've been running very high blood sugars for no apparent reason. My diet is the same... mostly chicken, lean meats, lots of veggies. I eat approx. 75-125g carbs per day. Wednesday I woke up high (349) after going to bed around 98. It ran on the higher side all day, but came down eventually. I did a site change right before dinner that night. I wound up with a bent cannula, knocking me up to 450-500 for several hours. Good thing I had a salad for dinner as I felt very sick. I d/c my pump completely and switched to humalog/lantus for the day Thursday. Woke up high (360) Thursday again, but feeling better. I corrected per usual with my pen and it floated around 160-260 all day. I chalked it up to needing a higher Lantus dose than I gave myself the night before. New supplies arrived in the afternoon and I hooked up my pump right before bed. My post-prandial dinner BG was 133 and before bed was 95.
Here, I figured everything was ok. I woke up this morning a little low, in the 60s. No big deal, corrected with using 15g of sugar in my coffee this morning instead of splenda. Ate breakfast (pre-meal 71). Had 28g carbs total... toast, bread, jam. An hour and a half later I was back up to 400. I've been stuck up here since. No bubbles in my insulin and my (new) site was fine. I changed everything out, of course, dumping a substantial amount of insulin in the process.
I've taken a LOT of insulin to chase it down, with no change. I'm afraid to take anymore for now (as I don't want to go low). Is this severe insulin resistance? Why all of a sudden? I'm afraid I'll end up in DKA at this rate and am not stressed (other than this issue!). My doctor's office is closed for the weekend now so I'm not sure what to do other than wait it out and keep testing.
The one thing you don't mention, kphil, is the insulin vial. Perhaps it's no good? Do you have another vial you can switch to and see if that's the problem. The other thing I would wonder is if you are sick, or incubating an illness or else taking any medication.
Only other suggestion I would have is not to wait as long to act. If I woke up at 349, I probably would have changed the site right away. Once you get up to those serious highs it can be harder to correct, and your usual ISF isn't enough.
Finally if you stay stuck that high I would test for ketones, and not hesitate to go to the ER if you have ketones and start becoming ill.
A few years back I struggled with unexplained overall high blood sugar numbers. While my A1c for years was in the 6% range, it drifted up as high as 8.5%. The doctors were no help in correcting this situation.
Looking back, I now conclude that I developed a resistance to insulin. My weight was creeping up during this time; I added about 15 pounds over three years.
I finally was able to pull my BG's down to the 6% range again with regular exercise, losing about five pounds, and starting on a CGM.
You mention that one morning you woke up with a BG of 60. If that low level of blood glucose had a duration of a few hours then your liver and counter-regulatory hormones made your body very resistant to your morning basal and bolus insulin. It's been my experience in this type of situation that my BG number is elevated (200+) for six to eight hours after I get up. I know that one of the cardinal rules for regaining overall BG control is to first stop the lows.
I realize that my experience may not apply to you but thought it could.
Good luck in figuring this out. I would be interested in reading about your ultimate solution. You seem like an organized and observant person. Those traits should help you regain your BG control.
This really bites. I have to tell you, going very high can leave you insulin resistant. When you woke up this morning, you may have restored a normal blood sugar, but your body may still require days to recover from this ordeal. When you have a very high blood sugar, you may require like double the amount of insulin expected to normalize your blood sugar. Some of this is probably a natural mechanism which downregulates glucose uptake, but it also may be due to dehydration and loss of sodium This has been known for quite some time as people who go into DKA can exhibit severe insulin resistance. And unfortunately it can persist for many hours if not a day or two.
I would recommend that you drink plenty of fluids and try to restore your electrolytes, sodium, potassium etc. And just don't be surprised if you appear insulin resistant as your body recovers. Just take the insulin that is required to maintain a good blood sugar reading, that is just what your body needs right now. It won't do you any good to skimp on insulin and just run high.
Not sure what happened with your control to bump you up the first time, but switching over to Lantus and a pen will most likely cause changes.
I use much less insulin while on a pump. I had to bolus with a pen when I left my Omnipod PDM at work and ended up running high most of the evening. Your highs after switching over to penss could definitely be because of differences in the pen delivery versus your pump.
Your morning low after going back on the pump was probably due to residual Lantus.
How long did you give yourself after correcting with the 15g of sugar before taking your pre-breakfast BG? You went from the low 60s pre-correction to 71 pre-breakfast. That doesn't seem like much of a change from 15g of sugar.
Maybe you were still on your way up when you tested and under-dosed for the correction + 28g at breakfast?
thanks for all of the help. I drank a few bottles of water and took a nap. Now I am down to 132 thankfully! It probably does have to do with going so high after my bent cannula the other night and I will just have to keep testing to make sure I don't go back up high.
Luckily my ketones were negative. I seemed a bit resistant off both the pen I was using and the vial, which both looked normal and were within date (and kept refrigerated safe in my butter drawer).
well, I hope the problem has resolved itself. SO glad to hear you're back down and feeling better...yes, high blood sugars feel HORRIBLE. would much rather be somewhat low then even a bit high sometimes.
