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Puzzled (again)

J

JonathanGi

Well-Known Member
Relationship to Diabetes
Type 1
Pronouns
He/Him
I seem to be needing more and more insulin. Usual 25g carb breakfast this morning and 4 units of NovoRapid. I always wait at least 30 minutes after injecting to eat. 3 hours later BG is 11.5 (fingerprick). I'm not unwell.
Am I becoming insulin resistant? I am 67 and have been Type 1 for 58 years. I weigh 53k. I am reasonably active. Although no marathons, half marathons or the ultra marathon I had originally entered as the kidney infection I had 2 months ago ago meant I couldn't get enough miles in
 
Have you ruled out everything to do with your "diabetes kit"?
Have you changed your pen and/or insulins? And double checked your BG in case it is a dodgy strip/something on your fingers/annoying CGM?

If so, maybe you are experiencing absorption issues which is likely if you have been stabbing yourself for 58 years.
Could you/have you tried alternative injection sites?

I am assuming this is not a one-off so definitely worth getting to the bottom of.
 
You don't mention your basal insulin - how have your doses of that changed? And - have you done a 24hr basal test recently?
 
JonathanGi said:
I seem to be needing more and more insulin. Usual 25g carb breakfast this morning and 4 units of NovoRapid. I always wait at least 30 minutes after injecting to eat. 3 hours later BG is 11.5 (fingerprick). I'm not unwell.
Am I becoming insulin resistant? I am 67 and have been Type 1 for 58 years. I weigh 53k. I am reasonably active. Although no marathons, half marathons or the ultra marathon I had originally entered as the kidney infection I had 2 months ago ago meant I couldn't get enough miles in
Click to expand...
How much less training are you doing now? I certainly found that during January when I wasn't riding as much/as regularly I needed to either increase basal (or rather this is what I should have done, but you only see the trend after a while!) or increase bolus (which is what I did) alongside snacking less and cursing the fact that my BG would just remain stubbornly high when previously it was fine.
 
But, rather bizarrely, I nearly always find that exercise puts my BG up! Whatever time of day I exercise I always have some insulin - usually 1 unit - and then run. No snacks or anything. Last Saturday Parkrun was a good example. My usual basal -6.5 units and 1 unit of NovoRapid. Started with 4.9 BG and finished 24 minutes later at 11.7. I now inject as soon as I finish - 4 units of NovoRapid. Walk home and then have breakfast (35g carbs) usually 45 minutes after finishing.
Yes, I have done a 24 hour basal test recently just before yet another colonoscopy!
 
Haven't changed pens or insulin. I regularly check with fingerprick when sensor seems incorrect.
I am definitely needing more insulin. Average last year was about 22 units (basal and bolus) per day. About 27 per day now. I think I am doing slightly less so far this year. Kidney infection didn't help. I always find it a surprise when I am unwell as to how much more insulin I need. And I'm not eating!
I find there's a big difference between running and cycling. Is it just the amount of time? Usually 5 or 6 hours on the bike and, at the most, 2 hours running. In fact my biggest fear of running the ultra was how to fuel myself. I run half marathons without food and usual insulin as it's less than 2 hours.
 
JonathanGi said:
Haven't changed pens or insulin.
Click to expand...

I think @helli was just suggesting it would be prudent to switch to a fresh cartridge or pen, in case the insulin i n th one you are currently using may have gone off slightly or become less effective?

I find my insulin needs rise and fall at different times of the year, but it is disconcerting when ratio needs seem to be rising month after month.

Hope things settle for you soon. Perhaps as the weather warms and the spring takes hold your insulin needs will drop back down a little again?
 
I reckon that despite your getting BG increases when you run (due to your liver helping you out as you're running hard/fast so producing stress hormones), there will still be an overall insulin sensitivity increase and requirement to replenish glycogen, which will be acting over a longer duration, producing a net reduction in BG. Quite possibly not the full reason for needing more insulin, but worth a thought.

Concerns about running low when a long way from home are always troublesome - I reduce basal for long rides as otherwise I need to eat almost constantly after a few hours. I still need to eat but just not quite so much/so often. I prefer to stop and have something a bit more substantial (so I get some respite from eating things which I can carry on the bike). Unfortunately (or perhaps fortunately as life might be boring otherwise), we're all different so it may well not work the same for you! I could imagine that eating a larger quantity of food, which takes longer to digest and release glucose, is probably not ideal when running from the point of view of it being uncomfortable.
 
Of course it's actually easy to eat on the bike on the move. It's really difficult to eat a slice of malt loaf whilst running!
It's the amount of time (and the reasonably low intensity) on the bike that makes the difference, I think.
I had entered an ultra marathon this year but I can't do it as I had a kidney infection which really curtailed training. My biggest concern was how to fuel myself. I run half marathons without food. My last marathon was a long while ago, well before sensors et cetera, so I fuelled myself for that.
 
everydayupsanddowns said:
think @helli was just suggesting it would be prudent to switch to a fresh cartridge or pen, in case the insulin i n th one you are currently using may have gone off slightly or become less effective?
Click to expand...
Yes, this is what I was asking. My question about changing insulin/pen was linked to my previous question about checking diabetes kit.

I have also been wondering wether @JonathanGi is finding his insulin needs are higher because he is doing less exercise. Although he finds exercise increases his BG at the time, the affects of exercise can be felt for the next 24 to 48 hours and usually lowering BG. For example, I was climbing last night. The "HIT" style of climbing plus the adrenaline results in my BG rising. However, overnight my BG was lower than usual and I needed a few dextrose to maintain it because I forgot to lower my basal. It's like my liver is dripping less glucose than nights when I don't exercise.
If Jonathan usually exercises and is doing less now, this can have the opposite effect. he is not having his glucose drip lowered by exercise so it is at "normal levels" which seem high to him.

However, I also think it is worthwhile checking his injection sites. Over 58 years, the insulin absorption could be affected, especially when other talking about the effect after 10 to 15 years.
 
helli said:
If Jonathan usually exercises and is doing less now, this can have the opposite effect. he is not having his glucose drip lowered by exercise so it is at "normal levels" which seem high to him.
Click to expand...
This is my take on it too, and I think I'm the same - I generally live in a constant state of somewhat higher insulin sensitivity, and occasionally have even higher sensitivity if I do a long ride or drop back to "normal" sensitivity if I'm not able to exercise for some days.

I think the question should be asked of what "normal" actually mean though, I imagine it's a continuum (though I've not seen any papers, but I've also not done any digging), and historically our "normal" would have been further towards the sensitive end of the insulin sensitivity spectrum.

I think there's also an element of habituation/adaptation to hepatic glucose generation (I saw mention of it in a paper once upon a time) in that with more activity (and use of the liver glycogen) the liver becomes more sparing in how quickly it produces it. It would be interesting to see if anyone has done research specifically in this area as there's probably an exercise-dosage to hepatic-response curve which would be useful for e.g. DP/FotF.

Sorry that was probably heading off topic!
 
JonathanGi said:
Haven't changed pens or insulin. I regularly check with fingerprick when sensor seems incorrect.
I am definitely needing more insulin. Average last year was about 22 units (basal and bolus) per day. About 27 per day now. I think I am doing slightly less so far this year. Kidney infection didn't help. I always find it a surprise when I am unwell as to how much more insulin I need. And I'm not eating!
I find there's a big difference between running and cycling. Is it just the amount of time? Usually 5 or 6 hours on the bike and, at the most, 2 hours running. In fact my biggest fear of running the ultra was how to fuel myself. I run half marathons without food and usual insulin as it's less than 2 hours.
Click to expand...

Might seem like a big increase but 5u isn't something to worry about if you ask me.
 
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