I have been on both short-acting and long-acting insulin for about 6 months now - my endo took me off the short term - seemed to work for awhile, now after eating small breakfast I went up near 300 and I went ahead and gave myself 1/2 unit of short-acting - my bg went up over 50 pts in less than an hour - I’ve called my endo for new directions. I dread the highs (and esp. the lows) - has anyone else experienced this? Please help me learn something new…Thanks, DD
im sorry…its so frustrating!
my insulin needs make absolutely no sense to me…they seem to change from day to day.
you aren’t alone in wonky bs readings, and trying to figure it all out 
I’m not at all sure why you are calling yourself “brittle” ( a term when docs don’t know how to manage?) or why you think you are sensitive to insulin. Have you learned what your I:C (insulin to carb) ratio is? 1/2 unit of short-acting is not very much, especially if you eat a lot of carbs for breakfast. I’m a bit confused, did you take the 1/2 unit AFTER eating? As a correction? I suggest figuring out your I:C ratio (start with 1:15 and work backwards or forwards depending on results), then learn to count your carbs and bolus accordingly. I totally don’t get the concept of your endo “taking you off the short-acting”!! because you were going high? It sounds like you need more, not less. Also is your basal correct? If your basal is too low also, you would be high at fasting, before meals and bedtime which is fighting a losing battle. I highly recommend the book Using Insulin by John Walsh, it makes it all more logical. There is a lot to learn, I was stressed to the max for the first couple months. It doesn’t sound like your endo is too helpful (welcome to most of our worlds!). Hang in there, it will get easier!
I have several other autoimmune disorders (rheumatic) that relapse into an inflamed state - right now I am having a bad relapse - swollen joints from arthritis, etc. The endo and my PCD said that I am actually getting better and need less insulin - my endo just put me back on metformin. still using long term at night - 6 months ago my daughter and her baby lived with me and I was caught up in her dramas - she is a T1 with an attitude. She and my granddaughter moved out and now I have peace and serenity in my 1 br apt. 
I was put on a ratio of 1:30 and found out that as my situation evened out I could go down to 1:20 if needed (in morning) and could adjust ratio in evenings up to 1:60. I just became unable to handle the short-term (still don’t understand yet…) I was bottoming out all the time - waking up at night in the 40s and falling off cliffs during the day - some 30s and 1 28 - very scary - that’s why endo took me off the short term. The term brittle means that due to ? your body becomes very sensitive to even minute changes. I’m just weird I guess. Thanks your feedback and or recommending the book. DD
This just does not sound right. You are a type 2? Yet you are taking a miniscule bolus and going hypo? What is your basal rate? Is it possible that your rhematism is highly variable and that your basal rate is just not properly matched to your changing inflammation? Why are you going low hours after your bolus should apparently have worn off?
It just seems very odd, most T2s tend to be insulin resistant, having an I:C below 1:15.
The books “Using Insulin” by Walsh and “Think Like a Pancreas” by Scheiner are really helpful. It really sounds like you are not brittle, rather your basal is at times set much too high (except when your daughter is giving your grief).
I am type 2 on Lantus(41 units at night) and Novolog(on average 8 to 10 unit a day). I diet on low carb/no carb and I shot to adjust before I eat. My last A1C was 5.5 so my unusual system works for me. I have arthritis on both knees and take pain meds most days. I use to walk to help control my sensitivity and that worked well when I cold walk. My usual 2 hr after meal is in the 170 area.
i have been on no carb/low carb this time about 7 months before I started I was taking 85 units Lantus at night and 15 to 25 units before each meal. I have lost 28 lbs. I hope this helps.
thanks. I have so many questions! I’ve wondered if I’m not a 1.5 instead of a T2??? my endo just put me back on metformin and to continue on the lantus at night…I am EXTREMELY fatigued today and need to go lay down for awhile, thanx everyone…
Can you find a new Endo? Do you have a diabetes education center close by? Diabetes education centers are often very valuable resources, sometimes MD’s know too little about too much, whereas an education center knows a lot about 1 thing - diabetes.
Weird metformin is used to combat insulin resistance by the sound of things you are very insulin sensitive so why metformin?
I agree, there are a lot of things that need sorting out. If you are going low at night and “falling off a cliff during the day” that may be too much basal, not bolus. When my doctor was treating me as a type 2, not the 1.5 I am, he had me on too high a dose and I was always low when it was just before mealtime, I thought that was normal. He also had me do insulin two hours after eating "“if I was high” and at much too high doses which resulted in a scary low. (I contributed to this a bit, because I didn’t know anything, like what a “correction” was for, let alone I:C ratios and decided I liked doing insulin “PRN” Talk about the blind leading the blind… off the edge of a cliff! I would suggest either traveling to find someone better or doing what I and many others of us have done and educate yourself through this board and do what works for you!
I don’t know - I am kinda confused about all of this myself - my docs tell me I’m getting better - maybe that means that I’m not as insulin-resistant as I was - still…if I eat too many carbs or things with sugar I shoot up into the 300s so ???I have lots of questions and no concrete answers or understanding at this point…
my endo is one of the best in the SE and I love him - I think a lot of this is revealing itself as we go and things change - I don’t mind taking the metformin again - it’s nice not to have to give myself all those shots during the day - but I know that in a flash things can change - that I can really count on with the big D!
Hey, I thought I’d share my two cents on this - we have a lot in common.
I was diagnosed type1 in december, and until last week when I started my pump, I was on long and short acting insulin as well. (lantus and novolog)
Until reading this post I thought I was in rare form because of the “brittleness” of my D.
Normally I’m running about 10 units a day on my pump now. (.2 units/hour of basal and the rest being boluses - it works out to ~ 50/50)
But I had a similar day to yours as well, just the other day…
Woke up at 77 - ate my usual breakfast - bolused just like always… Went for a walk with the dog, hung out and took a nap… 5 hours after my breakfast I was 216! (Which for me is totally unheard of… dialed a correction of 1 unit of novolog… Had a pounding headache… took 600mg of motrin and tried to sleep again… Now it’s about 7 hours after breakfast… 250!!! What the heck was going on… took 2 units of novolog (via my pen) switched infusion sets/resevoirs (thought it was an air bubble and sure enough it was). Hung out for an hour and watched tv/messed around on the computer… 6:15 comes around… 194 (right direction, still high) bolused normal for dinner (3 units of novolog via my pump), ate my normal dinner. did a 2 hour post and I was 51… had no signs of a hypo… ate a little ice cream and by bedtime i was 135…
so anyway, there are other “brittle’s” out there!! You’re not alone!
Thanks for sharing TIm. I saw my rheumatologist yesterday and he thinks I’m a T1.5 - (which is really a T1 and a little more complicated (a “wierd” category as he said…) I think my endo is leaning in that direction. When I see my endo next month I’m going to ask for all of the antibody tests for T1 which are the ICA (islet-cell antibodies, (IAA) insulin autoantibodies, and antibodies to glutamic acid (GAD - decarboxylase- my rheumatologist gave me an 8-page print out from his physician’s web site which I’m working my way through. With diabetes I’m always learning something new and to hear your story (and everyone else’ too…) really helps me a lot. Since I’ve started taking metformin again (still using Lantus at night - 9 units) my bg has definitely evened out - my fasting this morning was 120. Hope this lasts. I’m getting ready to go meet with a landowner (I write Forest and Wildlife Mgmt Plans). I hope to stay out of the ticks and not get any chiggers! See ya! DD
The term “brittle” diabetes was historically used to characterize patients that had a difficult time attaining control. It refers to recurrent large swings in blood sugar. Today, we understand that for the most part brittle (or labile) diabetes is a rare disorder. You don’t have “brittle” diabetes when your infurion set fails and you don’t have it when you don’t bolus or correct properly. It was initially thought that labile diabetes occured when your pancreas totally pooped out, making proper control difficult, but today we know that is not an issue and does not cause labile diabetes. You have labile diabetes when your blood sugar skyrockets for no apparent reason, sometimes sending you into DKA. There might be a few members here that experience brittle/labile diabetes, but this condition is really very rare and not well understood. If you want to learn more read (http://books.google.com/books?id=Yq3VCQpK2KYC).
Hey, thanks for the book reference - I’m going to order a copy today - my endo is the one who used this term brittle with me - I read part of the book preview and I seemed to fit - Last December I was almost hospitalized for adrenal exhaustion - I was close but got pulled back with cortisol tmt - I’ve been in the ER for almost 24 hours several times since Dec due to high bg that just shot up for no apparent reason and just wouldn’t go down - they gave me lots of fluids - I’ve also had extreme bg from over 400 then down to 40 in 2 hours - what a ride that was - I’ve had lots of hypos lately - yesterday I saw my rheumatologist (he treats me for inflammatory arthritis and scleroderma (systemic sclerosis- a rare disorder and a cousin to lupus) anyway, he agreed with my endo (he didn’t like the word “brittle”) but said I fall into a “unique category” and he also thought I was a type 1) he said he will ask my endo to do the antibody tests - He printed out part of an abstract from his “UpToDate” subscription for docs on T1, so, that’s the rest of my story - hope that helps fill in some of my background for you - I also have been treated for Grave’s Ds (autoimmune thyroiditis) and my endo manages my thyroid supplement. Again, thanks for your feedback.
You’ll find that book is very expensive, but you can see a preview of it on the link given or on amazon.com. It does look like a good book if you’re used to reading science papers - it seems to be aimed for physicians and not the general public.
Doctors frequently label people brittle. Basically, it means your blood sugars aren’t perfect or even very good, and you have lots of highs and/or lows. I think it’s just something they use (in the US) for insurance purposes, because people labeled as “brittle” can see the doctor more often or something. There have been other discussions on this, and we’ve all generally agreed there’s no such things as brittle diabetes. However, I’d never heard of that study bsc posted; people with those issues probably deserve the term brittle.
Jag1 is right, the book is highly specialized, don’t go and spend $200 on a book unless you really want it. You can read selected portions of it on books.google.com. If you then want to see it, look it up in a library. It should be available through many libraries through the common interlibrary loan program.
Trust me. I have serious book issues.