Yeah, I know I'm using up all my posting privleges, but that's how things have been for me this week.
I had posted on Monday about an unexpected serious low followed by a day stuck in the high 200s and low 300s. Thank goodness that passed. I concluded the extreme highs were from a combination of reaction to the low and poor absorption sites.
But I'm not back to normal because I wasn't normal for awhile before that crisis. I normally have pretty decent control Mostly I'm in range with the occasional spike or low.(My last A1C was 5.7) But starting two weeks ago I started having more highs than not, and these highs were at various times related to both to post prandial to basal. The highs weren't extreme, mostly in the high 100s. But high for me. And my correcting didn't seem to be working as well as normal, or I'd correct come down and go back up.
I do tweak my basals occasionally but mainly they work well (I have 9 different rates) and my I:C's have been consistent for months. So what could be causing all the highs? As I said I think I was having poor absorption in my hips which I had probably been using too long. But now I've switched to stomach and it's the same. I switched my insulin vial; I have no reason to think the whole batch was bad as it was fine before. I threw out a pen I'd been using for back-up as it was a year old. I don't have hormone issues as I'm post menopausal. My eating habits are the same and I'm not under stress.No major change in the weather. The only thing left is illness. As I've mentioned on here I rarely get sick and have a super strong immune system. But I have felt a bit like I'm fighting off a cold. My crazy immune system sometimes does that for weeks before I either finally get it or it passes. That could affect control. Finally I had slow onset adult Type 1, but as of 3 years ago when I started insulin my c-peptide was either .38 or .70 so I am assuming it bottomed out pretty much long before this. But who knows; maybe this is the final death march - my insulin use has been fairly low..around 20 TDD, so maybe I'm now "running on empty" and need to up it.
So it could be incubating illness, insulin depletion or some unknown factor. My question is what to do. A few highs are normal for a Type 1 I know and I don't stress over numbers usually. But this is day after day. I do like understanding things. But someone on here once told me something like it doesn't matter why something is happening just what to do about it. So even though my basals and boluses were well set for awhile before this they don't seem to work now, so should I just start slowly tweaking both until I get good results then watch to make sure I don't start having lows when whatever it is goes back to normal? What do you guys think?
I doubt that it is due to changes in endogenous insulin production, I think it is just that the body needs different amounts of insulin to function at different times of the day or the cicadian (spelling? I couldn't spell in English & now in American it is even worse!) rhythms, not just DP.
If you read the literature, the researchers seem to consider c-peptide levels of 0.2 or above to be significant (in that it correlates with lower A1c, lower insulin requirement, lower after-meal blood sugars, etc.). So, a result of 0.2 for Trudy is significant in the world of Type 1, and your 0.38 and especially 0.7 would be, even if it's decreased since then. If you look at studies like the Joslin 50-year studies that said that over 67% of Type 1s had some insulin production after 50 years, "insulin production" was considered to be a c-peptide of 0.03 or above. Only about 2.6% (if I remember correctly) of those studied had results of 0.2 or above, and all of them were adult-onset Type 1s. This level seemed to have at least some impact on their control, such as lower after-meal blood sugars, according to the researchers.
In all the literature I've read nearly all those diagnosed as adults (even as regular Type 1 and not LADA) produce some insulin for many years (even over a decade) after their diagnosis and starting insulin. Even adolescents often have some insulin production for a few years after they are diagnosed. It's really only the younger kids (diagnosed before puberty) who have very low or undetectable levels of c-peptide after a year or two.
I actually find the whole topic of c-peptide and residual insulin production really fascinating (hence why I've done some reading up around the subject)! I have never had mine measured but would love to get it done just out of curiosity. I doubt any doctor would do it, though, and I myself doubt I would have a detectable c-peptide level, but you never know!
Thanks, Jen, I knew the idea that some Type 1's still produced some insulin wasn't new, but I'm terrible at remembering where I read/heard things.
Ok, I have an idea, let's all go on vacation to Guatemala and we can have a c-peptide testing party! (How's that for a zany excuse to travel!)
Maybe we could count it as "sick leave" for those of us who work, too! ;)
There you go! Maybe we could get our insurance to pay for it as "medical necessity". Ok, now I'm getting delusional!
I once was on vacation in Mexico and decided to extend my trip. I called my work and lied (true confession) about being sick. I called from a phone with a view of the blue/green Caribbean in the Yucatan. It was so hard to keep that view out of my voice!
Ha ha ha, I like your style..
Count me in! LOL
I wonder where I'm at with that, as I was dx'ed at 16, sort of in the middle, and don't have any family HX, before or since, although the current generation concerns me? Perhaps I'm cheating with "home grown"?
Thanks for the info, Jen. The topic of c-peptides is really fascinating, as you said, as was today's Dr. Faustman video.
Zoe, thanks so much for asking this. I never thought of allergies as being a contributing factor to BGs, but I guess if the body is fighting something it's inevitable.
I always learn so much here, thank you all!
Hi Zoe. You've had a rough week! I hope things settle down for you very soon.
About allergies--pollens are important, but so are molds. I have a host of allergies that get better in the winter, but don't go away completely because, where I live, even if it's too cold for the pollens, it's plenty damp enough for molds to flourish. And then there's dustmites. You said you feel most allergic when you wake up in the morning. Maybe you could buy a new pillow and see if that makes a difference. Dustmites are almost impossible to get rid of but you won't find them in new bedding.
Allergies are auto-immune related and so I guess it's also possible that you've just become more sensitive to various allergens. These auto-immune conditions seem to reinforce each other, working in concert to keep us off-balance!