Sensitive to basal insulin?

[gillrogers]

So now dropped to a 2.5 dose of levemire for the day and half at night. Half was fine last night. Running a basal test again this aftetoon as yesterday afternoon i almost had a repeat of last weeks drop. So far its looking like ill be dropping another half unit tomorrow. Its starting to worry me why this is happening albiet i went that low in the hot summer. So im.wondering if you can become sensitive to an insulin to the point that you dont need it or need another type?

 

[rebrascora]

@Northerner found that he didn't need basal insulin at all after a while I believe and has been managing for quite a number of years now without the need for basal insulin now. He still needs bolus insulin. I think it may be that some people who perhaps have low basal needs, have enough beta cells left to tick along on the insulin they can produce but those cells are unable to ramp up production to cope with the larger amounts needed for food. I would not worry about needing less insulin as long as your levels are not going high, then it isn't a problem.

 

[gillrogers]

@Northerner found that he didn't need basal insulin at all after a while I believe and has been managing for quite a number of years now without the need for basal insulin now. He still needs bolus insulin. I think it may be that some people who perhaps have low basal needs, have enough beta cells left to tick along on the insulin they can produce but those cells are unable to ramp up production to cope with the larger amounts needed for food. I would not worry about needing less insulin as long as your levels are not going high, then it isn't a problem.

Thank you Barbera, thats a big help to know. im wondering then if the level can flucuate as my thyroid level has come back up on its own. I mean they are both classed as hormones. Thank you. Thats made me feel better.

 

[rebrascora]

I know many of us worry about how much basal we need and we often say that we need what we need, but that equally applies the other way, that you need as little as you need. I am sure Alan will be along at some point to reply and can hopefully reassure you that you are a welcome to join his very select sub group of Type 1s who need no basal insulin, if your levels continue to drop. The important thing is that you are doing the right thing in reducing your doses accordingly, so well done for that. It may be a short lived change or it may be longer term or permanent. None of us ever know with diabetes because the goal posts can and do change and all we can do is respond to those changes with new strategies. If your new strategy ends up being that you don't need basal insulin then all the better.... that is one less thing to have to think about.
There was a lady on my DAFNE course who had been Type 1 for 50 years and she only needed 2 units of Lantus a day and sometimes she hypoed badly during the night often involving paramedics but her levels went up to mid teens in the morning. She also only ate once a day and that was only 2-3 units of bolus insulin... so a total daily dose of about 5units! She is now on a pump to help deliver the tiny doses she needs, when she needs them.

 

[gillrogers]

I know many of us worry about how much basal we need and we often say that we need what we need, but that equally applies the other way, that you need as little as you need. I am sure Alan will be along at some point to reply and can hopefully reassure you that you are a welcome to join his very select sub group of Type 1s who need no basal insulin, if your levels continue to drop. The important thing is that you are doing the right thing in reducing your doses accordingly, so well done for that. It may be a short lived change or it may be longer term or permanent. None of us ever know with diabetes because the goal posts can and do change and all we can do is respond to those changes with new strategies. If your new strategy ends up being that you don't need basal insulin then all the better.... that is one less thing to have to think about.
There was a lady on my DAFNE course who had been Type 1 for 50 years and she only needed 2 units of Lantus a day and sometimes she hypoed badly during the night often involving paramedics but her levels went up to mid teens in the morning. She also only ate once a day and that was only 2-3 units of bolus insulin... so a total daily dose of about 5units! She is now on a pump to help deliver the tiny doses she needs, when she needs them.

Wow! To be hones if i can ditch my basal it will solve so many problems for me. As it is im starting to here from lyumjev group that it can last 7 hours in some pumpers . So thats another complication adding to the mix as its looking like thats the case today. 7 hours after breakfasr on my usual bolus and i dropped 2 more mmol and now levelled off. When i did my basal after that big hiccup my level was straight 6 hours after breakfast.

 

[rebrascora]

Whilst I don't find Fiasp as speedy as I would like, I do find that it is gone predictably quickly and 3 hours it is pretty well spent for me. Not sure I would fancy a kick in the tail 7 hours later! 😱

 

[everydayupsanddowns]

My insulin needs ebb and flow throughout the year too @gillrogers

Hope you find a new set of doses that seem to work for you for the time being. 🙂

 

[gillrogers]

Thanks Mike. Nothings working right at the mo and basal looks like its on it way back up again. Getting very down at the mo. I cant hold a basal long enoigh to sort out bolus doses. So making me think about a pump again.

 

[rebrascora]

if it is any consolation, my basal needs change on an almost daily basis, both up and down, particularly the night time dose. I don't mess with meal ratios but eating low carb helps with that for me, because I can't go far wrong and to be honest I don't really carb count anymore anyway, I just inject a bit of insulin and if I need more later, I inject some more. I just know that, if I am needing correction after correction, my basal dose needs increasing and if my Libre alarm is warning me I am going low more than once a day, I need to dial it back.

Hang in there! Hopefully it is just a phase and it will settle down. I can totally understand your concern and frustration though, especially when your nurse seemed to lack any real understanding at your last appointment. It doesn't inspire confidence to seek support from them when they don't appear to understand the basics, but perhaps you could see another nurse.

 

[gillrogers]

if it is any consolation, my basal needs change on an almost daily basis, both up and down, particularly the night time dose. I don't mess with meal ratios but eating low carb helps with that for me, because I can't go far wrong and to be honest I don't really carb count anymore anyway, I just inject a bit of insulin and if I need more later, I inject some more. I just know that, if I am needing correction after correction, my basal dose needs increasing and if my Libre alarm is warning me I am going low more than once a day, I need to dial it back.

Hang in there! Hopefully it is just a phase and it will settle down. I can totally understand your concern and frustration though, especially when your nurse seemed to lack any real understanding at your last appointment. It doesn't inspire confidence to seek support from them when they don't appear to understand the basics, but perhaps you could w

Hi Barbera, thanks . When you say a bit of insulin sort of how much? I cant go any lower than a half unit. If i manage to start the day low enough and use my ratios i can guarantee i wont come back past a 9 , then my correction doeses just dont work. Did a whole unit correction this morning as i was on about 9.5 6 hours later ive finally got to 8.8 . I xant tell if that's my bolus lasting longer or basals not high enough. Not doing lunch today to see what happens this afternoon. Last night i got down to 6 by 3 am after 1.5 units of evening correction then travelled alk the way up to 9.5 so my night basals got to go up again.

I only had that nurse as my usual one was on annual leave.

 

[Inka]

I have a pump and I’m constantly altering my basal rates at the moment. It’s a pain in the bum! Don’t let it get to you @gillrogers x

 

[gillrogers]

I have a pump and I’m constantly altering my basal rates at the moment. It’s a pain in the bum! Don’t let it get to you @gillrogers x

Thanks Inka, its affecting my job and voluntry work and hba1c because im not on a pump. My numbers not quite high enough yet to fit the criteria. I have to work alone and if i get into any difficulties like i did a couple of weeks ago ill be in big trouble with no help. My husband was at home then with me. Its not far off debilitating me.

 

[gillrogers]

So day time basal down to 1 unit now. Testing it this morning. Looking good so far. Well if this slide contiues of dropping half a unit every day ill be off my day time dose of levemir by Monday. !

 

[Spathiphyllum]

Thanks Inka, its affecting my job and voluntry work and hba1c because im not on a pump. My numbers not quite high enough yet to fit the criteria. I have to work alone and if i get into any difficulties like i did a couple of weeks ago ill be in big trouble with no help. My husband was at home then with me. Its not far off debilitating me.

Dear Gill-- Firstly, my basal is only 1.5 units a day; welcome to the tiny club! ; )

Secondly, though: You do NOT have to have high HbA1c to get a pump on the NHS. The guidance for who can get a pump on the NHS is here, https://www.nice.org.uk/guidance/ta151/chapter/1-Guidance :

"Continuous subcutaneous insulin infusion (CSII or 'insulin pump') therapy is recommended as a treatment option for adults and children 12 years and older with type 1 diabetes mellitus provided that:

attempts to achieve target haemoglobin A1c (HbA1c) levels with multiple daily injections (MDIs) result in the person experiencing disabling hypoglycaemia. For the purpose of this guidance, disabling hypoglycaemia is defined as the repeated and unpredictable occurrence of hypoglycaemia that results in persistent anxiety about recurrence and is associated with a significant adverse effect on quality of life

or

HbA1c levels have remained high (that is, at 8.5% [69 mmol/mol] or above) on MDI therapy (including, if appropriate, the use of long-acting insulin analogues) despite a high level of care." (underlining added)

So-- if you are having a lot of trouble getting your basal right to avoid hypoglycaemia, and this worries you and has "a significant adverse effect on your quality of life"-- you qualify for a pump under the first 'limb' of the guidance.

And on top of that-- there is a general exception, in the guidance, https://www.nice.org.uk/guidance/ta151/chapter/About-this-guidance :

"This guidance represents the views of NICE and was arrived at after careful consideration of the evidence available. Healthcare professionals are expected to take it fully into account when exercising their clinical judgement. However, the guidance does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient". (underlining added)

That last sentence means that, even if they weren't sure whether you met the guidance criteria, they could give you a pump-- and they should, as trying to manage without a pump is causing you such difficulties and you are finding it so stressful and debilitating.

When I last saw my diabetes consultant, he did me a referral to the local pump team, despite the fact that I'd got my HbA1c down to 46-- because I am finding it so stressful and debilitating, and that is clearly related to the fact that my insulin sensitivity is both high and variable. I'm seeing the pump team in May, fingers crossed!

Whether you or I would be able to get a 'hybrid closed loop' system as well as a pump is a different matter! NICE hasn't yet published final guidance on HCL, and their draft recommendations would only give HCL to people with high HbA1c. But even just the pump would be helpful.

Have you had a referral to your local 'pump team'?