Saw my Endo today and my a1C was 8.2 which has the doctor worried as I average about 135-140 units of insulin a day even on an insulin pump. As he said "I have never seen someone’s a1C so bad on a pump. That was encouraging to hear. Me too.
He is trying to determine where my insulin resistance is coming from. He wants this blood test included in my next round of tests including c-peptide.
Depending upon my results he may try metforim(sp?) again as I tried this before starting insulin shots many years ago.
I hope he finds something out as using this much insulin is needless to say alarming. In fact, my basal rate was adjusted to 2.80 units all day long. 4 hours after eating 40 carbs for dinner with a correction bonus my BG is 175 after being 79 before eating.
What doesn’t help my situation is a terrible case of adhesive capsulitis for the past 3 years. It has involved many many hours of PT and 2 surgeries the latest in Jan 2013 that only brought minor relief for 12 weeks before it froze again. Much pain and range-of-motion around 30% at best on a good day.
I agree this is of concern. I just posted about my experience struggling with higher than desired blood sugars. But you are clearly having a much harder time than I am. First, there are some systemic reasons your blood sugar can be elevated. Infection and inflammation are clearly implicated. And you know you have inflammation, you have these terrible, painful capsulitis issues. But it could be even more. You could have a gum infection. You could have Lyme disease (perhaps this is why your doctor wants antibody tests). You might suffer from sleep apnea (I do). So I think it is good to explore these possible causes.
But it could also at least in part be due to accumulating insulin resistance over the years. It happens. And higher blood sugars make you more insulin resistant. An A1c of 8.2% corresponds to an average blood sugar of 190 mg/dl. You are probably spending a good bit of the day with an blood sugar well over 200 mg/dl and this alone can cause insulin resistance as your cells downregulate the uptake of glucose.
I think one option to explore is a low carb diet (at least lower than 40 g/meal) and see if that helps you normalize your blood sugars. Your swing after your meal suggests that your insulin dosing was too low. If you are consistently correcting after every meal, you need to adjust your ICR. I'm sure as a veteran you know this, but I know that I consider each change to my basal or ICR increasing my dosing as "bad." But it isn't when it just reflects your insulin needs. And in my opinion, you consume more insulin correcting a high after a meal than you would dosing for the meal properly in the first place.
I hope that is helpful and you get to the bottom of this soon.
