Insulin resistance. What is it? If you google the term, you will find a standard definition of “the condition in which normal amounts of insulin are inadequate to produce a normal insulin response from fat, muscle and liver cells” or “condition in which the body produces insulin but does not use it properly”. While looking up the definition, there were references to type 2 diabetes or pre-diabetes. What about in people with type 1?
I was told by my old CDE that I am insulin resistant. She thought it could have come from the genes of my type 2 maternal grandfather. If this is medically possible, I’m not certain. What I am certain of is that there are times like yesterday afternoon when I cannot seem to get my blood glucose to a near normal range when it’s high no matter how much insulin I take. If you follow me on twitter, you would have seen my frustrated tweets yesterday when my BG went up to a good 350 mg/dl after lunch (around 2pm) and it took until about 6pm to start coming down. This was after I had upped my basal rate by 40% that entire time and took not one, but two correction boluses that my pump didn’t calculate for having insulin on board. I was running around 100 for a few hours prior to that, my infusion set had been working fine for over a day already and I checked the tubing for bubbles. Nothing. There should have been no reason why the insulin I delivered in those 4 hours, should have taken that long to work.
I don’t like when my BG is that high. Especially since I am working hard at managing my diabetes, I don’t like when it’s that high. I accept that I will have elevated readings at times. My pancreas doesn’t work for Pete’s sake! But when I am monitoring my readings every 5 minutes thanks to my continuous glucose monitor and correcting for high BG immediately, I don’t anticipate being out of range by that much for too long. But yet it happens. No matter what I do. I am trying to exercise on a regular basis as I know this helps increase insulin sensitivity and I eat pretty healthy. I’m not sure what else I can do to improve this situation but will be asking my CDE or endo about it at my next appointment. Does anyone else have any experiences with this sort of thing? I’m all ears for suggestions or stories!
Well, one thing to check is that it isn’t your insulin. When a bottle goes bad on me, I usually see a few days requiring higher basals, which I attribute to hormones, stress, etc, until finally hitting a point where corrections don’t seem to work… Then trying a fresh bottle and seeing a huge change in insulin requirements….
I think that some of us are just not as insulin sensitive as others. Sometimes, there’s no reason for it, which is very frustrating. For me, a big factor is my weight. If I’m at a point where I’ve gained weight (like now), I see my insulin needs increase dramatically. When I lose weight, my TDD goes down, too.
Unfortunately, my Dexcom looks like your photo more often than I would like. Starting next week, I’m going to stick to a very low-carb meal plan, which will lessen the spikes (for me). Have you ever tried that?
Wishing you better numbers today!
I’ve found when my sugar’s that high that it’s often really, really hard to bring it down. I think it’s the liver releasing glycogen trying to get glucose to your cells? Although I may be completely off-base. But I find I need to take way, way more insulin than is calculated by my pump for smaller corrections, often double, and I need to raise my basal like you did, or else my bg will keep climbing. (When I go high in the middle of the night, above 200, I’ll often end up soaring because my basals are so low at night they just can’t keep up.) Not sure if that’s your problem or if it’s something more.
Like I tweeted yesterday, I also always inject by syringe when I’m that high…I keep a syringe with 5 units in my pump case, and empty/refill it every couple weeks if I haven’t used it, so that I don’t have to carry around an unrefrigerated insulin bottle.
I would call your GI (or “our GI,lol) and run it by her also. Could be slow digestion too
My endo’s have warned about insulin resistance from the beginning, especially for type I’s… because we are on insulin for so long (a lifetime for most…) we can become resistant. This is where the lines between type I and II blur for me. Eating less carbs and exercising decreases the need for insulin (a little) and then my “resistance” goes away (some)… but this is just me. Try cutting your carbs at lunch. Try not to get frustrated – that just makes the sugars higher! :I
Hope that all makes sense. I’m 65 right now.
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I have been talking to my doctor about Metformin, a type 2 drug used to treat insulin resistance. Seems that more and more Type 1s with insulin resistance are using it with great success. In the past, my doctors have not been too keen on the idea, but they seem to be much more receptive these days. You might also look into Symlin which helps with after meal spikes. Symlin was a no-go for me because of my delayed digestion. Here is a great post by Amy at Diabetes Mine about Type 1 and Metformin: http://www.diabetesmine.com/2010/01/metformin-for-type-1-diabetes-really-why.html.
2nd attempt — last comment was eaten!
I have been talking to my doctors about Metformin, a Type 2 drug used to treat insulin resistance. It seems that more and more Type 1s with insulin resistance are using it with great success. In the past, my doctors have not been too keen on the idea, but they seem more receptive now. You might also look into Symlin, which helps with after-meal spikes. Symlin was a no-go for me because of my delayed digestion. Here is a great post by Amy at Diabetes Mine about Type 1s and Metformin: http://www.diabetesmine.com/2010/01/metformin-for-type-1-diabetes-really-why.html
I have been talking to my doctors about Metformin, a Type2 drug for insulin resistance. It seems that many Type 1s with insulin resistance are using it now with great success. In the past, my doctors have not been very keen on my trying it, but now they seem more receptive. You might also look into Symlin, which helps with after-dinner spikes. Symlin was a no-go for me because of my delayed digestion. Here is a great post by Amy at Diabetes Mine about Type 1s and Metformin: http://www.diabetesmine.com/2010/01/metformin-for-type-1-diabetes-really-why.html
I have been talking to my doctors about Metformin, a Type2 drug for insulin resistance. It seems that many Type 1s with insulin resistance are using it now with great success. In the past, my doctors have not been very keen on my trying it, but now they seem more receptive. You might also look into Symlin, which helps with after-dinner spikes. Symlin was a no-go for me because of my delayed digestion.
i hear you. I was told by my first CDE that it takes more insulin to correct a very high glucose than it does for a semi high glucose. So I typically increase my correction factor if I am > 250 (my correction factor is 1:50, but I would do 1:30 or so if > 250) Unless it is overnight, overnight, my correction is 1:75, I am super sensitive overnight.
D doesn’t make sense, at least we all have that in common…
I wish this disease was more cut and dry for you, I hate to see you frustrated, especially when I know you try so hard. Keep up your good work though!
For the high highs, I find that Caleb’s correction factor is a whole different ballgame. I had been using a superbolus (adding the scheduled basal for the next two hours to the correction bolus and then turning off the basal for two hours) to get him down quickly without risking a low. But I noticed that he actually needed that increased amount of bolus AND to leave the basal as is. It’s as if he needs 150% correction factor for something above 300, and usually an increased basal as well.
Yeah I also use a different correction factor for numbers above 300. I don’t have it down to an exact science, but an endo once told me that the higher the BG is the larger ratio it takes to bring it down. UGH, good luck w/ these highs!