Thoughts on changing basal rates?

Type 1 and LADA
#1

I'm not sure whats going on but for the 4th time in the last year my basal is needing to upped again. I went for a long time taking 12 units in the morning and 24 at night, then last year around July things started to change:

Month - Morning - Night

July - 13 - 27
December - 13- 29
March '14 - 14 - 33

Now here I am, its literally been 2 months, and I am waking at 250 again after just getting it to flatten out in March. I woke every morning for a week flat from the night before. and here I am, the last two weeks gradually rising back up to 6am 250s.

I don't know what to do. Nothing has changed, exercise (need more of it), diet, weight, nothing.

I am at a loss, its like my body is conspiring to kill me. Everytime I get my basal to flatten out, two months later its off again, requiring more. I am so frustrated.

Thanks,
Jason

#2

Let me start by saying that you need as much insulin as it takes to balance out what you eat and what your liver secretes.

I have some questions that may or may not apply to you. Do you snack between your dinner meal and bedtime? Have you gained any weight during this last year? Do you know if you might be going low while you're sleeping?

I find that my best overnight BGs occur on days when I don't snack after dinner. Weight gain can often accompany an increase in insulin resistance (IR). IR complicates insulin dosing; reducing IR, if possible, is the best way to regain good BG control.

Waking at a high BG like 250 is often the result of the classic bounce that can occur after a sustained overnight low. It's possible to drop down into the low 60s or so and it can take the liver and counter regulatory hormones a few hours to counteract the low. But when they do it often leads to multi-hour highs well into waking hours. How do these highs respond to corrections? Do they drop like normal or does it take repeated doses to finally bring them down? Repeated efforts to bring down a waking high is often a symptom of a low rebound.

One tactic to monitor your overnight BG is to set an alarm to wake you up at 3:00 a.m. to check your BG. If you're going low then you've found the source of your high waking BGs. If your BG is just trending high then you can increase your night-time basal dose with confidence.

Whenever I run into these kind of problems, I start to keep a log. Looking at a written record can give you some important perspective that a single data point lacks. It's the forest and tree thing.

Good luck. You will figure this out. Keep at it.

#3

HI Terry,

Thank for your reply.

A few answers to your questions. No I typically don't eat after dinner, unless I am low from dinner. I did gain weight last year when my thyroid was going crazy, but its been stable for a little over a year. I'll definitely start checking at ~3am, I usually wake up between 2-4, so until I get a nice flat number again, I'll go back to checking at that time. I would guess that I am not going low - Ive never had that problem, I'm not counting that out now, but I'll see if I can figure it out. Lastly, No, I can usually get it down with a single correction and Im fine the rest of the day, until 3-4am.

I guess I cant believe how much my insulin requirements have changed, and so quickly. I have been D for about 8 years, now, and over 5 of those years on insulin (T1.5). I always had some trouble with my basals on and off, but like going to bed at 110 and waking at 160. Its not until the last year or so that I've been getting these crazy 275 numbers. My A1cs have been consistently 6.6 and under, but I can't believe the insulin. I read others using 10-15u a day, I'm right under 50 now. I started at 20.

Thanks,
Jason

#4

Hey Jason. A couple of thoughts. I have found that mysterious rises in basal requirements can sometimes be a harbinger of impending illness - cold, flu or even a mild infection/inflammation, especially teeth/gums.

Another cause can be some supplements and/or medications. The last time I had a significant inexplicable increase in basal was due to taking Niaspan (Pharmaceutical grade B vitamin for cholesterol). It doubled my requirements. As soon as I stopped, my basal requirements plummeted back to previous levels. Also, any medication that contains even the smallest amount of steroid will spike me sky high.

#5

That's interesting. The last two weeks my back has been in near spasm, so I have been taking Flexeril and hydrocodone. Its just starting to feel better. And I have stopped taking them. It was weird as last week at 7 am, it was 100 points lower than today. I definitely need to do the 3am testing the next few weeks.

#6

A morning high that responds well to a correction probably means that you're not going low overnight.

Don't put too much stock in others with a lower total daily dose. They may have more endogenous or internal insulin production. I've read that an adult person with diabetes without insulin resistance will normally use about a 1/2 unit of insulin per day per kilogram (about 2.2 pounds) of body weight. This is a nominal amount and some variation from person to person and even the same person from day to day is to be expected.

Since you've been diagnosed as a LADA, type 1.5, then that means that your total daily dose of insulin would normally go up as your pancreas decreases its production. This can take years.

It may benefit you to do a basal rate test. I like Gary Scheiner's protocol. This will also require you to get up during the night to record BGs but once you've flattened your overnight BGs you will be rewarded with generally dependable overnight BGs and a good night's sleep, too!