Fluctuating insulin sensitivity

hello Ihatehypos too,

Could some of it be down to your injection sites?
As well as rotating sites properly, do you use a fresh needle at each jab?
Following this advice fixed my problem with erratic control, but it did take
several months to see an improvement.

Also, there are quite a few people who have problems with lantus. Not just erratic action,
but also a "groggy" head. I can recommend splitting the lantus 50/50 and injecting twice
daily for a more even action. If not, twice daily levemir may be an alternative.

Finally, there's nothing like the heat of summer to muck up good control.
The action of basal and bolus insulins changes in heat (quicker action, shorter duration)
and this can lead to some, frankly, bizarre blood sugars for some of us.

all the best,
timo.

Have u thought about changing ur insulin? U are on lantus, which is an insulin analogue-not insulin. I had the same problem as you with control- doctors threw their hands in the air and coudn't help, but critisized my very frequent testing. I had many severe hypo days that didn't relate to anything. It was my husbands suggestion last month that it could be the insulin and not me,that opened my eyes. I had been blaming my hormones, the weather, my period, wind direction( ), anything! I rang the IDDT(google it)and got some good advice. I have since changed to Pork insulin-which is purified animal insulin, and am still getting the hang of it, but I have not had any of the huge fluctiations that I had with lantus. I have been ID for 19 years, the last 3 and bit years since being on lantus have been hell on earth.
I'm still contemplating coming off humalog aswell. but I'll take it one step at a time. The one thing that the IDDT told me is that my control should not be the way it was, I had become despairing, and health "professionals" were as much use as a chocolate kettle. What a load of shXX us diabetics have to contend with, with garbage doctors, it's no wonder we end up depressed.
The manufacturers of Lantus, Sanofi Aventis seem to have a huge hold over the NHS -they are 1 of the 3 biggest pharmaceutical companies in Europe, You'd think that Lantus was the only blxxxx long acting insulin on the earth-and it aint even flamin insulin!! :evil:
In the old days, doctors would have found an insulin to suit you, now it's a one way trip.
Sorry to rant, but it really gets me down reading stories like yours- you need to educate yourself and then tell the doctors what YOU want. You can get a chart from DiabetesUK which tells you about the length of action of insulins and how they work- might help,and it sounds like it cant get any worse..
You really need to try another insulin.
Good luck
Jus

When are your hypos/hypers? as a rough and ready 'rule', if they are during the first 2 hours after a bolus then the bolus/carb ratio was to blame, if after this period then it is more probably the basal.As Timo says there may be an absorption problemin sme injection sites causing fluctuations. Insulinsensitivity/resistance can also vary because of temperature, the amount of exercise you did in the previous days, the time of the menstrual cycle, or as someone on another forum used to say because of the phases of the moons of Saurn

I know you say that you have no patterns but you also say that you have never achieved control so keep varying your basal and boluses. I wonder if your basal insulin dose is corrrect. Basicaly your basal is correct if on a 'normal' day your BS does not vary more than 30mg/dl (1.6mml) whilst fasting. Only then can you start sorting out your insulin to carb ratio properly. On MDI you really shouldn't have to eat the same things at the same time.
It may mean a change of insulin, change of dose or splitting doses. From what I read levemir is much better as a split dose insulin for people on small doses and lantus does not last 24 hours in many people .
There is some information on the different types of basals and basal testing at http://www.diabetesselfmanagement.com/articles/Insulin/Getting_Down_to_Basals/1
There are also a couple of books that you might find helpful Think like a Pancreas (G Scheiner, the same author as the above article) and John Walsh Using Insulin. (I haven't read the latter but have got hhis pumping insulin which is excellent)
Obviously you do need to discuss things with your doctor.


What shocks me about what I read here is the lack of advice given by professionals in the UK. When I was diagnosed I spent 10 days in hospital. I still think that that was over the top but they did give me a thorough 'MOT' and spent a lot of time getting insulin doses and teaching me how to manage the condition.

I've had similar problems with my basal insulin dose. To get decent results during the day, I have to up my basal dose. But when I do that I either go hypo during the night and end up munching on a hypo stop at 3am, or waking up feeling awful and having to supplement my breakfast with dumpling or something sugary to bring myself up.

I found some temporary relief by doing my basal injection at dinner time (about 6pm), but a few weeks later the night time hypos (or morning lows, depending on my bed time reading) returned. I am yet to find a solution.

I suspect Lantus may be a little more aggressive than it should be.

Hi Ihatehypos!
What you've said in your last posting mirrors exactly what I had been goin through with Lantus. I began to feel I was going mad, and I must be doing something wrong, It's no way to live and I know exactly how your feeling. Your state of mind will improve when you get a bit of control of your life. I felt that the day I stopped taking Lantus, I can honestly say that. My control is much more predictable now, although as i said I'm still adjusting doses 2.5 weeks in. I only changed my long-acting, thought it best to do one at a time, and my doctor agrees. I still like the rapid action of humalog, and am able to use it more effectively now- before meals, instead of to lower my BS from unpredictable highs!
As for the animal insulin- Our SarahQ on the forum, has been on animal insulin for 43 years, and still has hypo-awareness-amazing! Look up some of her postings. You could ring the manufacturers, they give helpful advice. Wockhardt for animal insulin(the only company that produce it in this country), were really helpful, and can explain things to you.
When I went to the Doctor, I went armed with loads of info I'd printed of the web, and info from IDDT.
I thought it was going to be a battle, and it wasnt.
It may not be the answer for either of us, but I thought anything was worth a try and so far, so good. Good luck
Jus

Hi ihatehypos

I sympathise with your plight, I've been at my wits end in the past, haywire despite doing all the wrong things and wrongly labelled as non-compliant.

By your description of how you've been on Lantus, I'd say its worth at least trying different insulin. I had a terrible time with the early 'human' types in the 80s, very erratic BS, v.sudden hypos with no awareness, also memory problems, persistent weight loss and a temper like the Incredible Hulk with PMT All settled on switching back to animal insulin, not perfect control but much better and improved QOL. However I'm doing better than ever on Levemir, Humalog and DAFNE.

If you were generally more stable on animal insulin before, and the only issue is late afternoon hypos, perhaps you could have a small snack mid-afternoon and take slightly more insulin than you need to cover the snack, to counteract the high. A compulsory snack may not be your favourite but if everything else is stable it may be a worthwhile compromise.

Alternatively, some people do better with Levemir than Lantus. Levemir tends to have a shorter action and you may well need it twice daily - an advantage if you need a different background dose at night from during the day. Small doses doesn't last as long as larger ones, but the only way to know how long it will last you is to try it. I and others here successfully use Levemir in unevenly split doses to resolve the 'high all day/hypo all night' problem.

HTH
Sue

I've only a few ideas for you and I wouldn't be surprised if you've already tried them.

1. Move to twice daily basal shots to eliminate any gaps and make absorbtion more predictable.
2. Limit meal insulins to no more than 7 units a shot to improve meal predictability ( you may have several injections for a meal however)
3. Limit snacking so you eliminate insulin stacking (except to cover exercise and hypos)
4. Are your injection sites damaged? eg lipoatrophy. One pointer is that the site is painless all the time.
5. Consider animal insulin if hypoawareness is a problem.
6. Is storage of insulin a problem ? Lantus is senstive to both heat and light more so than other insulins.

You sound like you are having an absolutely rotten time.

On the second last module of the course at http://www.dsolve.com I go into a lot of depth about insulin/meal matching. Whether or not you choose to limit your carbs there may be some tips that would help.

Hi Ihatehypos
Didn't I say say SarahQ was worth her weight in sugar!! She's right about splitting your dose of long-acting, which is why I followed her advice and not my doctor. He had never treated anyone on animal insulin, not many doctors these days will have. I take 12 units at 9pm and 20 units at 9am-ish of Hypurin Porcine Isophane.
If you do change to a new long-acting insulin be very cautious and take a very low amount for the first few days. I only took 8 units and 6 units on the first day and I stayed below 10- I had previously been on 34-38 unit of lantus. I gradually upped my dose day by day and by staying on the same rapid-acting insuin I could tell exactly what I needed. The reason for this is because the lantus may still be in your system for at least 36 hours after you last inject it. I read that a lot of it can stay in the injection site for this time, and not insignificant amounts either!! This probably explains the unexplained hypos and hypers on lantus, which I doubt has nothing to do with your injection sites. As I said I have been injecting for 19 years.
I hope this info is helpful.
Jus