Sudden Basal increase

Looking for some advice:

Been Type 1 for 4 years (26 yrds old), never an A1C over 7.4 even at diagnosis. Since switching to a pump over a year ago my Basal has been set at .7/hr and have had zero problems. My last A1C's have been 6.1's. Just this week, when I tested my blood sugar 4-5 hrs after eating or in the morning it has been in the 180's 200's. I always wake up with 85-90 blood sugar or down to 100 after eating before this starting happening

Yesterday I switched my basal to .95/hr which seemed to correct the overnight highs and after meals highs while still keeping the same carb ratio.

I am just wondering am I getting insulin resistance? If so why? I am in decent shape workout 3,4 times a week and don't eat like crap. Is this normal? I was avergaging about 35-40 units aday now it seems to correct highs and mor basal i have been doing about 60. Just trying to find out what's going on with me driving me nuts


I think that the ratios can change over time? I have not actually read studies but have 25 years of insulin (shots for about 22 of them?) and have seen changes over time. Even in the 2 years of pumping, every now and then the #s will creep up into the 100s instead of the 80s, I change the basal up a small amount and it goes back to normalish #s? Lately, I mostly change basals and when I change exercising (biking to running in the fall/winter and running to biking in the summer…), I also turn down the I/C ratio until I get used to the new form?

I don't think you should confuse a minor change in insulin requirements, with anything falling into "insulin resistance".

The usual endo definition of "insulin resistance" is needing hundreds of units a day. By comparison, taking your morning number from 180 to 80 is probably 1 or 2 or 3 units in your basal per day.

I've seen my dosages vary wildly over the decades. When I was a teenager I was taking upwards of 80 units a day. Today I take less than half that. For this reason I have a hard time ascribing, the way others readily do, a small change in insulin requirements to insulin resistance.

Now there is a long list of things that affect insulin sensitivity, don't get me wrong.

After many years of extreme stability you might have to become a little more flexible with accepting changes (both UP and DOWN) in your doses.

Kudos on the great A1c! I've been D since '74 and pumping since '92. At different times I have run across the same situation. Like you, I can't always find a reason. I tweak basals (both up and down) as needed.

About twice a year I make the decision to do the dreaded "basal testing". It is more comprehensive and I feel more secure with the results over just "tweaking". Regardless, I also know the basals I set after basal testing aren't going to last forever. But they are a good baseline and a great place to start when trying to fine-tune control.

Could you have been honeymooning all this time, and now it’s coming to an end? Are you Type 1 or LADA (a different form of type 1)? LADAs often honeymoon for longer (their beta cells continue to produce some insulin) and that honeymooning can be extended even longer, in some cases, by injecting/pumping insulin. But honeymoons DO come to an end.

Not too familiar with the pump in all honesty. However I have heard with insulin pump therapy interruption of insulin delivery can occur due to the infusion set becoming dislodged, infusion set clogs, leaks, or from the insulin no longer being absorbed properly. It might not be being absorbed properly for various reasons, maybe bumps / scarring under the skin etc. However it's likely that your ratios may have changed slightly or you have a fever / infection which can raise blood sugar levels temporarily. Have you had a sudden change in lifestyle ie less active job / stopped exercising / eating more carbs? If not it's worth just checking the insulin pump to ensure it's functioning correctly and adjusting your ratios for now.

This was my thought too. It’s more likely the end of the honeymoon than development of insulin resistance. Basal needs can change as we age, but that is a dramatic shift for such a short time.

Thanks for the replies...

That was my thought at first, I switched Insulin, then changed infusion sets to a different spot same affect. On the question of honeymooning, yes I was LADA diagnoised at 22 (thought I was type 2), went to an endo 3 months after being on oral's and confirmed I was type 1 with c-pepdide test. I was honeymooning for a good 2-3 years then she said I was basically done over a year ago.

I am curious why only my basal has to be changed, I eat the same breakfast and take the same amount of insulin 1:15 carb ratio and my BG 2 hours after is always the same be it on .7/hr or .95hr so I would think you would need more insulin to cover carbs if I was getting resistant?

This was also my thought. Studies have shown that even with regular Type 1, honeymoons last longer the older the person is at diagnosis. So, in general, a 22-year-old will have a longer honeymoon than a 12-year-old who will have a longer honeymoon than a 2-year-old. This is not taking into account LADA which can have an even more extended honeymoon than regular Type 1. My guess would be that you’ve been honeymooning a bit for the past few years and now it’s just ended. If you are developing insulin resistance then all your doses would likely go up (carb ratios, sensitivity factor for corrections) and not just basal. It’s also possible it’s something like an illness your body is fighting off, allergies, holiday stress, etc. I’ve read that someone is not considered insulin resistance until they are taking 100+ units per day, and even then things like their weight need to be taken into account (more weight = higher insulin requirements).

I have read adults diagnosed in adulthood with LADA often use a lot less insulin than those diagnosed as children. Have to assume this is because LADA is slowly progressing and there is beta cell function over a longer period of time (years, instead of months). If you are no longer producing any residual insulin, you may need more. .70 units per hour seems like a fairly low amount for a man. In Pumping Insulin by John Walsh, he has lots of charts and you can get a general idea if you fit near the norm or not. He also manipulates basal/bolus balance for better control, i.e., during times of insulin resistance (teenage years, for example), he advises basal/bolus balance can be 60 percent basal/ 40 percent bolus. This has really worked for us and it is not permanent (she is back to 50/50). He will give a general range; how your body responds is individual. Basically, you need what you need and of course pay attention if you are using huge amounts of insulin. You could switch to another insulin, try that, if you are truly insulin resistant. Does not sound to me that you are, though.

Well, maybe doc was wrong and honeymoon wasn't over after 2-3 years?

I certainly don't think you need to worry about being resistant - you don't take much insulin compared to many people, and nowhere near the hundred(s?) for the title of 'insulin resistant'. (I, for example, take more than that as my basal, as an average sized 24 year old. My LOWEST basal is for a few hours in the afternoon of workdays in which it's 1.05u/hr; highest is 1.5u/hr in the middle of the night for several hours).

You make it sound (and sorry, if I misread) like you use one rate throughout the whole day. Keep in mind that you can change it throughout the day, and create a 'program' (or several) if you notice patterns throughout the day. For example, I have Dawn Phenomenon (which it sounds like you have as well) and in order to control my fasting BG, I begin amping up my basals at midnight, and again at 3:30am, then take it back down considerably at 7:30am. This keeps my morning BGs under control.

No postprandial spike and 1 to 15 ratio… and .70 an hour for a grown man is low for Type 1. Not insulin resistant. Insulin use can be generally looked up based on weight and age, to get a general idea. When honeymoon is completely over, first we saw highs at night; next the postprandial spikes, last, ICR changes. We usually change basal first; bolus insulin remains stable for long periods of time. Basals fluctuate rapidly. Her basal pattern (time periods when she needs more or less insulin) always remains the same. For instance, she will always use more insulin hours 6pm thru midnight; always use less 12am to 3am; (as a teen, not child, always need more insulin 3am thru 9am) always need less hours 10am thru 4pm. Read “Pumping insulin”, basal test and figure out your patterns, when you need more or less, how to adjust. But use personal observation as your main guide to making changes.

I was diagnosed at age 57 (4 years ago) and my basals have increased steadily over the years while my insulin carb ratio has been much steadier and my correction ratio hasn't changed at all. I've seen insulin resistance defined as requiring over .8 unit of insulin per kilogram of body weight. If you are under 160 lbs, your total insulin usage might indicate the start of insulin resistance.

What was the percentage of your total daily dose was basa when you were taking 35 units per day l? If it was under 40%, the increase in basal is certainly consistent with continuing beta cell destruction.

In my experience, a small basal boost will produce changes like 30-50 points, maybe more? If my BG goes up (a couple of times/ year, I sort of change exercise regimens and it throws stuff off…) and I’ll turn my pump up or down as needed. Not a lot, just really a small nudge in the direction it needs to go but if I suddenly am low all the time or my BG creeps up, I’ll nudge the pump and it goes away.