Hyperglycemia WONT go away. Humulog and NO carb intake arent helping. HELP!

[hough747]

HERE IS MY PROBLEM: HYPERGLYCEMIA THAT WONT LEAVE
DAY 1: fasting BS 490 mg/dl. (I figured out i forgot daily Lantus the day prior). 11 units Lantus, and spot dosed with 5 units Humulog.B-fast: 2 eggs, 1 tomato, 1/2 onion.  Noon BS= 400's. Spot dose 4 units.Lunch: large chicken salad no dressing (raw veggies as toppers).Afternoon BS=500's.  Spot dose 5.5 units. Dinner BS = 400's spot dosed 5 units+1carb intake.Dinner: broiled chicken breast, broccoli, salad. Glass chardonnay Nighttime BS 460. Again, spot dosed 5 units
DAY 2:Same except afternoon BS was 300's instead. Began vigorous water intake(not more than 2 2-liter bottles a day). @dinner sub

[boseephus]

Add fast acting insulin eat healthy and lose any overweight problem. When you lose your insulin need will come down.

[hough747]

Thank you so much!! The information you gave me is invaluable.  I checked my Lantus, and each of the three bottles I have been drawing from were opened OVER one month ago.  I have always kept three kits - for the office, my car, and my purse, but I did that only out of laziness.  I realize now that it is essential to only keep one, and to discard after 30 days regardless of whether the whole bottle is used.   Again, thank you.

[JDRF-VOL-SG]

Lantus is the only insulin I have used that has a very DEFINITE expiration date -- one month is the longest you should EVER use a bottle of Lantus. When I started using it, I remember reading about its one-month expiration date on the small paper that comes with each bottle, but like you, I wondered if this was really true since no other insulin has ever expired in one month. I did some reading, and here's what I learned: Lantus works by crystallizing under the skin, and then slowly releasing all day long. It loses its ability to crystallize and release properly about one month after a bottle is opened. I notice a very definite difference in how it works after one month, and sometimes even a few days before one month. Others have commented to me about high sugar levels when the bottle gets "old", but in my case, I get slightly elevated sugar levels followed by severe lows that have to be because it is releasing in "clusters" rather than evenly as when new.

So I would bet that your Lantus is probably at least part of the problem. I remember being surprised that my doctor did not tell me about the one-month expiration date on this insulin when I was first put on it. I mark each bottle's date of being opened with a permanent marker now so I can keep track of how old it is.  

[hough747]

update: BS=330 this morning 8am, bfast: 2 eggs, 1/2 onion, 1/2 tomato, water.  Now BS=460 @ 12 noon.  

As for hormones: I'm in amenorrhea, and have been for years, so hormone fluctuation is probably not a significant factor causing the sugar change. As for effect of BS on the hormones or menstruation, I haven't noticed any.  And the hyperglycemia isn't consistent enough to note any correlation between hormones (or lack thereof) and BSs.  

I have not tested for keytones in 15 years.  Five years of consistent testing showed me that the patterns between BS spikes and keytone spikes were pretty regular, as sugar got over 300.  The levels were even more consistent when the BS stayed high.  I stopped testing because the BS patterns seemed an excellent indicator.  I have information gathered since then, and never come across anything to dissuade me from this course.  For example, even if I had keytones, what could i do other than what I am doing now?

I fluctuate between 3 different bottles, all open and unrefrigerated.  One Lantus expired in July, but in my 20years, I've found that a bottle has a good 6 months after the expiration date before it begins losing effectiveness.  Perhaps this is the cause, though.  I'll switch it up.

I called in for a prescription of Keytone strips. I'll let you know. But question: what else can Doctors do to lower my sugar that I'm not doing?  I'm considering stopping eating at this point, as I feel like I'm out of options.

(And thanks for your input.  I really appreciate it)

[JDRF-VOL-RL]

Have you changed out your insulin?  Are you changing your injection site regularly?  Do you need to update your correction factors and carb ratios?

[JDRF-VOL-SG]

If your glucose levels have been high long enough to put you in a situation where you are experiencing DKA, the hospital staff can help you avoid long-term kidney damage or even death. If you are not testing for keytones, you really SHOULD be. The following link gives some good info on keytones:

http://www.isletsofhope.com/diabetes/care/ketones_1.html

In any event, if you are having this trouble fairly often, I would check into changing doctors. There may be some sort of insulin or insulin delivery system that will work better for you than what you are using now. Sugars this high damage small blood vessels and can lead very quickly to eye, kidney, or heart damage, OR nerve damage, and all of these are things that can destroy quality of life. I would encourage you to not rely on a GP for help, but to insist on being referred to an endocrinologist who specializes in type 1 diabetes. You shouldn't have to live this way.

One more thing, have you noticed a monthly hormonal pattern to the high glucose levels? Some women do find that when certain hormones are high, glucose levels don't seem to respond to insulin as well. It is possible that some therapies to change your hormonal levels could help you if this is the cause.

Seriously, sugars this high can lead to coma, and if this happens, you may not have enough warning time (starting to feel woozy, etc.) to get to a hospital. I would encourage you to go NOW. You should not have to wait it out. I gather from the fosamax medication (I checked to see if that medication could be a part of the problem, and did not find any studies on it and glucose levels, but it might be worth removing it for a short time to see if it may be a factor) that you are female, and I truly encourage you to get to a specialist who knows how hormones affect women. I am also female, and I have not had to put up with levels like this, EVER!!!! Once damage has been done, it is too late to help you, so you need to be aggressive about insisting on getting the right help. Back when we were children, not as much was known and people did have to put up with swings in glucose like this, but so much more is available now to help us out that I really suspect that a good specialist can help.

[JDRF-VOL-RL]

I wouldn't stop eating.  Doctors can only give you fresh insulin and monitor closely.  6 months is a long time for a vial of insulin to last, I've heard of some people stretching out to a couple months, but 6 is too long.  I wouldn't be surprised that you get lower scores with a fresh insulin.

[Forum-vol-cmb]

I am thinking it could be the daily chardonnay.  I too like to drink wine, but have found that white wine makes my blood sugar go very high.  I instead drink red wine, in particular merlot.  I have found that it lowers my blood sugar a little.  I am not implying that it is some miracle to lower blood sugar, I am simply saying that it works for my body, so as not to make my blood sugar rise.  I limit my wine intake to 1 glass per day.  
Also missing your insulin doses will cause some problems.  That is why keeping on a schedule can be annoying and frustrating, but helps to maintain tighter control.  Your HBaIC's sound very good, so you are doing things right.  
Also, I am on a very similar plan as yourself(I am not on the pump)  I had my thyroid removed 5 years ago because I developed Graves Disease.  Maybe you should have your thyroid checked because when I developed the disease my blood sugars rose very high.  And are you on any new medications?  Different meds can cause your blood sugars to rise. Are you feeling unwell?  When I am sick(like the flu or a cold) my blood sugars rise as well.

[hough747]

Thanks for the reply.  It's nice to know someone else out there has experienced similar.  Your question about other symptoms: I'm having the normal (and not always worth notating) symptoms of irritability, dry mouth, acetone taste on tongue/mouth, fruity breath, frequent urination, extreme thirst, lack of bladder control, headache, nausea.  Over-watering myself (drinking a 2-liter in one sitting) will help the taste, irritability, and fruity breath, but I try not to b/c of the recommended limits on water intake & obvious other factors.  

Cost/benefit analysis question:

If i actually go to the hospital, (I have in the past in similar situations a handful of times) I recall the treatments you've mentioned IVs etc. but I don't recall the situation actually alleviating more quickly than if I stayed home.  What do you think? I wonder if there are worse things that I am causing (cell damage/etc..) by waiting it out...

I admit I have the 'Been there, done that' mindset.  I don't even call my GP anymore because it's always the same scenario, same symptoms, same recommendations, and same end result: just wait it out.  But if there are potential risks that could be lessened by hospital admittance, then I'd probably go.  (FYI last check @ 10:50 pm PST = HI.  The new Onetouch UltraMini cant read over 600, so it's up there somewhere)

[CharliesAngel77]

Many things can cause a high blood sugar.  I am not an expert, but a 29 year old woman who has been living with type 1 for over 14 years.  I have had many episodes like this, hyperglycemia for no apparent reason that just won't go down.  They always ask at the hospital if I have an infection or illness which never is the case.  The hospital CAN do more for you than you are doing.  You will probably be getting IV fluids and possibly IV insulin.  Once your BS gets up there and you get dehydrated, sometimes it is just impossible to get down by yourself (well in my case anyway).  Do you have any other symptoms?  It sounds like if your glyco is between 6-7, your diabetes is in pretty good control.  I hope you get some help and get that BS down soon!