Radical changes in insulin requirements

I use the word radical because these changes happen suddenly and are requiring what I feel is a pretty large adjustment in my dosing. When I say sudden, I mean literally today I did this and was fine and from tomorrow on I will need to do something different.

I’ve been on Symlin for about 6 months and am T1. I started at the higher T2 dosage of 60, then went to 120 mcg. It seemed to work very well for the first couple of months. Then I started experiencing lows after meals and lowered my dose back to 60. And lowered my basal rates. And lowered my boluses, Things seemed to get balanced again for another few weeks then it happened again. Stopped the symlin until I could get the lower dosage pens, still reduced basals and boluses.

Now I am at no more than 30mcg with dinner only and it is happening yet again. My insulin resistance seems to have gone through the floor but it is happening in sudden steps. Fine for a few weeks then run low for a few days until I get it all tuned again. Which means all the basal testing, carb ratios adjusts, insulin sensitivity changes.

I’ve lost nearly 30 pounds on this stuff, but has anyone else experienced that type of sudden, drastic changes in their insulin requirements? Could weight loss alone be causing it?

I have actually had similar changes with weight loss. I don’t know whether the changes actually happened suddenly or whether I only noticed them in that way, but it sure seemed sudden to me. I was once about 30 pounds heavier than I am now and lost all the weight before Symlin came around. I remember being surprised about what I felt like were sudden decreases in insulin requirements, but what I always figured might have actually happened more slowly and I just wasn’t paying close enough attention. A diabetes educator might have a better answer here. I’m sure we aren’t the only 2 type 1’s who have lost weight at one point or another.

Hi Scott -

I believe that for some - and you would be a good example - that weight and insulin resistance are closely tied. Some of us are just much more susceptible to this than others.

I am a long time Type 2 (18 yrs) but finally became insulin dependent about 9 months ago. I was within 10 lbs of “normal” when I started the insulin. Over the past 9 months, I gained 20 lbs - even though, I maintained a very strict low carb diet and exercised regularly! It was soooooooo frustrating. Plus, I started out on a very small amount of insulin but as I slowly gained weight, my resistance increased, requiring more insulin - and the cycle continued.

Even though my last A1c was 5.4, the weight was making me miserable. Believing that both insulin and a lack of natural amylin was creating the problem, I started Symlin about 10 days ago as sort of a last ditch. I am now up to 90 mcg, have already lost a few pounds, and my resistance is decreasing.

So, my belief is > less weight > less insulin > less resistance > and so on and so on.

Question - are you using any formula for deciding on your boluses? I mean, are you calculating carbs and then halfing your bolus or??? Also - are you bolusing right after your meal? You might try waiting an hour - that works for me (it was in Jason’s Symlin guides)

I find that I have to bolus before my meals and the reason really has nothing to do with D. I will forget to bolus more times than not if I try to take it later. I take my symlin at the same time. When everything is dialed in correctly, I will be under 150 at 2 hours and back to 100 or so at 4 hours. I saw where Jason had done that and tried it a couple of times (even remembering to bolus!). To make that pattern work for me would require more symlin and more insulin than taking them both before the meal.

I use the bolus wizard on my pump to calculate the dosage. When I have to adjust it, I will adjust the dosage down some and then calc that ratio in my head. I do that for a couple of days until I find what works for me then adjust the pump to match.

I see. I guess I can’t really relate then, as I am MDI. I do know that if I took my bolus and my symlin at the same time, I would get in to serious trouble in terms of lows. I check my BG 1 hour after eating, and depending on that, I take half of the calculated insulin/carb dose or slightly less. I check again in an hour and do a slight correction if needed (not usually).

But, in any event, I’d say losing all those pounds and lowering your resistance are major accomplishments! Just be careful about them bad ol’ lows. Must be hard to keep adjusting.

yea, it’s about to drive me nuts… err… nuttier maybe

I started using Symlin in September. I did not tolerate the titration well, I pthought the nausea was going to be the end all. Finally I got up to 60 mcg with each meal and I am changing the carb ratio coverage every few days. I am type one and have lost a few pounds. My endo said this would/could happen. I have had some lows but nothing is consistent. If I do the exact same thing everyday one day sugars are great and the next lows thru out. I have tried changing basal rate and then sugars are high. Any suggestion?

Hi Dianne -
I also started in September.
I find I do have to “keep after it” but it seems to be getting more consistent, especially since going up to 120 mcg. I actually had to maintain my basal rate - it was my bolusing that has been reduced. I’m hoping that my basal will come down as well.