3 months after surgery less insulin sensitive

For 3 months I’ve been eating lots and pumping lots, but BG was not awful. Then I experience big rises that don’t respond well to corrections. Spending 30 minutes on the stationary bike will bring it down but then it climbs again, not as bad.

I hope this is not my new normal. My BG seldom hit 180mg/dl usually peaking at 140 or less. Here’s a screenshot of today.


I have always tested high for anti-insulin antibodies.

Current test:

Normal value: 0.0 - 0.4 U/mL
Value >50.0 High

It may be advisable to ask your Endocrinologist to test?

Why the Test is Performed

This test may be performed if:

Insulin no longer seems to control your diabetes

You are taking insulin to control your diabetes and your blood sugar level varies a lot, with both high and low numbers that can’t be explained by the food you are eating relative to the timing of your insulin injections

anti-insulin antibody test


Perhaps completely irrelevant…but I’ve been hydrating quite a bit lately which has lowered the required insulin amounts.


Have you been able to pick up any mileage again?

One of the unfortunate side effects of recovery is less activity. And one of the unfortunate side effects of less activity is less insulin sensitivity.



I have been exercising daily, mostly cycling. For a while it has been without much resistance, but this week I have been using the smart trainer. This gets my heart rate up to zone 2 and 3 with occasional foray into 4. The other machine seldom gets me into zone 2.

In 4 days I have done 30 minute rides avg 8 miles. I did 2 sessions yesterday. I hope to get to a full hour and then go back out on the road. Using Zwift and the smart trainer does not have the same stress relieving benefits of being out on the road. Not sure why, the road is where I can get into the zone and let troubles fall behind me.

Thanks for the paper. I will read the whole thing, later.

It is possible that the immunotherapy is the root cause. I found several reports of drugs like Opdivo which inhibit PD1. That may cause problems with the GLUT4 mechanism. Some reports mention immunotherapy causing patients to develop autoimmune type 1 and to worsen type 2 diabetes mellitus.

Thanks, Eric, your link got me thinking about stuff. I knew about the possibility of developing T1DM on this drug. I thought that’s funny, but there was no mention of it affecting those of us with T2DM.
This link is the clearest I could find.


You all know I am not shy about doing stuff on my own to manage BG. I’ve been thinking about reducing pump basal rate and using Lantus. I just did that this morning and well report whether this works or not.


Do you mean reduce or shut off? I thought about shutting basal off & just using the pump for meal bolus.


@CarlosLuis Hope this resolves for you, perhaps @eric/others are right that some of the other things you’ve taken are finally impacting and when you’re off them the BG will return to your previous norm! Good thoughts!


Yes, definitely. Just like when you are sick you need more insulin.

And all of the things can contribute together.


Reduce with the Lantus being slightly more than the 24 hour basal dose decrease. C-IQ will decrease basal if i go low.


@CarlosLuis, that sounds like a smart idea. You will always have a background basal going, even if Tandem cuts it off. That can help prevent rebound highs, because you will never have zero basal.

Consider splitting your Lantus into 2 doses, because it generally does not last 24 hours!

It can be tricky because if it lasts 18 hours, you will have some overlap. Like if you do the 2 Lantus doses 12 hours apart, and the duration is 18 hours, you have 6 hours of overlap.

You might be able to time it so the overlap happens when you need more insulin.

A lot of people need more during the middle of the night and when they first wake up. So taking it right before you go to bed, and right when you wake up can help mitigate this. In this example, the overlap happens when you need more.


@Eric Splitting Lantus was my procedure when I was MDI. I will probably do it again if this works.


when I finally got off the dog killer NPH Lantus was my first stop. At that time I was taking 1 dose of 24 in the am & having DP badly. I went to 14 in the am & 10 at bed time & the DP disappeared. Weird same amount daily but hey it worked. :smiley:


@SobeiT Lantus is not flat. It ramps up, has a bit of peak at 6 hours and begins ramping down, probably at 19-20 hours.


@ CarlosLuis
I knew there was a rise in BG just after injecting but I did not know this. Thank you for the education :smiley:


Yesterday I went to 2 doses of Lantus, 60% morning and 40% evening. This is working better, but I still get big spikes. They do respond to physical activity. The first one mowing, the second pedaling.


This seems like a somewhat typical cortisol/adrenal response to the activity.

This gets better over time, as the activity becomes more normal.

If you were to do this every day or maybe 5 times a week, eventually your body would not care as much. It would simply shrug, this is normal. That is how we adapt to the stress of exercise.

And if it is hot there (I imagine it is!), that can make it even worse!


This writeup is detailed and gives a bunch of references. But this little section of it seems to kind of say the same general thing I put in the above post.

Yes, mine was overly simplified. But it does make me feel good when smart people say the same kind of thing I tried to say in my simple words. :smiley:

During short-term exercise such as an incremental maximal oxygen uptake (VO2max) test, the blood level of cortisol increases in proportion to exercise intensity once the workload is above a critical threshold (50–60% VO2max). This threshold intensity does however increase slightly as an individual becomes more exercise trained. Thus at the same absolute exercise intensity, the cortisol response may be lower following an exercise training program. During supra-maximal exercise, the cortisol response can be extremely pronounced, but this increase may not be displayed until recovery from the activity, due to the short duration of such activity. During sub-maximal exercise, cortisol responses are more variable and are influenced by several external factors. If the sub-maximal exercise is below the critical threshold intensity then cortisol levels may not increase above resting levels, or they may actually become reduced. If such low intensity exercise is prolonged enough in duration, levels may gradually increase over time above resting values. If the sub-maximal exercise is above the critical threshold intensity, then cortisol levels will initially increase and subsequently plateau, provided the exercise is steady-state. The level of the plateau is proportional to the intensity of the exercise conducted, but if the exercise is prolonged enough in duration, hormone levels will gradually begin to increase again over time. Consumption of a low carbohydrate diet for several days can augment the subsequent cortisol response to sub-maximal exercise . Furthermore, ambient environmental temperatures can dramatically influence the cortisol response to sub-maximal exercise. Extremely hot or cold temperatures can augment the cortisol response to an exercise session. Finally the more exercise trained a person, typically the more blunted the cortisol response to nearly any level of sub-maximal exercise condition.

Overall though, consider that only 3 months after surgery, your body is still working at getting back to where you were.

Don’t worry about rushing the progress. Any step forward, no matter how small, is always better than staying where you are!


Today I cut carbs and much better control. I changed the pump cartridge before bedtime that’s the big spike, maybe my infusion site was poor. Here’s the 24 hours


@CarlosLuis I was glad to see you mention lawn mowing! I thought I was just weird! It doesn’t seem that stressful or “exercising”, but if I don’t eat some a few carbs, set a lower temp basal, and allow an increased BG to about 140-150, I’ll go low about 1/2 to 3/4 the way thru every time! And that’s with a pretty small front/back yard (.2 of an acre minus the house, plant and garden beds).

Your graphs look very similar to my own, though since treating fat and protein with iAPS, the rise has been much smaller for the most part. Question: What was a typical mealtime carb load vs what you changed to?