Strange Insulin Dosage!?

Hi guys, I've had T1D for about two and a half years now and have noticed some strange changes with my insulin. I have been taking Novorapid during the day and Lantus before I go to bed. Initially I was on 10units of latus and about 4-7units of Novo depending on the meal size. I was about 115lb back then, and over the last few years growing up etc.. I went to about 230bs at 19yrs old. My doses have also significantly increased with this, Lantus went to about 50+ per night, and Novorapid anywhere from 18-30units per meal.

I dieted down to 205lbs which is what I'm currently maintaining but my doses have changed accordingly. I am now currently on about 30 lantus and about 16-24 Novorapid for my meals. I eat about 3/4 times a day, wish I could spread it out more but I'm busy with college and work. I also often drink lucozade to bring up any hypo's I get which is every day or two. I know all that sugar isn't good for me or my teeth. Are there any other remedies any of ye more mature diabetics maybe able to recommend?

Anyway, I was just wondering if these changes I've made myself to my doses are 'safe' or expected with such a change over the past few years.. just curious, any help would be appreciated. Don't worry my readings are mostly fine and my A1C was 5.1 last time I got it checked so I don't really think there is much to worry about there, it's just the deal with having to adjust dosages frequently enough is whats bugging me.
Thanks,
Padraig.

I also experienced increased insulin sensitivity with weight loss. At my diagnosis (about 8-ish months ago. I am a female around your age), I was around 155lbs and taking 19 units of Lantus a night with roughly a 1:12 I:C and 1:40 SF. I ended up gaining around 15 pounds after starting insulin, and my Lantus increased to 21 units and a 1:10 I:C. At around 145 (I am on a pump currently), my basal rate is equal to about 14units Humalog or 17-18units Lantus with a 1:14 I:C and 1:50 SF.

Unfortunately, adjusting insulin dosages is a pain-in-the-rear-end. It seems like the weather, what I eat, hormones, activity, site changes, and even what color shirt I am wearing seems to cause my insulin needs to change. It's a part of what we have to go through to make sure that we are functioning at our best.

One of the things I am concerned about is that you are adjusting your doses without notifying your diabetes team, and you are also experiencing a lot of hypoglycemic episodes. I recommend that you start recording when you experience hypos and use that to determine if you are taking too much basal insulin or too much bolus insulin. In addition, if you are afraid that your basal insulin is inaccurate, basal testing (testing your BG every hour for 4-5 hours with no bolus IOB) can help to see if your basal rates are keeping your BG steady.

Have you done basal testing recently? With your weight loss both basal and bolus doses will be effected. This is the norm for D. Sensitivities will change with changes in age, hormones, exercise, hot weather, cold weather, food choices, and seemingly phases of the moon.
Knowing how to test and safely adjust doses of both long acting and rapid insulins is an essential skill for good control.

Have you read Think Like A Pancreas yet or Using Insulin? These are two good books that give you the tools to understand what's going on. Both can be found in hardcopy as well as for ereader.

Sounds like you need to do basal testing first, once you have that adjusted you will need to test your I:C ratios, and correction factors. Be aware that you may need different I:C and C.F.s for different times of the day.

Also have you ever tested your duration of insulin activity - DIA? That also is an important piece of the puzzle.

It seems like a lot to do and it will need to be redone when ever you find your self having recurrent lows or highs at particular times of the day. Once you understood how to do this, it makes your life and you D a lot more manageable.

I really encourage you to follow hobbit's advice to learn more about how your body works with diabetes. Knowledge is power. Diabetes will likely last your whole life (unless there's a cure, of course), so learn as much as you can.

Some of my biggest lessons learned about diabetes came in my 28th year. Low carb eating and using extended boluses for protein and fat (I dose for carbs, too.) combined with everyday walking made a huge difference in my control and quality of life. I now take less insulin with better control than before this.

Your excellent A1c probably means that you pancreas still makes a significant contribution to your control. Maintaining good BG control will increase your chances to extend the function of your pancreas.

Good diabetes control is a moving target. Don't get stuck with what worked before but doesn't seem to work now. Adjust, observe, write things down, change something, repeat. This is a dynamic disease; don't treat it like a static one. You appear to have already taken this to heart with the changes you've made.

You are in the driver's seat, not the doctor. If you wait for the doctor's permission for any therapy changes, your timely response to changes will suffer. Don't get me wrong. Doctor's do play a helpful role in treating diabetes but don't marginalize the real power you have living with diabetes 24/7/365. You know more about your metabolism than the doctor will ever know.

Don't worry about the need to make changes. This is what diabetes demands. There will be periods when the changes lessen and you can enjoy good BGs without constant adjusting. If you stick with a fixed protocol when your needs change, your food, insulin, and exercise balance will be out of whack. Trust yourself. Take care.

You are in the driver's seat, not the doctor. If you wait for the doctor's permission for any therapy changes, your timely response to changes will suffer. Don't get me wrong. Doctor's do play a helpful role in treating diabetes but don't marginalize the real power you have living with diabetes 24/7/365. You know more about your metabolism than the doctor will ever know.
Don't worry about the need to make changes. This is what diabetes demands. There will be periods when the changes lessen and you can enjoy good BGs without constant adjusting. If you stick with a fixed protocol when your needs change, your food, insulin, and exercise balance will be out of whack. Trust yourself. Take care.

This was posted by Terry and is the best advice for any persons with diabetes thanks for your post. Padiraig, I use glucose tablets, and skittles for lows, will use a liquid for lows under 45. I am not hyp-ounaware and get mild ones in the 60's ,maybe once or twice a week. God Bless
Brunetta
Type 1 46 years

Ask your doctor to add metformin to the mix about 2000 mg/day. Start with less and build up. It should make BG control much more steady and more predictable.

Ya hopefully things will begin to settle down once ours bodies stop growing and hormones calm down.. It is very annoying, it requires a lot of attention. I've just been changing them slowly and it has seemed to be working for me, I visit my doctor every 4-6months, but get blood work done regularly enough. Thanks for the advice I will have lots of questions next time I visit the hospital!

Thanks for the reply, no honestly in Ireland I have never heard of the basal or bolus doses,, I have been putting these changes down to my body changing and have just had to change with it. I haven't read that book but have looked through a lot of articles online and blogs trying to expand my knowledge. I:C and C:f?? DIA.. all I was ever shown by a doctor was how to take an injection and a range of how much insulin I 'should' be taking, probably the reason why Ive been kind of experimenting on myself and have had to just try different doses out. I will be sure to ask these questions next time i visit my GP. Thanks Hobbit :)

Will do, cheers :)

That's how I feel, I'm given all this advice but feel that I truely have a better understanding of who my body reacts with my doses. Hypo's are almost a daily thing for me I must just try and fix that problem and test more after meals and just watch out for them. Appreciate the help Brunetta thanks :)

Padraig,
You can get either of the books I mentioned from Amazon, not sure if you can get an instant ereader download on your side of the pond but you can get them in hardback.

Gary Sheiner (Think Like A Pancreas) has a lot of good info free on his website. Here is a general link, check out all his group has to offer. He has quite a few online educationals.

http://integrateddiabetes.com/

John Walsh- Using Insulin also has a good site, check out his site and look at the tools section for lots of good info.

http://www.diabetesnet.com/diabetes-tools

Both of these books and sites will explain all the abbreviations I used and how they apply to your day to day dosing and self care.

Learning to count carbs and dosing for meals will make it much easier to keep from going low, as well as from chasing highs.

There are plenty of sites and apps that will help with the carb counting part of the puzzle. Once you get a handle on portion size and the carbs that match (may take weighting and measuring portions) then it makes dosing much easier.


Testing your basal to be sure it keeps you flat and level is another big part of the puzzle that is needed to keep you on track. Basal/long acting testing comes first, then rapid / Insulin to carb ratio/correction factor/duration of insulin activity.

You can do it! And it will make difference in your control. It will help you to adjust as your body, your life, your activity,your hormones etc change over time. Skills learned are skills practiced . You are in charge of your D. You don't need you docs permission once you demonstrate your understanding and that you know what you are doing.

I wouldnt be able for a low carb diet at the moment, I need all the energy I can get. Its been so busy lately and avoiding carbs would be nearly impossible for me Terry. My A1C is usually good never had it pass far beyond 6,I will try and get into a more solid routine of constant doses and try my best to be as frequent and as accurate as I know I could be. Thanks for the help, means a lot :)