Why does a 27-year-old woman with T1D face glucose swings?

Question

Hello doctor,

I have had type 1 diabetes for eight years and, despite closely monitoring my blood sugar and using an insulin pump, I still experience unpredictable fluctuations. I am 27 years old and fairly active, but my glucose levels swing from low (hypoglycemia) to high (hyperglycemia) without a clear reason. My last hemoglobin A1c was 7.4 percent, and recent tests show no kidney issues or complications, but I often feel exhausted and struggle with brain fog. I have tried adjusting my basal rates and carb ratios, but nothing seems to give me consistent control.

Could there be an issue with insulin absorption, like gastroparesis or stress hormones affecting my levels?
Would switching from an insulin pump to multiple daily injections help in some cases?
I have also read about dual-hormone artificial pancreas systems. Are they worth considering, or are they still too experimental?

Managing diabetes has been very frustrating, and sometimes it feels like no matter what I do, my body just won't cooperate. I would appreciate any suggestions for better control and ways to avoid burnout from constantly managing my condition.

Please help.

Thank you.

Kindly help.

Answer 1

Hello,

Welcome to icliniq.com.

I understand your concern.

Managing type 1 diabetes can be frustrating, especially with the unpredictable blood sugar swings you are experiencing. It sounds like you are doing all the right things, staying active, closely monitoring your blood sugar, and using an insulin pump, but a few things could be affecting your control:

Gastroparesis, which is delayed stomach emptying, might be an issue. It can slow down the absorption of insulin and cause unpredictable glucose levels, leading to swings between low and high blood sugar. If you are feeling full for longer after eating or having trouble with digestion, it could be worth discussing with your doctor.
Stress-related hormonal imbalances could also be playing a role. Stress can raise cortisol levels, which can increase blood sugar. You might want to try stress management techniques like meditation or mindfulness to see if that helps.

As for your treatment plan:

Switching from a pump to multiple daily injections is not usually recommended for most people with type 1, but it might work better for some. It depends on how your body responds to insulin. Some people find the pump complicated due to basal rate adjustments or issues with infusion sites, while others find it useful for more precise control. If you think your insulin absorption is inconsistent, you could discuss this option with your doctor.
Dual-hormone artificial pancreas systems are an exciting emerging treatment, but they are still experimental. These systems combine insulin with glucagon (which raises blood sugar) to help keep your levels more stable. They are not widely available yet, but you might be able to join a trial or study. For now, sticking with your current management plan and adjusting insulin doses is still the best approach.

To improve control and avoid burnout:

Regular follow-ups with your diabetes care team are key. Small changes to insulin types, meal planning, or bolus timing might help improve things.
If you are feeling exhausted or experiencing brain fog, it might be worth discussing your sleep and diet, or getting hormonal testing to check for other factors that might be affecting your health.
Finally, support networks (like diabetes coaching or group therapy) can help with burnout. Managing diabetes can be overwhelming, and talking to others in similar situations can ease the mental load.

Keep working closely with your healthcare team to try different strategies, and be patient with yourself. Diabetes management can take time, and it is okay to make adjustments along the way.

I hope you are satisfied with my answer.

For further queries, you can consult me at icliniq.

Thank you.