Increasing basal needs - almost daily - why?

[New2T1D]

Hi, I hope someone might be able to advise me. My son was taking 10/11 units of Lantus basal for a few months. Suddenly, when the hot weather hit, he needed less and less (hypo after hypo), until we hit 6 units. That lasted about 2 weeks. Since then, he's had increasing Lantus needs to achieve same basal and we're now at 12 units, 2 months later. What happens is this: one additional unit brings the basal back in line for one day, maybe two days, and then the need rises again. I normally leave the Lantus for 3/4 days at the higher level before increasing it more. Does anyone know what's happening here? I thought it could be ending honeymoon, as he was diagnosed 8 months ago now, but the bolus has only slightly increased and mainly in the evening, because the Lantus runs out between 6 and 7pm (10pm injection). Thank you

 

[Just_Me_Rachel]

Hi there,

I'll offer my thoughts / experiences with some of the points, but please do ask your son's health care team! Additionally, wait til some other members are around as they'll probably have more experience in dealing with children with diabetes. I'm answering as a T1D of 20 years, having lived with this since I was a kid.

So, re: honeymooning. I have no experience but I'd think that once you lose the honeymoon period, the basal would be the one that will need to increase, as opposed to the bolus. Bolus too, but I'd assume that it'd be affected with basal rates more, because that's the underlying insulin, so any insulin the body is still producing, wouldn't it go to the underlying basal than the extra food?

I wonder if it's possible that the 2 weeks prior to his needs rising - the pancreas kinda dumps in all it has left before totally shutting down. Parents dealing with honeymoon phases will be able to tell you if that is there experience, but it makes sense to me going by the rule of, before the very end, it gets better.

At the age of 10 or 11, my blood sugars were constantly high. My Mom took it on herself to DOUBLE my insulin, I think from 12 to 24 units. The doctor was surprised that it worked so well, he'd never have taken that risk, but I guess I was needing that whole lot more insulin because of growth spurt. I was long after honeymooning phase, so I guess I'm pointing out that depending on the age of your child, his insulin needs may increase just because of body growth.

One other thing I noted from your post: The sun!! Many summer holidays my family would leave the English weather and travel to a sunny somewhere. Without fail, my sugars would drop. The sun always brought my sugars down. When we did exercise, like walking, it was obvious, but just by laying on the beach in the sun - no exercise - my sugars would fall. I would have been surprised that you'd have been able to keep it at 6 units, that doesn't seem possible.

I'd still stick with the honeymoon phase ending, however you make sense of it - because that makes the most sense. His pancreas is "due" to stop at some point and when it does, his needs increase. But like I said, do discuss it with his healthcare team and read up some more about what it looks like when the honeymoon phase ends.

Good luck!

 

[dancer]

Quite often in diabetes there is no straight answer. It could be one thing or a combination of several things that caused this - age, weather, holidays, possible virus biding its time before symptoms show, etc etc.
The only thing you can do, till you speak to his DSN, is be reactive. Even your DSN possibly won't be able to give a direct answer. You'll probably just have to test and look for patterns, adjusting basal/bolus doses when appropriate.