Huge jump in insulin needs.

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Pat91

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Good evening all, is it quite normal for insulin requirements to change so drastically. I was on 1 unit per 10 carbs, now I'm needing 1 unit per 6 carbs ( and sometimes still going high) all of this has been in the last month or so.
 
Yes it can happen, a few years ago my daughter’s requirements almost doubled and have never really gone down again. There is no hard and fast rule about “correct” insulin doses, you need whatever you need to keep your numbers in range. In my daughter’s case it was probably due to puberty, but there are many possible causes - weather getting colder, are you under any stress or possibly going down with an illness, honeymoon period coming to an end if you are fairly recently diagnosed, sometimes things just change for no apparent reason. If you’re still going high after changing carb ratio that much though it might be that your basal needs adjusting, try doing a basal test first. If your basal is wrong then nothing else works either.
 
Hi there, oh right I see, just seems weird how it has changed so drastically just as I was sitting in good range most of the time. I was diagnosed in January so maybe the honeymoon period coming to an end. Thank you for your help.
 
I forgot to mention that my usual correction factor has changed also. Where 1 unit would take me down 2-3mmol noticing now it's bringing me down around 1 mmol. This is after changing insulin pens.
 
I find my insulin needs are constantly changing - it may be a day of more exercise or a day of stressful meetings or I strain my ankle on a run or I chillax for a day in front of the television or ...
My life is not the same from one day to the next so I am not surprised that my insulin needs vary. They wouldn't be if I didn't have diabetes - I just wouldn't know.
If you add the honeymoon affect into the mix when our pancreas can decide to give up one day and then have a splurt a week later, then a change insulin requirements is not surprising.
Then you may have a cold ... or your body may be fighting off a cold and your insulin needs increase again.
Or you may have just had a flu or covid jab.
On top of all of that, our tools (insulin) make be defective so we may find that they are not as potent as usual.

I think our DSNs try to keep things simple with an insulin to carb ratio that works "most of the time" and that suits most of us. Over time, we get used to making tweaks.

@Type1Pat it is great that you feel confident to adjust your ratios. Keep an eye on your levels and don't be too surprised if they go back down again.
 
Thank you so much for the reply, very reassuring to read this so thank you.
 
Type1Pat said:
Hi there, oh right I see, just seems weird how it has changed so drastically just as I was sitting in good range most of the time. I was diagnosed in January so maybe the honeymoon period coming to an end.
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Might well be. I find I need more insulin in the colder months and quite a bit less in the summer.
 
Type1Pat said:
Hi there, oh right I see, just seems weird how it has changed so drastically just as I was sitting in good range most of the time. I was diagnosed in January so maybe the honeymoon period coming to an end. Thank you for your help.
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Stress can mess with things @Type1Pat A few years ago, I had a stressful situation and although I didn’t actually feel stressed in a panicky way, I obviously was stressed because my blood sugar would go high for no apparent reason.

It could be a combination of things affecting you. It’s very tedious, but all you can do is concentrate on staying in range as much as possible. Remember too that things might change again - simply because Type 1 is an annoying little thing and always keeps us on our toes! My meal ratios have changed so many times over the years. It’s annoying but not unusual.
 
Might be a blooming good idea to do a basal test sometime fairly soon - you can fiddle with bolus and correction doses until the cows come home, but if your basal rate isn't as correct as it can be you're fighting a losing battle.
 
I would agree with basal testing. Personally I have never needed to change my meal ratios but my basal doses need quite frequent adjustment particularly for exercise and when my honeymoon period was ending I had three very clear increases in basal insulin requirements which happened over a period of 1-2 months each where I just had to keep increasing it until it held me steady again.
 
@Type1Pat It’s never easy to pin down just what has changed. I did note you had just changed your insulin pen when all this happened and it may be that for whatever reason the insulin in the new pen has degraded. Try a different pen.

However, I am a great believer in basal testing as others have suggested. I find my needs change with the weather. Do you know how to do this?
 
Thank you all for the help, I am going to increase my basal and see if that helps.
 
Which basal insulin are you using? The reason I ask is that some basal insulins are more "forgiving" than others if you get it wrong and it might be worth discussing an increase with your DSN before implementing it, particularly if you are on a very long acting basal like Tresiba or Toujeo.
It is best to do some basal testing before you start adjusting it, to see if that is the problem or not, by skipping a meal each day in rotation to see how your levels are for that period of the day without food (and bolus insulin) confusing the issue. If your levels are rising in the absence of food then a basal increase is implied but you need to be careful because your basal insulin can drop you too low overnight so do be cautious about increasing it.... no more than 10%.... and see how you get on at that and set an alarm for through the night to check your levels then. It is recommended not to increase again until after 3 days (if you feel that it does need further increase) to give the increase time to stabilize and have it's full effect. If you haven't had one, a DAFNE course or whatever your local equivalent is, will really give you the knowledge to spot when your basal insulin needs adjusting and how to go about it, so do ask about such a course if you haven't had one.
 
@Type1Pat - it would be really helpful if you could add - in your 'Signature' on your Profile, which insulins you are currently using - to help us try to give you suggestions relevant to those as well as whatever the current circs you are enquiring about - eg if it's Lantus basal, any alteration won't show its full effect for 3 days whereas if it's twice a day Levemir, you'd most likely have a pretty good idea whether that has worked or not, within 12 hours.
 
Here's a guide to basal testing, but as @Inka has said, don't go jumping into anything yet. Just see if your basal is holding you steady first.
 

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rebrascora said:
Which basal insulin are you using? The reason I ask is that some basal insulins are more "forgiving" than others if you get it wrong and it might be worth discussing an increase with your DSN before implementing it, particularly if you are on a very long acting basal like Tresiba or Toujeo.
It is best to do some basal testing before you start adjusting it, to see if that is the problem or not, by skipping a meal each day in rotation to see how your levels are for that period of the day without food (and bolus insulin) confusing the issue. If your levels are rising in the absence of food then a basal increase is implied but you need to be careful because your basal insulin can drop you too low overnight so do be cautious about increasing it.... no more than 10%.... and see how you get on at that and set an alarm for through the night to check your levels then. It is recommended not to increase again until after 3 days (if you feel that it does need further increase) to give the increase time to stabilize and have it's full effect. If you haven't had one, a DAFNE course or whatever your local equivalent is, will really give you the knowledge to spot when your basal insulin needs adjusting and how to go about it, so do ask about such a course if you haven't had one.
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I'm on tresiba at the moment, I am confident changing doses of both bolus and basal. I am noticing that around 8 hours after taking my basal I am dropping a few mmol into hypo numbers. So I have increased my tresiba but to try to stop myself going low at 5 in the morning I'm going to take my tresiba as soon as I wake up in the hope that at least I may see myself going low around midday.
 
Hi. I find my insulin needs vary a lot from day to day with no reason. I even do three injections of Basal some days to control it when the Bolus gives up! Excess weight can cause insulin resistance which is a known cause of higher insulin needs. My body fat is in the normal range thru gym tests so that doesn't appear to be my problem. Insulin isn't for many the precise art that newbies may be led to believe.
 
Type1Pat said:
I'm on tresiba at the moment, I am confident changing doses of both bolus and basal. I am noticing that around 8 hours after taking my basal I am dropping a few mmol into hypo numbers. So I have increased my tresiba but to try to stop myself going low at 5 in the morning I'm going to take my tresiba as soon as I wake up in the hope that at least I may see myself going low around midday.
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If you are going low at any point at all, without eating and without bolus then your basal dose is too high.
 
Type1Pat said:
Hi there, oh right I see, just seems weird how it has changed so drastically just as I was sitting in good range most of the time. I was diagnosed in January so maybe the honeymoon period coming to an end. Thank you for your help.
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Have you done a basic basal test? It could be that you need more basal rather than bolus.
 
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