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A case study of 1. Have you seen anything like this?

tim2000s

Expert
Retired Moderator
Messages
8,936
Location
London
Type of diabetes
Type 1
Treatment type
Other
Over the past week and a half, my normally settled T1 has been doing some funny things.

I noticed that I was having to feed hypos, so took the decision to lower my basal level, as I posted in @Natalie1974's post last week, however this weekend (well since Thursday really) it's all gone a bit crazy.

My overnight basal, which was 8u from 9.30pm to 7.30am I have had to drop to 3u and it's still causing me to drop low overnight, even with a starting bg of 7mmol/l before bed.

My daytime basal has gone from 14u to 10u and still needs to come down more.

As you might imagine, I've rather given up in I:C ratios and am surfing at the moment, with a pre-bolus on meals of roughly half my previous I:C ratio then small increments thereafter to catch any rises and avoid a sudden drop.

There are two correlating factors. I received news on Wednesday that was a stress reliever and I've gone down with a bug over the weekend, although I'd noticed the change starting before this point so I'm not sure there is a clear link.

Has anyone else seen this kind of dramatic drop in basal requirement (just under 50% so far) and if so, what did you attribute it to?
 
Must be a week for it Tim. My BS went haywire after the PWDC16 last week. Fasting BS of 10+ and rising. Didn't change anything except correction doses to get it down and then , Thursday, Friday and Saturday was fighting off hypo all day??? Must be something in that Nottingham water
 
A 50% drop is really unusual. You've probably been through the following tick boxes, i.e. recovery from illness, less/ more activity, change in eating patterns, temperature, new vial of insulin, emotional state? One or a combination can affect your basals/ bolus as you're more than aware. I agree though, it's very odd, will think on!
 
Yes, it's all very odd. I'm just glad I have a libre so that I could see it happening and take pre-emptive action. The other side to it is that I can't get the basal to last long enough at the reduced dose levels so there is a lot of filling in with Novorapid going on.

It just all seems rather unusual. It's really weird going to bed and using an incredibly low level of insulin.
 
Another thought, I think you're MDI so site variation could be another thing, if recently changed to a pump, I reduced everything by a third when I started four years ago. This could be a question for your clinic though.
 
Hi Tim have you considered faulty Basal. May be worth reporting to DSN as there may be other reports coming in or they can put the feelers out.
 
JaneC said:
Another thought, I think you're MDI so site variation could be another thing, if recently changed to a pump, I reduced everything by a third when I started four years ago. This could be a question for your clinic though.
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Whilst my bum may no longer be "virgin" injecting location, it isn't that well used (as I've only used it for a year) so I don't think it's site related.
 
Andrew Colvin said:
Hi Tim have you considered faulty Basal. May be worth reporting to DSN as there may be other reports coming in or they can put the feelers out.
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I'm able to discount that purely by chance. The onset came on late last week at the end of one vial and continued with the start of a new one. The old vial was from a different box received at a different time, with a different expiry date from the new one.
 
tim2000s said:
Has anyone else seen this kind of dramatic drop in basal requirement (just under 50% so far) and if so, what did you attribute it to?
Click to expand...

I've experienced ~ 50 % drop in basal requirement earlier this year when it was -10 degrees all week. In early 2014 , I lost a lot of weight and again had to drop my basal significantly. Lucky you've got a Libre.
 
Wurst said:
I've experienced ~ 50 % drop in basal requirement earlier this year when it was -10 degrees all week. In early 2014 , I lost a lot of weight and again had to drop my basal significantly. Lucky you've got a Libre.
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The temperatures here haven't changed enough to drive that kind of change (and again, it would be a new phenomenon if slightly colder weather caused my BG levels to drop).

Just mulling through things on top of this, the only other oddity was that on Friday, I ended up having an intermittent fasting day due to basal testing, and the sudden increased drop off (following a week of slightly lower needs) kicked in after that...
 
I think Tim is too masculine a name for this to be of any use to you, but happens every month for me: drop by 25% mid cycle (ovulating) when v insulin sensitive, then back to normal, then increase by 25-40% for week or so for pmt. So it is ever changing. Basal testing is not an attractive idea when it will only be of use for five days before your hormones screw it up!
 
I think you may be right, unless something really unusual has happened without me noticing!
 
Definitely time to go consultant bothering! Will probably relish the opportunity for something this unusual rather than the usual day to day queries.
 

It's so frustrating isn't it

I had a similar problem with my both my daytime and night time basal...although only had to reduce by around 25%...50% does seem like a very large reduction...especially if you've had a bug...which would usually drive insulin requirements up. Having said that...as mentioned in my post last week...stress can maybe be a larger factor than I'd ever really given it credit for...but having done some observations over the last few days...working from home...I don't get the same kind of morning rise that I would if I were getting up and following my normal morning routine of sitting in rush hour traffic etc...in fact the rise today was negligible compared to my normal day.

Could also be the intermittent fasting...I've read that many T2's find it a good way of increasing insulin sensitivity...although I'm sure you'll know more about that than I would.

Another thing that I did...that I've not had to do before because it never seemed necessary was to use half unit's of Levemir....it made a huge difference for me...despite being a total faff in swapping and changing pens around.

Hope you get it sorted soon
 
Make sure that the piston in the pump is working as it should and that the cannulas are ok along with the vial of insulin kept at the right temp.

Bugs and slugs can mess up the endocrine system so see if the low bg changes. Are you taking any med for the bug as those can make bg drop or rise.

Is the stress reliever regarding a certain D item?
 
Thanks @iHs, I'm currently off the pump, running on MDI ahead of clinic next week (and have been for a month or so). So it's definitely a non-pump issue.

The odd thing about bugs is that they normally push me up rather than down, and as I've not been taking any medication, it would be an unusual correlation! I'm not totally discounting it though.

Stress reliever was work related and has knock on effects outside of work, so it might make sense that this is the important factor.

This is why it's all rather odd. There are a number of circumstantial things that could all have an effect, but none of them individually seem to stack up to much. I guess I'll just keep an eye on what's going on and manage it appropriately. Makes for an interesting conversation on Monday though.
 
It happened to me once in the summer, about 40% less for me and, sorry, I've still no concrete ideas!

At the time I was thinking some kind of miracle was happening lol as with hardly any insulin I had perfect numbers?! On reflection, it was hormone and heat related (although it wasn't super-hot.)

A few months later I was diagnosed with hypothyroidism and I also wonder if that could have been it.

Good luck!
 
London36_ said:
A few months later I was diagnosed with hypothyroidism and I also wonder if that could have been it.
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I had a Thyroid test in January that didn't show anything, but it had crossed my mind too. Something else to check...
 
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