Hi, again. I am scared to ask in case something bad could be happening, but don’t see Endo for a few more weeks. I have been going low during and after meals, and in between. I am on MDI since May 8th and have used 13 units of Tresiba until June 15th and then have been mostly 12 and sometimes back to 13. July 11th, I went to 11, then 10 on 13th and now pondering 9 for tomorrow due to these lows and having to eat more calories, and the fear generated like just now when my glucose dropped to 74 and falling having been 103 post supper, and 105 when I gave insulin. I pre-bolus 10 minutes for all three meals. My ratios had been the same as usual (1:9 breakfast, 1:15 lunch and 1:11 Dinner) in May, but in last week I have had to alter lunch to 1:18, and today back to 1:15, but dinner has been ratcheted up to 15, then 14 tnen 12 today figuring the lower Tresiba would let me get closer to my norm (same for last 6 months easily). I have not used less than 12 units of Tresiba in over a year and possibly more. I am not honeymooning, but only got diagnosis of LADA almost 3 years ago at age 57. I have never experienced needing less insulin, only more and this seems significant besides throwing my life out of whack. I exercise the same amount as always, (6 days per week with 2 weight training days with 45 min. walk, and 5 or 6 days of 4-6 mile fast walk and same basic diet of 25-45 carbs per meal, no snacks. And I am 5 pounds more than last year this time (5’7” and 139 pounds). Treating lows has contributed to the extra 5 pounds, but it is not like I have lost weight and insulin needs changed. I am worried, but wondered if anyone has had something like this. They will do a blood draw at this upcoming appointment. But until then is there a direction I should look toward in figuring this out? I try not to change Tresiba until at least three days, but stuck so long with it at 13 that I began a roller-coaster period. And waited 2 days to go from 12 to 11 and now am on second day of 10. You’d think this would be happy, but it is scary with every day feeling so out of control and not knowing what will happen when I have been so regulated for these last 2 years. I will probably call about it Monday, but incase anyone has any ideas or avenues to look into, I would appreciate it. Still, it may just be odd and something particular to me. Thought I would reach out, anyway. And I have no fever, but have been more tired lately (but it is hot and humid). Anyway, thanks in advance if you know something and no worries if not.
Laura
During Spring and Summer it may be due to longer daylight and being more active without realizing it.
Hormonal changes can also cause rise/fall of insulin sensitivity.
Do you use a cgms?.
Be sure you give any changes to dosing with Tresiba several days to see the full impact. It can take up to three days to see the full impact of any change. If you make changes before seeing the full impact you may never see what a change has really done. It’s also possible that Tresiba may not work for you because the duration is so long and if basal needs are different during the day it would be possible to see too much insulin and too little insulin at various times of the day. Switching to a shorter long acting and splitting the dose may be the best way to manage things.
It’s normal for insulin needs to change from time to time. It could be the seasons, the allergens, hormones, activity level, or any of many other things. But really, it doesn’t matter what the underlying cause happens to be.
You saw that your BG seems to be falling all by itself, you correctly concluded that you need less insulin, so you’re doing the right thing by backing off bit by bit until you stop going low. It’s a nuisance, but you’re handling it right and it’s just part of the job to notice when the insulin requirement changes, and to change the dosing in response.
If you use any sort of HRT and have changed manufacturers (especially of estrogen, especially, in my experience, in using patches), hormonal delivery can differ between manufacturers. Varying estrogen delivery can change insulin sensitivity. That affects my basal needs by 10-20%. Sorry that you are dealing with this!
Thanks so much! Hopefully it will be ironed out soon. I did not want to wait another day to make it 3 days on 10 units because of between meal lows and another during the night well past max of 5 hours of Humalog being in me. So did 9 this morning, but fell low right before lunch, so punting now with that. I was just so much better in the past having controlled for just about everything by my rigid lifestyle and eating patterns. Now I find that I never learned exactly what to do when you go low before a meal, and I was driving home in the rain from my mom’s where I hit 200 (ugh!) due to changing breakfast ratio from 1:9 to 1:12 to avoid yesterday’s post breakfast low, and probably some stress and then got the 85 and falling alarm in the car and ate 2 glucose tabs just to be sure to not go low in the car. Then I reduced lunch carbs by 5 to account for 5 of the 8 glucose carbs. It truly is unfathomable to have been so ling between 12 and 13 and now to see what 9 does. It has made for a crazy time. I used to be able to give just boluses and basal and not even corrections most of the time. I am sort of glad not to be on the pump so this could be revealed and I can learn. Thanks for the hope that this is just part of the deal. I do appreciate it.
@MM2 Thanks for those thoughts. I feel like I am pretty much the same, but maybe less activity when it is 103 and sweltering outside. And I am post-menopausal and never did HRT. But those things do make sense. Thanks for chiming in!
Laura
@JessicaD Thanks for the empathy! I appreciate it. Alas, no HRT, so the mystery remains. Heat makes my exercise BG higher and I am noticing more post exercise highs than before, but maybe the heat in an overall way is reducing insulin needs. Very bizarre to me, but I am learning.
@Sjwprod Thanks for those thoughts. I wish in going from 13 to 12 I had changed faster to avoid such headaches that began then, but I have tried to go three days except when evident I am still having too many lows. I did that today after only 2 days on 10 units figuring it should show as staying high overnight or at least not going low between, at or during meals. I will stick with 9 for 3 days, for sure - it is so low an amount. And I will certainly ask the endo about a basal I can use twice a day. I know from pump data when I was on it that I use much more insulin overnight, but Tresiba in all this time has always landed me between 100 and 120 upon waking. I sure had basal dialed in for 2 years and It is now lower than my very early time when I went from 6 to 10 then 11-12ish. For a second I wondered if my pen was one with double an]mount of insulin or something, but have been through other pens from same box and all was my normal. I sort of hate that I so boxed myself in with eating times and amounts rarely changing, exercise same time and type and all these rules I have had in order to set and forget, sort of, my insulin and live well with Diabetes. Now I have very few variables I can control, so feel somewhat asea. Thanks so much for posting - it helps to feel I know what to do and to be reminded of options like a different basal. I feel like the puzzle can be solved if I just stay steady in dealing with stuff and try not to overreact. I do wonder if my lows and the rebound highs and such have just gained momentum and made my body lose it own intelligence for the moment. And I don’t know why I feel low now even at 90. Maybe being hypersensitive so I catch these things earlier. Tried to walk down a 180 after the low post-supper last night and then by bedtime gave a .5 correction to not stay in 15os all night, then 6 hours after injection, I get waked up with a low and wanted glucose to last for about 4 hours until I woke, so took 2 tabs which allowed me to wake at 123, but boy was I up high much of that time! Wonder what would have happened if I went to bed at 159 and not corrected? Maybe no low and no need for dern glucose tabs interrupting my sleep, but no I probably did mess that up. I realize how much I have learned and how little I know. I have had such tight control 90-100% TIR and 5.9 A1C, so I never thought of going to sleep on 159. I guess it wouldn;t kill me, but I do not like being high at all. I work too hard. Anyway, sorry - I just expressed yet more ignorance here. But thanks so much for posting and helping. As you can see, I certainly need some help. Thanks again!
You’ve hit 40-60 things that can impact the bg the way you’ve noted. Start by doing basal testing with no food or bolus for 4-6 hours. The you can mess with things. Changing a long acting insulin will not show the full impact for 24-72 hours so patience is key. Any other things you fiddle with will negate the testing you’ve done there is a great deal of info missing about what you are experiencing so I cannot guess specifically on anything, even after 52+ T1D years. Only you see all the factors in play.
Thanks! @Sjwprod I am just trying to deal with all the other things happening as bolus needs may have changed too, but do understand basal has to be dialed in first. I kept trying to leave boluses alone, but maybe should have dropped them the same percent as Tresiba Or at least some (but 1/2 units still can’t do it like a pump) and I eat 119-123 carbs a day and TDI 19-22. I have never let myself skip a meal, so have not done real basal testing, but know my pump had me using almost twice as much in some overnight hours than daytime. I may try basal testing, but am going to stick with 9 units for at least three days and see if things settle. And maybe 9 will then need to be upped to 10 if it reveals too little insulin. I really can’t be too far off now having dropped from 13 units July 4th and worked down now to 9. Seems like jumping off a cliff😁. Thanks for the reminders. I am working on patience and trying not to take too many actions. But I will not let myself go low - takes too long to get back to normal and creates fear in me. I guess I have been lucky to have good TIR and average glucose and standard deviations of 19-25 or so. Now I will learn and hopefully catch this sooner in the future. Thanks again for taking time to help!
Making changes is always a challenge. Minimizing the moving has always helped me.
Would you consider going back on pump. Current pumps can auto adjust basal rates and compensate for BG changes.
There are many factors besides food and activity that drive how much insulin you need.
I see that you said you are LADA and are about 3 years in. I think that we are in a little unique of a situation in insulin world. Even though I was diagnosed in DKA a few years ago I still make most of my basal insulin but only in the day time hours. So like you I would drive myself nutty trying to make a Lantus dose fit when in reality there would never be a dose that could not drive me low during the day. Add activity and I would have to eat 15 carbs every hour and a half. I don’t think it’s because anything is wrong with you. Our own insulin can last for years after diagnosis and it can vary greatly.
If you decide to stay on MDI you might try to just get the nights steady then plan on eating with a greatly reduced carb ratio during the times when the basal is obviously too much.
IMO a pump is a godsend for just the situation you are describing. Something that can change the basal as needed.
Oh my gosh! Thank-you so much for that information. And your idea sounds like a great approach. I have been fighting the pump feeling it is a punishment for failing, but I may have to use it to get straight. And I sort of want to learn so I can handle mdi in these situations. So have been on the fence. Since suffering this long, I think I will keep persisting and get my basal right. I sure never thought about adjusting carb ratio to get through these type of days. I am adjusting my supper rate right now and will maybe go from 1:11 to 1:15 and see what happens. Also thought maybe a 1:13 and no pre-bolus. Sure seems like last night the insulin hit hard and caused me to treat it with a full tummy. I always get worried that all that food will hinder my glucose tabs when heading south. So weird to go low on a full stomach. Anyway, by now I believe just my 9 units is gettingstarted (I take Tresiba at 7am), so will cross fingers and just try not to be too drastic when I bolus. Thanks again fir sharing - this is very helpful.
Hi, again, @MM2 . Yes, you and @Josie bring up a good point. I am getting weary of this and my body needs to feel good. I may try for a few more days and then go back to the pump. I just feel so free without it and exercise is so much easier to manage, but I may need to. I’ve just been so wanting to wait and be eager and happy and looking forward to getting back on the pump. I hate to have to go on it in defeat, but I may have to admit defeat very soon. Or I may take all the good advice I am getting here, and finally learn to go with the flow on these changes and get things situated. But thank you so much for saying that because I think I needed to hear it and both of y’all are so kind to bring that up. It’s kind of the elephant in the room. And I had so much tunneling and stuff with the Omni pod five but I’m probably going to use the T-Slim, which I’m lucky to have both, but only have about a week and a half or two weeks of supplies for it. But it stays in better and I was trying to wait until the Omnipod works with the iPhone before I do it again. The algorithm for T-Slim works better for me, but I don’t like the tubes and it takes me 20 to 30 minutes to fill the cartridges. Speaking of - if anybody knows, could I theoretically fill a cartridge or two and have it ready in case one fails in the middle of the night or unexpectedly and not have to stress over all that commotion and all those steps? And if I had no problems, I could easily just use the one that was the spare at the next change and then always have one in spare. Would that be a problem? That would take the mental burden off and last time when I took the pump off it was because I had pulled it out in my sleep and could not fathom trying to fill that tiny cartridge and get the air bubbles out and all that in the middle of the night. Alrighty again I can’t thank you enough for all of this I feel much better armed to take care of this. Thanks!
Please, let that go about failing. Failure for us is not doing what works for us, and what works for you may or may not for others.
This situation always scare the heck out of me. I’ve encountered it a few times because I always make these clean out the fridge giant salads. I use transcend gel packs for these times. I think they work a lot better when the stomach is full instead of glucose tabs which hit me rather slow. I will also put a glucose tab in my cheek at the same time. Not sure how well it absorbs but it can’t hurt?
@CarlosLuis Thanks for that. I guess I am sort of blaming myself too much. Plus, my emotions are out of whack with these roller-coasters. I appreciate your response so much!
Thanks, @Josie I eat large salads fir or with dinner very often and then remember how long it takes to eat them and think I should have a carbier thing first. I have never tried the transcend gel packs, but will get them. I think glucose tabs feel slow, too. I have been doing apple juice during this past week and wonder if liquid is any faster or can help work in a full stomach. I am very interested in trying the gel packs! Thanks for the great ideas and for sharing that there are others out there like me. Thank-you!