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Extreme decrease in insulin requirements

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elaine1969

Active Member
Relationship to Diabetes
Parent of person with diabetes
Kate had problems with high blood sugars for a couple of weeks but over the last week - 10 days things have really settled down and her control has been really good. She has suffered hypos following her evening meal so I have reduced her ratio and tweaked basal rates.

Today however she has been collected from school, she had 3 hypos during the morning despite having turned her basal rate down mid morning to 60%. At lunch time she had 60g carbs and just bolused 50% of her usual amount, her blood sugar stayed in the 4's and the insulin will not have finished working yet, she has just had about 30g carbs in a smoothie to try and prevent a hypo. She is not ill and has not been exercising, it is not to do with time of the month either.

I just wondered if any of you suffer such extreme changes in insulin requirements. We have had real problems in the past (periods of hypos lasting for hours/days despite stopping insulin altogether-last october 2010 she was admitted to hospital twice and needed a glucose drip for several days despite insulin having been stopped days earlier). I am wondering if these sorts of adjustments to insulin are "normal" or if it could be the start of the old problems returning.
 
I hope you get something sorted, can't be much fun. Have you spoken to the DSN to see what they have to say? Hopefully someone will be along soon who will be able to give you some ideas.
 
Yikes! Sounds awful Elaine. I've had some fairly extreme fluctuations when my basal has been a bit out (on MDI) but nothing on that scale. Seemingly a unit or two too little or too much Lantus would equate to 8-10u of rapid or huge quantities of carbs.

Any chance there is insulin being 'stored' in scar tissue during periods of correction/high BGs which then releases itself all at once? I think trophywench has had a bit of that in the past.

I wondered about a bit of honeymoon/sputtering pancreas (where the relief of being assisted by injections gives the remaining beta cells a second wind), this might account for Oct'10, but Dx might be a bit too long ago for that to still be having the same effect. Nothing would surprise me about D though... 🙄
 
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Yup - trophywench has LOL

Just cos you can't see 'lipos' doesn't mean they aren't there, unfortunately.

PITA.
 
Hi, just to say I have found on a couple of occassions now when Millie has had a period of high BGs due to colds/flu jab etc it follows with 2 or 3 days of chasing hypos until things even out again, not much fun! 🙄
 
She has been checked for "lipos" many times but as she is quite newly diagnosed I think they ruled that out. We managed to get a referal to Leeds and they put her on an insulin pump which helped but did not sort out the problem. Her consultant seemed fairly certain that it was an antibody issue, her body was producing antibodies which bound to the injected insulin stopping it working and then periodically released it causing sudden and severe hypos. Last May time it was getting so bad that we just not carry on, I was up hourly though the night checking her, I used to make batches of semolina to feed her though the night!. Her consulant decided her immune system needed rebooting to try and wipe out the antibodies and he was talking about giving her ant-rejection therapy. Whilst she was having further tests things slowly started to improve and so we did not need to continue down that path. Insulin had been changed from novorapid to humolog and it was thought this may also have helped.
She has been ok since June so we were all hoping that it was over and that life had returned to normal, I have to say that today I have this feeling of dread that the whole thing may be back again.
 
Hanmillmum said:
Hi, just to say I have found on a couple of occassions now when Millie has had a period of high BGs due to colds/flu jab etc it follows with 2 or 3 days of chasing hypos until things even out again, not much fun! 🙄
Click to expand...

Oh I really hope that is the problem!!
 
Hi Elaine,
has your daughters cortisol levels been checked?
It's just a thought as low cortisol will cause low blood sugars.
I hope things improve soon.
 
Mmmmmmmmmmmmmm

Sue makes a very good point there.

This sounds suspiciously like summat else too, that I also had - ie building up antibodies. With me it was to old-fashioned porcine insulin, fortunately they'd invented 'Human' insulin by then. I spose before they did that, I'd have been changed to Bovine.

Conversely - has any consideration been given to changing her over to animal insulin? - it can be done with a pump - Pumper Sue uses it in her pump, the onset etc is a bit different but it's definitely possible, provided you take care to understand the differences.

It may be that Consultant wants to continue with analogue unless he finds that 'simple' fixes won't do the job, which is quite sensible really overall.

I know someone - older than me and I'm 61 - who stayed on animal insulin throughout, having had trouble with all 'modern' insulins. However - latterly she swapped to a pump - and is now using an analogue quite successfully.

I know it's just horrid for you and daughter right now - but I'm sure there is the right solution out there somewhere, just takes a bit of time sometimes to find it.
 
Hi Sue,
Yes they were checked a year ago when it all kicked off. Leeds were talking about rechecking them in May this year but then things started to calm down. She was given really strong antihistamines in June as her hayfever suddenly became intolerable. It was at this time we noticed a massive improvement in her control (the prolonged hypos suddenly stopped). I have asked if antihistamines could have helped but have been told there is no explanation as to why they should have helped. She has just been weaned off them in the last month so it all looks a little suspicious to me! I'll see what the next few days bring and then contact the team in Leeds. Maybe today will just be a blip! This diabetes certainly likes to keep you on your toes doesn't it!🙂
 
Thanks Trophywench, because things looked to be so much better there have been no more discussions on changing insulin again. We just all hoped it was in the past and tried to look forward. She is now on 30% basal rate and seems to have stabilised on that - thank god we are not still relying on lantus for basal, she'd have injected nearly 20 units more that her body needed today - that would have been tricky!

Thanks everyone, it makes such a difference speaking to you all, its a pity I wasn't aware of this site this time last year, we both felt so isolated and didn't know which way to turn.
 
elaine1969 said:
Hi Sue,
Yes they were checked a year ago when it all kicked off. Leeds were talking about rechecking them in May this year but then things started to calm down. She was given really strong antihistamines in June as her hayfever suddenly became intolerable. It was at this time we noticed a massive improvement in her control (the prolonged hypos suddenly stopped). I have asked if antihistamines could have helped but have been told there is no explanation as to why they should have helped. She has just been weaned off them in the last month so it all looks a little suspicious to me! I'll see what the next few days bring and then contact the team in Leeds. Maybe today will just be a blip! This diabetes certainly likes to keep you on your toes doesn't it!🙂
Click to expand...

That's a fascinating observation. What are the problems with taking anti-histamines long term? Just because they don't know why it works, doesn't mean that it won't continue to work despite the lack of explanation. After all in trials even placebos are remarkably effective and there's no pharmacalogical reason for that!
 
I don't think there are any major side effects but I think her liver would need checking periodically. I will not let her take any more yet, I think I need to email her consultant if it carries on and see what he wants me to do. My concern has always been that she may have some other autoimmune thing going on in addition to the diabetes and the anti-histamines may be helping that which in turn stabilises the diabetes. She has always had problems with diarrhea which stopped with the antihistamines too though she has been checked for coeliac. She remains a mystery!!
 
As Kate is 14 years old, and all other possibilities such as increased exercise / activity, menstrual cycle and other medications have been considered, I'd suggest that it could be other hormonal changes of adolescence - or a last gasp of honeymoon effect. But can't know for sure, so definitely worth checking with diabetes team.
 
Oh dear, poor lass. I do hope you find out what is behind all this.
 
Elaine - can't add any help as you know more about this than I do, but just wanted to send you (((hugs))) and hope this is just a blip.

I do know my K goes through patches of needing extra insulin because she is growing, then all of a sudden gets hypo (like last week) because we assume she's finished that 'mini spurt'. Wouldn't rule out lypos as K already had one on her arm :(

Hope you get to the bottom of it soon xx
 
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