Out of control blood sugars

Diabeteswise, it’s been an awful couple of weeks. It started with a home exam in central-european history, followed by a cold. With stress hormones all over the place, the result was terrible blood sugars. As the cold’s passing and I’ve figured out the long-term consequences of the Munich agreement it’s time to troubleshoot the diabetes problem. Not only have I been seeing spikes of 12 mmol/l (216 mg/dl) for no apparent reason, sometimes twice a day, but my insulin requirements have also been creeping up. A couple of months ago, we were at 20-25u of insulin per day, which is now up to 35-40u, so not a small increase.
According to Diabetes: M, my average blood sugar has gone from 5.4 mmol/l (97 mg/dl) to 7 mmol/l (126 mg/dl). While this is not through the roof, it is high if you follow a low carb diet and obsess as much about your diabetes as I do. Let’s start looking at potential causes.

• Insulin pens are not working. There is a possibility that the insulin I’m injecting has lost it’s potency.
• New blood glucose meter. Maybe I’m walking around constantly hypo but have lost hypo awareness and failed to notice as a result of meter reading consistently high. It’s a funny coincidence that I changed meters, and the spikes started happening around the same time, but it could be just that.
• End of the honeymoon. This is the period that can last anywhere from a few months to years after a diabetes diagnosis, where your pancreas is still producing some insulin. It’s typical for your insulin requirements to shoot up when the honeymoon ends as they have in my case. The only way to know for sure is a c-peptide test.
• Weight increase and less physical activity. I’ve been moving around a lot less than I was before the pandemic, which could cause insulin resistance. I’ve also put on six kilos and although I wasn’t exactly fat, to begin with (55kg, 173 cm tall) I’m thinking those extra kilos might be doing more than just making my arse look big.

My action plan for trying to correct the problem looks like this:

• Change insulin cartridges, which should always be the first point of call.
• Better monitoring. I’ve put on one of my remaining libre sensors to get the bigger picture that continuous glucose monitoring allows. I’ve also ordered a control solution for my meter to check if it measures artificially high. It seems a bit redundant to be dosing insulin for the five grams of carbs in a crispbread when I have no clue what’s going on.
• Fasting and exercise. These are the two things that can improve insulin sensitivity. Skipping lunch for a few days will allow for basal testing, and I could benefit from a couple of walks a day, especially after dinner when the insulin resistance is vicious.
• Increase basal insulin. I’ve pushed my Tresiba from 13u to 15u a day. Since blood sugars creep up in the evening long after dinner, I’m guessing my basal dose is too low.
• Reduce stress. I’m only watching action movies on Netflix and reading crime novels in an attempt to totally shut down my brain.

That’s it. Let’s wait for the results to roll in.

Part 2 of this post can be found here.