Goofy patterns

Type 1 and LADA
#1

I’ve had this goofy pattern for much of covid lockdown. I wonder if it has to do with decreased activity levels.

I’m needing to take either:

1.) 10 units of bolus/15 grams, or
2.) Dangerously high basal infusion rates. Its making the overnights quite dangerous.

Does this occasionally happen to you guys - where you just can’t eat?

Right now, I have pretty good looking flatline data as long as I dont eat.
Today I ate 2 pieces of toast, took 20 units of bolus, and I still had a postpranial = 500.
Its maxing out the Dexcom’s ability to read.

#2

Sounds like you may have insulin resistance. Have you considered any Type 2 meds to help?

I have used metformin on and off, and it did reduce my insulin needs.

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#3

This happens to me from time to time. But not as severe. Usually I find my sugars come down after a bolus but then go up again for no good reason

#4

If it was insulin resistance, wouldn’t that affect his experience with basal as well as with bolus?

#5

Metformin was once suggested by a T1 in town. He was the 1st T1 that I knew who took metformin. Before that conversation, I didn’t know that we could do that.

I only take around 30 units of basal per day.

So, if I bump the basal up enough to lower the bolus, I’m gonna get severe lows. But, I’m REALLY uncomfortable with a 20 u bolus.

I don’t know the answer to that, John. But, I know that this pattern wont exist forever. It might have something to do with covid lockdown. I’ve had terrible probs during covid. I’m suspicious that it has something to do with my new lockdown lifestyle.

I like this idea. I think this is a possible solution…and prob a good one.

#6

In my “high dose” basal setting, I am taking close to 2 units per hour (1.8 - 1.9 u/hr).
That’s quite a bit.

In my “low dose” basal setting, I have some 6 hour AM intervals of 1.7 u/hr.
That’s also quite high, I think.

So, maybe it is happening in the basal as well?

#7

I wonder what I gotta do to get an Rx during this time.
I’ve spend 30 days trying to get an Rx refill. Things are rough out there.
But, I’ll try tomorrow.

#8

My basal rate of between.8 and 1.2 has pretty much been the same my whole life.
I was taking 24 units of ultra Lente. Pretty much the same deal with my pump.
However sometimes I need more insulin. Sometimes I need less.
Sometimes it rises for no reason at all.
I have never figured it out, but luckily it’s rare.

#9

This happens to me, too. It usually turns out to be a bad pod. Of course, it could be due to an illness, stress, causing the insulin resistance, too.

#10

Have you considered taking your meal time doses manually and letting the pump handle basals? Your body just may not be able to absorb so much insulin in one place. Do you see any signs of tunneling?

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#11

Well, honestly, right now, I’m using shots and the pump in combination.
Since I was on syringe insulin until about 4 days ago, I have syringes laying around.
So, I’ll deliver the typical (expected) bolus via pump - 4 units.
Watch it start to sky rocket.
Then, start delivering 7 unit bolus dosages via syringe a couple of times.
Deliver a few smaller 2-4 unit bolus via pump periodically (maybe 6 times) over the next 4 hours.

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I don’t think its tunneling because I was seeing similar behavior when I reverted back to syringe insulin.

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#12

I’m not under ‘stress’ in the traditional sense. But, I don’t think that my body likes living in covid lockdown. Its worse now that the snow has fallen.

I got a Primary care (who I thought might be dead from covid…relief this guy is back in the office) to renew the Dexcom Rx’s.

I’m scheduled to talk with him tomorrow because he wants to establish care. He comes recommended. I’ll hit him with the metformin idea. I guess he’s a young Ukranian. I expect to be able to do biz with him. Me and the Pakistani were going nowhere. He had a very rigid hierarchical view of the world - where the endo was on top, he was 2nd, and I was at the bottom. He was very sensitive about stepping on the endos toes.

My endo might as well be lost at sea. He takes 6 months to schedule with. I suspect that he might be a diabetic and working from home because he is unreachable. No paperwork is reaching him.

I don’t want to run out of sensors the way that I ran out of pumps. I really needed this Rx refilled, so I’m super relieved. Its dangerous to not have sensors when I’m bolusing these large dosages. Its dangerous to be bolusing these larges dosages even WITH sensors. I make mistakes. I’ve had some real close calls during covid.

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#13

I will say this to him:

I believe that I am seeing insulin resistance that results in a very high bolus insulin dosage for meals. I feel unsafe with that much insulin onboard and hope to temper those large bolus injections by using metformin.

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#14

For me, metformin reduced my basal requirements more than my bolus doses. But if I find that my boluses are suddenly inadequate, it’s often a sign I do need a higher basal dose. You’re on a pump, so couldn’t you just increase your basal for during the day and see if that helps? That said, metformin is easy enough to try, but be sure to get the ER formulation. I started with 500mg 1x/day, eventually went up to 1000mg 2x/day and I find that helpful (went from about 24u basal to 18u, and with better numbers).

#15

I’m gonna recommend the Metformin, too. I’m a terrible pill popper, but I try so hard to remember the Metformin because my numbers go crazy without it. My numbers get very volatile. Part of the problem I’m sure it’s just because my pump settings are incorrect without the Metformin on board, but still, it helps a LOT.

Maybe see about startng with a different type 2 drug, though. The first month of Metformin is ROUGH, until your system gets used to it.

#16

Why isn’t everyone on Metformin?
Seems like reducing insulin could have serious cardiovascular benefit.

Can you explain further?

I have been doing that during the first (larger) part of covid lockdown.
But, in order to bring the bolus dose down into something reasonable/typical for me (2 units/15g), I have to increase the basal to really pretty dangerously high levels.
I’ve been doing the best that I can with those. But, I have had more frequent and more severe lows that I ever have had in 20 years. I’m usually not very scared of lows, but I have become so during covid.

I will now refer to this persistent goofy pattern that has been vexing me for months as “the covid pattern.” I’ve trouble shooted this a lot of different ways, all of which work for a while, but are less than ideal and bordering on dangerous.

I just went out and shoveled because we have more snow coming. I made a nice path for cat and dog to walk down and go poo poo without getting cold, wet feet. I ate. No problems. I feel kinda comfortable assuming this covid pattern has something to do with really unusual inactivity levels.

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#17

I assume this refers to GI side effects/diarrhea. For what it’s worth, it’s fairly variable how this plays out—I’ve never had any noticeable effects from it. For some folks it’s severe and ultimately not tolerable. For most somewhere in the middle. Worth a try to see where you land.

I tried invokana as a different t2 med option, and would not recommend it. I found, similar to some other folks’ reports on here, that at first it seemed like a miracle drug. For a few weeks, it was like my control issues were miraculously improved, and I couldn’t break 200 if I tried. That pretty quickly wore off and it basically stopped being effective while continuing to make me more vulnerably to dehydration and yeast infections. Then I had one kidney test result that went from no protein to a lot (like levels indicating moderate kidney disease). Still not sure if that value was a fluke/mistake or what, but that was the last straw. I went off of it, without a major shift in control. Kidneys have been back to perfect since. If it had only continued to work as well as it did at first, I might have tried to sort out if that was a real issue or not, but hardly seemed worth it.

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#18

Oh no.
Oh my gosh.

#19

That’s quite a bit more than me. My average TDD is around 25, max bolus around 5. Less when taking metformin.

#20

Are you low carb? I’m high carb and I eat a lot. I am very, very hungry all the time. I take a lot of insulin. But, this is over the top. I’m concerned about cardiovascular risk, as well, from this much insulin. We shall see what he says tomorrow.