Constantly needing more insulin

[Gardevoir]

Hi,

Ever since I've jumped out of my honeymoon phase, I feel like I've constantly been needing more insulin. I went from needing 1:20 (1 unit per 20g carbs) to 1:15 to now 1:13 throughout the day and 1:10 in the evening. I'm rather skinny and can't imagine such resistance.
Perhaps I'm overthinking it or maybe there's something else I should look at. I take 12 units Tresiba daily. My rapid-acting is Aspart Sanofi. I'm just concerned about how fast I'll be going through insulin, but I guess that's not something I should worry about too much. My mind's a mess lately.

Thank you

 

[EllieM]

Hi @Gardevoir

I believe that the "standard" ratio that new T1s start on is more like 1 to 10, so I don't think that this necessarily means you are more insulin resistant. It could just as well be explained by your pancreas producing less of its own insulin.

To be honest, after 53 years of T1 (and I'm pretty sure I'm not producing much insulin now ) I still need to tweak my ratios according to weather, exercise weight and diet.

Assuming you don't have to pay for your own insulin, I wouldn't stress too much.

Tagging in @Antje77 who is also from the Netherlands and LADA and takes a lot more insulin than you.

 

[Rokaab]

I feel like I've constantly been needing more insulin. I went from needing 1:20 (1 unit per 20g carbs) to 1:15 to now 1:13 throughout the day and 1:10 in the evening. I'm rather skinny and can't imagine such resistance.

People need what they need, not everyone is the same,

For example, whilst I'm not as skinny as I used to be (I'm now in the middle of what my weight bracket sorta recommends for my height - ie not underweight anymore - I was for a long time), I'm on 1:5 in the morning, 1:7 at lunch and 1:8.5 in the evening mostly (changes with various things)

When I went on my DAFNE course the ratios ranged from 1:2 up to 1:50 ....- yes I did gasp at the 1:50, so did quite a few

Some people do just need more than others, just because - some people will be on much more, some will be a lot less

Do not worry amount how much everyone else needs, work out how much you need

 

[Gardevoir]

I'm on 1:5 in the morning, 1:7 at lunch and 1:8.5 in the evening mostly (changes with various things)

I'm a bit shocked reading this but that's only because I haven't heard of a ratio like this before.

Assuming you don't have to pay for your own insulin, I wouldn't stress too much.

I luckily don't

I'll continue adapting and changing up my ratios to see what works best for me. I work very early in the morning and have to deal with a high spike when I wake up only to then go to work and do rather heavy work for the next hour. It sometimes makes it difficult to try and figure out my morning sugars but I'll simply keep correcting and will figure it out eventually. I use the days I don't work on as days I can "freely" experiment with different foods and ratios
Thank you both for your insight and input

 

[Antje77]

From memory, my insulin needs have gone up and up for about 4 years after diagnosis, but for the last 3 years they've been somewhat stable. Meaning my needs still fluctuate, but on average they haven't gone up.

I'm not worried about the amount of insulin I take (which is way more than you do, and way more than average), it keeps me in range most of the time, which in my book is the important part.

Assuming you don't have to pay for your own insulin, I wouldn't stress too much.

Looks like both @Gardevoir and I are from the Netherlands, no paying for insulin around here.

 

[Nicola M]

Pre hybrid closed loop insulin pump I was on 15.5 units of basal a day and my ratios were 1:10 until evening where it was 1:12. Since being on closed loop (since December 2021) I’m now on average using 22 units of basal and my ratios are 1:9 in the day and 1:8.5 in the evening.

Over the years though my insulin needs have changed a lot and that’s even with having diabetes since I was 1 years old. I wouldn’t be too concerned with how yours have changed especially since you’re exiting the honeymoon phase, you’re going to need more as your pancreas is now producing less and/or no insulin.

 

[In Response]

Ever since I've jumped out of my honeymoon phase,

Looking at your bio, you were diagnosed in May.
6 months is a very short honeymoon period for an adult.
As @Antje77 mentioned, her insulin needs increased over 4 years. Mine increased over 8 years.

I am not a doctor, but I would be very very surprised if you have "jumped out of the honeymoon phase" already. Your insulin needs have increased but they are not high and I would expect them to rise higher. This is not a problem. It is what your body needs and likely to be the same amount of insulin that your body has been using since your diagnosis - the insulin you have been injecting has been supplementing what your dying beta cells have been able to produce.

I'm rather skinny and can't imagine such resistance.

The doses you are taking do not suggest insulin resistance regardless of your weight.

My mind's a mess lately.

Would you benefit from some counselling? People with diabetes are more likely to experience mental health issues so it is important to ask if you are struggling. Don't struggle alone.

 

[Gardevoir]

Thank you for the clarity. It makes a lot more sense now.

Would you benefit from some counselling? People with diabetes are more likely to experience mental health issues so it is important to ask if you are struggling. Don't struggle alone.

Thank you. Genuinely made me tear up a little for some reason. I'm not sure if I need that kind of support (yet?) but my specialist made sure that I'm aware of it being available. I like being reminded of it.

6 months is a very short honeymoon period for an adult.
As @Antje77 mentioned, her insulin needs increased over 4 years. Mine increased over 8 years.

I am not a doctor, but I would be very very surprised if you have "jumped out of the honeymoon phase" already. Your insulin needs have increased but they are not high and I would expect them to rise higher. This is not a problem. It is what your body needs and likely to be the same amount of insulin that your body has been using since your diagnosis - the insulin you have been injecting has been supplementing what your dying beta cells have been able to produce.

I now also expect it to rise higher, especially after having to inject more after my meals to correct. I've recently came to the realization that I shouldn't (solely) focus on correcting and should instead focus on changing my ratio if this happens to basically all kinds of food.

I also often suffer(ed?) from highs overnight but that's most likely related to not injecting enough during my evening meal. I'm trying to do better and to learn how to properly adapt and will otherwise be recommended a pump to fix that but maybe I won't need that. I like to think I'm getting the hang of it, even with that high

I like talking here a lot. The community makes me feel very listened to and always have something good, useful or sweet to say. Thank you once again

 

[In Response]

@Gardevoir I am glad you are getting support from the forum.

I had a few thoughts when I saw your graph
- don't get too concerned by the height of that spike. Libre often overestimates highs. It is designed to be more accurate at "normal" levels and gets carried away when high or low.
- your evening spikes comes down to normal levels. Unless, you took another correction, this suggests your evening meal dost is correct but taken a bit late. Do you pre-bolus? If so, how long before your meal? Injected insulin works at a foxed speed with a peak of activity after about 20 minutes (although this varies from insulin to insulin and person to person ... and sometimes different times of the day). Food is digested at a different rate and if you drew a graph. of when your body starts to absorb carbs, you would also see a peak. The magic is matching the peak of the carb digestion with the peak of the insulin activity. If you see your BG spike and come back down, it suggests the carb digestion is happening before the insulin activity. Therefore, you may see less spikes if you take your insulin earlier. The usual advice is to move it by about 5 minutes each time until the spike is something you are comfortable with. Do not look for a flat line, even people without diabetes will see a spike. And don't expect it to be the same every meal.

 

[Gardevoir]

- your evening spikes comes down to normal levels. Unless, you took another correction, this suggests your evening meal dost is correct but taken a bit late. Do you pre-bolus? If so, how long before your meal?

I inject right before my meal and sometimes only a few (~5) minutes before.
I don't expect a flat line but rather a very controlled spike. I'd rather spike and watch my insulin tackle it than have a flat line form at 17.5.

The magic is matching the peak of the carb digestion with the peak of the insulin activity. If you see your BG spike and come back down, it suggests the carb digestion is happening before the insulin activity. Therefore, you may see less spikes if you take your insulin earlier. The usual advice is to move it by about 5 minutes each time until the spike is something you are comfortable with.

I'll try to move it by 5 minutes until I'm happy with what I see.

don't get too concerned by the height of that spike

I try not to. My specialist often tells me I'm being too harsh on myself but also told me I very actively get rid of highs so I guess being harsh in a way pays off, although I might want to start correcting without beating myself up for it. My girlfriend is good at comforting me when my highs don't go low as fast as they did in the screenshot I showed. I previously sometimes would go high for a few hours (13-22) and get very "not okay" because of it but I now understand that that's when I should look at my ratios again and perhaps change them up.

 

[LucySW]

I think the advice you’re getting here is very good advice. I’d only add, that managing T1 is complicated and often frustrating. We just have to be methodical & a bit patient, & rather than beating ourselves up when the highs come, focus on working out why they did/what to do etc. So coursge.

 

[LucySW]

I myself often don’t take my own advice, but then I remember. Generally we can engage positively with what’s happening. Solidarity!