Insulin Activity Surprises

Kelsey Bonilla Health Guide
  • As most of us know, many diabetics experience increased insulin needs during the early morning hours. Dawn phenomenon is common, and needing more insulin to cover breakfast is also pretty typical. I know that I need far more insulin before 1:00 or 2:00 p.m. than I do for the rest of the day. Lately, however, the difference has been dramatic!

     

    Has this ever happened to you, or someone you know?

     

    You decide to indulge in something sweet or high in carbohydrates for breakfast. You know you really shouldn't, but that muffin, pastry, donut, piece of biscotti, whatever, sounds so good. Planning ahead, you bolus fairly aggressively and enjoy your treat. An hour or two later you test your blood and are greeted with a result somewhere in the 300 mg/dl range.

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    This is when you berate yourself, swear never to eat another baked good for as long as you live, and deliver a huge correction bolus.

     

    An hour later your handy pump beeps to rub in the fact that "your last blood sugar was high." The wave of regret washes over you once more as you reach for your meter. Considering the huge bolus you delivered in frustration, you figure the blood glucose meter is going to display a much friendlier number. When you see that your blood sugar is still over 250 mg/dl, you reach for the pump to bolus some more.

     

    It's nearing lunch and your blood sugar still hasn't dipped below 200 mg/dl. You decide to eat something low carb, and continue to bolus for anything that may possibly raise your blood sugar.

     

    After four hours to correction boluses and high blood sugars, you suddenly feel a little low. Testing, you discover that all that insulin is finally working as your blood sugar is now 108 mg/dl. For the next few hours you eat a granola bar, a banana, an apple, and some chocolate from your coworker's desk. All without bolusing for any of it!

     

    Apparently all of that insulin from the morning kicked in because you spent the entire afternoon eating to avoid dropping too low.

     

    This was how my Monday went. What I don't understand is what does a day like this mean for our duration of insulin action? I have my pump set for a 3 hour duration, but clearly some of that insulin lasted much longer than 3 hours. Perhaps this day was a result of a stubborn high (likely with a bit of ketones) that finally came down after stacking several insulin boluses on one another. The stacking might prolong the duration of insulin activity, so even though I hadn't bolused in 4 hours or more, my blood sugar was still dropping.

     

    Please share your thoughts if you've ever experienced something like this... it's happened to me on more than one occasion, so I'm assuming it's not a terribly rare circumstance.

Published On: October 28, 2008