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Crazy highs that make no sense

Discussion in 'Parents of Children with Type 1' started by Charlotte'sMom, May 25, 2012.

  1. Charlotte'sMom

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    I opened a new bottle of Apidra on the Sat the 19th.

    On Wed the 23rd in the wee hours of the morning her blood sugar shot up. I couldn't get it to come down, so by noon I changed out her site and put new insulin in her pump. She dropped back down to 100's a little too fast. But since then she's spiked up (and stayed) in the 300s, only coming down briefly now and then. It takes a lot of insulin to get her back down.

    Last night I decided it might be a bad bottle of insulin. I figured I'd change it out this morning. However, her bg came down about midnight and stayed in the low 100s the rest of the night. So maybe it's not the insulin since she eventually came down and stayed there?

    Of course, this morning she's back up to almost 400. She did have a rare Krispy Kreme donut with breakfast. However, I bolused from the Carb King book, and then she didn't eat it all. So she should have had extra insulin on board. Her IOB says it has way more insulin on board than is necessary to bring her back down. But then why the super spike?

    I'd blame it solely on the donut, except this has been our theme for the last 3 days, so it's something else too.

    She got a CGM a couple weeks ago, which has been so helpful. I've been whittling down her basal from almost 8 units to just over 6 and upping her ratios, as it seems she was getting too much basal and not enough meal insulin. It seemed to be working. But maybe I need to up the basals again?

    I'm just at a total loss here. I'd throw out the bottle of insulin, except I'm an insulin hoarder and hate to throw it out if that's not really the issue.

    And no, I've never checked for ketones. She rarely gets them, and only when she's sick. Besides acting thirsty and whiny the first day of highs, she's been acting totally fine since then.
     
  2. azdrews

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    Growth spurt?? We've had this happen often during the past year. I think year 5 is a big year for growing! Every time we go to see Dr. H, Adam has grown at least two cm. every 3 months. :) Usually when I can't figure things out, I log for 3 or so days, then email it off to Dr. H and he'll make some changes for us. Sometimes it's hard for me to see the forest through the trees. :)
     
  3. Charlotte'sMom

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    It could be and I thought about that. I upped her basals so they are up closer to 7 units for the day now. We'll see if that does anything for us. But would a growth spurt plant her firmly in the 300s all day? It seems a bit dramatic for a growth spurt. :rolleyes:

    I have felt like Charlotte overall insulin needs go up and down and up and down. Like she hits a growth spurt and then when it's over she trends low again until I lower her basal again.

    Darn you, diabetes for being so confusing!

    P.S. What is this "log" you speak of? Am I supposed to be writing stuff down?! jk.... I need to be better about that for sure.
     
  4. Charlotte'sMom

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    After a (modest) "rage" bolus, a temp basal increase, and a prebolus for food she still hasn't eaten yet, she's now over 400.

    Breaking out a new bottle of insulin.... *sigh*

    Ketones are 0.1
     
  5. caspi

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    Could it be an absorption issue? We have found that sometimes it's the site that is causing my son's highs (when we've ruled everything else out).

    I know it's very frustrating! Just when we think we've got things figured out, something else comes along.... :(

    ETA: You might want to try giving a correction via syringe with the old insulin first to see if that works. If so, then you know it's not the insulin. Good luck! :)
     
  6. wilf

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    I would consider the possibility of lows followed by rebounds and insulin resistance. Take a look at your records to see when she got boluses/corrections and the testing afterwards, to see if there might have been lows..
     
  7. azdrews

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    LOL! Yeah, I never log...unless I am desperate. :)

    Maybe try a new site location? Adam pretty much exclusively uses his belly for sites, and sometimes when we switch to arms, he actually goes low...so much better absorption there.
     
  8. Lisa P.

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    Checking ketones help so that you know if she's just got more glucose in her (either basal from a growth spurt or illness or food carbs and thank you so much for making me want Krispie Kreme!) than the insulin can match or if she's short on insulin. Ketones mean not enough insulin, which would support the bad bottle or a site problems, etc.

    Two notes from a compatriot -- over the last few years with the CGM, it's become ridiculously clear to me that Selah has a strong immune system and when someone in the house is sick, or a friend she plays with is sick, she often doesn't show any symptoms of the illness at all but has a week of high numbers. I'm convinced her body is pumping out basal glucose to fight the virus, successfully. There's nothing to be done but up her insulin, of course, but then watch for a drop after the viral attack has passed.

    The second, if you're new to the CGM, even as a very diligent uber-testing mom you're going to see it's a whole different world. When I say you're seeing numbers you have never seen before, I don't mean you are just seeing stuff in between the tests, it's kind of a different way of looking at the trends and the movement and the numbers. So don't discount that when analyzing the numbers, it takes a bit to get a "feel" for the new way of seeing numbers.

    Also, do make sure you're double checking the CGM, we can be 100 points off especially on the high end!
     
  9. Charlotte'sMom

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    According to the CGM she hasn't been anywhere near low in the last 3 days. Not even before the 1st drastic rise on Wednesday.

    I thought about this too. Except I did change her site Wednesday afternoon. And she dropped right away (almost like all the insulin finally caught up with her), but went back up again.

    I gave her a shot about 45 minutes ago with new insulin and she is coming down now pretty fast, according to both the CGM and her meter.

    I did check for ketones an hour ago and they were 0.1. (so does that mean it's not the insulin?) I have LOVED the CGM. She's had it about 2 1/2 weeks now. And I've been pleasantly surprised. I expected to see more food spikes, and it hasn't been as bad as I thought. The info for the past couple weeks has actually been rather encouraging. She's even bordered on the low side, getting 1 or 2 unbolused snacks during the day (that she would have eaten anyway). For that reason I've turned down her basal a bit as I could tell her basal was still slowly pulling her down 4-6 hours after her last bolus. Anyway, so these highs from the last 3 days are nothing like we've seen the two weeks prior to that. She's rarely gone above 300 at all, and now she doesn't want to be below it.

    And I am giving corrections based on the meter number. I've seen that the CGM number can be way off, but it's been pretty accurate as far as which direction the arrow is going.

    And that's interesting about a virus wreaking havoc on her bg numbers. That could explain past instances of general highs over several days, followed by normal numbers. That being said, no one is sick in the house right now... not that she couldn't still be fighting something. Something to think about though...
     
  10. emm142

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    Does she get hayfever at all? Around this time of year as I start to have seasonal allergies my BG goes crazy. Just as I got over the highs from reservoir failures that I was having last week, the hayfever crazy has just started for me. 400s today. It never ends. :rolleyes:
     
  11. Charlotte'sMom

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    Not that I know of... but I've had crazy sinus headaches for the last couple weeks! It's a possibility.

    I broke down and opened more insulin, changed the reservoir and did a new site.
     
  12. emm142

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    I hope that solves it for you!
     
  13. MamaLibby

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    My daughter is the same way. Her allergies are bothering her and she's stayed in the high 200s today.
     
  14. hawkeyegirl

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    That is exactly what growth spurts look like for us. ;)
     
  15. Charlotte'sMom

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    You know, I've seen crazy basal needs skyrocket during the evening hours and it seems like I read somewhere that those evening high numbers could be indicative of a growth spurt. (Charlotte's evening basals especially go up and down) But I've never seen such drastic across-the-board highs (in the high 300s) that weren't a symptom of something else.

    But diabetes is always throwing something new at us, so it's entirely possible it's *just* a growth spurt. Just when I get comfortable.... :rolleyes:
     
  16. hawkeyegirl

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    Yeah, sometime we just get them at night, but occasionally it will be a day-round thing. Nothing is ever easy, is it? :eek:
     
  17. kiwikid

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    Are you using a different batch of insulin altogether NOT just a new vial.
    We seem to have days and days of highs with a growth spurt rather than a few here and there. Suddenly we get a break through. :cwds:
     
  18. Charlotte'sMom

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    Apparently it wasn't the insulin. :mad:

    I thought it was better yesterday evening. But this morning her bg started climbing even before breakfast. I gave her a generous breakfast bolus and she's still over 300 and still climbing now. This is even after I upped her basals slightly yesterday. So today we are going to be a bit more aggressive with the basal changes.

    I hate wasting insulin. Darn.
     
  19. Yellow Tulip

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    We see numbers like that when basals are not enough. And it takes more than a slight increase in basals to bring the numbers down. Insulin resistance plays a big part in the beginning, so I usually start with a 150% (yes, I know :eek:) temp basal, until numbers are in range and a first low appears, then I either lower the temp or just change basals to be somewhere between the old value and a 150% of the old value, if that makes sense...

    Here is what I found very helpful:

    I made an excel spreadsheet, where I put all this basal values in one column. In the next several columns I put in formulas to display values for 85% of basal, 90%, 95%, 105%, etc all the way to 200%. So when I set a temp that works, I can find corresponding numbers easily if I decide to change the basal profile. Hope that makes sense... I can send you the spreadsheet if you want. It really eliminates blind changes...
     
  20. Michelle'sMom

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    I use spreadsheets for everything but never thought of this! Great idea!

    To the OP:
    My dd is much older but.....
    with Apidra, we've found that if basals are off by even a little, we get some horrible spikes, & those spikes are really tough to bring down. This is true regardless of the reason for the increased basal need...illness, allergies, growth etc. I've learned to be much more aggressive & have better results with both a correction & a short temp basal increase.
     

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