I find myself constantly fighting lows and much more insulin sensitive all of a sudden without explanation. I go through phases where I'm very insulin resistant and have to struggle just to keep my blood sugar under 200 followed by times like right now where cutting my insulin still doesn't prevent lows. Is this just a normal part of diabetes? Am I the only one who deals with this? What would cause that?
Can you rule out that it is your menstrual cycle? The hormone Progesterone can influence your sensitivity to insulin. The following diagram shows the typical fluctuations of Estrogen and Progesterone in the cycle. The first day is the day of the menstrual bleedings. As you can see the Progestrone level usually rises in the week before the next menstrual bleedings. Certain levels might reduce the sensitivity to insulin:
This of course is a generalization. The duration of the cycle is highly individual. So the task is to find the repetitive pattern that represents your cycle. This would give you an idea of the days/weeks of your cycle with reduced sensitivity to insulin. The next step is to work against this issue with a more aggressive basal profile - and that for just as long as the sensitivity is reduced.
Typically before my cycle my blood sugar runs very high. I am due to start any day now and I'm super insulin sensitive. I do tend to notice that my insulin needs fluctuate with my thyroid levels as my thyroid swings from high to low very quickly and my meds have to be adjusted about every 6 weeks. Its just so frustrating and unpredictable.
That would make the combination of at least two effects: the cycle and the thyroid. I have heard that thyroid alone can cause a lot of trouble because it controls the metabolic rate of your body. With a high metabolic rate the control of the BG would be easier than with a reduced rate. As long as the fluctuations continue I do not see how this can be managed sufficiently. Is there any prognosis on the status of your thyroid - is it expected to turn to hypothyroid within x months etc?
I can have my thyroid checked and it be very high (hyper) and they will reduce my meds, I will go back in 4-6 weeks and my thyroid will be very low and they will increase my meds.... and repeat cycle. Does the thyroid influence insulin needs?
Just found this:
The Influence of Thyroid Hormones on Insulin and Glucose Metabolism
In states of low thyroid status the response of insulin to glucose is delayed. With oral glucose tolerance testing, there is a characteristic flat curve response to glucose stimulation in hypothyroidism because there is a slow rate of glucose uptake by tissues and decreased rate of glucose absorption by the gut. In addition, in states of hypothyroidism there is slower degradation of insulin, and therefore, there is increased sensitivity to exogenous insulin. This response accounts for decreased exogenous insulin requirements where there is a presentation of co-existing hypothyroidism and insulin dependent diabetes mellitus.
The hindered response to glucose, the slow rate of glucose uptake, the decreased rate of glucose absorption, and the slower rate of glucose clearance present clinically as hypoglycemia. In hypothyroidism, despite glucose consumption, the ability for glucose to get into the cells is hindered, and therefore, although the patient presents with symptoms of hypoglycemia, the glucose levels are normal on the serum due to decreased uptake of cells. When a fasting glucose is conducted, they will not present as a hypoglycemic. This pattern leads to increased stress on the hypothalamus-pituitary-adrenal (HPA) axis because the adrenals will make attempts to release cortisol to increase the glucose load for the cells that require it, but are unable to utilize glucose efficiently. The end result of hypothyroidism on glucose metabolism is deceased cell exposure with symptoms of hypoglycemia and up-regulation of the HPA axis. In addition, in states of low thyroid hormones, it has been found that the response of plasma cortisol to insulin-induced hypoglycemia may be impaired.
The thyroid can have a great impact on your BG by changing your metabolic rate. I would expect that with a low thyroid you would experience insulin resistance.
Interesting - so hypothyroidism leads to a higher sensitivity to insulin. This is the opposite of what I have expected.
Does no one else experience random changes in insulin needs?
I do at times, Lil MaMa though sometimes I come up with a theory (such as poor absorption with infusion sets) - whether my theories are true or not is a different question; I hate things without answers! Not long ago I posted on here what sounded like a clear case of developing DP which I hadn't had at all previously. I gradually increased my basals from around .500 up to the point of .900 for a couple time zones! Then after a week or two I started going low and decreased them basically to where I started and have been there ever since...no clue! My I:C's stay pretty steady. I've heard some people talk about "LADA spurts" that can happen for years, but never seen any proof - and a spurt of more endogynous insulin would make you go low not high! I also had an experience one night where I just kept going down hours after my last insulin and despite much higher dose of glucose tabs than normal. I bottomed out at 28. I'm convinced that was a "knot" of insulin that got released slowly over hours but who knows.
I read on here about unexplained numbers fairly often. At this point if it happens to me, I try to resist worrying too much about definitive answers and just "treat the problem". I think some things will never get explained but if it happened to me on a regular basis I would try and find answers.
yes...and for me it was the wrong basal doses...i've cut my basal in half (on MDI), have started eating more carbs, which will help with liver dumps and keeps BG's steady, allowing the fast acting insulins to work better, what they're designed to do (with carbs) and still will probably need to cut my basal back as I'm dropping in middle of night. all about the basal sometimes. exercise, hormones, stress, sickness and anything else under the sun can contribute too but when one has wide fluctuations, highs - lows, it's often basal rates.
You must be suffering from a case of "my pancreas just jumpstarted and now I'm temporarily cured"; I get that sometimes too! While I like to think it would be fun to be cured, it never lasts long enough to figure out, and it never correlates well with anything I can think of so I can't recreate it on demand....
My last round was just a month ago, and I ended up reducing my I:C ratio by half to keep from going low after I ate, I got to graze all day without bolusing, and I had to run about a 75% temp basal at night to keep from going low. No known or traceable cause ever, and it only ever lasts for a week or two before everything is back to normal and I end up putting all my ratios back to where they were and go back to spending my days chasing highs post-meal instead of eating glucose tablets for "dessert".
I can't track it to anything normal or useful- not weight changes, hydration levels, frequent flyer mile balances, humidity, earthquakes, exercise, food choices, menstrual cycles, moon cycles, tide cycles, bird migration cycles, barometric pressure, stress, illness.... It only happens once or twice a year, starts and stops suddenly, and at least this last round knocked my average weekly BG from 160 to 130 even after I cut rates and ratios and finished off a bottle (not a tube!) of glucose tabs and made a good dent in another.
In a recently diagnosed person they call it a "honeymoon", but I was diagnosed in 1991 and although I haven't been tested, I just don't imagine I have many/any functional beta cells left, and certainly not enough that they could all start pumping out 50% of my daily needs on a whim. I have no idea what it is, what its from, why it happens... but I've more or less made peace with having to deal with changes on a daily basis, and if what I did yesterday isn't working today, then just I (try to just) change it and move on.
I don't know if its normal, but you're at least not the only one!