I’m wondering, because my sugar levels have been very high and I asked my endo DR. if an insulin pump would be of any use to me and he says " no because your insulin resistant"
I’m getting frustrated for having my sugars so high and I’m doing all i can to keep it low, like eating healthy and exercising and every time i go to my endo he just either puts me on a fast acting insulin or gives me more meds. Might sound crazy but i feel like he is trying to kill me, i feel hopeless and I’m really thinking of going to another endo DR to get a second opinion.
Any opinions and suggestions would gladly be appreciated. Oh and by the way i am type 2 diabetic and I’m taking lantus insulin 52 units twice a day and oral im taking janumet 1000mg a day and taking apidra (carb counting 1 unit for every 10 carbs)
When I was first diagnosed I was 360 pounds and through exercise and eating right I am down to 277 pounds.
Some drs - and insurance companies - don’t want folks to have a pump unless they have their numbers under control. But I’ve talked to some educators who say sometimes people only get their numbers under control with a pump.
But my first question is, what do you consider “eating healthy”? The quickest way to get your numbers under control is to go low carb, which, by the way, will also help you lose more weight. Another question is - do you journal everything? I use a notebook to track each day - I write down what/when I eat, take my meds, exercise - everything. In this way, I can see trends.
What other medicines are you on besides Lantus, Apidra, and Janumet? Also, I don’t understand why you’re taking Janumet (a mix of Januvia + Metformin) when you’re taking both long and fast acting insulin. Januvia can definitely raise numbers for some people and has lots of side effects. You might stop that and just use metformin - it helps with weight for T2s, even those on insulin.
What about using your Apidra for corrections - has your doc talked about how to do this?
One other note - I had to switch from Lantus to Levemir because it put a few pounds on me and no matter what I did, made it harder to lose. After switching, it came off. For me, each pound can raise numbers. What other medicines are you on besides Lantus, Apidra, and Janumet?
The best advice I can give you is to get as educated about diabetes as you possibly can so that you take control of your disease. Here’s a good place to start - http://www.phlaunt.com/diabetes/
The only difference between you and a non insulin resistant person is you will use more insulin in your pump that a non insulin resistant person.
Your problem is that your doctor does not know the benefits from being on an insulin pump. I would find another doctor. It took me 2 years and 4 doctors to find one that would actually do the work to get me placed on a pump. If I had to do it all over again I would do it in a heartbeat.
I would call around and see if there is an endo in your area that is pro pump for type 2s. Do not take no for an answer from your insurance company. If they deny you appeal, appeal, appeal! It is worth the fight.
I would wonder if he is referring to the insurance and medicare requirements that you need to get a pump. Most will only contribute to a pump if your c-peptide is at or below 110% the lower limit of the labs reference range. In other words, you have to prove your not making insulin/or you have antibodies indicating type 1.
Great job you have done to go from 360 to 277 lb. keep it up.
Exercise is about the only thing I have found to help with insulin resistance. If you can somehow get a good night sleep that also helps a lot. some people have miraculous results with metformin not me.
You have reason to be suspicious of your present situation. In the case of extreme insulin resistance more insulin is possibly very counterproductive. I have had better results as far as BG goes cutting my lantus from 35 to 30 units twice per day and cutting my fast (novorapid) from 30 to 15 units total pre day. sounds illogical but I think it is possible to saturate the insulin receptors.
You must go on a zero carb diet for a while to break this vicious circle.
I have severe insulin resistance and hate the vicious circle but realistically how do you break it? I find I need a bolus (at least 2 units Novorapid) even for a small zero-carb meal, for example two fried eggs.
Danny, 1 unit insulin to cover 10 carbs is normal insulin sensitivity. Have you tried changing your I:C ratio? If you are really insulin resistant, 1:10 won't be enough.
Congratulations on the weight loss, and keep it up! :-) I agree with some of the comments above -- pumping U-500 is a real possibility. I hope you can get a doc who really looks at your problems and deals with them appropriately.
Hey Danny, Congratulations on your weight loss! Wonderful.
Just looking at your post you are on a pretty hefty dose of Lantus. Are you eating as low carb as possible? Diet is as important to the drugs you are taking. Another suggestion is to ask your Endo about Victoza to curb your appetite. With that much insulin you are likely very hungry at times. It would also help to reduce your insulin requirements.
As to a pump T-2s run the gam met from controlling their diabetes with diet and exercise to insulin dependent. It comes down to how much your pancreas is damaged. I know T-2's who have damaged pancreas and are insulin dependent and on pumps. They need insulin because they deficient similar to a T-1, not autoimmune but deficient non the less.
What is your C-Pep reading? Is it real low? If its high then diet is key and that is where a drug like Victoza may really help you get the control and reduction in insulin you want. If your pancreas is really damaged and not putting anything out then a pump may be an option.
If you dont feel comfortable with this course of treatment by all means go to another Dr. Good Luck
Well, an insulin pump can help you with finer levels of control, and it does not matter whether you are insulin resistant or not, it provides finer levels of control. But in the end, what really matters is your success with your diet, exercise and your ability to properly manage your insulin regime. If you can't establish why your blood sugars continue to be high, just increasing the button pushes and upping the insulin levels may just cause you to regain weight, something you don't want to do.
You deserve a pump as much as anyone. But it is my belief that before moving to a pump with a dozen bells and whistles, it is important to demonstrate that you can "drive the car." You can do that by getting your blood sugars under control on your basal-bolus regime. Two good books on insulin use are "Think Like a Pancreas" and "Using Insulin." You might as well just go buy them.
As a type 2, being a big guy and claiming insulin resistance, you would likely do very well on a low carb diet. Cheri has given you great advice, do visit the website she suggests. Can you tell us how many carbs you are eating? Do you think you could reduce it? Could you go below 150 g/day? How about below 100 g/day. The less carbs you eat, the less glucose you have to cover with insulin (it can also really help with weight loss).
ps. You have done a great job on the weight loss, don't you think for a minute this is not working. Have faith in yourself and be patient and persistant.
Get a second opinion. You have the right to an insulin pump as much as anyone else here does! Something that should be considered is that usually when transitioning from Lantus/Levemir to a pump, your basal dose may drop. Just the way a short-acting insulin as a basal vs. a long-acting insulin works is different. I went from 36 units of Lantus down to 28 when I started the pump. (I'm up again to 32 after 2 years, but I'm also resistant). In addition U-500 insulin could be used, which is more highly concentrated and made for people who are insulin resistant!
I guess I would kibosh (sorry for the technical term) the whole U-500 thing. Danny is not taking a lot of insulin and U-500 is potent stuff and you really can't control below 1/2 unit level. And you are right, everyone should have a right to be considered for a pump.
Learn all YOU can about diabetes and insulin resistance. It will take some of reading and research, but it is well worth it.Can you get the book mentioned Using Insulin by John Walsh? ( cheap on Amazon, no cost if you check it out from your local library.
Congrats on your weight loss. U really worked hard to lose that much weight.
Diabetes is an individual disease, very specific in treatments tailored to the person. You are on a lot of insulin, 104 units divided into 2 daily shots, as basal; plus your corrections/coverage with apidra. Have you tried, as another poster suggested, U-500 insulin? If your endo does not seem willing to help you find the info and the treatment you need, then it is time to move on to another doctor. You are not supposed to run very high blood glucose levels for long periods of time.. Has your endo even heard of U-500?
U-500 is a form of Regular insulin available special order from Lilly. It won't substitute for your basal, sorry. I don't believe there is any basal insulin available in U-500. You would use it in place of your apidra bolus for meals. So let's say you had a moderate carb meal, 20 grams, which with your I:C ratio you would normally require 2 units of apidra. Now with the U-500, you would require 0.4 units (it is 5 times stronger). You just won't be able to measure doses that low. You can get 1/2 units, but not tenths. For a further discussion of U-500, here is an article by Irl Hirsch (http://www.diabetesincontrol.com/articles/features/5651).
Well, he's taking 104u of Lantus as a basal, plus I don't know how many units of Apidra for meals. Seems to me that it is a lot of insulin. If he had a pump with a 300u reservoir, it wouldn't even last 3 days. But if his insurance would cover more frequent set changes, it might be doable.
Is the 32u your total basal for the day? What would a non-resistant basal rate be?
The party line is that obesity causes insulin resistance, and you are certainly not obese. So I wonder what the definition of resistance would be in the case of basal rates.
It COULD be used in a pump though. Pumps go as low as increments of 0.025 units. There is a way to even tell an Animas Ping pump (via the help of a company rep) that it's pumping U-500.
I'm assuming the endo's main issue with the pump was that he'd have to change the reservoir daily on U-100. I agree with Kari that the U-500 would help to get around that issue. But I can't say that I entirely disagree with with bsc's concerns surrounding potency either (mistakes are made by the best of us!). Something to consider, but to be entered into very cautiously.
Danny, it's been 1.5 years since you posted this, if you're around, let us know how you're doing! I hope you've kept things going well, that was great to see!
