Cant stop BG Levels going up

I dont know what is going wrong, but clearly something is. i completed the course 2 weeks ago. last week, 50% of bg levels were >10, this week 50% are >14.... and i cant explain it. It's as if the QA is having >50% less effect. I did get the feeling that the 1:1 ratio I was put on during the course would ultimately need adjusting possibly to 2:1 and so reflect more (but still less than) the insulin levels I was taking previously. But then how to explain the relatively good readings during the DAFNE week? Yes, i am back at a stressful office but my levels were never this consistently high. I have followed the rules for monitoring, not injecting during meals, corrections and adjustments. I'm not overweight or unwell. I know to look for patterns - but the pattern I have is "up" across the board. The best example i can give is yesterday (readings are pre-eating, injections).

14.6 (b/fast), carb-free, QA4 correction. BI20 (up from 18 last week)
9.8 (lunch), 4CP, QA1.5:1, QA1 correction
14 (5.00pm)
11 (supper - 7pm), 8CP QA1.5:1, QA3 correction
16 (10:30pm). 2CP+8QA - simply to try to get the bg down. BI22 (up from 20 last week)

This morning, I'm 18.6 plus ketones.

I didnt wake with a hypo and you can argue that I had one and the figure is a rebound. But I always sensed hypos before. I was changed from Humulin to Levemir during the course - does it tend to mask hypos? I didnt do a 3am test...but I have on other occasions and the bg level was always >12 in the same circumstances so I dont think its hypo, more like hyper.

I followed sick-day rules and at 9;30am it was down to 10 and now at 11:30am its at 7.7. Nothing to eat this morning.

My biggest confusion in all of this is the following: if my bg levels are >14 at bedtime, and I take a QA correction (but no or only up to 2CPs), does the body (a) not release glycogen but simply lets the QA reduce the bg levels, (b) release glycogen to match the QA injected...then why take it, as it will simply keeps levels unchanged?, (c) release more glycogen than is needed - which seems to be what's been happening to me. The other point is whether a reduced carb in-take in the evening causes glycogen to be released. If so, I would have thought that before it is released, you would have hypo symptoms. I'm not doing anything in the evening that requires increased carbs/lower insulin levels - which takes me back to the start of this and thinking that since the course, the QA just isnt responding as well.

Anyone else going through this. Very grateful if anyone has some guidance.
Chris

WOW, seems to be a lot of stress, which is normal once you leave the comfort of the class room, I know, it was the same for me..............

Once you get back to normal routine your activity levels change and therefore your body will respond by letting the liver know what it needs, this means you need to look at your background again most likely........go to bed with no insulin or carbs on board and see what results you get in the morning, if all is well, you will hold and the dose is correct.....

What are your morning readings like..........? If high do you suspect dawn phenomenon.....?

From your results its hard to tell whats going on as its only one day, with DAFNE you need patterns.... one point I would make is that with correction, the higher your reading, the more units you need, this varies with everyone and takes trial and error to narrow down the margins, for a 14.6 I would of taken 6, 5 at least units to correct, something to think about.....they extra units may have got you on target at lunch as you were not far off.....

Try and get some 3 am tests done, you may have went low that night as you took a lot insulin for a small amount of carbs, with insulin still on board, all be it not much......

Whenever you think your losing focus, just make sure your BI doses are right, they are were it all begins..................to conclude I would recommend as a fellow DAFNE grad, re check your overnight BI dose, so no food or insulin before bed or after evening meal if you can, that will let you see whats happening overnight, take a 3am also to rule out dawn phenomenon..........

If you can get that right, you can move on to your daytime dose and adjust it for your now normal routine of work...........then its back to ratios again, 3 day patterns, you know the rest.....

Any questions just ask away....................have a look at the online diary in the dafne tools box on the right

Thank you very much for the helpful comments. Results show the BI is set OK as levels hold or close to...some adjustment may be made, but it will be minor. The issue has been in my not wanting to leave >14 unattended at bed. However, if it occurs tonight, I will follow your advice to confirm BI. I agree with your comment on taking QA6 corrective for the morning 14.6 and which I guess means not limiting correctives to QA4 which is what the course advised. Again, much appreciate the advice and support.
Chris

OK, so it seems your closer to a solution than I thought, if it looks like your evening BI dose is OK then you can go straight to the day time dose, you may need much more than you are on now, which may hopefully bring down your ratios.........

I am on a 3:1 in the morning and 1.5:1 the rest of the time so don't worry too much.....

If your BI is ok at night you should not be afraid to correct to get on target, its just sometimes the amount of correction doesn't always work. Through trial and error I have found the following:

<10mmol/l - 1 unit drops 2.5mmol/l
10-13mmol/l - 1 unit drops 2mmol/l
13-17mmol/l - 1 unit drops 1.5mmol/l
>17mmol/l - 1 unit drops 1mmol/l

By no means is this right for everyone but it gives you an idea of the amounts you may need when correcting......

It does mention this very subtly and briefly in the course handbook, I believe it should be highlighted as a main topic to learn.....

Let me know how you get on Chris.........

This is really useful advice and thanks very much....i'll report back, although i remembered I do 1 hour (hard) badminton Tuesday evenings - although this is the one time the levels stay OK (combination of luck+design).
Chris

The badminton will defo help with the blood sugars and help your insulin resistance.....

Once you have settled in to your regime you can start to think about dropping backgrounds when hard periods of exercise are on the horizon, then you can avoid lows immediately after and many hours after the activity......

Yesterday's approach seemed to bring BGs under control - BG7 at lunch.
Supper (6.30pm) - BG8, 8CP/4QA. Mars bar+banana prior to Badminton (8-9pm) - standard regime worked previously.
11pm BG18. Will probably up supper ratio to 1:1 next time. Took your advice and made no corrections and tested at 3am (BG1 and same again at 7:30 this morning. So, conclude bedtime BI22 is correct.
Interestingly, I corrected with 15QA and had 2CP for breakfast - but by 10am, BG at 3. I am concluding that the exercise has a longish delay with me before kicking in; compare with yesterday with essentially similar BG levels at previous bedtime and in the morning, and a bigger corrective QA at b/fast with no CPs but bringing BG levels down to "only" 7 by lunchtime.

Regards
Chris

those readings sound much better, well done, just keep that up for a few days, spot some patterns and you will be laughing............

Are you on any ratios that are below 1:1.......?

Please remember that your (hard) badminton session may cause an 'adrenalin rush' leading to liver glucagon release and cause BG rise as a consequence. Think insulin resistance is increased by most hormone changes. Alan Constable shared information with us in a thread called exercise within General Discussion back in November 2010 which could be of interest to you. Sounds like you are getting back on track. Well done.

Regards Garry

Many thanks to both of you for those posts - the encouragement is much appreciated. The only ratio below 1:1 has been 0.5:1 prior to badminton. But as mentioned, will now up to 1:1 given high reading after. Garry, thanks for the Alan Constable details. I will see if it offers any advice for mitigating the effects of the glucagon release. For the moment, it appears to be an unavoidable evil.

Regards
Chris