Declining honeymoon period?

[Mumpie_olgran]

Bit of a head scratcher here that I'd be grateful for the combined wisdom on.
I use Lantus and Novorapid and basically get along OK with them both. Subject to all the usual tweaks and unpredictability of course but I'm generally around 85% in range and average BS levels around 8.0
I've noticed in the last week or so that I've needed to fight much harder (use more insulin) pretty much for every meal throughout the day but particularly lunch and evening.
In the past that's led me to question whether I've actually for enough basal in the system but funnily enough I'm still staying flat to maybe slightly declining overnight most nights.
Does it sound plausible that my system is actually OK on the basal level as is and for some reason I just need to jack up the bolus? For context I'm injecting probably double mmy previously standard doses now
The only other variable I can think of is that in the last couple of weeks I've managed to take a chunk more exercise than my steady state. Although I might have expected that to reduce my total insulin needs.

Or maybe it's that my whole system is declining honeymoon period and all things being equal I might need more basal as well as bolus but given the exercise, my basal needs have dropped?

None of this urgent, just keen to learn from the collective experience if anyone has been bothered to read this far 🙂

 

[trophywench]

Well the short answer far as I'm concerned is, sounds like you're correct!
What Mike (@everydayupsanddowns) calls the forums spidey sense and I know as my very own instinct about my very own diabetes needs, is developing nicely for yours, to me!
Just do a Basal test if you haven't already, though sounds to me as if you pretty well have done.
We just need what insulin we need, when we happen to need it. Always! Doesn't forever seem entirely logical. So what!

 

[nonethewiser]

My insulin needs went up after coming out of honeymoon period then after period of time started to reduce slightly again, exercise tends to lower bg but some forms of it can increase it so leading to more insulin required, think member @helli knows bit about this.

 

[rebrascora]

It is certainly likely that you have lost a few more beta cells. Whether that is the last of them or just a few of the remaining ones, it is hard to tell, short of a C-pep test. My thoughts are that generally (but not always) people need less insulin overnight, so your remaining beta cells can manage that time period with the basal that you inject, but during the day there is more need for insulin with usually greater basal needs plus the insulin required for food, so if you have lost some more beta cells you may see the effect more during the day when they have more to do, than at night when there are less demands on them. So it may still be a basal issue during the afternoon/evening which a split dose basal might manage better than a single dose, if that is your current basal regime. Then you can have more in the morning and less at night and you might then find your ratios remained the same once you got the basal split balanced or you could just increase your meal time ratios to deal with it.
The way to tell if it is a basal issue or meal ratios is of course be to do some basal testing during the day, to see if levels are rising in the absence of food and bolus insulin.

 

[Inka]

Another thought - if this has just happened in the last week @Mumpie_olgran I’d change your bolus (meal) insulin cartridge or pen. A sudden change like that can be due to ‘dodgy’ insulin. My final thought is illness. Lots of it around. I had a cold which put my levels up even when it only seemed mild.

 

[Mumpie_olgran]

Thanks all, appreciated. You're right of course @trophywench it just needs what it needs....

Rather unsatisfactory to never get scientific closure on any of these things, though I'm just grateful for indulging in the thought experiments on it

And yes @Inka a previous nudge up in needs actually served as a leading indicator for me on a cold (i.e. I felt the insulin need rise before I actually felt symptoms) although luckily enough I'm still cold free at the moment this time round

And @rebrascora I have toyed with splitting basal previously but to be honest I gave up after not much trying at all as it was all a bit hard to figure out!


Again - thanks all for the thoughts

 

[Wendal]

Morning yes interesting that you seem to have undergone a change and good that you are seeking an explanation.
My BG levels have gone up since Xmas and my Time in Range has gone down but I have put that down just being more relaxed about my diet and doing less exercise.My stats are still pretty good and not worried but I really should make a more concerted effort at least for a few days to see if I can get my previous level of control even just to rule out any other change such as honeymoon period ending ( diagnosed 6 months ago) and then make any necessary adjustments.

 

[everydayupsanddowns]

Rather unsatisfactory to never get scientific closure on any of these things, though I'm just grateful for indulging in the thought experiments on it

It’s frustrating isn’t it!

Always just having to sort of fudge through with your best guess, and never really being able to definitively know for sure which of the dozens of factors are doing what as we scratch about for yet another workaround.

Still… it makes it clear that perfection is impossible, and not to be aimed for, and a-reasonable-guess-plus-trial-and-improvement is really the only way forward.

Hope things are back on an even keel for you before long 🙂