So when I was diagnosed about two years ago, I was diagnosed as Type 2, I was placed on metformin along with a number of different meds, but my A1C was still between 10-11 range. At that point I was reffered to endocronologist and I was diagnosed there as a Type 1.5. I was placed on Lantus and novolog and was still having high numbers. Then July of 08 I was placed on an insulin pump, and I’m still having these high readings all the time. My fasting my BG in the morning is always about 200, and I can eat two hard boiled eggs and piece of toast for breakfast and two hrs later my BG’s are in the 250 range. Right now my bolus ratio is 1unit=8grms of carbs and my basal is about 1.125 units an hr. It just seems my A1C was the same while I was talking oral meds. Is it possible that my Doctor could place me on a combination of insulin and oral meds?
Metformin for me did not work the average blood sugars and their standard deviations were the same with and without the drug. Insulin must work if you take enough of it. At 1.125 per hour that’s 27 units per day of basal. How much do you weight approximately? and how many carbs a day do you eat? If you cannot estimated list the approximate amounts and what you eat during the day.
If your fasting in the morning is way too high your basal rate is much too low.
Skip the toast till this gets straightened out. eat another egg. Could be that the 1unit=8 carbs is too low also. hard to say before basal is fixed.
It is not illogical to take metformin and insulin for some people it works
Sorry to hear about all the highs. How frustrating!!
It definitely could be something that you try! I know we have some members using both oral medications to fight insulin resistance and insulin pumps/ injections.
Ask you doctor if you can try this!!
It is possibile. Several times people are placed on multiple therapies. I wonder though, if two other things might help. With the pump you should be able to test and adjust throughout the day. You do not mention a test and adjust pattern but, if you do not have one, you may want to ask the doctor. Also do you know what setting your pump regards as normal. Mine is 100 and the pump is continually driving me toward 100.
I think maybe instead of adding meds, you should ask for a diabetic educator and/or a pump specialist. With increased testing and a good correction strategy you can likely bring it down without adding oral meds.
I am a T1 with insulin resistance (best of both worlds!). My problem was meals, I could eat a 40 carb meal and have 2hr numbers approaching 300. I have tried metformin with my pumping, but it didn’t help me. What did was Symlin. The Symlin helps make my insulin more effective. Check out www.symlin.com. It has been such a dramatic tool for me that I wish I had found it years ago.
Being 50 points higher at 2 hours is not that bad so your carb ratio doesn’t sound bad, overall it sounds like your basal rates my need to adjusted up some tho. When I started symlin, I was able to lower my ratios and basal rates, it has made tuning things much easier.
I would talk to your endo about the possibility of metformin or symlin and also get with an educator to work on your basals. Personally, I have 4 different rates. 0.6 from 10pm to 6am, 1.55 6am to 11am, 1.0 from 11am to 4pm and 1.6 from 4pm to 10pm. I also have different carb ratios set for different times of the day. It’s different for everyone, but multiple settings per day are not unusual at all.
Well, those have been my experiences anyway. Good luck with getting things working better, I know this has to be frustrating for you! Hang in there and let us know how things go!
When you added the symlin to your therapy, by how much did your daily insulin requirements drop?
I also tried metformin with insulin not sure it helped that much and it makes me sick. too bad because it is dirt cheap and does marvels for some people.
Sounds great on a pump that you can adjust dosages much more easily than on injections. I was thinking of getting a pump but I toss and turn so much at night not sure if this would be possible. Also I would have to pay 100% out of my own pocket so if the thing was a bust it would be quite a hit. would be good if you could rent one for a month a see what happens.
I have become so insulin resistant that now I need about 1 unit of insulin per 2 grams of carb. Makes a slice of bread expensive both health wise and money wise. what do you think you need as a ratio?
I am trying a pill called meridia to loose weight not sure if it will work? Also about 1 hour of exercise per day as faithfully as possible. Not sure if that helps weight loss but really helps your general health like lipids and BP and body strenght.
Being insulin deficient and resistant at the same time is a real nightmare. Do you have any other thoughts of what we should do? I am not sure if symlin is available in Canada? Mentioned it to endo he did not respond ! I was reading the insulin resistance article on wikipedia sounds pretty complex. Apparently removing some part of the digestive system helps insulin resistance a lot. It is possible they say that the part removed produces some chemical that counteracts insulin. But so far this is speculation. Give it a read and let us know your thoughts?
The pump is great, after nearly 40 years of MDI, it was different, but so much better. I toss and turn all nite too, the pump handles it just fine. I just sleep in shorts or whatever that have a pocket on them, clip it in there and I don’t even notice it. They are expensive, but medtronic gave me a 45-day trail period and have a payment plan you can use. Mine costs be $55 a month until the balance is paid. It has been worth it for me, even tho I had a helluva lot more problems getting started with it than most do. If you’re really curious, read some of my blogs. Excuse all the dashes in the tables please, this editor decided it had to help me format them by removing all the extra spaces, thereby making it pretty much unreadable
here are my before-symlin and after-symlin settings. The after numbers aren’t final tho, that was just after a two week sample. I was finally able to get it approved by insurance, so I think there is still room for improvement…
Before ----- After
12a 1:5 ----- 1:8
06a 1:4 ----- 1:5
11a 1:5 ----- 1:7
.4p 1:4 ----- 1:5
Before ------ After
12a 0.9 ----- 0.7
06a 1.5 ----- 1.55
11a 1.3 ----- 1.1
.4p 1.5 ----- 1.6
10p 0.9 ----- 0.7
I don’t know if Symlin is available in Canada or not, it may be marketed under a different name. It is a synthetic form of the human hormone amylin. The way it was explained to me was wherever you find insulin in the body, you will also finde amylin. From my experience, I would definitely try to at least get a sample. The effect was immediate with that first injection of it, no waiting for 2-3 weeks like with metformin.
I still don’t really understand insulin resistance either. For me, I’m wondering if it is more of a reaction to the insulin analogs I’ve been taking for the last 25 years instead of real insulin. I don’t know, I know I just don’t like the long-term on this. The question I keep asking myself is “Is my insulin resistance going to increase? What happens when I am totally resistant to insulin?” There just doesn’t seem to be a happy answer to that.
I just re-read this and I think I need to clear it up a bit. From what you said, IMO, you need to focus on your basal rates first. Then look at adding something in. I’m not a doctor, did not stay at a Holiday Inn Express last night, so this is just my opinion. It just just seems that your pumping could use a little fine tuning. If you look at my blog entry Jumping the Shark, you can see what the blood sugar patterns of a T1 with insulin resistance looks like. What do yours look like?
Thanks for the suggestions, I currently weigh 180lbs,which is about 35lbs more than what I should, I’ve gained that in about the last year. As for eating I have a pretty busy schedule, Tues and Thursday are my days off but I have school those does from 8:30 am to 1:00pm. On those days I grab a piece a fruit, granola bar, or to be honest sometimes I dont eat at all. So when I’m fasting in the morning I’m in the 250’s I usually wait to eat my moring snack until about 10:00 am (BTW which is my most boring class). When I check my BG again around 12:30, my BG is either around 170 sometimes a little higher and or a little lower, I just feel for the amount of food I’m eating and I’m running around campus that my BG is way too high for that amount of food. I’ll pick up lunch on my way home those days and usually I’ll eat a sandwich for subway which about 45carbs, I also do take smylin which I forgot to mention. The smylin does help at first but it seems asif I always spike 4 hrs after the smylin. Dinner I eat really lite usually a piece of chicken (or protein of some sort) and a salad, and some veggies or a small baked potato. I’ll usually take smylin with my dinner and before I go to bed I’m usually within the 140 range but I still have enough insulin on board to reach my target. I do check my BG in the middle of the night sometimes and BG levels can be from 103 to 180 but it seems like after 5:00am is when I spike up into the 250 level. The bigger problem is the the other days of the week I work swing shift so I go in to work at around 3 to 11pm. On those days I usually don’t wake up till about 11 am so I’ll eat lunch usually no more than 60carbs and I’ll even take the smylin and my BG are either in the 300 level or high 200 level. Once I get to work things only get worse, my job gives me alot of anxiety and its kind of stressful, so within the first couple of hours I’m there I’m constantly checking my sugars and I"m usually always high, its not till around lunch time at about 7pm that my levels can be from 100 to 180, it just depends on the day and what time I get sent to lunch. However when I go to lunch at that time I’m usually not hunger so I’ll eat really lite usually a small chicken salad, and by the time I get off of work I’m driving home with either a normal be BG level in 90’s or I’m somewhere in the 60’s. Its when I get home and I get hunger at this point, I’ll eat whatevers in the fridge and in the middle of night of those nights even if I know counted my carbs right my BG sometimes can reach the 400 level sometimes I feel like I’m more insulin resistant when I eat late at night, does that make sense?? I KNOW I shouldn’t be eating that late but I haven’t made the commitment to change it…
I’ve never heard of this test and adjust pattern I’ll definetley ask my doctor about. Just so I know a little about it could you explain to me what it is? My setting for my pump for normal is about 110. I did ask my doctor to set me up with a pump specialist in September of 08, and honestly I’ve met with the same lady before and she wasn’t very helpful I met with her twice and she basically coverd the basics of the pump. What upset me even more is that my insurance did not cover me meeting with her so I had to pay out my pocket. I’m just curious is it typically for most insurances not to cover a diabetes educator?
One other area you might want to take a closer look at is your carbs. What kind are you eating - white rice as opposed to brown? white flours as opposed to wheat? You may be suffering from digestive issues where it’s taking longer for your body to absorb the nutrients from food. If after verifying that your pump rates are accurate you may want to explore with your doctor going on a low glycemic index diet. My two cents worth after 44 years of type 1 experience. Good Luck.
yea, different schedules on different days of the week can jack things up. I know my weekend numbers are often odd as I tend to stay up alot later than normal and usually skip breakfasts…
Often a 4hr spike is indicative of a basal rate that is too low. There is a book that gives great pumping info called Pumping Insulin: Everything You Need For Success On A Smart Insulin… by John Walsh and Ruth Roberts. It could help alot if insurance won’t cover education (I can hear it now … “insulin pump? sure, not problem, but you’re nuts if you think we’ll cover training you how to use it” /grumble)
The description you gave above is a little hard to sort out, have you kept a log of times, carbs, dosages? Tuning pumping is all about info. You have to know what and when to really get a hold of it. It really sounds like you have been on your own with it since you got started, so I honestly think you just need to really stop and take an honest look at your numbers. That’s not saying anything bad about you, I had to do exactly the same thing. Only then was I able to really understand WTF was going on.
What type of pump do you have? I have a Minimed and their site has Fine Tuning worksheets that can help you fine tune your settings. They recommended starting with your overnight rate, getting a fasting morning sugar in range then moving on to the daytime number then the evening numbers.
Just out of curiousity how (what kind of blood work was needed) and when did you find out you were T1 with insulin resistance? When I was diagnosed by my endo in Nov of 07 with “Type 1”, my doctor never you used the term Type 1.5 LADA, he bascially he said that my test results came back inconclusive. I remember him saying that my body still made some insulin but eventually over time I would stop making insulin and I would be considered a Type 1 person later in life. I saw the endocronologist twice and I’ve been seeing his P.A. ever since. the PA I see just refers to me as type 1, does it really matter wether I’m referred to as a type 1 or type 1.5? Anyways I’m actually taking insulin now, I’ve been on it since about September I take about 60 micrograms for my heavier meals. The thing is I get incredibly nauseous with the symlin, so on days that I have to work its hard for me to take the symlin and then have to start getting ready for work. I’ve tried lowering the dose and it doesn’t seem to work as well. The only thing with the symlin at times is that I’ll spike maybe 4hrs after eating, its really strange. I have another question for you Scott, (I’m probably gonna have a million other questions in the future so I apologize now) did you work with an diabetes educator to adjust your carb rates and basal rates, or is that something that you worked on by yourself? I just feel like I go see my doctor and I’m with him for the max of 10 minutes and then he’s off to the next patient. I’m not expecting my doctor to take care of my health for me, but atleast guide me in the right direction, I feel so lost…
I’m certainly no expert! However I have read that stress can cause your BG levels to increase. It seems to me that it’s a combination of the food choices and stress.
I would talk to your doctor… create a diary of your stress level, activity level, and food choices along with all your BG tests and medications. If he has that kind of information to review perhaps he can find a better solution for you.
I hope you are able to gain better control soon.
Well, I’ve been T1 since 1970, I was seven at the time. Insulin resistance is just the latest wrench in the works, that determination was made about a month ago, but the symptoms have been there for 3 or 4 years.
LOL, there are so many types of diabetes now, I can’t keep 'em straight! As I understand it, LADA is juvenile diabetes (T1) that occurs after you become an adult, what the differences are past that, I’m not sure.
I also went thru a honeymoon period (most diabetics do) where my body produced some insulin, but it eventually stopped. I really don’t remember how long that period lasted, I barely remember what I had for breakfast. Symlin also makes me nauseous at times, sometimes bad, sometimes not.
Boy, not being able to take the symlin on days you work could really mess up numbers. Do you adjust your carb ratio on those days?
I’m on my second educator since starting to pump last October (the first one got fired), but I tend to do my own adjustments at this point. Sometimes I have a question tho, usually when I “can’t see the forest for the trees”, most of our contact is actually thru email. But she was the one who saw the resistance and suggested Symlin (I gave her a gold star for that). Before I started the symlin, my numbers would run so high 2 hours after meals, that it was impossible to set basal rates correctly. There were a number of times that I almost stopped pumping, luckily I had a lot of support from the folks here. One of my favorite sayings is “There is a fine line between perseverance and stupidity”. I cross that line alot.
I do have MUCH more contact with my educator than my endo. I know my CDE will discuss things with her when needed, but I only see her 3 or 4 times a year, whereas I often chat with my educator on a weekly basis at least.
Yea, guidance is what we need. We have to really do this ourselves because we’re the only ones who really have the time for all the day-in, day-out crap we have to deal with. Not to mention that our health is our responsibility, educators and doctors can only be advisers to us
Thanks a million for such a thorough answer. It does seem like pump is the thing, here in Canada I do not have any coverage for that so it is totally out of pocket both pump cost and supplies. Symlin sounds good too but is not available except as a mercy mission and that takes big bucks for lobbying the Govt.and mucho red tape. and anyways they would say I am perfectly fine with an A1c below 7% so no dice. the fact that I am gaining 10 lb per year on insulin is my fault because I have no will power This worries me as I now need 1 unit per 2 grams of carb. I am worried why the insulin is no longer working. May be I should change from novorapid to some other insulin. Can see endo only once a year. So will have to wait unless GP will be nice enough to give prescription. Do you change insulins once in a while?
My personal opinion is that if your blood sugars are above a “normal” range most of the time, you will gain weight. If your sugars are high, your liver will store what it can and your body will covert the extra sugars to fat. This happens because this is what the human body does. If there is so much sugar that your body can’t convert it fast enough, it will flush it from your body in urine.
The problem with that A1c number is that it is an average. And, at least in the States, 6.5% is what the medical community is shooting for now, although a lot of the insurance companies hang on to that 7% number.
I was on Humalog forever and I switched because I seemed to be having an immune response to it. I didn’t notice it until I started pumping, but I would end up with knots at my infusion sites and often the insulin would seep back out. I switched to Novalog, but it seemed to stay in my body for too long. Now I am on Apidra and it seems to be working well.
Yes if God had been kind to us he would have suppressed appetite if BG are high. If your theory is right then cutting down on insulin to loose weight is a bad idea. Other theories say the opposite that more insulin makes more fat. It would be nice to know for sure. From a pure thermodynamics thinking I would not be suprised that your theory is correct. The more there is in the blood the more driving force there is for storage.
It also takes less energy to convert carbs to fat than it does to go the other way… that whole “conservation of energy” thing… lol.
It’s all about balance. Too much insulin drives consumption of carbs, I bounce high quite often if I am not careful from lows. Not enough insulin and your body wants to make fat. It seems like only in the middle can we actually control what happens
Oh, and I think we hijacked Giovanna’s thread
If you are somewaht insulin resistant and assuming your pancreas is not longer working much. You would need a minimun of 0.7 IU of insulin per kg of body weight per day and this for a low carb diet (for a normal carb diet may be 50% more.) which works out to 57 IU per day for low carb and 85 for a normal non diabetic diet, are you taking at least that much. I tend to eat quite a bit at night a really bad idea as you know this skyrockets the BG. If you have to, make the nightime meal as close to zero carbs as possible.
Could be dangerous to drive in the 60’s may be you should eat something 15 minutes before starting.
You could be like Scott and I pancreas dead and insulin resistant not a good thing mades BG control very dificult.
Pop a few vitamin D tablets up to 1200 iu per day most diabetics are deficient it is supposed to help a bit with insulin resistance. Otherwise I dont know what causes insulin resistance. But it seems to increase year after year making me worried. Of course everybody seems to agree on loosing weight but dificult to see how without being incarcerated in a dungeon for 6 months.
Metformin does not work for me but some people it does can be added to insulin.