Cutting Back Insulin
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T1DCarnivoreRunner
Posts: 11,502 Member
So I am a type 1 diabetic. I'm ALSO a type 2 diabetic (i.e. double diabetic). Starting Jan. 1, I decided to make serious effort to lose weight. For a few weeks, it was absolutely amazing how much I was able to lose in such a short amount of time. I won't pretend it was easy, but it worked.
Then, out of nowhere, I started having to feed lows constantly. For about a month now, I've barely lost anything because I have to constantly eat in order to treat lows. This happens even sometimes if I skip insulin for a meal (if it is a small meal, the basal insulin covers it because my basal rates are obviously too high). I keep cutting back my basal rates because they are obviously too high, and it looks like I'm almost to a solid rate and will still need to cut back my bolus ratios also. But all of this is taking time and it is really discouraging (and annoying).
What's worse is that I can no longer function as well (for example, I didn't wake up Monday morning because I was so low - I ultimately rebounded but was late for work; then today at work, I had to postpone something involving heavy machinery because I suddenly ended up with a meter glucose of 36).
I'm not asking for advice... I know the answer is to keep decreasing until insulin ratios work out for me and seek advice from the endo next time I see him. I'm just really really really upset that I'm losing time and thus losing out on my goal. I've been a type 1 for 19 years (and a type 2 for 16), but I still can't get over being depressed and jealous of others who don't have the same roadblocks.
End rant.
Then, out of nowhere, I started having to feed lows constantly. For about a month now, I've barely lost anything because I have to constantly eat in order to treat lows. This happens even sometimes if I skip insulin for a meal (if it is a small meal, the basal insulin covers it because my basal rates are obviously too high). I keep cutting back my basal rates because they are obviously too high, and it looks like I'm almost to a solid rate and will still need to cut back my bolus ratios also. But all of this is taking time and it is really discouraging (and annoying).
What's worse is that I can no longer function as well (for example, I didn't wake up Monday morning because I was so low - I ultimately rebounded but was late for work; then today at work, I had to postpone something involving heavy machinery because I suddenly ended up with a meter glucose of 36).
I'm not asking for advice... I know the answer is to keep decreasing until insulin ratios work out for me and seek advice from the endo next time I see him. I'm just really really really upset that I'm losing time and thus losing out on my goal. I've been a type 1 for 19 years (and a type 2 for 16), but I still can't get over being depressed and jealous of others who don't have the same roadblocks.
End rant. 0
Replies
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It's very aggravating to have those lows. I don't blame you one bit for being mad. Keep at it and eventually/hopefully you'll find the right basal rate. I've cut back my basal and bolus rates nearly 50% and still have times when I go low and have to eat something. I wish I had a CGM, but my insurance doesn't cover it (maybe I should call 911 a few dozen times and maybe they'd change their minds). Are you on an insulin pump? You might be able to get better control on a pump. Wishing you all the best, Terrie0
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I've just come to the conclusion that at the second you get all of your insulin adjustments "right" you will need to rethink your plan because something will change all that!!! I know the low game all too well. I know that often it's hard to just eat 15g of carbs to bring a low up. It seems that most of us just binge until we feel better. I'm a pumper and use a CGM. When I notice myself dropping I just suspend my basal for an hour or an hour and a half and that usually takes care of it. If I need to eat something then I go for some Scooby Snacks (fruit snacks). Not only do they taste good but they're 20g of carbs and only 80 calories. You can do it. You just have to work real hard to find what works for you:)
Claire0 -
Yes, I'm on a pump with a CGM. The CGM lags, so I often feel low before the CGM tells me about it.0
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I know how you feel. It seems like what I eat, how long I sleep, the phase of the moon, the day of the week, the weather, and even what color pants I wear affect how much insulin I take.
I noticed that looking at when I go low compared to my MFP diary seems to help. If I am going low 1-4 hours after eating a meal, I know I need to increase my insulin to carbs. If I am going low at random times for no true reason at all, then I know I need to lower my basal. It has also helped me to try to get my glucose within 110-150 at bedtime -anything lower is very likely to cause me to go low in the middle of the night, and anything higher risks me going higher and developing ketones overnight.
I feel like I am the opposite of a lot of diabetics. When I am in the 60's, I will only have one or two glucose tablets (more if I am below that but rarely above 24 carbs). Once I get above 120 though, I am one that immediately corrects even when I should only correct when I am above 160 (one full unit of correction). It's driven me into way too many lows.
The increase in lows could be from your weight loss. I experienced a similar thing even when I lost only ten pounds and had to increase my insulin to carb from 1:10 to 1:14.0 -
You can try setting your CGM low limit a little higher than the warning you actually want so that it warns you before its too late. The downfall to this would be running steady in the low end of normal risks the alarm going off when you are actually at an acceptable level. Its a personal choice. I have my low alarm set a little higher than I would be concerned about so that it warns me in time - I don't feel my lows until its almost too late. I just silence the alarm if I'm having a nice steady day in the low end of normal.0
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Sorry to reply so late in the game, but have you read Pumping Insulin by John Walsh? It is a great resource for pumpers and has a lot of info on how to use your CGM data to make adjustments to your basal, bolus, I:C, C.F., DO I. Sounds like you need to test and refine more than one of those very important numbers.
Congrats on the weight loss, as well as on the need for less insulin!
I'm a t:slim, Dex G4 user, and have had to play with rates /time blocks as my activity, carbs, and weight have changed. I have very different basal, bolus, C.F. settings depending on time of day and will run a temp rate on weekends to cover increase or decrease in activity.
Have you tried using temp rates to help refine what your basal should be at various times of day?
I also second the reset of low alarm. I keep mine set to 70 and at night have it sitting on headboard, usually on top of my kindle. The vibrations is amplified by the glass surface of the kindle, and have not slept through it so far. You can always try the glass and spoon trick as well.0 -
I don't really have something to put it on while sleeping that would be any louder. I move around in my sleep, and to be honest, putting it on a glass or sheet metal surface probably won't work anyway. I sleep very deeply, and it not only takes something loud, but also persistent to wake me up. In fact, I set alarms to start going off 2 hours before I need to actually wake up. By the time I could figure out what was happening, I'm sure I would be completely passed out anyway.
Here is an update, though: After more than a month of gaining back part of what I lost in January, primarily due to feeding lows, and adjusting insulin down 5 times, I have few enough lows to feel safer sleeping and to start to lose weight again. I'm not sure that I have the "right' rates, but they work for the most part. In time, I plan to do some basal tests, but it doesn't feel like a good time to do them until I either start to plateau again or when I achieve my target weight. I'm not ready to waste energy and my extremely limited time to do a basal test with useless results (because things are still changing or soon to change).0 -
I too am a pumper and CGM wearer and agree whole-heartedly about setting the low limit up a bit so I treat before I'm inconvenienced. I try not to get below 100 when working out and use 80 as my low limit for general days and nights. Treat early and gently for lows is my motto. I can usually get by on a couple glucose tabs if I catch things just as I start to drop. Hang in there~0
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Congrats on your weight loss and I definitely understand the frustration about the lows. I have been going through the same thing myself - had an insulin reaction the other morning which I haven't had in years! I'll just leave you with one positive about being a diabetic on this journey - we can see the impact of the work we're doing in the changes with bolus and basals and for me, that's rewarding. Sometimes I'll do just a mile walk with my dog or even some house cleaning that I will question if I REALLY burned calories and the decrease in blood glucose will confirm that I did
Good luck in your journey!0
