Increasing insulin sensitivity

(Mia) #1

My son was Dxed with T1D 1 year ago this week.
He has been stable on basal and rapid acting insulin for at least 6 months following his Honeymoon period.
Suddenly this week he has had significant swings in his control. We have had to increase his carb ratio from 1:20 to 1:50 as he was having rapid drops. No change in diet or exercise.
Has anybody experienced this rapid change and do you know why it occurs? Almost like his pancreas is making insulin again?

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(joe) #2

@nursemia28 hi Mia,
About every couple years I start making insulin again and it screws me up. I’ll drop after a meal and then need to eat as many carbs as I bolused for just to correct the low. Then I think I bolused twice. It lasts a couple days for me and then things go back. I can get at least a couple meals in where I don’t need extra insulin at all.

Good luck.

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(Mia) #3

Thanks for your reply! I kind of felt like maybe he is making insulin again.

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(wadawabbit) #4

I’ve been diabetic since 1963 and have been pumping for over 15 years now. I find that I do have to change my pump settings - basal rate, carb ratios or both - from time to time, especially in winter and summer for some reason - I don’t really know why. I imagine a non diabetic body may make adjustments as well; but since it does it automatically the person isn’t even aware.
If you want to verify if your son’s body is making insulin talk with your doctor about a C-peptide test. As it was once explained it to me, when your body makes insulin it produces C-peptide as well, so this could confirm things for you.
Your diabetes nurse educator may be able to assist with understanding what’s going on.

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(Dennis J. Dacey, pwD) #5

@wadawabbit, you summarized the “c-Peptide” lab test well; every result I’ve had with that reads “less than 0.01” which means none could be found indicating that my body never produces its own insulin.

Yes, our bodies change with the season - well more accurately with the ambient temperature - and we need to make adjustments in our insulin calculations. I need different basal insulin rates, carb:insulin ratios and sensitivity factors - that is one reason I do “fasting pump validation” checking with all seasonal changes. I discovered this [to me] phenomenon more than 30 years ago and reported it to the Joslin Research team and they did a study confirming my observation and now this fact is included in many teachings.

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(wadawabbit) #6

Thank you Dennis. When I was diagnosed they used the glucose tolerance test, which may be passe now :thinking:. There was an event at my office where they were discussing diabetes for anyone interested in attending, and that’s where I first heard of it. Of course when I told the doctor how long I’d had it (40+ years at the time) he said I wouldn’t need to bother. At that point I was zero, zilch, nada - no surprise.

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(Dennis J. Dacey, pwD) #7

@wadawabbit, I just wish that the intelligent Medicare [CMS] Administrators were as aware as your doctor. Medicare is absolutely certain that autoimmune diabetes, T1D, has been cured. Every time I get a new device, Medicare insists that I get a new c-Peptide lab at a cost of $368.

And Medicare records are so good that they have no way of seeing the results from the earlier c-P.

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(Mia) #8

I didn’t know about the C-Peptide, thank you!

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(Mia) #9

Thank you, Dennis, I was unaware that seasonal changes can effect T1D. I will consider this going forward in treatment decisions for my son.

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(John) #10

We’re experiencing something similar with our 10 year old son who was diagnosed in July of 2018. We’ve had to scale back his ratios and basal rates about two weeks ago. Most likely because it’s spring time and he has been more active with warmer weather and DST. His hockey season just finished too, so we thought we would have to increase his insulin, but that’s hasn’t been the case. It’s been the opposite.

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(wadawabbit) #11

This may not be universally true, but some people find they have to make adjustments with different types of exercise. It could be related to placement of the infusion set for pumpers, as well as other factors - perhaps the amount of aerobics involved or the different muscle groups. I’ll let the exercise physiologists address that theory but I do recall one friend saying she had to do a morning bike ride to keep her numbers good between breakfast and lunch. Walking the same route didn’t have the same effect - nothing worked but her bike.

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(Julie) #12

Hi Dennis, can you please say more about how you do a fasting pump validation? Our daughter is 12, diagnosed 1/29/18, pumping for about 6 months. We have been working on her settings continually because she still was running high in general (Dec A1C was 8.5, March 8.4)

When we adjusted settings in December after her endo visit, there was almost no change in her readings. At the same time, she also stopped having PE at school, was out of seasonal sports for a few months and had weeks out of school for break. Now we’ve adjusted again from the March visit and she’s going low multiple times a day, but also back in PE, back in sports, and it’s spring and she’s just more active in general.

It seems like the new increase in basal rates (10% change) tipped us over some threshold, because I’ve scaled back the carb ratios to where we were before, but that almost seems like too much during the day. Rather than keep guessing, I am wondering how we can get better at this. It seems like a baseline / fasting test might be helpful for changes in weather-seasons and sports seasons too.

Thanks!

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(joe) #13

hi @julied5600 Julie,

I am sure @dennis will have more to say, but in the meantime, MDI and pumping are always all about monitor, adjust, monitor.

If you are seeing a lot of lows after a 10% basal change, you can always change back, make sure she returns to whatever she used to be, and then make a little less of a change (lets say 5%).

Fasting tests are for checking basal rates. There’s a great book called “Pumping Insulin” and it has a detailed protocols for testing sensitivity, carb rations, and basal rates.

Fasting tests include starting with a blood sugar (not CGM) that’s in range right before lets say lunch. Then you skip lunch. Then you monitor blood sugar every hour until the next meal. If she goes out of range (high) you stop the test, correct, slightly increase basal rate for that period (starting 40 minutes before lunch) wait a day or 2 and do it again.

If she goes out of range (low) you stop the test, correct by eating, reduce the basal for the time period, wait a day or 2 and do it again.

If she’s in range during the time period - test concludes basal is correct for the time range, Eat a meal. wait a day, do it again for breakfast or dinner, whichever you want.

It is important that all the other tests depend on a good basal rate. So testing basal rates are the first thing you want to do and get right.

Growing kids and changing seasons are always 2 important variables for basal rates.

here is a good graphic of a “good basal” over time chart:

cheers good luck this takes many repetitions. don’t get discouraged. Cheers!

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(joe) #14

it’s also important to know that for people with highly variable days, that it is a good strategy to have a “regular day” an “active day” and a “couch potato day” basal rates, all tested and stored in a pump…

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(Dennis J. Dacey, pwD) #15

Hi Julie @julied5600 what @Joe wrote is about as complete as could be.
All I will add is that I do the “overnight” a little differently, in effect checking the supper bolus ratio - for a “measured meal” and the basal rates right through the following lunchtime. All these “validating checks” should be done on days of normal activity.
I eat a supper for which I can very closely calculate the number of carbs and then check my BG every two hours entering it on a chart and not eating again, unless needed to raise a low BG, until lunchtime the following day. This validation stops if I need to take a correction bolus or eat.

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(DDrumminMan) #16

Not sure about your son, but for me of 41 years with T1 I can say my insulin dosage must change somewhat frequently. I use the expression “just when I think I’ve got it figured out, things go haywire.”

It’s just part of it that things change. Doctors and the literature seems to indicate if you eat the right amount and dose the right amount and exercise it will all work out. My experience tells me sometimes yes and sometimes no. Mostly yes.

Usually my strategy works, but dosing etc does have to change with the times sometimes.

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