Variability in insulin production

[gavin86]

So being newly type 1 I expected some variability, but this has caught me off guard.

I went from taking approx 34u bolus (12/12/10) and more restricted carb intake, just trying to keep my bgl steady; to the next day taking 22u (8/8/6), eating more than I usually would, and still going low after each meal. (plus all the stuff I ate/drank to treat the lows)


How long did it take some of you to get settled?

Also, when I was first diagnosed, I was on 40+ units bolus per day. Is it normal to get this reduced need for insulin?

I seem to remember an educator or dietitian saying that my requirements would go down at some point, but I've had so many medical appointments lately I couldn't say.

 

[MangosteenElbow]

Depends on the foods you eat.
Depends on any extra physical activity, alcohol, stress ...
If you don't test enough after eating or otherwise (by BGLs or CGM) you might be under estimating insulin needs.
Losing excess weight and CGM probably are generally best non-nutritionl means of reducing basal amount. Pump helps but not as much.
For bolus adjustments, knowing your carb intake and response is second best.
The best? For me: ketogenic adapted diet. Daily insulin now averaging less than 40% of pre-keto. Lots of other biomarker improvements. These are covered in other threads.

 

[GrantGam]

So being newly type 1 I expected some variability, but this has caught me off guard.

You're correct on your assumption to expect change, that is very common in newly diagnosed T1's. It certainly was with me.

The ability to count carbohydrates (or at least estimate the quantity) will be your best friend in sorting out your bolus doses.

Basal rate testing is something which I'd strongly advise as a fellow T1.

https://mysugr.com/basal-rate-testing/

I'd also suggest that you purchase the following book. Not only will it likely answer many of the queries you currently have, but it will also answer queries you didn't actually know you had:

https://www.amazon.co.uk/gp/aw/d/B06XCDTPP1/ref=tmm_kin_title_0?ie=UTF8&qid=&sr=

Let us know how you go!

 

[col101]

There are some very good online courses that include carb counting. Don't have the link but if you Google BERTIE diameters online you'll find it. Good luck it's a learning curve but gets easier with experience.

 

[gavin86]

Thanks, yeah I spoke to my endo today about it too - think it's just my pancreas in its last gasps. There wasn't any exercise/unknown food/fat/weirdness to my routine.

Sorry should've been more specific.
I do count. My carb intake has been through the roof these days where I had less insulin (.. had to have more carbs/sugar than I wanted to today - whereas the past few weeks I've been struggling on the strict reduction).

Not mad if this keeps up for a little while! I'm actually in the situation where I need to put on weight

 

[catapillar]

Sorry should've been more specific.
I do count. My carb intake has been through the roof these days where I had less insulin (.. had to have more carbs/sugar than I wanted to today - whereas the past few weeks I've been struggling on the strict reduction).

I'm actually in the situation where I need to put on weight

Why have you been on strict carb reduction? Just curious. There is no requirement for a type 1 diabetic to low carb. That's not what carb counting is. Carb counting is understanding how to bolus for the carbs you are eating. The Bertie online course takes you through how to do that - https://www.bertieonline.org.uk

 

[GrantGam]

Thanks, yeah I spoke to my endo today about it too - think it's just my pancreas in its last gasps. There wasn't any exercise/unknown food/fat/weirdness to my routine.

Sorry should've been more specific.
I do count. My carb intake has been through the roof these days where I had less insulin (.. had to have more carbs/sugar than I wanted to today - whereas the past few weeks I've been struggling on the strict reduction).

Not mad if this keeps up for a little while! I'm actually in the situation where I need to put on weight

The whole honeymoon phase concept is interesting. Some diabetics find that their diabetes is a lot easier to manage soon after diagnosis when there may still a reasonable quantity of insulin production. Others like yourself, find it harder because of the unpredictability of your BG. It just goes to show how different the condition can manifest us T1's.

As for gaining weight, I wouldn't actively attempt that just by eating more carbs. It may cause your BG management to be even more difficult than it is. Moderation is key in type 1 diabetes, and the same logic applies to carbohydrate consumption. From my personal experience, I find anything between 120-200g gives me the best results. Your quantities may be different however, and you'll find that out yourself in due course

You do have fats and protein as an option for gaining weight, but be clever in your choices as some are seen as healthier than others. I'm in no way endorsing supplementing ridiculous amounts of fat into your diet like a lot of people here do. But again, moderation

You are very focused on bolus insulin though, have you considered your basal insulin dose as a possible problem?

 

[gavin86]

Why have you been on strict carb reduction? Just curious. There is no requirement for a type 1 diabetic to low carb. That's not what carb counting is. Carb counting is understanding how to bolus for the carbs you are eating. The Bertie online course takes you through how to do that - https://www.bertieonline.org.uk

I started on a fixed insulin dose out of hospital, so had to eat according to the dose, rather than dose to what I wanted to eat.

I've since moved to a little bit of variation, but mainly in terms of reducing insulin when not needed. I was feeling confident enough to give myself extra when my BG was high (not exactly confidence, more like afraid of long term issues).
But now i've had a few rapid drops due to unknown causes that have made me reconsider.

 

[catapillar]

I started on a fixed insulin dose out of hospital, so had to eat according to the dose, rather than dose to what I wanted to eat.

I've since moved to a little bit of variation, but mainly in terms of reducing insulin when not needed. I was feeling confident enough to give myself extra when my BG was high (not exactly confidence, more like afraid of long term issues).
But now i've had a few rapid drops due to unknown causes that have made me reconsider.

Ah sorry, I read your response "I do count" as meaning you carb count. Obviously being on fixed doses is of insulin is rather different to carb counting.

You can ask your DSN for advice on your correction dose. Or you can have a go at working out your correction factor using the 100 rule, just to give you an idea of how far 1 unit could be expected to drop you, but it's only an idea. Have you got a half unit pen? that can be helpful in someone honeymooning.

 

[gavin86]

Not sure what you mean about being on a fixed dose and carb counting? - I have to count how many grams I eat to match my dose

Doesn't seem like I'll need to worry about the half units - BG is back to being it's usual higher numbers. This dip has made me wary though.. if things change again suddenly when I'm on 10-12 units I worry what might happen. I took it easy yesterday and ended up at 20 though, so have started on the dose again. I spoke to endo, have been given a bit of range to maneuver now, although trying to figure out a ratio could be hard. I'm going to try eating exactly the same things every day for the next week and hopefully that will give me some solid data.
Also ordered a libre, but unfortunately will have to wait a bit to use it as I have an MRI and don't want to waste an expensive sensor!