I have been t1 for a little over three years and have been low carbish (about 80-100 gr/day). my insulin needs have always been low, as im t1 as opposed to t2, i exercise a lot, eat low carb, and was able to catch the d quite early on, so i think i had a lot of beta cell happiness still going on.
i have mostly been on basal only because i schedule my physical activity around my meals. i really do not like the long tail of the short acting insulins ive tried.
for the past month i have been high, over 200, like every day, at least once a day. i am correcting like crazy and am very frustrated. i am going to up my basal i think, and see if i can fix the problem with just that. the
could this, after three years, be the end of the easy control? have any people diagnosed with t1 late and who had "easy" long-term control dealt with this? how much can i expect insulin needs to increase? i take 5 units of levemir in the am and 7 in the pm. im going to increase each by a unit. i know ydmv, but what is your average, if you dont pump? is there anyone t1 who uses exercise and low carb and strategic timing so they dont have to use fast acting? i cannot imagine the disruption that fast acting is going to cause.
Everyone is different. It could just be that the honeymoon is over. I believe a typical total daily dose is about 0.5 U/kg for an insulin sensitive T1. I doubt you are anywhere near that.
After diagnosis I was on 5-10u of Lantis plus 500mg Metformin for the first 2 years. I exercised 4-5 times a week, ate a balanced, healthful diet. Then in the span of 2 months my BG stayed pegged over 200, no matter what I did. This was obviously the end of my honeymoon, though I fought for a year trying everything BUT fast acting insulin to gain some sort of control. I just couldn't break through the denial that I was indeed T1. It was one of the most stressful years of my life. Once I got tired of working so hard with no results I broke down and went on MDI. I honestly wish I had done it immediately once my BG control drastically changed. What really slapped me into reality was the C-Peptide test(<0.2) and the GAD Antibody test(>250!).
I'm now on a pump/CGM combo and loving it. Ironically, I have far more freedom now than when I tried to force my BG down with only diet/exercise when I was obviously T1.
I'd suggest you ask your Doctor to do at least a c-peptide test, do a full Anitbody panel if he will(alot of Primary Care docs won't). From the sounds of it, your results may break through some denial.
I take about 20-25 units per day. Before I got on the pump I took 16 of Levemir, I forget the split. Now I take about 12. Sounds like (depending on when your highs are occurring) you might be ready for bolus insulin. I could never manage without it. I got my "honeymoon over with on oral meds (15 months) before I correctly diagnosed myself as Type 1. It has now been a total of 7 1/2 years. My needs have been fairly steady though periodically things go wonky in one way or another, but it can be either up or down. There has been no steady climb, I think because, as I say, I got that out of the way while still on oral meds. My c-peptide now is .10 so I am running pretty empty (it started, I believe at .70.
I won't lie to you, bolus insulin does come with its own set of difficulties and more chance, of course of going low or high. But with medium low carb (me also) my I:C ratios stay very stable and I am mostly in a rhythm of it with not too many bad surprises. Like anything about D there is a learning curve, but then it becomes routine (except when it's not!)
I was diagnosed about 8 years ago and my insulin needs have climbed from about 15 units a day (once I achieved basic control) to around 27 units a day. I still consider myself the beneficiary of some beta cell happiness.
I doubt if you are going to be able to take care of daily excursions to 200 by just increasing your basal. For a first estimate, just add your corrections to your basal and consider whether you'd feel particularly safe.
The best way to deal with the "long tail" is to increase the amount of fat and protein in your meals. We're all different but my normal pattern is to rise 3-5 hours post meal and bolus.
I was on bolus insulin from day one but was able to skip a bolus if I ate a low carb meal and exercised. Things got much easier for me once my endo cut my basal and increased by bolus so that I had to take a shot before pretty much every meal. The basal/bolus regime was shown by the DCCT to lead to better outcomes and patients who started intensive therapy as part of the DCCT have continued to do better even though members of the control group were eventually moved to basal/bolus and now have approximately the same A1Cs as veterans of the intensive therapy group.
Good luck with your decision and a happy new year,
I take about 45U/day, probably less when the cookie buffet that our office has turned into stops soon (I hope!!). I'd wonder if maybe your activity level changes during the winter? Even if you don't have "polar vortices" to deal with in Spain, maybe you slow down a bit or don't ride as much, which I would think might be a more "basal" problem. If your food is the same and food is causing spikes, I'd blame the ratio and change that to take a bit more and see how it goes. With my pump, I usually just to "a click" like .1G/U or .025U/ hour to see what happens but I wouldn't change too much, just a bit to see what happens. Happy new year!!
thank you for all of the responses. i am really kind of in some denial like thing where i go, "yeah, this food wont make me high, that was yesterday. now things should be back to normal." kevin, i have the gad antibodies and stuff, so i was diagnosed with t1 initially, but i was doing really well with just the basal on most days. i so dont want to bolus, it just sucks. i have had to use bolus insulin on and off, but things have always settled down after a couple of weeks. in the summer, i was down to eight units of basal! it was like i was almost cured!
i considered the exercise/winter thing, but im actually exercising MORE recently! acidrock, i dont know how you people do anything in chi-town, my friend is visiting there and it was like -9 the other day. i would die. you are soldiers!
thanks again for all of the advice. one more thing, very vain, i know, but will this make me fat? i would think no, because i am just replacing the insulin i was making with the analogue, it should be more or less the same amount. right?
Presumably you're going over 200 after meals. And yet your fasting, morning BGs are still well controlled by your basal insulin. Trying to control post-prandial spikes with extra basal insulin is a big mistake, you'll just set yourself up for lows when you're not eating or when you're exercising. Expecting to be on just basal insulin long-term as a T1D is unrealistic. So yes, I think it's time to embrace the reality that you need bolus insulin to cover your meals. And the quicker you go there, the less you'll stress your beta cells, and your body more generally, with spikes like you're experiencing now. The good news, thousands have trod this path before you, figured out effective strategies, and you can learn from that, and it also means there's hope for you, too. Welcome to the club!
All things equal, injecting insulin so your body can absorb glucose that would otherwise have hung around in your blood for a while and/or spilled into your urine, is likely to cause weight gain. Then again, spiking and crashing blood glucose may cause overeating that can cause weight gain, too. And if I were a doctor, I would tell patients who were thinking of shirking on insulin to control their weight that this was an excellent strategy, because just think of all the weight saved when I had to amputate their legs due to diabetic complications of those spiking BGs (diabetes is the leading cause of adult limb amputations in American adults). Sorry to be so morbid, but if you can't keep your BGs tightly controlled without insulin, then it's time for insulin, full stop.
I think you need to add in fast acting now, it will be an adjustment for sure, but you will be ok and you don't want to go that high all the time. My basal is 8-9 units levemir now, when I was in the icu it was 30 and it quickly dropped to my current dose. I have never had easy control unfortunately, but I think I did have some sort of honeymoon after dka since my dose reduced a lot when I got out of the hospital. I'm starting a pump soon and basal will be 25% less: 7 units. I have never monitored my total on a regular basis on mdi but my fast acting is around 10-20 units depending on meals and corrections. The pump(training on saline so far still) seems to have the total at 17 units with a .3 per hour basal but I think I have forgotten to add in some corrections or adjustments.
I gained back weight from dka weight loss and then I noticed I was gaining more on lantus so I switched to levemir and now I'm stable. I'm pretty active but not as much as you have mentioned I think. I have days of low and high activity.
When you say you are correcting like crazy, are you correcting with fast acting?
Overall since starting insulin four years ago I'm a couple of pounds lighter than when I started. It really has more to do with your choices about diet and lifestyle.
I've gained 5 lbs since starting insulin (bolus only), because I've been a pig. Actually it was 7 lbs, but I've taken 2 off since ending the party. I need to lose a total of 15 to get to my ideal weight.
Go easy on the carbs (100/day or so) and you'll be fine. Follow the ADA nutritional guidelines (300g/day) and take enough insulin to cover those carbs well and control your BG, and you'll be a blimp in two weeks.
Don't worry about the insulin and weight. It's a very controllable variable. The biggest difference will be much better BG control.
One more thing to add -- in getting to know you here, I have the strong impression that handling the technicalities of a strong bolus regimen will be a breeze for you, and not be complex or too challenging. What I can offer from an experience standpoint is that, once it becomes routine, it won't be any meaningful inconvenience or effort.
For me it's roughly become sort of like wearing glasses. They're a PITA inconvenience sometimes, I have to remember where I put them now and then, I get pissed when I forget my "computer work glasses" at home and have to work all day looking down my nose through my progressives, etc. etc. etc.
In other words, it's a bit of a pain, but it's just a part of life. I expect you'll be happier for it, after the dust settles.
T1's typically need much more insulin than T2's, not less, and definitely need fast-acting with meals of any significant carbs. If you are truly T1, then you have had an exceptionally long "honeymoon period", where some of your beta cells were still functioning and producing insulin, but their function may be waning now. When I was doing MDI (multiple daily injections), I typically took 6-10 units of Regular and 30 units of Ultralente per day. Once I switched to a pump, I only use 30-35 units total of short-acting insulin. Just upping your basal is not the way to go, you will need to start taking fast-acting with your meals. It takes some trial and error before you figure out which ratios work for you, and they do change over time, but with an endocrinologist's help you will get it!
niccolo, i am not trying to control my weight with(out) insulin. i use levemir every day, exercise a lot, eat lowish carb and if i want a treat i use apidra with an insulin:carb ratio that i was able to figure out using trial and error and books like "think like a pancreas".
yeah, im correcting with fast acting-apidra. the doctor gave me a half unit pen which is, or was, really helpful-looks like i wont need half units anymore...
thank you, dave. i have used bolus on and off these three years and the only thing that is annoying is that it interferes with exercise and i have to really plan everything more. goodbye spontaneity!
I feel that way sometimes, but if you shift your focus, you can say it adds spontaneity. Say you're out with friends and that bread/cake/whatever looks mighty tasty. With bolus, you can have a taste and not feel like you have to immediately bike it off or worry about a big spike. Re: your weight gain question, I've found that my metabolism is the same as before the whole T1 dance began. I had to watch every bite I ate before I started insulin and I still have to do that or I gain. I don't think it's the insulin, it's just the way my body works.
