Bouncing of Blood sugar

[matin34]

I am type 2 diabeteic patient. Due to skipping meal, I developed adrenaline stress and by diamicron  metformin
But blood sugar was never high. Doctor gave me Lantus and Humalog. It was working well for a year. Then blood was becoming high, Doctor gave me LEVEMIR. If I take 10 units of humalog, after two hours sugar drops 4 points, I think this is the right dose for humalog for what I eat. I eat 60 gram Carb every meal. But 3 hours, sugar tries to go low, but insead, it bounces back and proceede to values and I start to feel hypo,  though I never see sugar 9. It is not hypo value, why sugar bounces up, why feel shaky, fear etc. I use LEVIMIR as base insulin. Why body is obstructing sugar to low, and why it gives hypo feeling.

Can any body me the reason and how to overcome this situation? My sugar is going high now.

MATIN

[diabetes86]

60 gr is a lot of carbs/meal  (for me, I keep it under 20gr)

Have you herd about the law of small numbers?

if you eat small amount of carbs, you use small amount of insulin, you have small BG swings.

you might need Apidra Insulin it is faster than Humalog (might help with the 3 hour low)

Or your timing on the insulin is off, might have to take sooner before eating so its running out as your BG drops  Before 3 hours

when your BG drops too far your liver will dump glucose to raise BG but it over does it

[matin34]

Thank you for your answer
Yesterday night, before going to bed, blood pressure was not high. It was very close to 100/60. I was hesitating to take 300mg Avapro(BP medicine)
I took 22 unit of Levimir at bed time. At 4am, I woke up. measure the pressure , it was 165/100. I took 150gm Avapro. My sugar was 8.1mmol. I got up from bed, sit down quietly for 10 minutes. BP became OK. I went to bed again, and got up at 6. BG was 9.4. I want to bring morning sugar to 6or 7. I am facing a very unstable situation in blood pressure and sugar and these two are working against each other

After 3 hours of eating, no humalog is there, but why I feel shaky and then BG starts increasing? Though sugar is not low.

MATIN

[diabetes86]

Humalog lasts 3 hours in me.

What was your BG number when you felt "shaky"

Could be a "false Hypo"  you body is used to high BG numbers, when it gets a number that is normal your body thinks it is to low because it thinks normal is 9 so 4 feels low.

[matin34]

Is there any way to stop this false hypo and dumping of sugars by liver?

Do you have any idea about Levimir ? Does it lower sugar in day time?

[diabetes86]

Getting used to lower BG is the cure for a False hypo

Levimir last 24 hours so yes it works in the day.

you need to keep an ACCURATE  Log, you need to test before bed, when you get up, before you eat, then 1 hour after 2 hours after  and any time you feel wrong.  

time      BG test        carbs eaten       insulin used

do all that and you should see a pattern develop.  just guessing and testing willy nilly, will get you willy nilly info.

[matin34]

I was trying to bring the morning sugar to 7 mmol. Yestarday night and day before night , I took 24 units of Levimir at 10 pm, In both the days, I woke up at 4 am, sugar was 8.1 and 8.4, I went to wash room and go to bed again, I measured at while in bed it was 9.4 and 9.9, I ate a cookie, it went down 1 point. How can I bring down BG to 7, How can I stop the liver dumping.
I am giving you yestarday's history.
AT 4 am I woke up, sugar was 8.1, went to washroom. Went to bed again,, got up at 6am, sugar is 9.4.
I ate, 45 gram of brown rice + Cabbage + 15 gramm of milk(1cup) +2 spoon of olive oil.
I took 11 unit of HUmalog, Sugar 8 am is 10.4 but 11.9 at 10 am, Then I walked to bring it down. Before eating at 11am it was 9.3 at 1 pm it 10.6, before super at 5 pm it was 9.7, I was taking 1 cookie at 3 and 4 pm at 7 pm 11.1, it was going high, I walked brought down to 9.4 at 10 pm and the 24 units of levimir
I took 10 units of humalog before lunch and 11 units of humalg befor super.
I have lot of anxiety.

MATIN

[diabetes86]

Anxety can raise BG

looks to me like you need more insulin and less carbs.
your not matching the carbs with insulin thats why your high at 2 hours.  stop eating cookies for snacks (if they are the same thing as what I call a cookie), find a low carb snack to eat.

Your 2 hour post eating BG should be almost the same as your pre-eating BG in its hi you need more fast insulin and or less carbs.

carbs raise BG


Metforman helps with DP by slowing the livers ability to dump sugar.and it helps with insulin resistance

[matin34]

Actually my complicacy was not eating sufficiently in 2009, Metformin and Diamicron created stress on adrenaline. Metformin harmed me, I do not know, it is OK to take metformin  in this situation?

I am afraid of increasing more insulin, if body does not allow to lower, then it will bounce and make it higher.
If sugar goes low but not too low, and not bouncing, I can tolerate that.
But if it bounces, I cannot go lower.

Sugar increase is not that high. 9 to 13. I like to come within 7 to 11

[diabetes86]

I cant tell you if it is safe to take met (im not an MD)

I can say you have a meter and you test are you going low (lower than 3.8)  that is low, if your not going low then you need more insulin to bring your numbers down you are still too high.

every time your BG is over 7.8 you are doing damage to your body.  so 11 is way to high.

[matin34]

How many times you eat with 20g Carb. How many times a day including snack? How much protein you eat every day? It would be better for me, if I could eat every three hours maintaining uniform BG. Please suggest me a meal planning. Do you have any idea about tyramine rich food?

[diabetes86]

I eat 3 times a day
breakfast   eggs & bacon, coffee

lunch sandwich made with low carb bread ~18 carbs

dinner   meat and salad or vegies

snacks any number of low carb

NO rice, pasta (except shirataki noodles  0 carbs), potato limited fruit.

[matin34]

Can I ask one more question?

I am taking 22 units of levimir at bed time.

The number "22", does it depend on bed time sugar?

Will 22 units of levimir be same for both  bed time sugar 7 and 10?

[diabetes86]

That depends;  the amount of levimir depends on your fasting BG  IE 6 hours of no food you should be around 5 to 6  if your higher add 2 IU every third day till your fasting comes down.

***  for some people Levimir does not last 24 hours,  for them they split the does 12 hours apart IE 11 IU in the morning and 11 IU in the evening

[matin34]

Please explain me clearly once again. I could not understand yet. Last time I eat at 5 pm. Take 11 unit of humalog, I go to bed at 10 pm to 10-30pm.
Sugar remains then 10 to 10.5. I do not eat any more. If I walk and able to make it down to 8.5, then I drink 2 ounces of skim milk at bed time. If right amount levimir is taken, how much should be fasting BG.

I am very confused with the behaviour of levimir with me. If I take 23 unit of levimir, I awoke at 4 am and see sugar is 8, but blood pressure up, the if I seat or get up, I get 9 to 9.5, sugar increases.

Probably I cannot go to 5 and 6 as fasting sugar, I have adrenal weakness, I may not tolerate that. I am 65 years old

Please explain two terms you mentioned:  a.   Fasting BG   b. 6 hours of no food.

Yesterday night, I brought to 7 by walking, I woke up at 4pm, sugar was 9, pressure did not increase. I gave only 18 units of levimir.

I feel worse in the morning, specially at 8:30, cortisol releasing time.

I tried only 4 units in the morning and 20 units in the night. 12 hours apart. But blood pressure become high. I stopped it.

[diabetes86]

Insulin does not effect blood pressure.

fasting is fasting no food or drink (except water) for 6 to 8 hours sometimes MDs want to see 12 hours no food or drink except water.

If correct levimir dosage is when your fasting BG is between 3.8 and 5.5

7 is too high so is 9  
test before you eat dinner COUNT THE CARBS YOU WILL EAT!! take your fast insulin. eat dinner, test 2 hours after you eat your BG should be the same as before dinner. if its higher than before dinner eat less carbs OR take more insulin.  repeat next time you eat.

I am not an MD

But proper BG levels are better for your body than high BG who says you cant have NORMAL BG with "adrenal weakness"

You should see an Endocrinologist (diabetes specialist MD)

[matin34]

I am about 1 and 1/2 month with high BG, as insulin or food tries to lower BG, blood pressure tends  to increase. I ate at 11am, hence no humalog is present in my body,Now time is 3-30pm,  sugar is 10.5, I ate a chicken leg, I am feeling shaky, blood pressure increased, and sugar went down to 9. Due to lack of food, sugar was going up, liver was dumping, chicken leg helped to stop dumping.  As soon as sugar will be stabilized, blood pressure will be stabilized. My problem was due to skipping meal, I must have to eat every three hours, atleast a little . But sugar is increasing for that too. I need more insulin, Levemir. I do not know  how I cope with the opposing forces of blood pressure and sugar decrease. My body will have to be habituated, so that it does not declare emergency, and excite liver and adrenals for dumping of sugar and increase of pressure. Now I am starting to believe that, meat can do that job. Three time carb and vegetable and three times meat. I will try it from tomorrow.

[diabetes86]

why is there no humalog because you eat at 11:00?  If all you eat is a chicken leg you dont need humalog.

I am confused  you eat , take insulin  measure BG with no plan and get unknown results.

I explained how to make a chart and how and when to test.  fill in the chart to see how it works.

STOP stressing it will raise BG

[Super_sally888]

I recommend the book, Think Like a Pancreas.

If you blood sugars are too high then you need to increase your insulin doses.

Levimir is your background insulin.  It shoudl keep your blood sugars stable, even if you don't eat.  You need to do something called "basal" testing to work out the correct dose.

Humalog is your fast acting insulin and should prevent your blood sugar rising high after you eat.  Humalog can also be used to 'correct' blood sugars that are too hihg.   You need to have a carb;Insulin ratio worked out.  This is usually worked out by trial and error and is indivicual.  Often people start off with a ratio of 1 unit of Humalog to 20 g of carbs and then adjust from there.

If you are eating low carb, then you will also probably need to dose for protein (about 50% of the insulin needed for carbs).  ie. something likee 1 unit of humalog for 40 g of protein (but you need to fine tune this for yourself).

Testing and monitoring and adjusting insulin based on the blood sugar results will allow you to have better control of your blood sugar.

But you also need to control what you eat, particularly the carbs.

[matin34]

Can you please explain the situation:
I took 300gm Avapro before bed(BP medicin)
Bed time Sugar 10.8, took 20 units of Levimir at 11pm.
2-20 am Sugar  8.8 got up & went to washroom
4-20 am sugar 9.2
6am       sugar 10.1
While sitting, blood seemed low, but after taking Levimir, went to bed and blood pressure was 135/77/64
I ate brown rice 150gm brown rice by weight, 1 cup of cooked cabbage @ 2 ounce of milk I took 10 u nit of humalog at 6am. 8am sugar is 11.7
At 9 am humalog will finish, and it it will increase.

Yestarday before eating at 5am. sugar was 10, took 12 unit of humalog , sugar was 9.3 after 2 hours(7pm), at 9 pm it was 12, I walked 15 minute to bring down and it was 10.8 before bed..

Please give me suggestion

[matin34]

But  I have adrenal fatigue. It has been done by metformine, while i was not eating sufficiently . I had hypoglycemia, But I did not see low sugar in my meter. Emergency could not catch it, because liver dumped it imediately

Harbalists say to take lot of vitamins and minerals to recover adrenal. Harbalists say, eat  whole grain carbs very limited amount. I cannot eat white rice, any kind white, or anything with high glycemic index. I cannot eat white rice, it gives me very absurd feelings because of adrenal. They suggest to eat lot of protein.. BUt probably, MDs do not believe in vitamin theory

Can I take high dose vitamin C and B5.?  Some people take vitamin and minerals for adult over 50. Are all those OK with insulin? I understood your insulin fixation concept. Thanks

[matin34]

3 pm  now I feel bad, I see my sugar is 9.8, why I am feeling bad? Then I ate a little meat. Within a moment, sugar went down to 9. I must have to give food after three hours, otherwise I feel bad, I described it as a hypoglycemia, shaking. Due to skipping meal problem, body still remembers it, and demand food, if I do not eat then i feel bad and sugar bounces.  I need a food, that I can eat every two hours but sugar will not  increase that much. I could do it with nuts, but I cann0t eat nuts, because I am reactive to tyramine rich food. I cannot eat protein, other than animal protein. If I could in this way body used to forget this issue. If I eat protein, sugar increased before bed time, because it releases sugar later Please suggest me what can I eat. I will have to eat 3 pm and 9 pm

[diabetes86]

"I ate brown rice 150gm brown rice by weight, 1 cup of cooked cabbage @ 2 ounce of milk I took 10 u nit of humalog at 6am. 8am sugar is 11.7
At 9 am humalog will finish, and it it will increase.
"
you tell me

insulin lowers BG,  carbs raise BG...   your BG went up by 17%  and you say will continue to rise.  insulin lowers BG if your BG continues to rise you might need what is called a wave bolas some when you eat and some later.

Insulin lowers BG

you need to find your I/C ratio (insulin/carb)  and your how much each IU on humalog will brings down your BG when you dont eat.

Suppersally gave you some good advice.

[Super_sally888]

Hello,

your blood sugars are high.  Because your body is used to being high you will feel low, even you aren't. B ut damage is happening so you need to bring your sugars down.  I'll put my comments in capitals below


Bed time Sugar 10.8 (194.4), took 20 units of Levimir (LONG ACTING) at 11pm.
(WITH BLOOD SUGAR AT 158 YOU PROBABLY SHOULD HAVE TAKEN HUMALOG - YOU NEED TO WORK OUT THE APPROPRIATE CORRECTION DOSE TO CORRECT FOR THE HIGH).

2-20 am Sugar  8.8 (158.4 STILL HIGH)got up & went to washroom

4-20 am sugar 9.2  (165.5 STILL HIGH AND RISING - PROBABLY DAWN PHENOMENON)

6am       sugar 10.1  (181.8 THIS IS A VERY HIGH FASTING.  OPTIMAL FASTING IS 80 - 95 RANGE.)

While sitting, blood seemed low, but after taking Levimir, went to bed and blood pressure was 135/77/64

I ate brown rice 150gm brown rice by weight, 1 cup of cooked cabbage @ 2 ounce of milk I took 10 u nit of humalog at 6am. 8am sugar is 11.7 (210 AFTER EATING.  THIS TELLS ME THAT YOUR HUMALOG DOSE WAS PROBABLY SLIGHTLY LESS THAN YOU NEEDED).

At 9 am humalog will finish, and it it will increase.

Yestarday before eating at 5am. sugar was 10 (180 ), took 12 unit of humalog , sugar was 9.3 after 2 hours(7pm) (THE 12 UNITS OF HUMALOG DID COVER YOUR FOOD REASONABLY - AS YOUR WERE 10 BEFORE EATING AND 9.3 AFTER), at 9 pm it was 12, I walked 15 minute to bring down and it was 10.8 before bed..

TWO COMMENTS:
1. Your basal insulin dose (levemir) appears too low, as your background blood sugar is always high.  I would recommend that you work with your doctor to increase your levemir dose such that you can get your base blood sugar levels down to a more normal level.  

That may need to be done over a period of days to weeks.  You may want to try splitting the levemir into 2 doses 12 hours apart as some people find this gives better coverage.  So, if you take 22 units then take 11 units each 12 hours apart.

Then you would increase (with your Dr. supervision) your levemir by probably 1 unit per dose every 3 - 5 days until you get your fasting numbers on target (ideally 80 - 95 range - though your dr. may set a slightly higher number).  Your before eating numbers should also be in this 80 - 95 range.  Increase only slowly and once you get close to target make adjustments even more slowly.

Your humalog is then used to cover what you eat and to prevent you going high from the food that you eat.  It seems that your humalog dosing is reaonable - you are fairly close in numbers before and 2 hours after eating.  I would not be changing your humalog dose at this time.

however, you do need to work out how to do a correction of high blood sugars using humalog.  For me, 1 unit of humalog will drop my blood sugar by 2.2 points.   So if I am say 9 and wanted to be 7 I would take 1 unit of humalog.

btw the coversion between numbers is 18.

Hope this helps.

Strongly recommend the book "think like a pancreas". See if you can get it from your library or find it in a bookshop.

The levemir is not dosed based on your blood sugar at the time of dosing.  It is based on your fasting blood sugar and your before eating blood sguars (assuing that your humalog dose is sufficient and you are not going terribly high after meals - which you could if your humalog is not enough).

[Super_sally888]

you will cause even more adrenal stress by having blood sugars all over the place.  So please do work on getting yoru blood sugars more stable and lower.

In your numbers for the targets:

Fasting ideally: 4.4 - 5.3
2 hours Post eating: < 6.6 (or maximum 7.7) - but also should not be lower than 4.4.

You will need to bring your sugars down slowly as you will feel hypo with normal numbers at the beginning.

Please be careful. While your nubmers are too high, we also don't want you to be going low.  This means you need to eat on a regular schedule, test frequently and be consistent with exercise and activities.  If you are more activce than usual you may need to eat a bit more / test blood sugar.

Please do also work with your Dr.  But be an educated patient.  Diabetes is nto something our Dr. can manage for us. We need to manage it for ourselves.

Hope this helps.