Why Is My Blood Sugar Still High with Insulin? 7 Factors to Consider

Managing blood sugar levels when you have diabetes can be challenging, especially when you're on insulin. If you find yourself asking, "Why is my blood sugar still high with insulin?", you're not alone. Several factors can contribute to persistent hyperglycemia despite insulin therapy. Understanding these factors is crucial for effective diabetes management. Let’s dive into seven common reasons why your blood sugar might remain elevated even with insulin.

1. Incorrect Insulin Dosage

One of the most common reasons for high blood sugar despite insulin use is an incorrect dosage. Your insulin needs can change over time due to factors like weight fluctuations, activity level, diet, and illness. The 8 Best Foods To Eat To Help Stabilize Blood Sugar Levels

Insulin-to-Carb Ratio: If your insulin-to-carb ratio is off, you might not be taking enough insulin to cover the carbohydrates you're consuming. Work with your healthcare provider to adjust this ratio.
Basal Insulin: Your basal insulin dosage (long-acting insulin) might not be adequate to maintain stable blood sugar levels overnight or between meals.
Bolus Insulin Timing: Taking your bolus insulin (short-acting insulin) too late, after you've already started eating, can cause a post-meal spike in blood sugar.

Actionable Step: Monitor your blood sugar levels closely and keep a detailed log. Share this information with your doctor or certified diabetes educator (CDE) so they can adjust your insulin regimen appropriately. The Best Types Of Exercise For Lowering Your A1C And Blood Sugar

2. Improper Insulin Injection Technique

Even with the correct dosage, improper insulin injection technique can significantly impact how well the insulin works.

Injection Site: Injecting into areas of lipohypertrophy (hardened or lumpy areas under the skin) can impair insulin absorption. Always rotate your injection sites. Recommended areas include the abdomen, thighs, and upper arms.
Injection Depth: Injecting too shallow (intradermally) or too deep (intramuscularly) can affect absorption rates. Use the correct needle length as recommended by your healthcare provider, and inject at a 90-degree angle (or 45-degree angle if using a shorter needle with a thin individual).
Leakage: If insulin leaks out after injecting, you might not be getting the full dose. Count to ten after injecting before removing the needle to help prevent leakage.

Actionable Step: Review proper injection techniques with your diabetes educator or healthcare provider. Ensure you’re rotating injection sites, using the correct needle length, and avoiding areas of lipohypertrophy.

3. Insulin Storage and Handling

Insulin can degrade if not stored and handled correctly, reducing its effectiveness.

Temperature: Insulin should be stored in the refrigerator (between 36°F to 46°F) until opened. Once opened, it can typically be stored at room temperature (between 59°F to 86°F) for a certain period (check the manufacturer's instructions). Avoid extreme temperatures.
Sunlight: Exposure to direct sunlight or heat can degrade insulin. Keep your insulin pens and vials away from direct sunlight.
Expiration Date: Using expired insulin can lead to inconsistent blood sugar control. Always check the expiration date before using.

Actionable Step: Store your insulin correctly and always check the expiration date. If your insulin appears cloudy or discolored, discard it, even if it hasn't expired.

4. Diet and Carbohydrate Intake

Your diet plays a major role in your blood sugar levels. Even with insulin, consuming too many carbohydrates can cause hyperglycemia.

Carb Counting: Inaccurate carb counting can lead to underestimating the amount of insulin needed. Use measuring cups and food scales to accurately measure your carb intake.
Type of Carbs: Simple carbohydrates (e.g., sugary drinks, white bread) are absorbed quickly, leading to rapid blood sugar spikes. Focus on complex carbohydrates (e.g., whole grains, vegetables, beans) which are absorbed more slowly.
Portion Control: Even with complex carbohydrates, large portions can raise your blood sugar. Be mindful of portion sizes.

Actionable Step: Work with a registered dietitian or CDE to develop a meal plan that aligns with your insulin regimen. Improve your carb counting skills and choose complex carbohydrates over simple ones.

5. Physical Activity Levels

Physical activity affects insulin sensitivity and blood sugar levels. Both too little and too much activity can impact your blood sugar.

Lack of Activity: Insufficient physical activity can decrease insulin sensitivity, requiring more insulin to manage your blood sugar.
Intense Exercise: Strenuous exercise can sometimes cause a temporary increase in blood sugar due to the release of stress hormones.
Inconsistent Activity: Inconsistent physical activity makes it harder to predict your insulin needs.

Actionable Step: Establish a regular exercise routine. Monitor your blood sugar levels before, during, and after exercise to understand how your body responds. Adjust your insulin or carbohydrate intake as needed.

6. Stress and Illness

Stress and illness can significantly impact blood sugar levels, often leading to hyperglycemia.

Stress Hormones: Stress hormones like cortisol and adrenaline can raise blood sugar levels.
Illness: When you’re sick, your body releases hormones to fight the illness, which can also elevate blood sugar.
Medications: Some medications (e.g., corticosteroids, decongestants) can increase blood sugar.

Actionable Step: Implement stress-management techniques such as meditation, deep breathing exercises, or yoga. During illness, monitor your blood sugar more frequently and follow your sick-day management plan provided by your healthcare provider.

7. Underlying Medical Conditions

Certain underlying medical conditions can affect insulin resistance and blood sugar control.

Insulin Resistance: Conditions like obesity, polycystic ovary syndrome (PCOS), and metabolic syndrome can increase insulin resistance, making it harder for insulin to lower blood sugar.
Hormonal Imbalances: Conditions that cause hormonal imbalances, such as Cushing's syndrome, can also affect blood sugar levels.

Actionable Step: Discuss any underlying medical conditions with your healthcare provider. They can help manage these conditions and adjust your insulin regimen accordingly.

Summary Table of Factors Affecting Blood Sugar Levels with Insulin

Factor	Description	Actionable Steps
Incorrect Insulin Dosage	Wrong insulin-to-carb ratio, inadequate basal insulin, or improper bolus insulin timing.	Monitor blood sugar, keep a log, and consult with your doctor to adjust the insulin regimen.
Improper Injection Technique	Incorrect injection site, depth, or insulin leakage.	Rotate injection sites, use correct needle length, inject at a 90-degree angle, and count to ten before removing the needle.
Insulin Storage and Handling	Insulin degradation due to incorrect storage temperatures or exposure to sunlight, using expired insulin.	Store insulin in the refrigerator, protect from sunlight, and always check the expiration date.
Diet and Carbohydrate Intake	Inaccurate carb counting, consuming too many simple carbohydrates, large portion sizes.	Improve carb counting skills, choose complex carbohydrates, and practice portion control.
Physical Activity Levels	Lack of activity, intense exercise, or inconsistent activity levels.	Establish a regular exercise routine and monitor blood sugar before, during, and after exercise.
Stress and Illness	Stress hormones and illness can elevate blood sugar levels. Certain medications can also increase blood sugar.	Implement stress-management techniques and follow your sick-day management plan.
Underlying Medical Conditions	Insulin resistance due to conditions like obesity or PCOS, hormonal imbalances.	Discuss underlying conditions with your healthcare provider and adjust the insulin regimen accordingly.

Taking Control of Your Blood Sugar

Persistent high blood sugar despite insulin therapy can be frustrating, but understanding these potential factors empowers you to take action. Working closely with your healthcare team, including your doctor, CDE, and registered dietitian, is essential for optimizing your insulin regimen and achieving better blood sugar control. By addressing these seven factors, you can improve your diabetes management and overall health. Remember to regularly monitor your blood sugar, keep detailed records, and communicate openly with your healthcare providers about any challenges you're facing. Managing diabetes is a continuous learning process, and staying informed is key to your success. Your Printable Blood Sugar Chart For Tracking Daily Levels