Sudden changes in need in daytime insulin (Humalog)

[Joe Fairclough]

I'm 73, male, fit, insulin controlled diabetic for about 13 years. Got diabetes due to Pancreatitis 20 years ago. Over the last 5 years or so my Humalog daily need has varied quite a bit, but up till about a fortnight ago it was generally between 15 and 20 units a day. Highest ever intake was 34 units, and my lowest 3. My GP (lead in diabetes in my area) has told me that this is due to Pancreatic Insufficiency caused by the Pancreatitis, and I understand that. Meds include Creon. About a fortnight ago, my daily Humalog need suddenly went from 18 to 25 to 45 to 11 to 36. OK at times of increasing need, but when the need suddenly crash dives I get massive hypos before I realise that a huge change has occurred since yesterday. I spoke to my GP about this and he told me that I was "managing it," and that I simply needed to "develop more confidence." 24 hours later, I had a massive hypo 1 hour after breakfast that wiped me out for most of the day. My diet and activity levels have not changed at all. Has anyone else experienced anything like this? Any advice? Cheers. Joe.

 

[everydayupsanddowns]

Welcome to the forum @Joe Fairclough

We have a few people with ‘3c’ diabetes only the forum and/or pancreatitis who may be able to offer suggestions @eggyg @mikeyB @Hepato-pancreato

Presumably the significant increases in your insulin doses were in response to elevated BG levels?

Have the sudden unexpected hypos coincided with swapping to a new insulin pen by any chance?

Any problems with your injection sites that you know of? Some people have experience of insulin getting ‘locked‘ in scar tissue or lipohypertrophy, (so doses appear ineffective) only to suddenly escape later (with resulting BG crash)

Just wondering if there may have been other factors involved in your need to raise doses, which are now responding differently?

 

[trophywench]

What Basal insulin do you use, or are you using the Humalog in a pump?

 

[Joe Fairclough]

Thank you so much, both of you. Here are the answers to your questions.

Yes, the sudden significant increases in insulin doses were a direct response to sudden and totally unexpected increases in BG.

No, I haven't switched pens. Sudden and unexpected hypos have occurred when I was up at 35 - 45 units the previous day, and calculated my injection regime based on that, only to keel over next day after less than 2 hours. So for example, on the day before I spoke to my GP I needed 34 units. The day I spoke to my GP I needed 45. The next day I got up and took what seemed like an appropriate dose in the light of that, but dropped into a hypo in 1.75 hours. My total dosage that day wound up at only 21 units. I'm now on day 18 of this episode, and more stable, but still swinging between about 30 and 38 units Humalog.

No, no signs of any problems with injection sites. My annual check up has always been fine about that. Throughout the whole episode I've continued to shift injections round the whole available area. I always have. Thanks for the link to the person on 3c. I'll follow it.

About the Basal Insulin, I'm on Lantus. GP advised to inject at bedtime. Up till recently I was taking 18 units, as my GP said that he expected the amount of Lantus to roughly parallel the amount of Humalog. Now that my intake of Humalog has pretty well doubled, I'm gradually increasing the Lantus. Softly, softly, catchee monkey. Don't like keeling over. Not a good idea. Got a 1500 sq m lawn to mow! And next winter's logs to cut.

Thanks both. Any further thoughts much appreciated.

Joe

 

[Inka]

Now that my intake of Humalog has pretty well doubled, I'm gradually increasing the Lantus.

Hi @Joe Fairclough I’d be wary of increasing the Lantus if the only reason is to match your Humalog. Although many people’s basal and bolus (meal time) insulins do split 50/50, equally many people’s don’t, including mine. I’ve always used more bolus insulin than basal.

I can’t think what’s caused your recent dose increases but the hypos sound frightening. I hope you get it sorted. It must be very frustrating to change doses so frequently like you’ve described.

 

[trophywench]

Joe - if you want to work out for yourself how much insulin you actually need in the background, ie specifically adjusted for YOU and nobody else - please do a basal test. It's a waste of time messing about with mealtime doses of Humalog if your background insulin isn't pretty smack on what you need when you need it.

Basal insulins « Diabetes Support Information Exchange

www.diabetes-support.org.uk

 

[mikeyB]

I agree with @trophywench, Joe.

It’s difficult at the best of times coping with a shabby pancreas (only 2% of the pancreas is concerned with insulin production). You will only end up confused if you change the doses of both insulins at once, because you won’t know which change is effective.

You should, if you can, do a basal test as advised by TW. Get that sorted, then adjust your Humalog doses according to the carbohydrates you eat.

You’ve been badly served by your GP. He
has zero expertise in Type 3c diabetes, and likely little in T1. I was a GP for twenty or so years before I saw sense, and never saw anyone with chronic pancreatitis, and no-one with new onset T1. Statistically, that’s far from unusual. When we return to normality, you should be seen by a Diabetes specialist who should be able to guide you.

Meanwhile, tap into our experience and we’ll try and muddle through. There’s thousands of years of experience on this forum, so ask any question you like. You won’t be able to ask a question that hasn’t been asked by any of us, and answered by all that experience.

Welcome to the forum, and best of luck. Stay safe.🙂

 

[Joe Fairclough]

Thank you everyone for your support. I shall indeed start testing the basal insulin needed as suggested. I've already had a look at what is involved and will take a day to digest it and think a bit before I start. I'm glad someone else thinks the same as I have come to think about my GP. I have indeed become disillusioned with his attitude and non-advice over the last 3 years or so, and I'm surprised I didn't tap into this forum earlier. I belong to another self help organisation, and know very well the value of pooled experience. However, my missus and my adult daughter have encouraged (rescued) me. I shall crack on with a bit more confidence. Yours. Joe.

 

[Joe Fairclough]

OK, I have been monitoring my bedtime, during the night and in the morning BS levels, morning levels, and I've now arrived at 10 Lantus, down from 18. I did a first morning to lunchtime level check with no breakfast and no Humalog, and had only gone up exactly 10% over the whole of the morning, so I suspect I'm making some progress at a better understanding of what's going on. I shall continue this for a week or so before moving on to a lunch time to dinnertime monitoring. I could fancy getting in touch with the 3 people linked in Mr Administrator's early response, but when I click on the links, I only get a readout of all their posts. Is that how it is, or is there a way I can contact them directly? Cheers. Joe.

 

[SB2015]

Hi Joe

Are you carb counting for your meals? Sorry if you have already told us this and I have missed it.
I know that my quick acting insulin for meals over a day often matches the amount in my background insulin, but it very much depends on what I eat each day. Sometimes it is a lot lower, especially if I am out walking or doing gardening, some times it is higher. I adjust my meal insulin to match the carbs I a, eating at each meal and then take a bit off if I am going to be active, and add a bit in if I am am going to be ‘slobby’.

 

[everydayupsanddowns]

is there a way I can contact them directly?

When people are tagged in posts ther often contribute if they think they have anything useful to add (as @mikeyB did above)

After a while when you switch from New Member to Member, you should get access to the Private Message function too.

 

[Joe Fairclough]

Thank you both. To SB2015, I would say that I am not "counting" carbs as in weighing and consulting charts, but I do know the foods that are low and high for me and I have to vary the Humalog accordingly. I also recognise the impact of exercise and non-exercise. We have a 1500 sq m garden, plenty of country walking outside our front door and a small sailing yacht in a local harbour. If I have an "indoor (lazy) day" I adjust my intake. Before my "episode" I was accustomed to my Humalog intake varying as detailed above. (8 - 10 units variation a day over a week or so) What threw me was that I suddenly entered a 10 day period where my intake zoomed up then plummeted and zoomed up again by 34 units overall, at its highest level 30%+ greater than my previous highest ever, and without any significant variation in either my routines or my lifestyle or my food intake to cause that. My GP provided no accurate advice of any kind, and so I've now started a more accurate calculation of my basal insulin needs as detailed in "TrophyWench's" contribution. Once I've done that, I should be able to work on my bolus from a greater knowledge base. It really has only been guesswork by me in the past. I suppose only time will tell if I get any recurrence of the much bigger "need swings." I've had them increasingly over the last 5 - 6 years, and I'd like to reduce the likelihood of them carrying on if I can. Thanks again. Joe.

 

[rebrascora]

Most of us find that basal needs change quite frequently. Sometimes it is in relation to the seasons or the weather or hormonal changes or even other medications.... for instance I have seasonal asthma and need to use a steroid inhaler during the autumn and winter and that requires me to increase my basal insulin a bit whilst I am using it.

You should ask to be referred to a diabetes clinic or at the very least a training program like DAFNE (Dose Adjustment For Normal Eating) which will teach you a multitude of skills including identifying when your basal needs have changed and perhaps more importantly, sick day rules, which in the current climate is pretty vital information, as well as carb counting. It also gives you an opportunity to meet other Type 1 diabetics (I appreciate you are Type 3c but there is a lot of common ground) and as you are aware, exchanging experiences with people in a similar situation can be very enlightening and DAFNE educators (usually a very experienced DSN and a dietician) very much encourage that.

Good luck with getting your basal insulin sorted. It can be the difference between shooting at a fixed target or a randomly moving target..... ie much easier to get meal time bolusses right if your basal insulin is holding you steady.

You need to become the expert on your personal diabetes and not rely on a GP who sees or speaks to you once in a blue moon and has very limited experience of how insulin regimes work in general let alone understanding the huge variations in needs between individual diabetics and their food choices and exercise regimes.

 

[eggyg]

OK, I have been monitoring my bedtime, during the night and in the morning BS levels, morning levels, and I've now arrived at 10 Lantus, down from 18. I did a first morning to lunchtime level check with no breakfast and no Humalog, and had only gone up exactly 10% over the whole of the morning, so I suspect I'm making some progress at a better understanding of what's going on. I shall continue this for a week or so before moving on to a lunch time to dinnertime monitoring. I could fancy getting in touch with the 3 people linked in Mr Administrator's early response, but when I click on the links, I only get a readout of all their posts. Is that how it is, or is there a way I can contact them directly? Cheers. Joe.

Hi Joe, I was one of those tagged but it must have passed me by. I’m really sorry I’m only seeing your posts today for the first time. I’m Type 3c because of pancreatitis in 2001 and then a subsequent distal pancreatectomy in 2007. I was diagnosed Type 2 in 2010. Like @mikeyB says most GPs and DSNs don’t have the foggiest about it. It’s been a long haul for me to get the correct treatment. I’m on different insulins to you but I see you’ve had some good advice. When you’re able, I’m happy for you to PM me. It can be a lonely place in Type 3c land. 🙂

 

[trophywench]

All of us are still here and available to help if we can Joe! - though I see you have now posted enough times to be (automatically) designated 'Member' so if you click on anyone else's name on the left of their post, you get 3 choices - Follow, Ignore, private message. You can't choose to Ignore 'Admin' though - someone has to prevent the outbreak of War if necessary!

 

[KARNAK]

Hi Joe thankyou for being a member and you have received some excellent advice, as Jenny says we are all here with our own knowledge to pass on to others. My own experience is I was taking 10000 PHEur capsules with each meal and to be perfectly honest there wasn`t enough toilets to cater for my needs. 😱😱😱 After many near accidents and proper ones I managed to contact my Consultant/Endocrinologist who was horrified and she increased my Creon to 75000 units with meals and 50000 with snacks, I said thankyou but **** happens.😱 My Basal was increased from 16 am and 4 pm to 30 am and 25 pm wow quite a lot and still remains there, my point being that since increasing the Creon I am now able to control my daily life better with the help of my Endocrinologist and my DSN and Dietician. The other point being another drug introduced into your daily regime may upset your daily balance in controlling your Diabetes, the maths is horrendous but the result is still the same, you live by how well you control it or you die by how well you don`t. Take care my friend great to meet you.