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I don't know what's going on, advice needed.

PaulinaB

PaulinaB

Well-Known Member
Messages
594
Location
London, UK
Type of diabetes
Type 1
Treatment type
Insulin
Hi everyone,

For the last week I've been having some issues which I have no idea how to explain. Let me start with some history:

History: I've been diagnosed with type 1 in March last year after a period of lost weight and muscles (up to the point where walking was a problem), gigantic thirst and peeling all the time. BG tested 50mmol/l and ketones 0.9mmol/l. Sent to diabetic clinic, put on premixed insulin.

Since then I got a Dexcom CGM, got basal-bolus and my control got "very good". But I still wasn't very happy as after my diagnosis I gained all lost weight and then some, before my insulin was set properly. I tried a lot of exercise but the weight wouldn't come off.

Even thought I was diagnosed as "simple" type 1, I always thought I was in fact LADA. After diagnosis I got cataracts (complications after just 2 months of high bg? A bit weird) and I remember having false hypos since I was a teenager. Back then I didn't know what it was and my doctors ignored it. I also had hyper thyroid which was treated with radio iodine and is now hypo thyroid. I also have PCOS which I'm pretty sure causes some insulin resistance for me.

Last week: my boyfriend was told he needs to lose weight so we decided to try LCHF. Since then my bf seems to be going through a "standard" first week. I, on the other hand, jumped straight into the good stuff: ketosis started almost immediately, I feel great and weight is coming off.

The problem: issue is, since starting on LCHF I basically haven't bolused (apart from 1u/day the first 2 days) which is awesome - my BG stays flat through the day. But my basal is going crazy - I've been getting low in the morning hours. I've been taking 27u of levemir in the evenings. First 2 days I went low around 3-4am. Since then I've been lowering my dose and I'm now at 18u(!) and still went low at 10am this morning. Lower doses seem to delay the hypo but not prevent it.

My worry is: if I keep lowering the dose at this rate I'm soon going to be off levemir totally! I have no idea what's going on - I'm pretty sure my original dose was not covering any carbs... Is this some kind of delayed honeymoon period that kicked in when my pancreas got a rest from carbs?

Before LCHF I was on 27u levemir and 30-40u on novorapid. Im now eating less than 10g of carbs per day, plus around 30g for morning hypos (juice).
 
No idea what's going on @PaulinaB, but just continue to reduce your basal insulin until the hypo's stop, its quite warm at the moment and many of us do find basal needs decrease in the warmer weather and increases again when it turns cooler.
 
noblehead said:
No idea what's going on @PaulinaB, but just continue to reduce your basal insulin until the hypo's stop, as its quite warm at the moment and many of us do find basal needs decrease in the warmer weather and increases again when it turns cooler.
Click to expand...
Thanks, I was thinking along those lines too. And maybe added weight loss (2.3kg so far) decreases insulin resistance as well?

I'm thinking, should I try contacting my DSN if this continues, especially if I end up on a very low dose of levemir? Or should I wait a week or two to see if this persists?
 
Give them a ring on Monday if your concerned, but provided your bg levels are under control it doesn't matter if your insulin requirements have reduced, but certainly losing weight helps with insulin resistance and so does exercising and reducing the carbs in your diet.Several years ago my TDD was between 60-70 units but now averages around 30-34 units, I've lost some weight since then and exercise more which I think has helped matters and reduced my insulin needs.

But your very lucky if you can eat LCHF food and not bolus, many wouldn't get away with it and some people like myself need nearly as much insulin for a LCHF meal than one that contains carbs, anyway hope your good progress continues :)
 
Weight loss, especially if it is reducing body fat, does reduce insulin resistance. I saw the same thing happen when I lost 10kg. My basal requirement plummeted by around 50%, in fact my TDD with Low Carb and weight loss dropped by 50% so it's highly likely this is what is happening. In addition, it sounds as though you are taking a single basal shot. With levemir, you might find you get a steadier bg by splitting the dose into two shots.
 
Quick update on this. I'm down to 13u of basal and will stay at it for a while but it may need further reduction.

Now that my basal is not compensating for my food, I need to start blousing again, although a small amount (no more than 3u per meal), but with my regular ratios. This is still better than a high carb diet and taking 20-30u for a big meal...

With those small doses I get dilemmas when I'm in between doses. I have 0.5u pen but still I'd sometimes like to take a 0.75u, hehehe :)
 
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