Suddenly Very Sensitive to Fast Acting (Humalog)

Treatment Insulin
1

Hi,

Well my personal version of diabetes is currently in flux. I have no idea what is going on (I am not pregnant), but it is posing some big challenges and having to rethink my approach completely. It is almost like getting D all over again.

The changes:
1. I now go high very easily. Any carbs at all are sending me into the high 100s and even 200s, I think I'd be going even higher if I wasn't avoiding most carbs (this is compounded by my new problem with Humalog, and I don't know how much to take any more). Things I could eat before I can't any more. Protein is also having far more impact than it did in the past. I will have to experiment and find my carb & protein: blood sugar impact : insulin dosings all over again.

2. I have had to increase basal insulin significantly. I still need to do basal testing to accurately determine new dosing. I am now up to about 25 units of Humalin-N, split am 10-11 units and pm 13-15 units. However, some mornings I am high (like 114 this morning) and other mornings I am low (like 69 the day before). I am not comfortable with either extreme. I don't think I am overdosing the Humalin, but will have to do some all day fasts with monitoring to see for sure, and some nighttime testings.

3. Also, I am now extremely sensitive to Humalog. In the past I would have an insulin : blood sugar for corrections of about 1:15. Now every time I take Humalog I am going low.

For example: the other day I was 170. I would like to be somewhere between 80-100. So I decided to be conservative and took 2 units of Humalog to drop me by say 80-90 points (in the past that would have needed 4 units). After 45 minutes I felt weird and tested and I was 29! My lowest ever. Very scary! 45 minutes and I dropped by 140 points.

Today I was 130 (after 2 cups of coffee with cream and an appleskin breakfast without taking any fast acting) and took 1 unit of Humalog for correction and was feeling funny and just tested and I was 69 at 1 hour after taking it). So 1 unit dropped me 60 points and would have still been dropping as the duration of action of Humalog is longer than 1 hour.

I don't know how and why this could have changed so much. I am totally in a spin over this and going to have to do major testing and readjusting. It's like getting D all over again when everything I did in the past no longer applies. These lows are also super-scary and while I am working things out I might have to accept higher than my previously acceptable numbers just to avoid them.

Maybe change to regular insulin (slower impact)??? Try dosing with 1/2 units of H.

The only thing I can think of is that I was on low-dose dexamethasone for about 2 months - 0.5 mg/day. This did not appear to have a noticeable impact on my blood sugars. I stopped about 8 December, a week before going to Australia - and it is during the past 3 weeks in Australia and now back in Manila that things have been so strange. Could this dexamethasone have reset things? Even in low dose it would have immune system impact - that's the whole reason to take it.

2

Have you tested overnight to make sure you really require more basal insulin throughout the whole day? It may be that you're just dealing with the dawn phenomenon and rising in the early morning hours. If that were the case, then raising your basal rate is good for the morning but too much for the rest of the day. (Although, personally, I would hardly consider 114 to be an extreme high for a Type 1.)

Also, I know it's not a 50/50 split for everyone, but it sounds like your basal and bolus balance might be off. If you are taking 23-26 units of basal insulin a day, then according to John Walsh one unit of insulin should lower your blood sugar by 38-45 mg/dl. Obviously this is just a general guideline, but if your basal was even lower then having a unit of insulin only lower your BG by only 15 mg/dl seems very high to me. Is it possible that before you were actually covering your basal with boluses and when you raised your basal your ratios got closer to what they should be? Have you changed your I:C ratio? If your insulin sensitivity has changed and you are having to use less insulin to correct, you should also be using less insulin to cover carbohydrates.

I don't know about going high after meals, but I've read on here about people who are on very low-carbohydrate diets for a while becoming more and more intolerant to any carbohydrates, and protein having a larger and larger effect the longer they are on that eating regimen. Maybe this is happening to you?

I hope you get it figured out soon. I know all too well how frustrating blood sugars can be when you feel like they make no sense!

3

I agree with Jen, Sally. 114 is not high at all for most type ones. I like to start a meal at between 80 and 120. 2 units to correct a 170 would be too much for me, and I am not as insulin sensitive as you are. Gary Scheiner, author of Think like a Pancreas, was on the Thursday interview/video chat this afternoon. He also, like Jen mentioned, suggested that a long-term very low carb diet could eventually cause proteins to be used as a metabolic fuel; and would convert to a carbohydrate function easier/ quicker/when consumed with no to very lo carbs than when paired with moderate carbs. I may may have not paraphrased that distinctly nor accurately. Ask Ms.Emily Coles, the moderator, for the specifics or maybe you can see a re-run of the interview. I know you have been super low-carbing for a while..
And again as Jen suggested, maybe you need to lower the basals and raise your carb ratios to cover more carbs with less insulin. I have had to do that and sometimes I do not know what caused the change. "Why" is sometimes the never answered question for us: Just how it is with type one. When it comes to changing my rates or sensitivities, like Nike, I "just do it".

God bless,
Brunetta

4

http://http://chealth.canoe.ca/drug_info_details.asp?brand_name_id=1372&page_no=2ove
check out this link above:

I found this info in it Diabetes: Dexamethasone may cause an increase in blood sugar levels and glucose tolerance may change. People with diabetes may find it necessary to monitor their blood sugar more frequently while using this medication.

People with diabetes or those at risk for developing diabetes should discuss with their doctor how this medication may affect their medical condition, how their medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Maybe the insulin you took when using the drug was right for that time, but when you stopped using it, your need for an increased dosage changed? Maybe that, combined with the low-carb long-term effects that are listed in the previous reply, may have put your blood glucoses into a tailspin. Sally, Just a thought.

God bless,
Brunetta

5

Maybe it is the dexamethasone? Why were you taking that? It could be traveling also and the different environment/temperature etc. I agree that 114 isn't really high. I would be happy to wake at that number instead of the 150's I sometimes get and for me 69 isn't low at all unless it's dropping fast. But we are different in our results/reactions. I would definitely do half unit doses and use only 1 unit to correct for 170 range. I'm not sure why you are becoming more carb sensitive but I guess adjusting your diet and insulin/exercise is the best way to deal with it. I wouldn't eat without taking fast acting so you won't go high and then don't have to correct later and maybe go low.