Insulin requirement changes?

[lauraw1983]

Ok bear with me here....

Diagnosed last November, onto insulin December 2011.

First I started on ratio of insulin 1:10 for carbs. Seemed ok for a short while but they were still fiddling about with my background too - was on Humilin I, now on Lantus - I take 13u at bedtime.

Gradually I have changed my ratio as it wasn't always covering my foods enough. I thought last couple of weeks I had got it spot on with 1:7 but again it seems like this is not quite covering my foods. I will now try 1:6...

However I just want to know if this is because I caught my D diagnosis early and therefore my pancreas was definitely still doing something in those earlier days (I responded a little to metformin and byetta - but not enough control) but now it's knackering out more and more?

I know everyones requirements are different BUT I suppose I just want to know if anyone followed a similar pattern to needing quite a bit more fast acting to cover carbs within their first year of diagnosis?

Just when you think you have worked it out..........🙄 Grrr!

 

[Northerner]

Well, I'm weird but I actually started using less insulin as the months went on, so rather than my pancreas slowly deteriorating it appears to be slowly recovering! 😱 To the point that, after requiring 40-45 units novorapid per day and 20 lantus (4 years ago) I now need around 20-25 NR and zero lantus (although occasionally I do need a couple of units of lantus, apparently if I've been lazy, so lots of pressure not to be lazy!)

I think from what I have read of a lot of younger people, the total loss of insulin can happen over 6-24 months usually, causing a big rise in units required.

Perhaps you're like me in the fact that your pancreas can support your basal to a good extent, so it doesn't need big increases, but carbs in meals are just way beyond anything it can deal with?

 

[everydayupsanddowns]

I needed to tweak my 'general' doses upwards for the first few years - I took it it was my flagging pancreas gradually losing the last of it's valiant beta cells, though more recently I have learned that many T1s continue to produce (and then kill off) new beta cells for many decades.

Doses have long since settled (by which I mean that they go up a bit, then down a bit, then back up a bit but stay more or less the same)

Incidentally - have you tested your basal systematically to make sure it is doing its job?

 

[lauraw1983]

I needed to tweak my 'general' doses upwards for the first few years - I took it it was my flagging pancreas gradually losing the last of it's valiant beta cells, though more recently I have learned that many T1s continue to produce (and then kill off) new beta cells for many decades.

Doses have long since settled (by which I mean that they go up a bit, then down a bit, then back up a bit but stay more or less the same)

Incidentally - have you tested your basal systematically to make sure it is doing its job?

Hmm last week I did 3 x 3am tests and all were steady from what I'd gone to bed on. Upon rising however they've nearly always shot up to 8/9. Grrr.

I've done no carb meals and it's held me steady too so think its ok - what other testing should I do?

What were your ratios on mdi if you can remember?

 

[lauraw1983]

Well, I'm weird but I actually started using less insulin as the months went on, so rather than my pancreas slowly deteriorating it appears to be slowly recovering! 😱 To the point that, after requiring 40-45 units novorapid per day and 20 lantus (4 years ago) I now need around 20-25 NR and zero lantus (although occasionally I do need a couple of units of lantus, apparently if I've been lazy, so lots of pressure not to be lazy!)

I think from what I have read of a lot of younger people, the total loss of insulin can happen over 6-24 months usually, causing a big rise in units required.

Perhaps you're like me in the fact that your pancreas can support your basal to a good extent, so it doesn't need big increases, but carbs in meals are just way beyond anything it can deal with?

It's really interesting isn't it? So many variables to it, I think they need to use you in their research for a cure! 😛

What's your insulin:carb ratio now? I'm clueless if there is a normal dose but these bigger number of units required scare me a bit.

 

[everydayupsanddowns]

Hmm last week I did 3 x 3am tests and all were steady from what I'd gone to bed on. Upon rising however they've nearly always shot up to 8/9. Grrr.

I've done no carb meals and it's held me steady too so think its ok - what other testing should I do?

What were your ratios on mdi if you can remember?

Sounds like your basal is good, though worth checking again if plagued by unexplained highs/lows I always find.

Boringly I settled pretty much at 1:10g for eve meals and slightly more insulin for breakfast (1:7g) and lunch (1:8g).

I don't think there is a 'normal' really - one of those variables... You need what you need. Having said that I think the reason that DAFNE and other courses often start at 1:10 is cos it's not a million miles out for a fair few people.

John (using insulin) Walsh suggests TDD (total daily dose - a rough average of a normal day's boluses plus normal basal) is *usually* between 0.5 and 0.7 units per kilo per day.

 

[trophywench]

My TDD isn't that now I'm pumping, it was on MDI though - weigh roughly 56kg and took 30-ish u TDD.

Is 0.4u/kg now or a bit less.

Laura - basal tests see
http://www.diabetes-support.org.uk/info/?page_id=120
and scroll down a bit.

What you did but slightly more intense.

To get your insulin to carb ratio, start off at some level where you aren't hypo and you aren't high (so you don't need to correct a high or treat a low)and eat an exactly measured number of carbs and inject what you think your carb ratio is - so eat say 20g, inject 2u cos you think your ratio is 1u to 10g. Test after 2 hours - 'ish' - doesn't have to be to the minute. BG should be within 2 or 3 mmol/L of waht it was before meal. test again after 4 hours - should be back where you started from.

Don't eat anything complicated or extra fatty or multipart. Test meals need to have easily calculated carbs and the carbs need to be ones that work quite quickly. Some egs my clinic give are

2 weetabix & 200g milk 30gCHO
2 medium slices of toast and 100ml fresh orange juice 40g CHO
Sandwich - 2 slices medium bread + filling and a Muller Lite yog 30g +17g CHO
Medium jacket spud (245g-ish) with cheese 50g CHO

Was it right? Fairly obvious what you have to do if it wasn't!

 

[Doghouse]

I was started on 1:10 carbs of Novorapid, and 10 units of Lantus in 2009. After some adjustment to start with, my sensitivity to insulin steadily increased, and now I am around 1:33 for Novorapid, and 3 units Lantus. I remember a consultant telling me that 1:30 was quite common. I wonder if 'clean living' caused by having T1 has perked up my B-cells. This seems to be opposite to your experience.

 

[trophywench]

Well nobody has any idea how aggressive your GAD65 antibodies are going to be.

ie to what extent and how quickly they will kill your islets.

Plus I don't think squeaky cleanliness can have anything at all to do with it, I'd been squeaky clean since I was approx 14 (and also was as a child - sweet rationing, bread rationing etc)

In fact the fatal attraction of Caramac bars was one of the things that gobsmacked me so much in the fortnight leading up to diagnosis - I had tried them years and years previously - but didn't actually like them as they were far too sweet and sickly, yet here I was eating two whole bars on the daily way home from work on the bus/train ...... and Terry's dark choc Waifa biscuits .....