What happened to that insulin i just took?

(Jess) #1

Hi All,

I had a frustrating thing happen last night, and wondering if anyone can help me explain it. I took my bolus dose for dinner 15 minutes prior to eating, and felt that I had easily covered the carbs I was going to eat (chicken, cauliflower, very small sweet potato, sauce). About an hour later, I was going to treat myself to some ice-cream, and took another 2.5 units to cover those carbs. I usually wait to make sure my BS is not too high, or at least heading down, before I start eating something like ice cream. So I check, and waited, and checked, and waited. My blood sugar just continued to go UP (keep in mind I had not eaten the ice cream). Two and half hours after my first bolus, and half and hour after my second (for the dessert I never ate) I was at 170. So while I don’t typically do this, I took another unit (in my arm muscle). My BS SLOWLY went down over the next hour and a half. It was as though I never took that initial dose, and I had taken way more than twice the amount I would normally do for the crabs I was easting. I did eventually - about two hours after the shot in the arm - go too low, at 53. I was able to bring it up without too much difficulty but ended up staying up way past my bedtime just to make sure it was going to stay up. I have no idea what happened, and honestly it was really frustrating and confusing. Could that first dose have gotten “lost” in my body (I have heard someone say something about insulin getting lost). I have only been dealing with diabetes for about one year, so I can’t imagine I have already developed scar tissue? I do try to rotate my injections. I am also wondering, if that first dose did get “lost” somehow, does it make sense the once it was high it took longer and more insulin to bring it down? I would appreciate any feedback. I do have variations now and then due to hormones, etc., but I have never had an experience like this, and it really made me concerned because I am trying to expand my eating to include more “fun” foods, and not be afraid of carbs. I keep thinking, if I hadn’t been so vigilant in checking and had eaten the ice cream without checking my BS, I would probably be soaring into the 350s…

Thanks,
Jess

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(Dennis J. Dacey, pwD) #2

Sure Jess @Jsich, I can give a ‘very simple’ explanation - you have what is known as “autoimmune onset diabetes” which by definition means Expected the unexpected. No, your insulin didn’t get lost; I would guess that it kept you from having a higher BGL than you did. The major mistake you made was “stacking” insulin - a real NO NO - which pushed you toward hypoglycemia.

There are several reasons your question can not be answered with better accuracy, such as: your activities [including food] during the day, portion size and your guess at carb count, your insulin:carb ratio, etc. The really good news, you learned something and your knowledge of your body increased. Every day can be different and what worked yesterday may not be the proper dosing for today; I’ve been continuously learning how my body reacts to foods and insulin for over 60 years - and I’m still learning. Just these last two weeks - season change - I’ve had to calculate adjustments in all my basal rates and all my various carb:insulin ratios. Right now I’m trying to validate the insulin sensitivity factors I have for various times of day.

Good luck to you!

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(Ed) #3

Jess, I haven’t done the carb:insulin balancing act as long as Dennis (only 40 years), but another factor for me is the fat content. You indicated a “sauce”, but what kind of sauce? A creamy sauce? Even though fatty foods won’t initially cause a spike in my blood sugar, it will keep it elevated. For example, if I eat a rib eye steak for supper, I’ll typically have to take an additional bolus at night. I look at a graph of my cgm, and I can see my blood sugar just creeping up after the quick acting insulin wears off. Anyway, if that was a creamy sauce you ate, it may have contributed to keeping your blood sugar up for what appears to be at least 3 hours after eating, but not enough fat to keep it up past that. It’s just something your going to have to experiment with to see how different foods influence your blood sugar over a period of time. Dennis is also right, the problems with it dropping after what appears to be 3 hours is due to “stacking”. A problem I’ve learned the hard way. Since you’ve had type 1 for over a year, I would suggest looking into a cgm. You can get a visualization of your blood sugar over a period of time and make notes on how various foods affect your blood sugar.
Good Luck,

Ed

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(Jess) #4

Hi Dennis and Ed,

Thank you so much for your replies. Having given it another day, and having had time to think about it, my best guess is that it might have been a combination of slightly less physical activity, hormonal changes, weather and seasonal changes, emotional states, and under-estimating the carbs. Honestly, I think the carb count was pretty darn close, and I am really vigilant about that. I know about this fat thing, and I don’t think that was it this time. I do try to eat a lot of healthy fats, but in this case it was minimal. I think the thing that makes me feel the most relieved after this episode is that #1, it happens to other people, even those that have been doing this as long as you two have, and #2, that things like changes in season, weather, etc, can make a big difference. And I am guessing that sometimes a “reason” can’t be found? So again I want to thank you both. This is a crazy disease, and perhaps the lesson I need to learn from it is that I can’t control everything, and that is OK!

Jess

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(Dennis J. Dacey, pwD) #5

Your last two sentences say much, Jess. Sometimes there just isn’t a logical answer in this crazy disease.

When these days happen, accept what you can learn and make “tomorrow” a bit better.

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(Jeff) #6

This has happened to me a handful of times. Like you, I am just over a year post diagnosis. I wondered what the heck was happening. But after a few more times I just said OK, so this is how diabetes management works. Good thing you checked your BG. Every day is different.

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(marshalj) #7

Just chiming in to say, honestly, it is pretty common for me to have shoulder shrug moments of just no idea what happened because, like you, I was confident in my card count and bolus. One thing I’ve learned about myself in my 13 years of T1 is that if I beat myself up or go looking too hard for answers EVERY time, I’m not gonna make it. Sometimes I shrug my shoulders and hope for better next time.

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(jjmnav) #8

The unexpected, but how we react is the important part - For the past 4 days I’ve been needing roughly 60% more bolus than normal and just increased my basal by 10%. No real change in activity, diet or health. Maybe try another pen of bolus just to be sure the current one is good.
At the same time, both types seem to sting 1-2 seconds after injection, therefore withdraw needle much sooner than count of 10.

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(Elizabeth) #9

I’ve had the same thing happen to me from time to time, even after 42 years of diabetes. My doctor told me once along time ago that it’s one of the hardest diseases to manage because it requires so much self regulation. It sounds like you’re doing an excellent job of watching what you eat, carb counting (critical), bs testing, insulin dosing, etc. one thing to remember is to KEEP TRACK OF WHEN YOU OPEN UP A NEW VIAL/PEN OF INSULIN AND THROW IT AWAY AFTER 1 MONTH. Insulin loses its efficacy after a month and will not work as well (similar to what you’ve described).

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(tedquick) #10

Another stray factor, that we don’t tend to think about, is that if the shot went into scar tissue from earlier shot(s) the insulin can be trapped in a “bubble”, surrounded by scar tissue. Scar tissue doesn’t absorb insulin as fast (if at all) so the insulin just stays there and seeps out slowly to be absorbed by normal tissues outside of the “bubble”… Then it takes effect some time later.
Rather unlikely with your short term experience (compared to my not quite 63 years, at least), but STILL possible.

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(Janice) #11

Hi Jess, I have had the same problem, even though I have been taking injections for 66 years, I do have scar tissue and just plain dense tissue. My insulin gets lost and I have to piggy back an injection just to bring it back under control. I have heard many reasons for this, Dennis just gave you one. i am also allergic to insulin so it doesn’t work like it should, you may want to have an "insulin antibody test " if you are allergic this can also affect the say your insulin works what ever the reason, you have to do what you need to , to get your BS where you want it. We are all different, and you have to find out what works for you. I found out that very muscular tissue on me can slow down the way insulin is absorbed… If i piggyback i don’t take as much as I normally would because i have found out that piggybacking may be just the push that my orig. injection needed. Doesn’t make sense i know but sometimes it works. I am extremely allergic to my insulin so sometimes it is a great surprise when it works like it should. Hope this helps…Have a great day Bye Jan

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(Ibrah) #12

Hi Dennis can you please be my friend and get some help from you??

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(Ibrah) #13

Am suffering alot in my studies coping with diabetes I humblly expect some advice from you

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(Dennis J. Dacey, pwD) #14

Certainly @Ibrah, feel free to ask anything about living with diabetes. I and many others her will happily share with you what has worked and how we go about living well with diabetes.
I’m not a medical doctor, but I will share from what I have learned while living with diabetes.

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(Kim) #15

Preach! I always find the right post at the right time. Tonight ate a pretty high protein meal with a little mashed potatoes and probably over bolused. I was trending down around 107 and the next thing I know I’m at 224 three hours later??!! I too am almost at a year. The one thing I’ve learned is that I’m way ahead of the game from pre-diagnosis DKA and that a bad day won’t kill you or truly throw off your a1c. As long as you are taking the time to reflect on what you might do better, you’re moving in the right direction. Thanks for a great post when I needed it. All the best to you. We got this.

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(anita) #16

I have been a type one diabetic for 56 years. I truly feel that our bodies have their own minds. I feel that you have to put times where there is no explanation behind you and forget about that one time incident. If it happens again then it is time to think about it and what is going on.

Anita

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