So, I am a bit curious if I’m the only one who has this issue… I am just getting over a cold which progressed to pneumonia. I’ve noticed that each time I have an infection/surgery/some insult to my body that my insulin needs go up and stay up. I was still producing some insulin on my own, so I am wondering if the activation of my immune system is further damaging my beta cells, or if this is a continuation of my very long honeymoon period. I’m more thinking that each activation of my immune system does more damage as I run a temp basal for awhile, and then finally just up my basal rate for good once I’m fully healed. I’ve been running a temp basal between 115% and 120%, and I think I overall need to go to the 115% permanently.
Does this happen to anyone else?
I’m constantly doing temp rates, my needs change a lot. Lately I feel like I need 115% more too but then I can start crashing too so I have to just watch it all the time.
An infection like pneumonia is a huge inflammation in your body. While the immediate infection may have been eliminated by antibiotics you may remain inflamed for quite a while afterwards. Until you are fully recovered it would not be surprising that you would still be inflamed and require additional insulin. Recover may take 6 to 8 weeks. Do you really think you insulin needs have increased permanently or is it just far longer than you thought?
This is a well-known phenomenon and I am surprised your endocrinologist has not told you to expect higher insulin needs with infection (or almost any kind of illness) and developed a sick-day protocol for you. Here are some general guidelines that hopefully you can use during your next conversation: http://www.diabetes.org/living-with-diabetes/treatment-and-care/whos-on-your-health-care-team/when-youre-sick.html.
The explanation for the increased insulin needs is in there too, but essentially it happens because in moments of stress (which a sickness is for the body) other hormones get released which offset the glucose-lowering effect of insulin.
It seems permanent. I can’t tell you for sure with the pneumonia as I am just getting over it (The infection seems to have cleared up, but my breathing is still wonky, which is normal and will take 6-8 weeks to normalize for me per past experience).
The reason I say it seems permanent is I had a surgery in May, where my overall need (I:C and Bolus) went up and while my I:C came down my bolus needs settled at a bit higher rate (I was MDI, so 2 or 3 extra units of Lantus). Then had an infection in a surgical site in early July, where the same thing happened and while my I:C level settled back down, my overall basal increase about 10% on the t-slim.
This illness is on the same pattern. I:C went wonky, then has slowly flattened out to where it usually is (as in, it works and brings me back to where I started), but my basal went up and has stayed up.
Stress, hormones, etc. don’t have a lot of effect on my blood sugar level overall (I’m a bit more resistant, but not a lot). Just these super inconvenient infections. 
I would be alert to still having a lurking infection. Even stuff like periodontal conditions can be a problem and explain your continued need for more insulin.
We have a sick day plan… My Endo is pretty good about keeping me accountable for my own care. She trusts me to make the adjustments that I need to keep my blood sugar at a goal I’m comfortable with (and to call her when something is going wrong). My A1c has dropped from a 8.6 when my diagnosis was changed to type 1 to a 5.6 at my last appointment, so I feel like we are a good team. I try to stay educated on what’s happening in my body (I’m studying medical sociology, so it come up a lot), and am considering applying for a CDE certification as part of my educational plan (I am doing a Public Health certificate as part of my PhD) on an exemption application.
I fully expect a change in my overall needs when I am ill, but not a permanent change in my basal rates. My endo isn’t concerned about it, and I’m not so much either, just really more curious if I’m the only person who has experienced it and if it seems to be infection related or just transitioning. It’s my research brain at work.
Hmm… That’s a though. Maybe I should have a sed rate checked again? They did this at my last couple of regular doctor appointments because of the previous infection, but it’s come back clear.
Do you think running a repeat GAD would show anything if the inflammation isn’t positive? The GAD was the only positive test I had, other than my c-peptide was low.
I’m not super worried about it, just curious. I was labeled non-compliant for so long after my diagnosis changed from 1 to 2, so after being changed back to type 1 I am especially vigilant about my care and changes in my body.
I would suggest you talk with your doctor about this. Sed rate is one test for inflammation as is CRP (or even better hsCRP). But if you have not been to the dentist in a long time you should also think about making an appointment.
Something similar happened to me after my surgery last February. Even though the timing was a lil weird, I still attribute it to my surgery.
There reason I say the timing was a lil weird is I had expected my insulin needs would go up right after surgery while I had a lot of pain, but they didn’t do that, at least not right away like I expected.
Right after surgery, while I was doing the most healing and had the most pain, there was no change in my basal needs, like I expected there to be, but my boluses needed to be increased.
About the time I started feeling better, my blood sugar started slowly creeping up until a few weeks after surgery, I had to start increasing my basal. I ended up going from 9 units all the way to 12 before I was done increasing it, and by that time, my boluses went back to normal. I had been at 9 units since shortly after my diagnosis a lil more than 2 years before then and never felt a need to increase it until then.
Since then, I had a short period of time where I was able to bring my basal back down, but that was the same time that we got really hot weather. Then, just a couple of weeks later, I had to increase it back up to the 12 units. It kind of seemed like once my body got use to the heat, my insulin needs went back to what they were before it got hot.
Here is is 7 months later and I am still at the 12 units I had to increase it to after surgery. I have had no indication that it will be going back down to my pre-surgery level even after all this time.
Hey. This JUST happened to me. I am in my eigth year as a T1D, and so I am far past my honeymoon period. I was recovering from an infected tooth, and had fully completed a round of antibiotics. A few weeks later, my BGs went into the mid-500s…and would NOT come down, despite support and intervention from my endo. Once they realized I was coming off an infection it all made sense, but for TWO days I was giving myself crazy high boluses and NOTHING would bring it down except time. And this from a fairly seasoned diabetic pro. (Oh, and it was awful. Like being hit by a crap truck.)
So, my infection has cleared up (yay good xray!). Still bad to bump up my insulin rate. Talked to my endo, who basically said it is what it is. She said that my numbers are not bad if I leave it alone even, but my obsession with keeping my A1C under 6 isn’t a bad thing since my lows have decreased at the same time. However, if I start seeing lows, it goes back to the previous setting. I am making a dentist appointment to make sure everything is good there too. Thank you everyone!
My bg goes up and I have to use a temp basal for a cold, a fever, any infection, and when my dermatologist gave me a steroid shot for hives. My temp basals are in the 150% and I slowly back it down until I’m completely well.