Type 1.5 Insulin needs have gone up rapidly

[michelle88]

I've been diabetic for over 6 years now (I'm 39 years old) and have managed it alright with Novorapid insulin. I've been using Levemir for the last 3 years because my fasting BG kept creeping up. HbA1c's almost always in the low to mid 6's, occasionally in the high 5's. My insulin to carb ratio has mostly been 1:10 throughout these years.
But for almost 2 months my insulin needs have been going up rapidly and I have no idea why. I've had to inject 3 to 6 units of Novorapid on top of my normal ratio. This has caused me to be terribly stressed and confused, because why are my insulin needs going up for no reason? Could it be hormonal? But I'm not in my 40's yet. And the more stressed I am, the more units I need to inject to keep my levels in range. The past week I've had sleepless nights and of course it's not been helping my well-being. I'm scared it'll develop into insomnia. I try hard to be positive but this is really getting me down! I don't want to stress but I don't understand why my insulin needs have gone up in the first place. Please help!

 

[Deleted Account]

There are many things which cause our BG to go up.
- Have you suffered any illness?
- Have you started taking any more medication?
- Have you changed your diet?
- Have you done any less exercise?
- Do you ever find the cold weather results in higher BG?
- You mention stress about your BG - stress increased BG. Have you changed your job which has resulted in extra stress?
- Are you using the same insulin pen? If yours is 6 years old, it may be having trouble with its doses and it could be time to get a new one.
- Have you been on the same batch of insulin in the last 2 months? They may have been contaminated or not kept cool at some point so lost their potency.

If it is none of the above, perhaps you could talk to your diabetes team who may suggest increasing your ratio ... or your basal dose.

 

[Circuspony]

One of the consultants I see believes the honeymoon period last for a lot longer than they originally thought - so it could be that yours is finally at an end.

 

[michelle88]

There are many things which cause our BG to go up.
- Have you suffered any illness?
- Have you started taking any more medication?
- Have you changed your diet?
- Have you done any less exercise?
- Do you ever find the cold weather results in higher BG?
- You mention stress about your BG - stress increased BG. Have you changed your job which has resulted in extra stress?
- Are you using the same insulin pen? If yours is 6 years old, it may be having trouble with its doses and it could be time to get a new one.
- Have you been on the same batch of insulin in the last 2 months? They may have been contaminated or not kept cool at some point so lost their potency.

If it is none of the above, perhaps you could talk to your diabetes team who may suggest increasing your ratio ... or your basal dose.

Thanks for your reply, helensaramay. I use the disposable Novorapid and Levemir pens. Not currently suffering any illness but my insomnia is getting worse.

 

[michelle88]

One of the consultants I see believes the honeymoon period last for a lot longer than they originally thought - so it could be that yours is finally at an end.

Yes, that could be, although I'm still hoping it's not the case. How I wish I could go back to my 1:10 ratio. Now it's just really a struggle and I find it hard to cope, adding to this my sleepless nights. Although I don't think I've ever had a honeymoon period because I was put straight on insulin since diagnosis and my ratios never changed until now.

 

[ringi]

Is your weight stable?

 

[michelle88]

Is your weight stable?

Yes, always has been ever since being diabetic

 

[ringi]

Then it is unlikely to be increasing insulin resistance due to fat on the liver. (I assume you have checked your liver function test results.)

 

[michelle88]

Then it is unlikely to be increasing insulin resistance due to fat on the liver. (I assume you have checked your liver function test results.)

I do suspect it's increasing insulin resistance though because when my BG is high it takes more units of Novorapid to make it come down. Could I have fat on the liver even though I'm slim?

 

[ringi]

I do suspect it's increasing insulin resistance though because when my BG is high it takes more units of Novorapid to make it come down. Could I have fat on the liver even though I'm slim?

Yes, but lots of fat on your liver is licky to show up as a liver function test result that is slowing getting worse, and increased triglycerides (part of a full lipid test). If you have online access to your test results, have a look at a graph of these, otherwise, ask for the printouts going back 5 years. There are also scans what will show fat on the liver, but the scan the NHS uses will only show it up once it is very bad.

But needing more Novorapid could just that your pancreas is no longer producing at much insulin of its own, a c-peptide test will show this, and your GP can order one. (Real shame they are not done as standard each year for people with diabetes, so you can see how it changes over time.)

If (and we don't know) it is fat on your liver, then avoiding all sugar (including fruit), reducing carbs and avoiding most alcohol is proven to result in reduced liver fat. Remember that protein needs insulin if you are not eating any carbs in a meal, and the insulin dose may need to be split. If you decide to go "very low carb", then as you don't need to lose weight, you will have to become happy with eating lots of "good" fats. But "low carb" can often be made to work by increasing protein and avoiding "low fat" products.

Resistance training and HIIT have also been proven to reduce insulin resistance, so has a 10 minute walk just before and/or just after eating.

 

[michelle88]

Yes, but lots of fat on your liver is licky to show up as a liver function test result that is slowing getting worse, and increased triglycerides (part of a full lipid test). If you have online access to your test results, have a look at a graph of these, otherwise, ask for the printouts going back 5 years. There are also scans what will show fat on the liver, but the scan the NHS uses will only show it up once it is very bad.

But needing more Novorapid could just that your pancreas is no longer producing at much insulin of its own, a c-peptide test will show this, and your GP can order one. (Real shame they are not done as standard each year for people with diabetes, so you can see how it changes over time.)

If (and we don't know) it is fat on your liver, then avoiding all sugar (including fruit), reducing carbs and avoiding most alcohol is proven to result in reduced liver fat. Remember that protein needs insulin if you are not eating any carbs in a meal, and the insulin dose may need to be split. If you decide to go "very low carb", then as you don't need to lose weight, you will have to become happy with eating lots of "good" fats. But "low carb" can often be made to work by increasing protein and avoiding "low fat" products.

Resistance training and HIIT have also been proven to reduce insulin resistance, so has a 10 minute walk just before and/or just after eating.

Thanks ringi! Very helpful information. It's hard to deal with all the curveballs diabetes throws your way. Being diagnosed as diabetic was a shocker for me but all these years of dealing with it didn't really get me down because until now it's been relatively easy to manage. Now it's a nightmare having to figure out how much insulin I need for every meal, that I need so much more of it especially when I'm stressed, and having to always test my BG, more than before.

I weigh only around 50kg, so my total insulin dose should be between 25 and 30 units. At the moment it's more than that!

 

[Kristin251]

I just posted this too.

My needs have gone up too. It’s been very cold lately and we had a mil December. I’ve been trying to pin point it. Nothing I do seems to change. My fasting is the worst. I’m afraid to up my basal for fear of a hypo but I’m nowhere near a hypo now. In fact the last 2 nights when I one up I tested and injected around 5 am. Then my fasting is better but certainly not a habit I want to get into

My foods haven’t changed. Just eating a lighter dinner to see if that helps. Nope.

It’s frustrating. And then all of a sudden it changes again for no reason and there’s the hypo

 

[Bananas 2]

others have covered many possibilities....
but, one more possibility is that I have noticed certain allergy/congestion medications can have a significant detrimental effect on insulin efficiency/resistance.

 

[Kristin251]

others have covered many possibilities....
but, one more possibility is that I have noticed certain allergy/congestion medications can have a significant detrimental effect on insulin efficiency/resistance.

Oh yes. Loads.
I wonder how long after a virus things can be wonky. Seems like after our trip that we got sick on and was still kind of sick after New Years, everything has changed. But it’s been well over two weeks that I’m back to normal as far as the virus. Just not the bs

 

[Antje77]

I weigh only around 50kg, so my total insulin dose should be between 25 and 30 units. At the moment it's more than that!

I didn't think insulin doses have anything to do with body weight, except maybe when starting insulin to decide a starting point from where you adjust to find your personal dose. Must be a thread somewhere about how much insulin we all take and I seem to remember it varies a lot between different people.

 

[Jaylee]

I've been diabetic for over 6 years now (I'm 39 years old) and have managed it alright with Novorapid insulin. I've been using Levemir for the last 3 years because my fasting BG kept creeping up. HbA1c's almost always in the low to mid 6's, occasionally in the high 5's. My insulin to carb ratio has mostly been 1:10 throughout these years.
But for almost 2 months my insulin needs have been going up rapidly and I have no idea why. I've had to inject 3 to 6 units of Novorapid on top of my normal ratio. This has caused me to be terribly stressed and confused, because why are my insulin needs going up for no reason? Could it be hormonal? But I'm not in my 40's yet. And the more stressed I am, the more units I need to inject to keep my levels in range. The past week I've had sleepless nights and of course it's not been helping my well-being. I'm scared it'll develop into insomnia. I try hard to be positive but this is really getting me down! I don't want to stress but I don't understand why my insulin needs have gone up in the first place. Please help!

Hi @michelle88 ,

Personally. I'd start from the ground up with the basal.. (In your case, Levemir.)
It's a possibility (from my interpretation of your post.) that you might be compensating with your higher dosage of Novorapid because your Levemir needs adjustment?
You should consult with your HCPs on this. Here is a link to basal testing.. https://mysugr.com/basal-rate-testing/

Hope this helps..!

 

[Ann1982]

I am having the same problem at the moment and I have no idea what is causing it. I was sent for blood tests for everything they could think of that could be causing it, my mum had rheumatoid arthritis and my sister has lupus. I went for the tests last week and the phlebotomist didn’t get a drop! Trying again tomorrow. Here’s hoping.

 

[jackois]

I've had similar lately.

Last summer/autumn, I had to reduce my insulin use significantly. I started on 18 units Lantus and between 30 and 40 of Novorapid. My levels had me reducing both to the point where I was only using 8 units of Lantus & only taking insulin with my evening meal. I suspect either another honeymoon period or improved insulin resistance. I've been diagnosed for around 5 years and this is the third instance of this.

Currently, I'm back at 15 units of Lantus and 35 of Novorapid.

I adjust my long term (Lantus) by looking at my waking results each day and should they show an upward trend, add a unit & monitor for another few days. Similarly, I have a few dishes that I can be exact over carb numbers which I can use to check the efficiency of my fast acting insulin.

Finally, it's always worth trying a brand new pen, especially with long acting as they are quite long lasting and may lose efficiency over the period of use.

Hoe this helps.

 

[michelle88]

I just posted this too.

My needs have gone up too. It’s been very cold lately and we had a mil December. I’ve been trying to pin point it. Nothing I do seems to change. My fasting is the worst. I’m afraid to up my basal for fear of a hypo but I’m nowhere near a hypo now. In fact the last 2 nights when I one up I tested and injected around 5 am. Then my fasting is better but certainly not a habit I want to get into

My foods haven’t changed. Just eating a lighter dinner to see if that helps. Nope.

It’s frustrating. And then all of a sudden it changes again for no reason and there’s the hypo

Yes I hear you, it's so frustrating and the stress is definitely not helping. It's been almost 2 months now and I still need significantly more insulin than usual. Is this my new normal? Currently I need to take 12 units Levemir before bed and around 25 units Novorapid per day. Just 2 months ago that amount of units would have sent me hypoing all the time, but now I never hypo, although with this much insulin my BG is more or less in range.

 

[michelle88]

Hi @michelle88 ,

Personally. I'd start from the ground up with the basal.. (In your case, Levemir.)
It's a possibility (from my interpretation of your post.) that you might be compensating with your higher dosage of Novorapid because your Levemir needs adjustment?
You should consult with your HCPs on this. Here is a link to basal testing.. https://mysugr.com/basal-rate-testing/

Hope this helps..!

Thanks Jaylee, very helpful. A few months ago I had to up my basal from 9 units at bedtime to now 12 units. Most of the time the 12 units seem to cover it, but these days, especially when I'm stressed, my fasting is too high. Today it was 9.6! But usually under 7.5, which I know isn't ideal either. Then sometimes I'm in the 5s and 6s. I can't figure it out.