Why am I having trouble managing my blood sugar with T1D?
Patient's Query
Hello doctor,
I am 25 years old and was diagnosed with type 1 diabetes 20 months ago. But my glucose control is dangerously poor despite using advanced technology. My last HbA1C (glycated hemoglobin) was 12.1 percent, and my endocrinologist is concerned about rapid progression to complications.
My time-in-range is only 28 percent according to CGM (continuous glucose monitoring) data, and I am having severe hypoglycemic episodes four to five times weekly with glucose dropping below 45 mg/dL. This morning, my blood sugar was 378 mg/dL with large ketones at 2.4 mmol/L, indicating impending DKA (diabetic ketoacidosis). My C-peptide was undetectable.
Please suggest.
Hello,
Welcome to icliniq.com.
I have read your query and can understand your concern.
Your 2.4 mmol/L of ketones and 378 mg/dL of glucose are unsafe to manage at home without medical guidance. DKA (diabetic ketoacidosis) can develop quickly, especially when insulin delivery is disrupted. Having blood sugars less than 45 mg/dL multiple times per week is dangerous. You may have hypoglycemia unawareness. Your body may stop warning you before having severe low levels.
As your C-peptide (connecting peptide) is undetectable, which means the pancreas is not producing any insulin. So you are 100 percent reliant on injected or pumped insulin to stay healthy. If you feel nauseated, weak, confused, drowsy, or short of breath, go to the ER (emergency room) immediately. Hospital admission is best to stabilize glucose and ketones. Temporarily switch from pump to injections if pump delivery is suspected to fail. With rapid intervention, you can regain stability and avoid long-term complications.
The first step is to treat today’s ketones and reassess your insulin regimen immediately under expert medical supervision. If you want to use an insulin pump, you can use a hybrid closed-loop pump or adjust CGM (continuous glucose monitoring) systems with low alerts to catch lows sooner. The probable causes are pump failure and hypoglycemia unawareness. The probable diagnosis is pump failure. Seek emergency treatment and have a glucagon prescription for emergency lows.
Adjust insulin dose. Have a temporary switch from pump to injections if pump delivery is suspected to be failing. Have a re-evaluation of basal rates and insulin-to-carb ratios. Please consider working with a diabetes educator. If possible, you can use a hybrid closed-loop pump or adjust CGM low alerts to catch lows sooner. Please consider working with a diabetes educator.
With rapid intervention, you can regain stability and avoid long-term complications. The first step is to treat today’s ketones and reassess your insulin regimen immediately under expert medical supervision. Make sure the pump setting is between 70 and 300. Carbohydrate counting is a must. Have a follow-up after 15 days.
I hope this answers your query.
Let me know if I need to assist you further.
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