High blood sugar even with insulin adjustment

Hello, I have had great control over my type 1 diabetes since diagnosed back in 2014. My A1C’s have been around 5.4 for the last several years. For the past few months, my numbers have been going up (especially my morning numbers). I have always had to deal with the Dawn Phenomenon, but I would quickly correct it with some Novolog (and it wasn’t crazy high…around 140). So lately, my numbers have been in the 200’s when I get up and it is more than alarming. I eat VERY low carb (always have), so it has always helped keep my numbers lower. I tested my bg in the middle of the night and sometimes it is normal (85-90) and sometimes it is slightly high (120-130). I tried increasing my night time dose of Levemir and my numbers seemed even higher, so I decreased and there was still no change. Now even my numbers throughout the day are higher than they usually are and no matter what I do (more Novolog and Levemir or more Novolog and less Levemir) nothing is changing. I am at the end of my rope here. As a side note, I have been having irregular periods and my GP said I was approaching menopause (I am 49). I am also quite thin (5’6" and 112 pounds), so I would be surprised if I am insulin resistant now (I know even people who are thin can be, but my doctor doesn’t think I am). Another note, I do wake up drenched in sweat, so I did think that maybe I was dealing with the somogyi effect instead of the Dawn phenomenon but lowering my Levemir dosage didn’t seem to make much of a difference either. I haven’t changed anything in my diet (last time I had some issues, it was due to a keto ice cream I was eating after dinner and as soon as I stopped eating it my numbers went back to normal), but I haven’t been eating anything different this time. I don’t use a pump or a CGM (I like the “old school” ways). What could I possibly do if I tried both increasing and decreasing my Levemir and neither helped? It really sucks that I don’t eat any sugar (except for what is in berries) and I don’t eat bread, pasta, rice, potato, cereal etc. and I still have high blood sugar! thanks!

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Hi @krit138 . I use a pump so don’t want to (and can’t) advise you on your injecting protocol, so I wanted to suggest you check out posts on Levemir on the forum. There are a number of discussions on the topic and there are treasures to be found in the comments as you wait for responses (be sure to be the date - sometimes posts are old).
I also wanted to commend you on your enviable A1C! I haven’t been at that level even on a pump, although for me I think it would be uncomfortable. As the saying goes, “If it’s not broke, don’t fix it!” so keep up the good work with this shots. I hope you get some input soon.
https://forum.jdrf.org/search?context=topic&context_id=69783&q=Levemir&skip_context=true

thank you wadawabbit! I will check it out.

I also wanted to note that I take Levemir 2x a day (had to split my dosage several years ago because one dosage wasn’t lasting a full 24 hours). Once split, my numbers were consistently good.

I noticed that in a former post but since I can’t really speak to it I didn’t want to mention it - you’ll find mention of it in other posts. Happy reading!
PS - if you’re new to the forum please know, people here live with diabetes and share our experience and give suggestions of this to look into. We’re not giving medical advice so check with your doctor if you are not experienced with making changes.

hi @krit138 in order to control something you have to measure it. I would want to know as close as possible what’s really happening, not guessing, not feelings, and so the right move would be to wear a CGM or get up every hour and take a finger stick. This is different than committing to wearing a cgm forever, this is for input information and so it would be probably 2-4 weeks of data for the purpose of understanding.

every person alive has insulin resistance. It is not a question of “if” it is a matter of degree. in some cases the degree, or the total resistance, shifts, for me it shifts in spring and fall and is based on temperature and on baseline activity.

hope you get more data. IMO it will really help. cheers

Hi joe, I check my blood sugar A LOT and write everything down in a “diabetes” notebook (have done that since I was diagnosed), but I do agree that I need more data throughout the night. If my numbers don’t improve by tomorrow, I will call my endo. and see if I can wear a CGM again for a week or so (did that when first diagnosed) to see if we can figure out what the hell is going on. I don’t usually see any changes in my numbers due to seasons, but I live in Florida and we don’t really have much of a change in seasons. My activity levels haven’t changed either. thanks!

you’re welcome and this sounds like a great plan. there are so many factors besides weather, that can affect baseline insulin sensitivity (sensitivity is a better word than resistance, but mathematically sensitivity is the inverse of resistance).

I have confidence you will find a cause and a strategy that works for you if you put this kind of energy into the problem. cheers!

100% agreed that you need more data to guide corrective actions.

As for why it’s happening, though, I’d guess it’s menopause (note: I am not a doctor, either, so definitely don’t take my word for it). Hormonal changes change insulin needs dramatically, and somewhere around late forties/early fifties, irregular periods and night sweats sound like hormonal changes. In other words, nothing you’re doing wrong: not your fault, not under your control. So of course talk with your doctor, but it sounds like it’s just another day that ends in “y” as far as diabetes management goes: follow the numbers. They’re not good or bad, they’re just information.

(Sorry for the lecture: clearly, with your history of great control, you don’t need to hear it. I mostly typed that out as a pep talk for myself! :slightly_smiling_face:)

Thanks srozelle and joe! The weird thing is that I have been trying to correct that morning high since 5:30am today and the number isn’t really going down too much! Started at 202 and so far I have given myself 8 units of Novolog and my number is still at 160 (that is more insulin than I usually use in an entire day!). I did have breakfast, but that was only a very small helping of eggs and 3 strawberries. I also gave myself 11 units of Lev this morning instead of 9. Number still at 160 at 11 am. wtf? I have never seen my numbers unaffected by Novolog in this way. Luckily I had a brand new Novolog pen with me here at work, so I am going to switch to that one to see if anything changes. Thank you everyone for your advice!

more data…so I just threw away the Novolog pen I have been using the last few weeks and gave myself 2 units of a new Novolog pen at 11am (number was 162) and I just checked my number before lunch and it is now 102 (yay! finally came down). So perhaps the fact that my number wouldn’t budge all day even though I gave myself 8 units over the course of 3 hours was due to bad Novolog (even though it wasn’t 28 days out of refrigerator yet), but that doesn’t explain my horrible morning fasting number. More investigation needed.

Not to fault your record keeping choice but have you thought about using tracking apps and downloading your readings? I’ve had diabetes for nearly 60 years and really prefer doing it that way - I do remember putting everything on paper but the graphs from my CGM downloads are particularly helpful for discerning patterns. I understand you can duels standard meters and some pens now, and there is an app called Tidepool that combines data from different devices. My pump/CGM are connected to my phone via Bluetooth, and I’m linked to my doctor’s office so if I need them to look at something they can pull me up easily. I do recall the days of reading over the phone and find this much more efficient, I think for doctor as well as me.

wadawabbit, download my readings from where? Excuse my ignorance here…are you saying I can download readings from my meter? I don’t think it has that capability, but I can check. I kind of like writing it all down (I currently work in an R&D lab and we write EVERYTHING down in lab books, so I am used to doing that and being extremely detailed).
I really never needed to have more extreme records/data since my numbers are usually quite good, so I never looked into any other record keeping methods.

I agree with the advice @Joe offered, rather than making a guess, measurement is really much better. Also from what you wrote, it appears that your doctor, and you, are aware of the professional CGM that a patient will wear for 10 days as an assist in insulin adjustments. Finger-stick BG checks can be good, but in my opinion, the CGM is miles better; and like you, I too write everything in a notebook - 15 years ago when we downsized, I had to dump almost 50 years worth of “diabetes notebooks”.

You didn’t mention if you check your BG when you awaken during the night in a heavy sweat; for me, this was an indication that my BG was critically low. Yes, the body can “self cure” this low, and in the ‘natural’ process the liver will flood the body with stored glucose - this glucose dump could possibly contribute to your higher-than-expected BG readings when you get up in the morning. A possible contributor to low BGL when sleeping might be the timing of your evening Levemir which has an onset 2 - 4 hours after injection. I can’t relate to your very low carbohydrate diet - I have consistently, since diagnosis in the 1950s eaten meat & potatoes, pasta, fruit, etc. providing me with over 200 grams of carb every day.

Even though I’ve lived in Florida [Manatee County] for 21 years, my diabetes is still affected by seasonal temperature changes - although not as severe as when I lived in Massachusetts.

No problem. I would think that most or all meters have a USB port that downloads your readings from your meter to software on your computer, and some even use Bluetooth to send readings to an app on your phone; but you would need to check the specs for the meter you use.
If what you’re doing works for you keep going - I just wanted to let you know about some of the options out there. If you’re checking your numbers A LOT you might do well to look at a CGM. If you try one as @Dennis suggested you might be pleasantly surprised at how convenient it is. You can simply take a peek at your receiver anytime, anywhere, rather than pulling out your kit to test. I use one by Dexcom which has lots of bells and whistles and works with my pump to display updated numbers every 5 minutes; but there is a simpler one called Freestyle Libre which you scan periodically to show you how you’ve been doing. I certainly don’t know about your insurance but I believe monthly cash cost if you pay out of pocket is less than the cost for the test strips.

I have checked my BG at night when I had the night sweats and it was either normal (in 80s) or slightly high (120s). I was going low at night only a few months ago (along with the sweats) and I would be up eating a glucose tab to fix it. The lows then stopped and everything was normal again up until a few days ago. BUT even when I went low at night and didn’t eat a glucose tab, I didn’t wake up high (no liver dump). I learned a while back that a small amount of alcohol before bed helps prevent the liver dump (yeah, I know…sounds like a bad idea, but this was discussed with my endocrinologist and he was fine with it; I take one shot of rum or vodka before bed 4 nights a week and it really helped keep my morning number under control).

Like I wrote earlier, I switched to a new Novolog pen and now my numbers are good again (102 before lunch and just checked and it was 89 (over 3 hours after lunch). I don’t think a bad Novolog pen would cause my morning numbers to be as high as they have been the last couple of days, so I still need to figure that one out. I will see what tomorrow morning’s number is and then contact my endo. to see if he can hook me up with a CGM again. thanks for your advice!!!

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My endo. prescribes me a shitload of test strips because he knows I test A LOT in order to keep a good eye on my numbers. With the test strips manufacturer’s discount card I get 50% off my co-pay too, so I am only paying $15 a month for all the test strips. I was just going to pay cash for a CGM, but then read about the consumables and more than likely my insurance won’t cover it (I was told you have to apply to get permission to get the CGM or a pump and the doctor has to show that you have trouble controlling your BGs.). I don’t know if that is true, but since my A1C’s have been consistently in the low 5’s, they said I wouldn’t be able to get the ok to get one. I will still ask my doctor anyway.

It can’t hurt. I believe when I first got my CGM you had to show medical necessity. From what I read on the forum it seems new newly diagnosed Type 1s are getting on board right away or not long after diagnosis, although I don’t know if things are different for this of us with more experience. But do look into it. Some CGMS now fall under pharmacy benefits rather than durable medical equipment (DME), which could explain what you read about consumables. Insurance coverage does vary by plan and I’m just talking very generally so do, do some further research. I mentioned cash expenses before just to suggest a comparison of costs. While your out of pocket is great, there’s still the amount your plan pays - again, I don’t know your plan but it’s possible their portion could be less for a CGM as well.
As you may or may not have noticed :blush: I am a big CGM advocate. All those finger sticks do damage to the skin over time. I used to have calluses and marks on my fingertips from repeated testing over the decades - a manicurist looked at my fingers as she was doing my hand massage and was trying to figure out what was going on. English was not her primary language and I certainly want going to demonstrate as she was about to work on me!), and they have since disappeared.
Some diabetics have harmed themselves in the process of keeping tight control. If your 5.4 A1C has worked well for you with no problems, that’s wonderful. Keep in mind (when the time comes) that as you get older you might want to aim a little higher to allow some wiggle room for body changes that might happen with age. You sound really on the ball - kudos! - but this could be a factor in getting you approved for a CGM. Although you are running higher right now unexpected things are happening that could possibly go the other way. A CGM can alert you if you need to take action or keep an eye on how you are trending.
I don’t want to frighten you - just give you some points to discuss with your doctor to make the case for medical necessity if it’s needed.
The link below references people in their 80s and 90s but factors other than age may play a part (my thought); so talk with your doctor about your personal situation to see if it might help make a case for a CGM

wadawabbit, thank you so much for all of your advice! You rock!:slight_smile: Yesterday I took a closer look at my meter and it does have a computer data port! Cannot believe I have been using that thing for years and I never even noticed that! I will have to get a data chord and try it out.

Last night I lowered my Levemir dosage by 1 unit and this morning I was 160 instead of in the 200s. Still not good, but at least it went in the right direction this time. I am still planning on talking to my doctor about the CGM. My insurance does have “condition care” and I pay less of a co-pay for any meds (even brand name) that I need to keep any conditions under control, so I will talk to my insurance company about the CGM also.

My fingers look pretty normal even with all the sticks. I stick in various areas and on various fingers each time so that has helped.

It is funny you mentioned the “tight control” thing. My endo. is very happy with my tight control, but one time I went for an appointment at his office, I saw his Physician Assistant instead and she seemed to have the opposite opinion and thought I should bring my numbers up. So far I have had no other issues (liver and kidneys good).

I also have a “diabetes alert cat”:slight_smile: He stands on my pillow and screams at me until I wake up when I go low in my sleep! Unfortunately, since we just got another cat, he hasn’t been doing that as much (new cat is a jerk and harasses him, so he has been “off his game”), but hopefully he will adjust:) I know, not really a good alternative to a CGM, but…

ok, sorry, I was rambling there! Thanks again for all your help! This forum has been fantastic and I always seem to receive a lot of good advice really quickly.

Feel free to ramble - it’s nice getting to know more about our forum friends! Way cool to have an alert cat. Was he trained, or did he learn on his own? Some of our furry friends do pick things up and can be great life saving animals. Unfortunately he is not being very professional at the moment but letting a new pretty into the territory can cause problems. When we adopted our dug a few years ago she was our only pet - still is and is spoiled TOTTEN! We thought it would be good fit her to have a furry playmate but she’s so used to being THE ONE we just sweep the idea under the rug.
Yeah, the USB plug is a hidden treasure. You can keep writing if that’s what works best, but I find sharing with my doctor is super helpful. Mine had to send me a link or some information so I could share my data with them.
When it comes to the prickly topic of fingers my problem was I always used the pads; and because of the calluses I had to set a deep depth for my sticks - so if I did try the side new and then bit did it hurt! I had a meter (don’t recall which) that allowed for alternate site testing but anyplace else made me itch😫.
I find its best to leave it to the pros when it comes to getting devices. When I’ve talked with my insurance about coverage details of usually comes back to getting getting info from the doctor - at the very least s/he will need to provide a prescription. I would suggest letting your doctor know you’re interested in a CGM. With Dexcom they put me in touch with a rep who would ultimately do training. The rep worked with my insurance and I believe got the necessaries from my doctor to put things through - that’s how I recall anyway. I don’t believe Freestyle required the training the Dexcom did (as I mentored before Dexcom was some advanced features some of which apply only to people who pump), so your doctor’s office might just need to provide a scrip, and any special information your insurance may need for approval. My doctors’ offices have ask been very adept at navigating any red tape so give them whatever they may need to make your case and let them or a device rep do the work.
Keep up the good work with your A1C, and keep in touch with your doctor about what would be a good level given your age, health, pregnancy goals (if applicable) etc. I’m not a medical professional but it looks like you have some wiggle room.