Mysterious May

I was wondering if anyone else has experienced a notable departure from their established treatment regime possibly indicating significant changes in their insulin sensitivity or carbohydrate tolerance or perhaps experienced something akin to death throes of their few remaining β-cells.

Allow me to explain:

The month of May 2014 represents a milestone of sorts in the manifestation of my Diabetes.

For reasons unexplained, during the month, my body’s requirement for exogenous basal insulin has dropped 30% and bolus insulin by 25%! May 28th's A1C was 6.0 - This is the lowest I've seen in the past 25 years with diabetes! March's A1C was 7.8. All of this despite very little change in my diet or activity level.

Correspondingly, unfortunately, I have suffered from several severe, sometimes traumatic, hypoglycemic episodes during this time as well. One step forward, two steps back.

My logbook shows thirty-one such episodes with ten being be in the 40s and two in the 30s. These have been occurring at seemingly random times throughout the day. Only intense, vigilant monitoring and management on my part has prevented more serious repercussions. In an effort to regain some semblance of control, I've been making twice-weekly adjustments to my dosages (in consultation with my physician) based on frequent (upwards of 18 times per day) BG measurements.

Only after assembling weeks of data, have I noticed some hint of a pattern, or set of patterns perhaps. But this/these are being masked due to apparent imbalances between basal & bolus levels with the timing of those doses and meals; plus my own peculiar, at times, reactions.

In any case, I believe I have reached the limits of effective, safe, treatment on MDI. My doctor and I have been discussing transitioning to an insulin pump for the past several months due to variability of my BG and agreed in April to proceed. That was before all this weirdness.

I’m really hesitant to proceed with further experimentation now that my pump and CGM have arrived and I await ‘training’ scheduled for the 18th. Based on the curious developments over the past month, I suppose we will need to refine the pump settings from that which was originally prescribed. I'm interested to see what happens when/if we reduce my dosage by the typical 20-25% when transitioning from MDI to a pump.

I was just wondering if anyone else has experienced a similar significant, no, profound change in their body's reaction to insulin and/or Carbs.

Been there done that! Have not had the extreme lows but have had my requirements fluctuate dramatically with changes in activity and eating habits. Warmer weather and more summer activity are known to decrease insulin dosing requirements for many, and the reverse happens in the winter as well.

Don't know what pump and cgm you chose, but my recommendation would be to go live with just the CGM first and learn what your food choices and dosing patterns are doing in realtime. That was a huge eye opener for me. I thought I had good control but my CGM told a very different story.

Next use the CGM to do your basal testing. You need to seperate your basal effect from your bolus effect. If your basal is too high then you crash.
If your basal is too high and your bolus is to high you crash faster and wind up on the rollercoaster.

Have you read Pumping Insulin by John Walsh yet? There is a lot you need to do before pump go live so you have the best data to base your pump program on.

And then when you do go live have lots of flash carbs handy, my basal rate dropped by 50% when I went to a tslim. Also be aware that different infusion sets can have different absorption rates for you personally.

Being fully comfortable with the CGM prior to pump start made a huge difference for me. I had two months of CGM experience before I started pumping and it was a vital tool for me in getting there safely.

Well, I live in Florida and the only difference between 'winter' and summer is simply the frequency of afternoon thunderstorms. :-)

I've got the Medtronic 530G w/ Enlite.

I've had several conversations with my doctor and DCM and we've agreed on a fairly conservative initial settings. I doubt there will be any risk of hypos due to basal settings. At least we did before most of this started: We will just have to adjust further downward.

The schedule is to start on the pump first and do the CGM the following week. Normally they want 6-8 weeks in between, but due to my 'advanced' level of understanding (Doc and DCM's words, not mine) they advanced the schedule.

DCM said she was customizing the training because it's obvious I already count carbs, completely understand the theory and operation of the pump (I completed all the on-line training within two days of notification of the pump shipping), do my own data analysis and am already embarking on TAG bolusing. I even told her not to be upset when I arrive for 'training' with a sensor and infusion set already inserted and ready to go. :-)

If you are that savvy and will come to training ready to go then consider running the CGM for "educational" purposes from now to pump training. It will let you see how it plays for you and how close/far off it is from your FS readings.
With your extensive FS records matched to your CGM data you will be miles ahead.
Not sure why they do not not start the CGM first- to me it just makes so much more sense then going pump live while blind!