Extreme Insulin Resistance?

Hi all,

I signed up at tudiabetes a while ago, but have only recently begun to stalk the forums. Was diagnosed in 2008 with diabetes…reading in the 500s. Did a ton of research initially, found Dr. Bernstein and followed an extremely low carb diet, kicked up the exercise, went on Metformin and dropped by A1C almost 4 points. Life happened…separation, divorce, 4 kids, working, part-time grad student and I buried my diabetic head in the sand. I was hospitalized in January 2010 with readings near 700…started Levimir and later that year Novolog. Still didn’t take my diabetes seriously, very poor self-care and was told nothing about how to use insulin. Fast forward to about a month ago. Several situations made “it” click with me…that diabetes is real, that it will not go away, and I will still have it (and develop complications) regardless of whether I pay attention to it.

So, I began researching insulin, how it works…basal and bolus…kindled “How to Think Like a Pancreas” and have figured out a few things. I know my Novolog ratio is 1:25, and my I:C is about 1:6. It does seem like it takes forever for my Novolog to kick in. I read a post by some else who said he was extremely insulin resistance, which I beginning to think may be my situation as well. Once the Novolog kicks in I can drop pretty fast (at the 3-5 hour mark, but not always consistently). This was challenging to monitor as first as then I had to deal with correcting lows.
I am also very reactive to exercise. I would go hypo during/after exercise before I was diagnosed with diabetes. I can drop anywhere from 20-100 points after a 45 minute walk, without insulin on board.

So, my long winded introduction-set-up to ask… what is the best way to test when the novolog kicks in? Frequent bg readings? How do others with these variables manage? How do you combat the weight gain that increased insulin contributes to by causing increased resistance? Since I have been using insulin appropriately to maintain good numbers, I’ve gained 15 pounds…in a couple of weeks. I know I’ve thrown a lot out there, but would appreciate any advice.

OK - I’m a little confused. You say your Novolog ratio is 1:25, which I’m guessing is 1 unit for 25 grams of carbs? But your I:C is 1:6? Which means 1 unit for 6 grams of carbs. Which is it?

I do believe Novolog takes the longest to kick in out of all the rapid-acting insulins. When I’m more insulin resistant (like first thing in the morning), I usually take my Apidra 20 minutes ahead of time to give it some time to work. I would probably give longer for Novolog, but that’s just me. I can’t tell from the numbers you gave if you seem to be very resistant or not. Most folks with severe insulin resistant take 50-100 units of Lantus a day and some even have 2:1 I:C ratios. In the most severe cases, U500 insulin is used. Compare that to, say me, at a total daily dose of about 20 units of Apidra.

As for the weight gain, it sounds like you’re probably gaining weight you lost from having very high numbers for a long period of time. Too much insulin can cause weight gain because of the calories you need to take in to prevent or halt low blood sugar episodes, but it can also cause weight gain when finally getting things under control because you’re actually using the carbs you eat instead of peeing them out.

Thanks for your reply, Kimberly. I’m probably not using the correct terms. When I need to correct my bg, 1 unit of Novolog lowers my numbers by 25. When I’m bolusing I plan 1 unit for 6 grams of carbs.

I do take 60 units of Levimir at night, and average 30 units of Novolog during the day. I still struggle to have am numbers under 190.

Welcome. I’m glad you found us. One of the things you need to understand about the book “Think Like a Pancreas” (and “Using Insulin”) is that they are written focused on insulin regimes for type 1s with normal insulin sensitivity on the ADA recommended diet. You may fit none of those criteria. As a type 2, if you are insulin resistant, your I:C and correction factor will be different than calculated in those books.

If you can find a diabetes center, they could really help you get your basal properly set and help determine appropriate I:C and correction factors. We can help you with suggestions, but if you are able to get local help that can be even more helpful. And many of us struggle with insulin and exercise. Maintaining consistency helps, exercise every day. You may find that certain times are not good for exercise, like right after meals or in the morning. And finally, many of us have found that a low carb diet makes a “HUGE” difference.


Thanks for your information. I probably knew that different food affect the timing of blood sugar increases (like fiber and fat) but hadn’t remembered that. That’s another good thing to add into this ever growing list of things to track.

I also appreciated the reminder not to add just “more” insulin. Once I finally resolved myself to use insulin, I have been using to get the numbers in line. While I’ve felt better being more consistent, I’m seeing the results of extra insulin. Really good reminder to use diet & exercise as corrective (and preventative) measures.

Thanks for taking the time to share your advice.

Thanks bsc, for your reply. Would you suggest using the guidelines in the Think Like a Pancreas book at least as a starting point? I’ve really been trying to track all aspects what effects my blood sugars. I’ve not been very good at keeping things consistent, but do see good results when I do.

I know my blood sugar levels do respond well to low carb…but I do admit, I’m having a hard time doing what I know I should do. Do you have pretty consistent meals? Could you give me an example of what your meals look like in a day?

Thanks again for replying.

I think it is fine to use these guidelines as a starting point, but you should do your own testing to establish you basal levels and proper ratios. You should first get your basal levels established through basal testing. Then you can use testing to again establish appropriate I:C and correction factors. If you are truly insulin resistant, you will likely find you need a markedly higher basal level and you I:C is more like 1:2 and correction factor is like 10. But the only way to find out is through careful testing. Don’t go an just “use” an I:C of 1:2, if you aren’t insulin sensitive you will have a bad hypo. Not good.

And I do have very consistent controlled meals. My diet is my first line treatment, I make my diet choices first, then I implement my insulin regime. I follow a low carb diet, 75-100g/day. I am a big guy. I prepare most of my own food, I do all the family cooking. I basically eat the same breakfast every day from just a limited selections, protein shakes and eggs and meat are the standards. For lunch, during the week, I’ll have a core 4-8 oz meat/seafood entree and veggie sides, typically a salad, a bag or box of frozen veggies. Then for dinner, I’ll have a very similar meal, meat/seafood 8oz-1lb, 2-3 veggie sides. I don’t count calories, I only count carb equivalents. My goto snacks are nuts, cheese, deli meat and cottage cheese. I keep my meals generally under 30g of carbs.

If your basal dosage does not cover your needs it can feel like being insulin resistant. In reality you are misusing some of your Novolog to act as the missing basal insulin. One indication for that is the ongoing need for corrections. Thus it is important to find out if your basal needs are truly covered. The basal rate test should be covered in “Think like a Pancreas”.

If you are really insulin resistant then a combination therapy of Insulin and Metformin can be helpful. The Metformin will moderate the glucose release of the liver. With less glucose in the blood stream the Novolog can be utilized primarily to cover your meal. As a side effect you will need less insulin and this likely leads to less weight problems. We have some members here with great success on this combination. But expect that your doctor will not like the idea.

I would not call your situation extreme insulin resistance since 1/6 I/C ration is not extreme and your sensitivity to exercise is a good sign.

You made a lot of good points, and gave me some more to think about! I have thought about splitting my Levimir. I have always had higher am numbers (even when I had good control), so I would probably do a higher percentage at night. I do see an increase after 12 hours of Levimir, so that would probably be a good time for the am split.

It’s interesting that you suggested a mis-diagnosis. I’ve never even considered that, but after your post remembered that the first diabetes educator wondered if I could be a 1.5 because the onset was pretty dramatic. I’ll add the GAD65 to my talk to doc list.

I’ve not had any signs of neuropathy. In fact, just had my diabetes eye exam today and all was good…no signs of any damage. I’ve heard that dropping the A1C too quickly can have negative results…do you experience that?

I do appreciate your response. This is such a learning process and I’m thankful for those who are farther along on the journey who are willing to share!

Thanks for your reply. I did reread the basal calculations in “Think Like a Pancreas” and should probably bump up some. Your point about not having enough basal insulin to cover my needs was thought provoking. That really makes sense. I’m really thinking that I need to split the basal dosage between pm & am, because I notice an increase in bg numbers about 12 hours after I take the Levimir the night before, even when I only have a 4 carb protein shake for breakfast. Look like the experiment continues!

I do take Metformin, but I’m not sure how much that helps. What type of combination are you aware of that seems to work for other members? I’d be interested to learn more.

Thanks again for adding to my knowledge!

Yeah…I like a good sign. I’ll take it.