Why do ratios and basals change?

Hello,
I have been an incredibly hard time managing my diabetes the past year because it seems like my ratios and or basals change almost every couple of days and i can't keep up with it. Never used to be like this when younger. Any idea why?

It's the way of nature. Change is inevitable. Sometimes, I'll attribute it to astrology but I don't monitor the planets to correlate it to my BG.

Perhaps this has nothing to do with your ratios actual changing and instead reflect natural variations in your body. When you are active, and particularly if you run like acidrock, you will be insulin sensitive for up to two days afterward. Not just a little, but a lot. And then, if you do the couch potato thing to watch the superbowl, it then does the opposite.

I have the same problem. I've tried eliminating every possible variable that could impact my BG readings. I maintained a strict wake up, work, exercise and bedtime schedule. Each meal was identical to the previous day's - time, selection, quantity, injection time & site location. After 3 weeks of that I sat down and computed how much the readings were changing. Frustratingly they were all over the map. My endo had been on me for not maintaining tight control, but when she saw the data we agreed to dump the NPH/Reg regimen and go to a pump. It worked better but still the control wasn't nearly as good as we hoped for. One nugget of wisdom and experience I learned is that no matter how hard you try you are attempting to mechanically replicate a natural body process. Try as I might I cannot anticipate ever changing ratios and have no choice but to react to them the best I can. For some people it is much easier than for others. In the end if you fall into the latter category all you can do is the best you can. A continuous monitor helps but we must also balance living life with trying to manage a complex disease with imperfect tools.

I think this is a constant struggle for diabetics aiming for near perfect control. For instance, You have a lot bigger tight rope to walk on if you are aiming for an A1C of 8% compared to 6%. I can also throw in a baseball analogy. To the casual fan it may appear that the pitcher is just pitching the ball down the middle of the plate for the batter to hit it. The real fan knows that the pitcher is throwing the ball high and tight to set up the outside corner pitch for a strike out. Or, the more you go for tight control, the more you will notice your body's ideosyncracies.

There are just too many variables at play when you are aiming for near perfect control. The best I can do is react quickly to the changes to keep my control as good as possible. I try not to beat myself up about these adjusting to these changes. T1s just do not have the means to keep up with them at this point in time. Control is a neverending saga.

I don't know the exact cause, but I am sure it's a combination of things. Hormonal changes within your body, changes in the weather, changes in the potency of your insulin, changes in the amount of physical activity you do, etc -- all these things affect your basal/bolus needs. With a normally-functioning pancreas, the body automatically makes these adjustments, but with T1d, you have to do the work of your pancreas.

The best you can do is track things and react to the changes as they occur. And not stress about it too much.

Blame it on the gremlins! :)

Seriously though I've often wondered the same thing. Just when I had my basal locked down...then the craziness hit for no explainable reason and I start either dropping 60 points overnight or spiking 100 points at 1 a.m. even without food. This morning my normal everyday routine of 1 unit of Humalog for 1 cup of coffee resulted in a low that took me an hour to pull out of and made me late leaving for work.

Some days I can just roll with it and other days have me pulling my hair out.

Thank GOD you are growing (Fast and strong). keeping the same parameters when you are at a development age would be not appropriate. Pay attention in yourself and talk to your ENDO frequently about any changes you may need for your prescription. Please be aware that sometimes changes can be secondary to damaged meter.

The fact that they do change is reason why health care professionals must keep an attitude of accepting facts, analyzing them, and helpfulness, and not ever, ever, let their own frustrations come out in emotional criticism of the PWD to whom these changes can become justifiably overwhelming.

I agree Leo. That should be the first thing taught and ingrained with the medical community who treat diabetes. Blaming the PWD causes more harm than good.

When I was first diagnosed, Type 1 but actually misdiagnosed as Type 2, and the oral meds weren't working, I remember a nurse telling me "if you don't start taking care of yourself, you're going to die, is that what you want?"...all the while I was begging to be put on insulin because I was so sick. Moved to an endo after that and got proper treatment.

Space aliens.

haha im 22 though! i should be done growing!

i guess i just don't know how to adjust to it quickly enough because usually adjustments take trial and error over at least a couple of days- and by the time i got that nailed down my body is doing something else.

Ive been lifting for years now- never really had this probably until the past year and a half- but think it could be from lifting?

Hi You are totally right about the BONES. Muscles and some other specialized tissues will still be changing positively. Then you will come to my age (46) and will will experience the in-growth... But really pay attention because it is really a very complex task to keep yourself on the good move. If you can afford to have a CGM it can make the TASK much more easy.

That is right, and that is the main reason why is so complex to construct an artificial pancreas. We are now starting the development of smart PC program to help the basal and carb correction adjustments during the day.

Yep, that's just like me. Except sometimes I get angry and rage bolus out of impatience..which starts the high/low roller coaster ride.

Hi Tom,

It might be easier to find an answer to "Why does the wind blow?"

If you're struggling with insulin adjustments related to exercise, you should get a copy of Sherri Colberg's Diabetic Athlete. It's available on Amazon and everywhere else.

Good luck and cheers,
Mike

I agree with the whole "phases of the moon/space aliens" thing. For awhile I tried to figure out the reason for variations, and sometimes there is one which is great. For awhile I thought I might be having "LADA spurts" - making periodic insulin which skewed my results, but there was never a way to know for sure and given how little I was making when I was tested 3 years ago, I doubt it.

I was looking for answers to some particular craziness on here one day and someone responded something like, "there are a lot of possible reasons, but mainly I would just suggest responding to what's going on without worrying about why." Most of the time (except when there is an actual reason to learn from) that is what I do. I seem to go through "clusters" myself, where everything will be stable and then I need to make a bunch of alterations for a few days; mainly my basals, my I:C doesn't change much. I do encourage you to continue with your show pace of adjustments, because otherwise you risk the old roller coaster ride.

Fritz Perls, a famous Gestalt Therapist had a saying, "understanding is the booby price" - I think it relates to D management very nicely!

Zoe, I love 'understanding is the booby prize'. I may have to put it on my fridge. I tend to being OCD-ish about my numbers, and I really WANT to know the 'whys', but I've come to realize that I can't, always. Not that I like it one bit.