Diabetes Forecast

Why Do Insulin Needs Change?

When I was diagnosed with type 1 diabetes, I started with 22 units of Levemir—dropping down to 7. I was told I was in the “honeymoon phase.” Sure enough, my units gradually climbed. However, almost three years after diagnosis, my insulin needs continue to go up and down. Is this fluctuation common? What can cause it? Barbara Mattson, Spartanburg, South Carolina

Christy L. Parkin, MSN, RN, CDE, responds:

Your insulin fluctuations are very common and can be caused by a variety of factors. When you are newly diagnosed, it takes time to figure out all the variables that will influence your daily insulin dose, including insulin-to-carbohydrate ratios, correction factors, basal (background) insulin, the timing of injections, your level of physical activity, and how much insulin you need for the carbohydrate you eat.

As you note, during the "honeymoon phase" of type 1, newly diagnosed people may need less insulin at first because the pancreas still produces some insulin. But like other honeymoons, the diabetes honeymoon doesn't last forever. Its length varies (weeks, months, or occasionally up to a year or more), and not everyone has one.

The honeymoon does not mean your diabetes is improving or in remission. When insulin is injected, the pancreas may get a small break from having to produce insulin. This rest period can stimulate the remaining beta cells to begin producing insulin. These cells, however, will also eventually be destroyed by the autoimmune response that characterizes type 1, the pancreas will stop producing insulin, and then the honeymoon is over.

After the honeymoon phase, even if you take insulin and eat a consistent amount of carbs, the level of glucose in your blood can change unpredictably. Various factors can be at work. The use of certain medications may require changes in your insulin dose to keep blood glucose on target (for example, the corticosteroid prednisone usually requires increasing your insulin dose). During a cold or other illness, your body typically produces hormones that raise your blood glucose. Alcohol can cause either high or low blood glucose, depending on how much you drink, whether you eat food with it or not, and your activity level. Prolonged stress may cause your body to produce hormones that can prevent insulin from working properly.

In women, as hormone levels fluctuate during the menstrual cycle, so can your blood glucose levels, particularly in the week before your period. Pregnancy and menopause may also trigger fluctuations in blood glucose.

'In short, if your need for insulin is a moving target, that's a troubling but common part of living with diabetes. Your best tools for dealing with it are careful tracking of your food, exercise, and medications, reviewing the results with your diabetes care team, and making adjustments in lifestyle and medication as you go.



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