Insulin pump basal (too much) causing glucose to rise?

I’ve been using an insulin pump for 2 1/2 years now. Initial basal was started off on what my Lantus dosage was (30 units divided by 24 = 1.25 per hour). Then adjusted were made accordingly to make it fit applicable ups/downs during fasting to determine proper hourly rate. At time went on, small changes have been made here/there for additional fasting basal changes. However, after adrenal insufficiency diagnosis, I’ve had “spells” where my glucose would rise out of the blue without food AND/OR during the same period I’d take a bolus to correct and the bolus wouldnt have a dent and may even cause it to rise more. Mentioned to endo and he had no clue.

Well, I’ve discovered, by accident, that during these periods for some reason, if I 1/2 the basal rate, blood glucose just drops.

I have not seen my endo since this discovery but it will be in the discussion for my next visit but I am curious, anyone else ever run into this? I’m theorizing it’s the liver/alpha cells detecting & compensating for what it seems like too much insulin.

Without my endo having a clue about what I was talking about initially, taking a guess no one here has an idea either but posting in hopes of finding someone to confirm my suspicion.

As a possibility, examine the day of your pump infusion when this tends to happen.
Day 1? Day 2? Day 3?

Sometimes tissue loses its ability to absorb insulin after a few days. See if there is a trend when it mostly happens on day 3.

I’ve witnessed something similar. During periods when I concentrated on optimizing basal rates, I’ve noticed this counterintuitive effect. In general, cutting basal rates often leads to a rising blood glucose, and increasing basal rates means blood sugar comes down. Now I know there are a lot of other factors involved in glucose metabolism.

So when I’ve cut basal rates and watched BGs fall, it’s hard to make any sense of it. I’ve watched this phenomena in myself many times. Fortunately, it indicates to me that I am making great adjustments to my basal rates. It lets me know that I am in the right neighborhood. With insulin, I’ve often observed that less is more.

Your speculation that too much insulin elicits metabolic counter-regulation is reasonable. Diabetes really is the Goldilocks disease, not too much, not too little, just the right amount is the prize.


This is exactly what’s happened with my daughter for about 6 years now. It’s positively maddening when there’s no way to be sure if she needs to lower or raise basals without trial & error. Added to that is her CDEs’ useless comments…“that doesn’t make sense.” Yea, now tell me something helpful. According to her endo, too much basal causes a stress response which causes her BG to continuously rise. Sounds plausible. Thank the pump gods for temp basals!


Thank you. To be honest, when I mentioned it to my endo that I had a couple of times a day mid/late afternoon and mid-evening, that I took “tons of insulin”, he wasn’t sure about it. I did not expect others to experience the same so, again, thank you for giving me some evidence.

But again, I went through 3 endos to finally diagnose my primary (autoimmune) adrenal insufficiency. Took them 4 years to check other markers to validate after I’d been requesting them for 4 years. But the last endo finally did after my potassium went sky high with no explanation. Anyways, i digress. Needless to say, i know the entire endocrin system inside and out now – pcp hates me, endo is a love/hate relationship. I honestly did not expect the stress response as a plausible explanation. :slight_smile: The vials of insulin I could’ve saved knowing this. :slight_smile:

tiaE - There are so many questions I’d like to ask your daughter but with you being on here instead of her guessing she’s younger. If so, would like to ask you some of these things if you do not mind (private message). Working to go to a dermatologist in next step. It’s frustrating and ever changing as I can imagine you’re aware. There’s some peculiarities that I’m curious to know if you’re daughter has as well to try and formulate something for the doctors. Please let me know if you’re ok with me pvt messaging you about this to discuss further.

Thanks for all the info everyone’s provided. Trust me, it’s extremely complex. I dx my primary addison’s disease after the initial elevated ACTH. My PCP will confirm this as on my first appointment, getting tired of doctors ignoring me, him and I got into it. 4 years later when I was dx, he actually confirmed our conversation 4 years earlier. Extremely smart and articulate about details/analysis.

A new example, the times constantly change. I’ve gone from 35u day on basal now down to ~8u day basal. Last Thu at lunch, eating late at 1 which i knew was a bad idea since my glucose was ever so slowly rising since 10:30 and knew any bolus wouldn’t lower it (yeah, i know sounds like type2, but it’s not as you’ll see). So it dawned on me, i hadn’t tried it in a while so I changed my basal to 0 and then took my bolus for the meal plus a little to cover my missing basal. Low and behold, my glucose started dropping really quickly. That’s not type 2. :slight_smile: Anyone else able to change their basal and have it take effect immediately? Everyone I know of it takes 15 to 30 minutes for it to kick in.

  1. constantly changing. Can go 1 or 2 days during smooth/great glucose for the afternoon for example, eating the same thing. Then wham! Day 3 or 4 it changes on me and got to play the game again of finding that basal rate where my glucose doesn’t rise. Some ranges that I’ve found happy mediums are 0, .025, .05, .1, .175, .600, .9. Today for example, is day 3 where the 2 previous days the 0 worked flawlessly between 10:30a until 3p with snack/bolus in there to cover the missing basal. But at 3pm when I resume basal at .1, glucose doesn’t rise. It just hums right along like the basal wasn’t missed. Thinking it’s a skin, stress response scenario. Father, brother and sister, including myself, have extremely tight/young looking skin. A nurse commented before how ‘tough’ it is to stick a niddle through (mainly because it’s very elastic/stretchy resulting in tough). I know, I sound insane! Trust me, I probably am but with me being able to reproduce these results on request, it’s wierd.

What are your c-peptide results, if you have any?

They were <= .1 (essentially nothing). 41 years T1D.

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Thanks Eddie. I’ve changed site/infusion set and it’s an instant effect like nothing changed at the new, even rarely used site like arse.

Terry, yeah. Unfortunate thing is spending close to 30 hours a week to manage it and if I ignore it on day 3 after 2 days of dream levels, it can be 180 before I know it and then easily 280 before I get the “just right” basal. I’m not big fan of change and eating same thing, same time, etc is no big deal for me. Endorsement questioned gastroparesis (delayed absorption) but have no other symptoms and went from an a1c of 5.0, nice even flowing by with cpeptide of <=.1/no natural insulin to off the charts, for me. Food/carbs digest quickly. Started out as an afternoon early night factor now its moved to overnight to nearly 24/7. Key being is even when I do not eat much on a weekend to troubleshoot, no stress, etc. like mentioned, can reproduce it like I’m playing a video game with my cgm (bad analogy but applicable). :slight_smile:

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@Eric30 my daughter occasionally reads here but she isn’t a member. She’s almost 20. I would be happy to be the middle-man for a conversation, & I can probably answer some of your questions myself. Feel free to send a message.

Something else worth mentioning during this process… despite these periods where the incorrect basal rate can quickly raise the glucose levels, in the process of trying to constantly keep a happy medium, my overall basal rate has decreased 75%. Previously at the “normal” basal rate, if I used this much my glucose levels would be sky-high constantly. Mentioning my analysis to my endo in my upcoming visit to see if he can check for it but suspecting it might have to do with GSD or glycogen storage disease, on top of T1D and primary Addison’s.

For those that offered insight or future readers, on the way to having a conclusion and looking to get confirmation from docs. It has been a while but believe I have found the root cause. Gluconeogenisis is where the liver will overproduce glycogen without being triggered by the pancrease alpha islet glucagon. Its also a type II diabetes. Like type I, there are a couple to a few “root causes”. What I cannot explain yet is why because insulin isn’t usually the “trigger” for the liver to produce more glycogen but rather a trigger to turn if off. If you ever want to investigate for yourself, a gastriotologist, heptologist in addition to a endo should be able to help. Metformin is a genetic drug that’s been around for years and years and works to slow down/stop the enzyme process in the liver to over produce. Not on metformin yet but hoping to get an exact explation of why more basal insulin triggers it to excelerate in glycogen release/glucose rise.

Note: For me, I’ve also “lost” my only adrenal (congenital birth defect – only 1 kidney/adrenal gland to begin with) due to it being attacked by autoimmune system. Might have an effect since I’ve lost all other methods of body to raise glucose levels.