Fasting blood sugars... what on earth is going on here??

So I did DAFNE in October and I believe I totally understand the 'rules' in theory, they just don't seem to be replicating in practice. I know my background insulin is not right and have changed from lantus to levemir but still haven't got the dose right (I got two good days but none since).

So did a big long fast to try and see why its not behaving. I went low in the early afternoon so had a small snack of long acting (carb points are certainly correct as off the back of the packet... I don't eat anything unless I have exact carbs for it) and then just shot up and kept going up ever since. I reduced evening levemir because of morning levemir making me go low and I didn't want to go low overnight (possible reason for the 20 in the morning as was only 8 the night before). And I know I shouldn't have corrected with QA without eating a meal but I couldn't stand being so high as it was making me feel sick.

So which part of my dose is wrong?!

I think that correcting with QA without a meal is fine. You just need to avoid over-correcting. If you hadn't corrected, at 07.06, you would have been high all day. I correct quite often with QA and without carbs, and I don't usually have any hypos as a result as long as I follow the DAFNE principles of correction - 1 unit of QA tends to drop BGs by 2-3 mmol/L. So your 4 unit dose of QA at 07.06 should have dropped the BGs by 8-12 units once the QA was absorbed, and looking at your 11.40 reading, it had dropped by 10.4 units which is within that 8-12 range.

Is your insulin good quality? Has it been out of the fridge for more than 30 days? Has it got hotter than 30 degrees at any point, does it look OK - not cloudy before injecting? It is very unusual that in the space of 90 minutes, you went from 5.2 to 15.3. It may just be a one-off though, and if you don't usually fast, then perhaps it is your body's way of coping without food. Also, unexplained rising of BGs can indicate that you are getting sick, or battling a virus etc.

Instead of fasting, you can achieve much the same result by having carbless meals - green vegetables, protein etc. Try an omelette with salad, and the carbs in that are very negligible, but you might see less fluctuations in your BGs.

If you get a reading higher than 13, then certainly correct with QA, with or without carbs. Two consecutive readings that are above 13 (e.g breakfast and lunch, lunch and dinner, dinner and bed, or bed and breakfast) is cause for a concern and you should be testing ketones if that happens. Any reading higher than 17 should always have a ketones check. If ketones are higher than 1.5, you need to follow the sick day rules - see the section "Coping when you are ill" in the DAFNE handbook.

In the data above, there is no record of a ketones check. Is that because you aren't doing one? It is really important to do one in the above situations as elevated ketones could lead to diabetic ketoacidosis.

All the best with it.
Warwick.

your AM dose it too much, your PM dose may be too little.........

tackling one period at a time is wise though........

So make a change to the AM dose first, record 3 days, continue dose adjustment until you get 2-3 days steady, repeat for PM......

I find that I frequently go very low overnight, despite taking a tiny amount of QA with supper (ratio 0.6:1). When this happens I usually awake, at around mid-day, with BG well into double figures, often over 20. Over 30 a few days ago. This is, I believe, because there is insufficient carbohydrate in my system due to insufficient insulin to convert it into energy. As a result my body starts to convert my fat for energy but since the body's control system does not work in type1 diabetics there is no means of stopping the conversion of fat once it has begun, this results in high BG readings. I find that taking more insulin at night, either QA or BI results in hypos so bad that an ambulance is needed and reducing it, or cutting it out results in dangerously high BG readings, so I haven't cracked this one yet.

The level of BI (Levemir) I use keeps me level overnight if I take no carbs or QA at suppertime. The level of QA taken at suppertime keeps me at a reasonable level for much of the time, but I have frequent, inexplicable swings, both high and low. I have been trying for over thirty years to identify a reason for these without success. The medics have been trying too, enjoying much the same level of success as I.

I don't know how relevant any of this is to you, but it occurred to me that your body too is breaking down fat with insufficient insulin to convert that into energy, resulting in your high BG levels.

Kind regards, and Merry Christmas,

Roger

What does an over night basal test show for you roger, like every hour......I know that might not be possible in your case......

I am also about confused about your theory that there is insufficient carbs in your system because there is insufficient insulin to convert it into energy.......so you then burn fat.....

It is us that put the carbs in to which we then match with insulin and inject. The food is then digested and the glucose is delivered in to the blood stream. The insulin then allows the glucose to pass into the cells. So no conversion as such, at least on the insulin front....

Everyone will have some fat burning overnight as our stomach are empty, there will also ketone production, very small amounts, but they are used by the brain and other parts of the body......our basal dose will process these.....

High readings in the morning are common for everyone....

Hi Novorapidboi,

I am, as usual, thinking in technical terms. As you may know, energy can be neither created nor destroyed; it can only be converted from one form to another. This is a basic law of physics and it was in this sense that I used the word 'convert'.

I accept that my argument may be flawed. I did think, upon reading it again after I had posted it that it seemed somewhat shaky. I can only plead tiredness, as it was during the wee small hours that I sent it. I knew some bright spark would query it though! :-)

As you clearly recall, I cannot usually take hourly tests overnight so I am forced to judge that, since my morning BG levels are almost the same as my previous suppertime levels (if no carbs were taken for supper) then my nightly BI dosage is correct. This assumption seems to be born out by the few readings that I have made during the night.

Kind regards, and Merry Christmas,

Roger

Gemsa said:
So I did DAFNE in October and I believe I totally understand the 'rules' in theory, they just don't seem to be replicating in practice. I know my background insulin is not right and have changed from lantus to levemir but still haven't got the dose right (I got two good days but none since).

So did a big long fast to try and see why its not behaving. I went low in the early afternoon so had a small snack of long acting (carb points are certainly correct as off the back of the packet... I don't eat anything unless I have exact carbs for it) and then just shot up and kept going up ever since. I reduced evening levemir because of morning levemir making me go low and I didn't want to go low overnight (possible reason for the 20 in the morning as was only 8 the night before). And I know I shouldn't have corrected with QA without eating a meal but I couldn't stand being so high as it was making me feel sick.

So which part of my dose is wrong?!