How can we manage type 1 diabetes mellitus with gluocose spikes?

Question

Hello doctor,

I am a 24-year-old college athlete diagnosed with type 1 diabetes mellitus three years ago. My continuous glucose monitor shows overnight blood glucose spikes above 300 milligrams per deciliter, even when I go to bed at 120 milligrams per deciliter. I increased basal insulin twice, but still experienced the dawn phenomenon. During practice, blood glucose drops dangerously. I quit midgame twice last week. My hemoglobin A1C increased from 6.8 percent to 8.4 percent in three months. I count carbohydrates strictly. I fear complications and hypoglycemia during games. My coach is frustrated with frequent glucose checks. An insulin pump representative mentioned trials with dual-hormone pumps. My endocrinologist gives 10-minute appointments and says, Bolus more. I already use almost twice as much Insulin as I did last year. Possible insulin resistance or stress? Final examinations and championship games are near. I cannot risk hospitalization again. Need advanced options.

Please help.

Answer 1

Hello

Welcome to icliniq.com.

I understand your concern.

Several factors could be contributing to your blood sugar fluctuations. The dawn phenomenon is a common rise in blood glucose levels during the early morning hours due to natural hormonal changes. While increasing basal insulin is a typical approach, it may not always be sufficient. Exercise, especially in athletes, can cause significant drops in blood glucose levels, making it essential to adjust insulin dosing and carbohydrate intake around training sessions to prevent hypoglycemia. Psychological stress from academic exams and athletic competitions can also contribute to elevated blood glucose levels.

Managing stress through relaxation techniques and ensuring adequate sleep may help improve glycemic control. A noticeable increase in insulin requirements may indicate developing insulin resistance, which can be influenced by stress, hormonal changes, or weight gain. A dual-hormone insulin pump, which delivers both insulin and glucagon, may offer more stable blood glucose management; although these devices are still in clinical trials, it may be worth discussing them with your endocrinologist. Given the complexity of your situation, scheduling a longer consultation with an endocrinologist is strongly recommended to reassess your regimen and tailor a more effective treatment plan.

I hope you are satisfied with my answer. For further queries, you can consult me at iCliniq.

Thank you.