We all have those days and nothing is more frustrating than a stubborn high blood sugar. Increased insulin resistance and increased hepatic glucose production (when your body produces glucose in your liver) can both contribute to a stubborn high blood sugar. This may be attributed to a number of factors including: menstrual hormones, fighting off infection, and stress.
Unfortunately, having a blood sugar over 200 mg/dL that just won’t budge is extremely frustrating. You may feel like you keep throwing insulin at it (insulin stacking) and then many hours later it may suddenly come crashing down for seemingly no reason. Instead of rage-bolusing, take a deep breath, and address the underlying issue.
Make sure to speak with your doctor if you are experiencing periods of insulin resistance to discuss options that may work best for you.
Here are five things I consider when having a stubborn high:
1. Change pump site
The first thing I consider is changing my site. Sometimes, insulin isn’t as effective because there is something wrong with the pump site (if you’re on a pump) or injection site. It may be that the tubing is kinked or that there is a piece of tissue blocking the tubing or that the site is simply old and your subcutaneous fat at the site has begun to thicken (lipohypertrophy). In general, it is also a good idea to change your site every three days. Also, consider using a different bottle of insulin if your insulin was left out of the fridge, is past it’s expiration date, or may have been exposed to heat .
Sitting in front of a computer all day can impact your blood sugars. Get up, take a brisk 10 minute walk, maybe a few squats, or jumping jacks. Note that exercising when you have ketones can be dangerous. It is not advisable to exercise if blood sugar has been >250 for more than a couple of hours, and you test positive for ketones in your urine. Personally, medium intensity exercise such as a brisk walk or short jog has been one of the most effective ways I’ve found to get my blood sugar down. Added plus is that it’s also a great way to clear your head.
3. Stay hydrated (Drink water)
It’s important to stay hydrated when experiencing hyperglycemia (high blood glucose). Drinking water will help your kidneys flush out the excess glucose in your blood.
4. Hot shower or bath
Hot water can help the insulin diffuse more rapidly with the added benefit of potentially helping you relax a bit.
5. Correction dose into the muscle
Most of the time we inject insulin into our subcutaneous fat; however, Injecting insulin straight into your muscles can help it absorb faster. Insulin injected subcutaneously must absorb first through the fat, which can slow it down. Although it may hurt, injecting directly into the muscle (via the forearm, triceps, or quadriceps), can help bring your blood glucose down at a faster rate; however, it is important to cleanse the injection site and use a sterile one-time use syringe or pen needle, as there may be a higher risk of infection.
Other- Inhalable Insulin
Although not a good option for those with chronic lung problems, Afrezza is a rapid acting inhaled insulin that enters your bloodstream quickly and works within 12 minutes, much faster than fast-acting insulin injected subcutaneously. It may be a good option for treating hyperglycemia quickly and effectively, and an option to discuss with your provider. It may not however be a good option for people on HCL systems/ pumps that deliver automatic corrections.