Officially migrated from the T2 crew to the T1 crew

[Jeremy.M]

Hi Jeremy
Sorry to hear you have had another frustrating day, and you are not even having much to eat. As you are underweight I would be surprised to hear that you are insulin resistant however something is obviously not working so I think calling the GP tomorrow is absolutely the right thing. Let us know how you get on.

Thank you for the sympathy. Definitely calling tomorrow.

For the time being, I decided to eat and just take extra insulin. I'm at home, surrounded by family, so I want to try and aim for something low rather than high. At 4:30 pm ET, my glucose level was 7.7 mmol/l, so I went on my elliptical for 20 minutes. Took my glucose right after and it went down to 7.0 mmol/l. Just to make sure I wasn't going to spike afterwards, I waited until 5:15 to check my blood sugar again before eating. Thankfully, it continued to drop and came down to 6.3 mmol/l. For dinner, I decided to go with 40g of Oat Bran (19g net carbs & 7g protein) topped with a 1/4 cup of Walnuts (2g net carbs & 4g protein), cinnamon and about one tbsp of carb-free maple syrup. Additionally, I had a huge plate of asparagus, broccoli, cauliflower and a few mushrooms cooked with a touch of extra virgin olive oil in an air fryer.

I checked my blood sugar one hour later at 6:15 pm ET and it was 7.1 mmol/l. I think I'm going to end up spiking in one or two hours rather than experience a drop, but checking every half hour from here on out will give me an idea of when I seem to be spiking. 6 units sometimes wasn't enough for this meal, as I could still climb 4 mmol/l+ two hours later, so we'll see how 8 units plays out.

I'm thinking insulin resistance. Even though my tests came back with high GAD antibodies, low c-peptide / low insulin, I think I might have accrued some insulin resistance because of my very high HbA1c over the last 6 months. Still, 8 units of insulin for roughly 25g of carbs seems ridiculously high. Hopefully this will get figured out soon.

Edit: So it's 6.9 two hours later. Anyone have any thoughts on why I'm needing 8 units of insulin for 25g of carbs, 30g of fat and 20g of protein?

 

[EllieM]

HI @Jeremy.M .

Am sorry you are having issues at the moment but sometimes T1 is like that. Just a thought, but could there be issues with your basal insulin (eg it's been out of the fridge too long and has gone off, or has a crack in the vial). In general when my levels go up for non obvious reason I go through some of the following
1) check vials for cracks, consider how long vial has been out of the fridge. My lantus sometimes stops working properly after a couple of weeks. You can also check whether your insulin pen is delivering insulin correctly. (The bottom section of the needle cap that you throw away holds 20 units.)
2) am I coming down with an illness (eg a UTI might not have any symptoms but increases my insulin use).
3) consider rotating your injection sites more carefully.

Anyway, I've come to accept that my bg does crazy things sometimes and I just have to live with it. (Though, admittedly usually I know it's something I've eaten that I've accounted for wrong.)

I regard myself as a bit insulin resistant and I would use 8 units of insulin for 25g of carbs, but my consultant says I'm not. She's dealing with people who are using U500 and U300 insulins which are 5 and 3 times the strength of normal insulin because their users need 100s of units a day. People genuinely vary in their insulin ratios, and I think it's counter productive to assign a particular level as being insulin resistant. You need what you need and if it's not leading to weight gain and you can keep your sugar levels vaguely in range then there's no point stressing about it. (Personally, I low carb because my dad is T2 and I find it a lot easier to stop weight gain and control my sugars when I don't take too many carbs. But I don't do keto because I don't want to have to count protein as well ).

Of course, if there is a chance you are still producing some insulin and are honeymooning, then that is yet another reason for your insulin needs to vary.

 

[KK123]

Hi @Jeremy.M , Ellie mentioned your basal above and that made me think. Are you still on 6/8 units of it? I know you said in an earlier post that you take your basal in the evening and your glucose levels are between 5 & 7 when you wake, but basal is intended to keep you steady over a period of 24 hours so as well as keeping you in range after sleeping (fasting), it is also supposed to carry on doing the same the rest of the day (between meals). However it does work in tandem with your bolus, very generally the ratio between bolus & basal is that the total days amount of bolus (in your case around around 15 units??) should account for 50% of the total insulin, meaning that the other 50% would be made of 15 units of basal. Now this is VERY approximate and many people end up with a ratio of 60/40 for example, it's trial and error. I just wonder if your basal is too low because if the basal isn't right then no amount of bolus/correcting etc is going to work. I know you are seeing your diabetes team so hopefully they will be able to help you. I must emphasise again though that it really is different for everyone so this was just a thought. x