Grieving insulin rate changes

I should preface this by saying that I'm grateful that I have had the same basal since diagnosis 1.5 years ago, and that my total basal is really low (3.6 units/day!). (It is the meal time bolus that I need the most!)

Recently, I got fed up with having too many morning highs and started to change both basal and bolus, with basal going up ~40%. Still testing them, but that is a rough approximation.

I know I am just giving my body what it needs, but it just makes me sad because of my body losing native insulin production. Things have been really stressful at work and I'm hoping that it isn't because of that! That has actually been a motivation to make some life changes since I don't want anything external and temporary (like a job) to adversely affect my health.

So, besides having the empathy that you guys have (unlike friends and family who don't get it), I was wondering how any of you progressed in your insulin needs. Was it a huge spike up, was it gradual?

Thanks for your support..and for totally getting it :-)

I should note that it originally was 3.6 units/day. Now up 40%...

Hi Annie: I actually had two "blips" up, and then leveled off to where I am now. It wasn't really gradual. At the time, 17 years ago, I don't think I really realized the significance, other than I felt like "the little overworked guys" (that would be my struggling remnant beta cells) died off. So come to think of it, I felt like there was a death.

I would say just give yourself a lot of credit for the excellent care you have achieved. Your basal is still incredibly low. You still have some little overworked guys :)

It probably seems huge, but 40% of 3.6 is 1.4 units, and a 5 unit basal rate is still really small! I change my basal rate by 3-5 units every few weeks just to account for my hormonal cycles! That's not taking into account things like illness, stress, or weather changes, which can cause even more insulin resistance.

For me, stress has a huge effect on my blood sugars. My endocrinologist used to be able to pinpoint midterm and final exam weeks just by looking at my logs and seeing which weeks I ran super high (at the time I was on R and NPH and didn't adjust my insulin much). A job interview or a stressful client at work can make my blood sugar shoot up by 150-200 points with no food at all. I actually left a job last year because of stress. It just wasn't worth the effects on my health, both physical and mental.

i completely get you. i am going thru the same thing and my basal has gone from 5 to 9 in a matter of months. it shouldnt have actually been a matter of months but i was so resistant to up the dosage because i didnt want to face the music. i still dont want to, but like you, i want to do whats best for my body.
for me, i think the reasons are that my beta cells are taking a pounding from the normal immune attack and i had a bad cold a couple of weeks ago.

Your insulin needs are what they are. You may have just delayed changing them for a long time, hence the jump. And they may always change around as your body and life changes. But don't grieve over the changes in your insulin, that stuff just happens. Grieve over your true sadness, that you, like all of us, have diabetes. I always felt that my feelings after diagnosis went through the K├╝bler-Ross five stages of grief, D'Nial, Anger, Bargaining, Depression and finally Acceptance. And acceptance will come and you will be able to look yourself in the mirror and tell yourself that you can live a long, healthy and happy life and nothing can hold you back.

I hope you do make some changes to be healthy. It is good to not be overstressed. But your insulin needs (tiny as they may be) aren't really an issue.

I completely agree with Brian. I didn't realize it at the time, but came to eventually realize that I definitely went through the stages of grief - and it took me many years to come to Acceptance.

Even though I feel as though I've fully accepted my reality, things still come up like the significant basal increases that make me sad. I try not to dwell on it and just keep pushing forward. And I make a conscious effort to always look for the positives now.

Hang in there, Annie. We get it.

i completely agree! im all acceptance and the tdd goes up and i get really angry for while (grrrr, i hate pancake day!) or sad (why me?). i really hated pancake day on tuesday. these feelings really feel like a step backwards, i feel so much happier when i dont have them!

I totally sympathize! I'm on 6 units a day basal (with pen needles) and it IS frustrating watching my morning bs's go up and up. When I was first diagnosed I had gone into the ER with very high constant bs so they started me at 15 units of lantus and I got down to 2 over the summer and now I'm at 6. We moved over the summer and I lost a wonderful amazing caring NP who oversaw my care and worked so well with me. I am so discouraged with my new Endo. We haven't worked well at all together and my bs #'s are so out of control. I have days where I am SO angry at my Endo or I am SO angry at my family for not getting it, but then I think I am most angry at LADA because in the end it really is just my body being crazy and kicking in some of it's own insulin some days and screwing things up big time. It is SO SO SO frustrating!!! I started working out for the first time in many many years which I know in the long run is so good for me, but as far as diabetes goes is yet another thing that totally messes with my blood sugar. Maybe I am crazy, but I do feel like the workouts are the one thing saving my beta cells and LADA from getting worse. If I have to take a break from working out (vacations, taking care of my kids, life happens, etc.) then my bs # are actually easier to control but my bs starts creeping up. Anyways, I've had diabetes since 2009 but have been diagnosed LADA since last Feb (under a year). I'm right there with you...

I don't pay that much attention to insulin needs but just stay on top of my BG. Every now and then, the numbers will get all over the place and I'll go "wait, let's turn something down..." and sort of reel it back in and get stable again but it's all about the BG. You don't get any points for using this much insulin vs. that much insulin. It's the BG!

Agreed, but without getting obsessed and silly about it, there are valid reasons for keeping the dosages as low as is practical:

(1) The Laws of Small Numbers (small dosages allow for small errors, large dosages create the potential for BIG errors)

(2) Really large "industrial" doses of insulin can themselves be inflammatory, which sort of defeats the purpose, at least in part

Well, take heart. When you are T2 your doctor often plays out the part of Josef Mengele, keeping you treated with just enough medications to keep you from spiraling out of control, but not enough to keep your blood sugar from continuing to slowly kill you. Finally, after years of this torture, you are told you have failed and finally granted insulin, but only after years of damaging high blood sugars.

Even as a T2, I decided that the progression of my condition "is what it is." All that really matters is properly managing the condition.

You omitted (3) weight gain.

And it's friend Insulin Resistance.

Too true, Brian. Like you I finally said "Enough! I want insulin and I'll go get it myself if no one wants to prescribe if for me." Then I went shopping for doctors until I found one who wants to work with me, not against me.

BTW, I found this quite interesting, you may also. Barbara found it for me:

http://behavioraldiabetesinstitute.org/video-Patients-Reluctant-to-Start-Insulin-2009-05-30.html

Hi Annie,

I totally understand what you're feeling. I too went through a honeymoon period about a year or so and then my progression out of it was a bit more rapid. I started out with using on 2 units basal...now, I'm on 15 units levemir (on MDI's). It feels like a ton of insulin. My Endo told me most of his T1's typically take between 15 - 20 units basal per day and it's not a lot of insulin. So, yes...I too felt 'sad' when this happened, felt like I had no control because what worked one day didn't work the next, literally daily was adding more and more insulin. I don't have any cpeptide left so I hope I'll stay steady at 15 total levemir. I start my pump on Thursday so it will ALL change again.

Hang in there...just, like you say, listen to your body and give it what it needs. :)

Excellent video

I agree Brian. My basal rate (24 units Levemir ) hasn't changed since I was diagnosed ( Type 1 LADA ) six years ago.