Increased insulin sensitivity - a curious story

t1dluke

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TL;DR
I am coming up to 3 years since diagnosis of T1D, every couple of months I have a bad hypo and need to reduce my basal insulin from about 4 units per night to 0.5 units. Why do I become sensitive to insulin all the time?

Hi all,

I just wanted to share my curious story to see if anyone has experienced anything similar.

I was diagnosed as a T1D in December 2017 at age 25, I then blissfully managed the disease for about a year until December 2018 when I started playing 5 a side football every Thursday with workmates. I was naive and didn't adjust my insulin ratios to accommodate the exercise. In February 2019 I became quite ill and suffered a hurrendous hypo, my heart sank, my body felt heavy, I couldn't feel my pulse, I had a feeling of utter dread, I fell at the top of the stairs and thankfully my girlfriend was there to give me some glucose to get me out of it.

However the following week after this I had noticed my basal insulin requirements had decreased drastically. I went from 25 units of basal insulin to around 5 units per night. In the following days I had dizzy spells, constant nausea, confusion and I would go in and out of lucidity. I ended up going into hospital as these symptoms persisted and I became really unwell, before I got to hospital I had all the hallmarks of a panic attack, breathing erratically, pins and needles in lips and fingers tachycardia etc.

I was admitted to hospital for a few days and the doctors ran bloods and everything was normal apart from I had raised liver enzymes and slightly raised calcium (only very slightly). My symptoms improved over the few days and I was released from hospital. The diabetic consultant at the time suggested I had potentially been overdosing on insulin which may have caused the symptoms.

Over the next two months I lost a lot of weight going from 103kg to 95kg (16 stone 5 lbs to 15 stone) due to not eating very much as I'd largely lost my appetite, I think I was totalling around 1000kcal per day at the time. Over these two months I got gradually better but had waves of being unwell in the days; my insulin requirements were very low and some days I didn't need to bolus before eating and bloods would stay in range, I have also had chronic loose stools ever since the hospital admission. By around Mid-April 2019 I began to feel somewhat normal again and I was no longer having waves of sickness in the day times.

I thankfully had a few months of normality until August 2019 when I had a very stressful situation at work that triggered gastritis like symptoms and a big reduction in basal insulin from 6 units per night to 0.5 units per night. It was at this time that I realised how much of an effect stress has on my insulin requirements, for some reason I become very sensitive to insulin when I am stressed.

My basal requirements slowly recovered over the next few months and I was taking 4 units of basal per night by November 2019.

Since then the pattern has continued, in March 2020 my basal insulin requirements went from 4 units per night to 0.5 and again in June 2020 after another really bad hypo. Interestingly, I had been working from home between March and August and admittedly did not get enough exercise and put on a bit of weight but still became hypersensitivite to insulin.

And here I am today in September 2020, currently taking 1 unit of basal per night and I'm thinking of reducing it to 0.5 units tomorrow due to another sudden increase in sensitivity to insulin.

So I am coming up on 3 years since diagnosis (Dec, 2017) and I am wondering if this pattern of increased insulin sensitivity is normal? Has anyone experienced anything like this before? Also, my basal to bolus ratio is highly skewed in favour in bolus. I can take about 9 units of bolus in a day but only need 0.5 units of basal once a day.

My consultant is putting it down to an extended honeymoon period but no investigation has been done it's just guessing.

I am currently using Lantus and Humalog and just as an FYI, I have also been diagnosed with erosive gastritis and a hiatal hernia.
 

EllieM

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My consultant is putting it down to an extended honeymoon period but no investigation has been done it's just guessing.

Are you sure you're T1 and not MODY?
 

MarkMunday

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... My consultant is putting it down to an extended honeymoon period but no investigation has been done it's just guessing. ...
A c-peptide test during these periods of reduced injected insulin requirement may help confirm if there is increased insulin production. I went through periods like this for perhaps 15 years after my T1 diagnosis. I would reduce insulin dosage by up to 59% and these episodes lasted for days or weeks. It eventually faded away, and has not happened for many years. Increased insulin sensitivity may be an issue, but IMO increased endogenous production is the main cause. Sounds like your consultant thinks so too.
 
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t1dluke

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Are you sure you're T1 and not MODY?
Hi Ellie,

Thanks for the response, I think when it comes to the genetics, MODY is passed down in an autosomal dominant way, neither my mother or father (nor their respective parents) have diabetes so I don't think it can be MODY, at least I think that's the way it works.

I have elevated GAD antibodies and autoimmune problems do run in my family. My brother has Ankylosing Spondylitis, I got T1D, it's bit like the autoimmune lottery in my family.

I'll have to do some research into other types of diabetes.

Thanks.
 
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t1dluke

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A c-peptide test during these periods of reduced injected insulin requirement may help confirm if there is increased insulin production. I went through periods like this for perhaps 15 years after my T1 diagnosis. I would reduce insulin dosage by up to 59% and these episodes lasted for days or weeks. It eventually faded away, and has not happened for many years. Increased insulin sensitivity may be an issue, but IMO increased endogenous production is the main cause. Sounds like your consultant thinks so too.
Hi Mark, thanks for the reply. It's interesting to hear other people's accounts. Perhaps I am still producing endogenous insulin. I did mention to the diabetic nurse recently about having another c-peptide test to see how my levels have reduced (or not) since diagnosis. I am waiting to hear back from them about it as they are not sure whether it would be useful to do that.

Thanks again.
 

jimmax

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t1dluke,
in your initial post you said you suffered from loose bowel motions.
About one year ago my BG became much harder to control and I also had loose bowel motions. I took Imodium tablets for the bowel problem. It fixed that and I started to notice an improvement in my diabetes control. After a few weeks my control was back to normal. I think I may have been suffering from Diabetic Gastroparesis. I'm still taking Imodium tabs.