Insulin requirements seem to constantly be changing.

[Diabetictwentysomething]

Hello! I'm new to the forum, though I have been lurking for a while, I've found it really helpful in feeling less alone when going through dark times with my Diabetes.

So, quick introduction, I'm a 25 year old male, from the UK, who has been a Type 1 Diabetic since about the age of eleven; up until last year I'd pretty much denied the fact that I had Diabetes, and let my sugars run rampant. I found out at my last eye screening appointment in early 2020 that there were some slight signs of retinopathy, and this was the kick I needed to finally take ownership of my Diabetes, and work on my control.

Fastforward nearly a year, I've lost five stone, really improved my diet, reducing the amount of carbs I'm having (not on a LCHF diet by any stretch, but alot less than prior to my weight loss!), and over the last year as a result, I have been able to dramatically reduce my insulin requirements. I feel like my eye sight has dramatically improved since Ive had a lot more controlled blood sugars, and feel better overall! I tend to spend a good 80%+ of my time in my target range (4-10 mmol). I used to often wake up with my sugars in their twenties, high teens, and never give it much thought, where as now I get peeved off if I'm unexpectedly at 12!

I'm currently using the Freestyle Libre, aswell as doing finger prick tests as required, I take Lantus twice daily, and Novorapid on a 10g:1u ratio when carb counting. I haven't had my HBA1c done for quite a while due to the irritating Covid situation we all currently find ourselves in, but my projected HBA1c from my Libre readings is around 6.5% (48 mmol).

Here's the issue (Rant warning!):

Due to all my weight loss, I'm really struggling with my dose management, and going through some quite nasty diabetic burnout at the minute, which is really getting me down. I've been on and off furlough for the last year, which has been great for controlling my Diabetes, and getting more of an understanding if my condition. I have now consciously made an effort to stop losing weight and maintain it at eleven stone bang on (healthy weight for my height) which seems to be working.

Despite stopping losing weight, just as I feel like I've had a good few days with no low blood sugars or anything crazily high, something changes, and my insulin needs seem to change! I'll suddenly become really sensitive, and struggle to keep my sugars up, with no changes to my regime, no increased activity, sickness etc. This has been going on for a while, and it's getting to me now. I'm getting to the point where I'm scared to return to work (working in hospitality, presently on furlough) because I'm worried about my sugars crashing, even getting apprehensive about going to sleep incase I go low during the night etc. I've had a lot of poor night's sleep as of late because of these lows.

I honestly don't know what to do, and I'm not expecting answers, just advice and understanding really from others who have had similar experiences! I'm just incredibly frustrated, worn out, and feel like my life is being controlled by intermittently fighting low sugars off at the moment. I think that my Novorapid ratio is correct, I have played around with these over the last couple of months but it just complicated things and made my control worse. When I've had the good days where everything is working well, my sugars seem to level out well within a few hours after a meal, however on my bad days, like today, where my requirements seem to of changed again, I think it's my basal insulin that's pulling me down.

I'm taking 12 units of Lantus in the morning, and 6 in the evening. I don't know if I need to go onto a once daily basal insulin, have none at all, or what! I do have good support from family and friends, and a really good Diabetc Nurse who I seem to be calling all the time at the moment, but my head just feels completed scrambled at the moment.

Rant over! Cheers for reading, look forward to hearing from you guys, wishing you all the best!

 

[Deleted member 527103]

Sorry to read you are struggling with the fickle thing which is diabetes.
But before I ge on to that, Huge Well Done on getting on top of it.

You asked if you need to adjust your basal. The best thing to do to answer that is a basal test. There is little point tweaking your bolus if the basal is wrong. The great thing is that you have a Libre which will make this much easier than pricking your finger every 30 minutes or so.

Once you are confident with your basal dose (this could take some time to get it stable), you can look at your bolus.
The important thing to remember is that our basal needs change - some people need more in the summer, some need less, some people need to reduce their basal after exercise, you may need to increase it if you are ill or stressed. You may need less if you lose weight or change your diet.

The other thing to remember if you are struggling is to talk to your diabetes team. They should be there to help you mentally as well as physically. And my DSN is amazing at spotting trends which I miss.

 

[Diabetictwentysomething]

Sorry to read you are struggling with the fickle thing which is diabetes.
But before I ge on to that, Huge Well Done on getting on top of it.

You asked if you need to adjust your basal. The best thing to do to answer that is a basal test. There is little point tweaking your bolus if the basal is wrong. The great thing is that you have a Libre which will make this much easier than pricking your finger every 30 minutes or so.

Once you are confident with your basal dose (this could take some time to get it stable), you can look at your bolus.
The important thing to remember is that our basal needs change - some people need more in the summer, some need less, some people need to reduce their basal after exercise, you may need to increase it if you are ill or stressed. You may need less if you lose weight or change your diet.

The other thing to remember if you are struggling is to talk to your diabetes team. They should be there to help you mentally as well as physically. And my DSN is amazing at spotting trends which I miss.

Thank you for your reply, I appreciate it! I feel that I'm now on the right path towards getting really good control, I don't think I'm far away, I've just got some tweaks to make and that's the hard part when everyone's experience with Type 1 Diabetes is unique, and not a 'one size fits all' kind of condition.

Thanks for the information about changing basal rates, it's something I know can depend on various different factors as you have explained perfectly. One thing I'd never really thought of (probably naively!) is doing a basal test! Without sounding dense, forgive me for my ignorance, how does that work? I'd assume it'd be a case of injecting your basal as usual and fasting and monitoring it throughout the day / night and looking for how it impacts your blood sugars.

I feel blessed to have the Libre, it's been a real game changer for me, and I know as you've said that will help with monitoring when doing a basal test. Any further info on this would be much appreciated!

Thanks again!

 

[Deleted member 527103]

One thing I'd never really thought of (probably naively!) is doing a basal test! Without sounding dense, forgive me for my ignorance, how does that work? I'd assume it'd be a case of injecting your basal as usual and fasting and monitoring it throughout the day / night and looking for how it impacts your blood sugars.

Pretty much. Most people do it for 8 hours at a time. This gives enough time between finishing a meal (and the bolus running out) and not getting too hungry