Am I imagining this ?

EllieM said:

Hi @James472
I have variable insulin resistance, and genuinely feel that after ten years lantus no longer works for me. My team are authorising a pump and I'm going to try it. Given the option I would try an alternate basal first (tresiba or levemir) but that isn't available for me. (And I honestly suspect/hope that the pump will be great for me)

If you are worried about allergies you should be able to get tested quite easily. There are also diabetic complications which I believe can cause resistance issues so I would honestly also talk to your team and see what they suggest. T1 evolves over the years/decades. I understand your hypo fears but really your diabetic team should be able to address them.
Good luck

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Hello @EllieM . The insulin pump does sound an option, but not just yet, for me.
What I wanted to say to you was, if there is mileage in my nonsense, then maybe you don't have 'variable insulin resistance' ! Maybe it's this 'unknown thing' going on ?

I'm going to take a shot at something - now, I am pretty certain it'll sound far-fetched, but hear me out.

I don't know you, but your Avatar shows dogs ? Now, if they're memories of previous pets, I don't want to touch a nerve, so don't take it the wrong way.
But if you do have pets, (and obviously based on the nonsense I'm wondering about with hair being linked - and they do talk of folk who have allergies to pet hair), could you at least imagine this scenario .......... maybe one of the pets moves around more on certain nights, and loses more hair - maybe rolling around. The diet on certain days could make it feel more itchy, and want to roll around more, I don't know. But more hair loss could mean more of my nonsense, so maybe that could alter your BGs, hence you think your Lantus is no longer working. And if the DM population in your house isn't too high, you might not even notice any nasal rhinitis, but your BGs could still alter.

I can't possibly say that's what's going on, but it is theoretically possible.

I'm just trying to help. But if you go ahead with the pump, good luck.

Westley said:

To clarify to the point about dose dependent duration, here's a figure (from here). Bigger doses don't just bring down sugars more, they continue acting for longer.
View attachment 63941
I believe a similar effect happens to varying degrees with other insulins.

So doses much bigger than typical for most could be causing stacking effects much later than the durations we get told for a given insulin.

I'm not suggesting you use less insulin than it takes to get your BG down, just pointing out that these long tails can sometimes explain variations that don't make sense when going only on the common simplified descriptions of insulin action.

These long tails do get flatter towards the end, so lots of big doses during the day might give a somewhat basal like effect overnight and make it seem like real basal isn't needed, but it's coming at the cost of the rollercoaster during the day.
An actual basal is a more controllable way of achieving this though, and should allow the bolus doses to come down.

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Wes, I appreciate what you're saying about the stacking effect, but the things is, that would hit me eventually, and I'd end up with a massive hypo - which I don't get. And as for them acting like a pseudo-basal overnight, again no. I'm not stopping basal because I think I don't need it, I'm stopping it because at least with my NovoRapid bolus, I know it's only for a few hours, so I can make calculations and judgements on how much to dose up, and when to sleep. But with basal, it's ticking over for 22 hours, and like I say, if I get busy (and lucky), and remove the 'unknown source', I can get a smooth run where I don't want extra insulin ticking over. My perfect flatline nights are too few, but it would only take one, with 29 units of basal (calculated earlier) coming along, and I'd be in A&E.

I'm not lying. My bloods are mostly up, and I just keep having to force them back down. And I am really confident that they're not up because of the way I'm managing things, it's something else. I'm managing things this way purely because I have no other choices.

Although ......... agree pump could be an option.