Situational type 1 insulin resistance

Type 1 and LADA
1

I am 19, have had diabetes for 12 years, and over the past couple months I have found that while 0.4 units of insulin might bring me down from 9.0 to 4.5, as soon as I go over 11.0 I need between 2-3 units to bring it down into range. This is in situations where there is little to no active food, and blood sugar has slowly crept upwards while I was doing something else.

I have been getting 3-4 hours of sleep a night because my blood sugar tends to fluctuate wildly when I sleep, and as soon as It goes above 11, it just starts going up on a quadratic curve.

If anyone has had this issue before I would appreciate any advice.

Thank you.

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2

My advice, regardless of what the underlying issue is, look into getting a CGM such as the G5 or G6 if you have coverage for it. CGM Alarms can save your life or your sanity when sleeping thru a bad low.

When I get far higher than usual, and at night especially, I’ll need more of a correction than a more “typical” high, during the day. Thankfully, now that I have a CGM, my bg excursions are far less wild.

3

I forgot to mention I am using a libre senor

4

while it is great, it doesn’t have alarms because it only updates when it actively scans the sensor site.

5

which has no alarms. it isn’t suitable for a T1.

6

There is a gizmo you can put over it that scans every 5 minutes, IIRC. BluCon.

7
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Ok thank you very much

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9

please let us know if you get one and how it works for you. (I hope the Libre is accurate for you)

10

You don’t mention if it is all day or a certain time of day? But you do mention night fluctuations. I have dawn phenomenon and it can affect the whole morning.

I have always found the much higher BG levels require a lot more insulin for me to bring my levels back down. Plus it makes you want to give too much insulin trying to get it to come down thinking you need more but it’s really just taking longer to work. You have to be careful of that unless you want to start chomping candy or drinking juice! It’s easier to deal with by stopping it at a lower number. Dave’s right in that a CGM really helps to stop it from happening and to learn trends to try to deal with it.

I have dawn phenomenon and I didn’t know I had it until I had a CGM. Sometimes I would wake up to high numbers and sometimes not. When I got my CGM I could tell I climbed every morning usually around 6am, but sometimes it can wait until I had been up for an hour. And in fact for me I avoid eating or eat something very low carb in the mornings as my BG level will disproportionately rise and is too hard to control.

The best way to help with that was when I got an insulin pump and could program higher insulin amounts in the mornings, and lower insulin the first 5 hours of sleep.

This I found helpful to understand why I am so bad in the mornings even after I’ve dealt with my spike. I hope this helps.

Jim_in_CalgaryType 1 or LADA

26d

@NatureOrbs - Carbs (or glycogen released by your liver at around 4am) are not the predominant cause of early morning rise in blood glucose.

Your body has an adrenal release (it secretes higher levels of growth hormone, cortisol, glucagon and adrenalin). These effectively increase your short-term insulin resistance, after which even normal low levels of glucose in bloodstream cannot be neutralized.

PS, I didn’t see the Libre CGM posts until after I posted, but Dave’s right again! It doesn’t have alarms to tell you when you have climbed too much or when you are dropping. Both are extremely useful by being able to catch it (and wake you if needed) before it gets out of control.

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11

Marie brings up a good point: don’t stack your insulin. I’m really bad about doing that and I do it knowingly because I hate high bg’s. But it’s not recommended for the obvious reasons of 1) it can be downright dangerous, 2) it leads often to another low which means another round of carbs which leads us to 3) if watching one’s weight, stacking leading to rollercoaster highs and lows means more carb intake for the day.

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12

In addition to @Dave44’s suggestion of the blucon there is also the Miaomiao which is rechargeable and flatter so you won’t catch it on everything. For those on the U.S. 14 day sensors though neither of those options currently work.

As for your original post though I have the same issue when bg’s go higher than 170 or 180 (10) I need boatloads of insulin to bring it back down and it will take longer than it should too.

13

You should remember that generally it takes more insulin to bring high blood sugar down, than it takes to keep blood sugar in balance. So it will generally take more to bring down a high blood sugar than a just out of range blood sugar.

14

I’d suggest starting at the basics and doing a basal test

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15

Do you mind posting the Libre data? That might help us read into whats going on.

16

I have an erratic and time-variable dawn phenomenon (and sometimes an afternoon or evening phenomenon, too), and I don’t treat it with a corrective bolus. I treat it with a Temporary Basal.

When my high alarm goes off (anywhere from 4am to 8am, and occasionally later, or not at all … perimenopause sucks!), I look at how fast my BG is rising and start a Temp Basal of 1.0 to 1.5 units/hr. (My basal rate at that hour would usually be between 0.5 and 0.7 units/hr, depending on which basal pattern that I am currently using … again, perimenopause sucks!)

If my high alarm goes off again (set, for this reason, at a one-hour interval), I adjust the Temp Basal. The time-frame that the Temp Basal is set for depends on just how high the Temp Basal has to get before it does any good. Sometimes 1.5 works, and sometimes it has to be 2.0, or even 2.5. This goes on for anything from 2 to 6 hours.

I have a fall-rate alert set for 2 mg/min because, once my BG starts to fall at this rate, it indicates that my chemistry has shifted and the Temp Basal is no longer necessary. HOWEVER, I try to notice when it is dropping at +1 mg/minute, and has gotten below 180, because that is usually the best point to stop it at, as it wil continue to drop for 1 to 1.5 hours before leveling out.

I am still refining this, as not catching the drop fast enough leads to 10-30g of candy, which doesn’t help my weight.

The reason that I don’t use a bolus is two-fold. First, is that there is no way to know how much insulin will be needed. And second, there is no way to know how long this BG rise will last. I figure that the hormones, or whatever, are not usually being released in one short burst, so the treatment shouldn’t be, either.

I’m getting pretty good at using Temp-Basals in this way, and rarely use corrective boluses. Even so, I rarely get away without a BG over 200-250 during these episodes, and occasionally get as high as +300. I am getting better at judging what is likely to be needed, and for how long. But, I have only been pumping for just under 1.5 years, and have been experimenting with these Temp Basals (very cautiously) for about 8 or 9 months.

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17

Having re-read this, I want to point out that the higher that you set the Temp Basal, the more quickly you have to respond when your BG starts to drop.

The Temp Basal insulin is the still the same insulin, and it doesn’t peak right away. The idea is to get your BG down, and to level it out, so it’s important to increase your Temp Basal in small-ish increments, and to wait 45 minutes to an hour before changing it upward, so that you can see the effect of the Temp Basal. Is your BG still rising, going down (& how fast), or holding level? Also, remember that the insulin is peaking at about 1.5 hours, so you should expect your BG to (usually, or at least often) start to drop then, or to speed up in it’s drop.

If you plan to eat, you need to be SURE that your meal bolus is based on a Temp Basal amount that holds your BG LEVEL, as your pump should be adjusting your bolus to add in a corrective amount. You don’t need to have your Bolus and Temp Basal correcting for the same amount. It’s the same as stacking … not a good idea!