Hi I have been type 1 for almost 8 years. Recently I ran into diabetics who take less than 8 units of NovoLog or Humalog a day. I currently take 26 units of Lantus and around 15 units of NovoLog on a daily basis, which seems like an extraordinary amount compared to the above mentioned people. What scares me my endo never tried to lower it much, but the last thing I want to do is have my body to over indulge in insulin. I would love to take less insulin but I am scared I will be starving all day. Plus I am just becoming a vegetarian, which is hard, carb wise, due to soy proteins having decent amount of carbs in them. Any help or opinions would be awesome.
There really isnt such a thing as too much insulin. The most important issue is good blood sugar control without having highs or lows. But theres a catch, if you keep eating junk and sweets and needing to take insulin with it, you can gain weight, which can lead to needing more insulin. I would highly suggest you speak with your endo about your concerns and ask for them to point you to a good dietitian that can help you transition to a fully vegetarian diet and how to avoid overly carby food sources, or use them in moderation, and adjust your insulin accordingly.
You need what you need. The important thing is having decent control. I know a bunch of us here have said we find that we need more insulin as we get older - I know that is true with me. Your TDD of 41 units does not seem that bad. It is only slightly more than what I use. I have gone thru periods that I have used way more than that - when my thyroid went kaput, I had to practically triple the amount of insulin I was using (I was using a little less then but ended up taking about 100 units per day). Once my thyroid settled down, I was able to cut back on what I was using.
I can use up to 80 units a day… its a case of YDMV… some people are more sensitive, some eat more carbs, and some need a boatload of insulin to even nudge their numbers down… There really is no such thing as requiring too much insulin…but you can probably lessen your insulin requirements if it really bothers you by eating things with less carbs more often…
There is tremendous variation from person to person. That is because insulin resistance is, first of all, NOT specifically a Type 2 issue – ALL people have more or less insulin resistance, and fall on a bell-shaped curve that is a bit skewed to the right (meaning more insulin resistant). You may have more insulin resistance than some other Type 1’s, but your TDD is NOT really indicative of a problem when you consider that severely insulin-resistant Type 2’s can be using hundreds of units a day and still not get really good BGs. Non-diabetic people who tend to store their fat around their middles usually have insulin resistance; you just don’t know how many units they are producing daily because you can’t see it in a syringe, LOL!
Insulin usage also varies by the size of the person – a tiny 98 lb. woman is usually going to take less than a 190 lb. man!
It is hard to limit carbs as a vegetarian, but it can be done – there are several people on here who are doing it. Talk to Zoe about it – she has some very good ideas.
And just for comparison, I average about 35 units a day, and I know I have some insulin resistance. But I’m not really worried about it, because it’s still within a pretty normal range – I’ve been told the docs don’t worry about it until you get above 60 or 70 units a day!
Thanks, I have been living in NY for 10 months and been to a couple endos, but did not feel comfortable with any of them. I am seeing a new one in the next couple weeks and will pick his brain. I do not want to lose weight, just maybe a little body fat. I am 6 ft 1 and 180 pounds, so there is not much weight to come off.
I agree with everyone else. For me, too much insulin led to long-term weight gain but I was using insulin and food like something you’d buy in the parking lot at a Grateful Dead concert. I am running anywhere from 33-50U of Novolog/ day in my pump (20 day avg is 38, as I only have 20 days since my pump blew up…) so 41 seems like as good a spot as any? If you don’t see yourself gaining an unhealthy amount of weight, 41 should be fine?
Everyone is different on Insulin needs. I take 15 units of Lantus and about 15 of Humalog, depending on how many carbs I eat. Do you have an Insulin to carb ratio that you go by or are you eating to meet your dose? How are your blood sugars?
I’m about 5’7", 145 lbs, and take about 30 units per day. You’re a bit taller and heavier than I am, so your dose does not seem outrageous to me by any means.
8 units a day is exceptionally low. Not uncommon for someone in early LADA but still… exceptionally low.
“textbook” total daily doses are between 0.5 units per kg per day to 1 unit per kg a day. I think the 1 unit per kg per day is kinda old fashioned (means maybe out of a textbook 50 years old! but might be not far off for adolescents or pre-adolescents.) Using the lower number… that means for (say) average adult male at 75kg, expected total daily dose might be 37 units a day.
But it can vary a lot obviously. Hard to say what the “right number” is. If someone is in DKA a lot and losing large amounts of weight… pretty good sign that the doses are too low. If someone is going hypo constantly… pretty good sign the doses are too high. But those are just stating the obvious!
I think the recently-diagnosed LADA young adults are a little over-represented on the internet in terms of vocalness. For someone like you 8 years in… your experience probably counts for more.
One other thing to consider is units per shot? Bernstein touches on it in his book but shots of > 7U I think it is get absorbed differently. Right before I started pumping, I tried splitting my 20U or so N shots into 3-4 shots and it seemed to work better but it was probably for like 3 days and then I got the pump so I’m not sure if it was really an actual result?
I agree with everyone else, but if it makes you feel any better, I’ve been a type 1 diabetic for almost 12 years and use about 32-33 units of Lantus a day with my doses split up into 26 or 27 during the morning and 6 or 7 at night. If I go above 33 units total, I get bad lows at night. I also take quite a lot of Novolog too (maybe 15-20 units overall?) with my insulin to carb ratio but I try to go low carb as much as possible.
I have always had some insulin resistance (despite being in good shape) which has gotten a lot worse due to thyroid issues as well as lots of stress. However, I’ve been to a variety of endocrinologists throughout the past couple of years and none of them have really batted an eye at my insulin usage. I wouldn’t worry too much unless you notice yourself gaining tons of weight or your baseline numbers are running way too high or low.
I think the difference is that by splitting the NPH into 4 shots a day, it’s truly using it to get a flat-ish basal curve which is a big win over the more traditional (for say, the 1970’s) 1 or 2x a day NPH+R regime where the NPH is intended to peak out-of-phase with the R.
I did MDI with NPH as a basal for 20+ years and got excellent results. I was taking about 20U of N a day for basal, and did in 4 shots of 5 units each.
I remember in my teenage years some truly lopsided doses like 35 units of NPH in the morning. I actually did need twice that many units overall in my teenage years… but 35 units of NPH at once was hardly optimal in terms of timing and it was such a huge win when I switched to MDI (at like age… 19? 20?)
Actually, this inspires me to dig out a question I’ve thought about asking several times:
How few insulin is too few?
The thing is, it’s hard to answer. I recently met someone who’s taking 200+ units as a basal on a daily basis (and happens to be lean, so it’s not due to a higher weight)! That’s an amount that would kill me… I would never be able to eat enough, not even with eating pure sugar all day.
Until about 3 months ago, I took about the amount you’re taking. And suddenly, I seem to need much less insulin and can’t figure out why. Sure, I’ve lost weight (one factor for insulin need is your weight!) but my needs have decreased so much that I doubt it’s just the weight loss…
I think there are several factors than influence how man units a person needs.
e.g. to my experience, I can tolerate more insulin without going anywhere near a low if my bg is 140+ (and seem to need it) while the same amount of basal ts clearly too much for a bg <120. I don’t know how much of thruth is in this but that is my personal experience.
I think comparisons can be a bit dangerous. People really differ and people manage their diabetes in different ways. Some one on a very low carb regiment may use far less insulin than someone on a moderate carb regiment. I do not believe one is better than the other – it’s what works best for you. Also weight, exercise, stress, and lots of other factors play into the need for insulin. What is important is that you keep your BGs within a healthy range and that you do that with a combo of healthy eating, exercise, and insulin.
Would you be kind enough, please, to do a math example step by step? Every time I try to do this, my math doesn’t work. So I think I’m doing it wrong. But, my Lantus is approximately 42-43% of TDD. Thanks so much, either way.
To the OP:
Sometimes, other medical conditions, can also affect insulin usage. I was born with a diabetic autoimmune kidney disease, and because damaged kidneys cannot filter out all of the insulin, my insulin needs are low (TDD = about 18 units), plus I am very insulin sensitive. However, I am getting older and find that my needs are increasing some. Everyone needs what everyone needs. I was DX’d almost 30 years ago, and I am Type 1.
Hi Rotti: It’s not a question of taking too much insulin, it’s a question of taking the right amount of insulin to achieve your goals/good health. At 81.6 kgs and 41 TDD, you are in a good range (0.5 units per kg is excellent). 8 units is someone who is probably in their “honeymoon” phase, because that is REALLY low.
Don’t make the math too hard. Using the same example:
Average adult male = 75kg.
Use ballpark guess for TDD of 0.5 units per kg per day.
75 x 0.5 = 37.5 units TDD.
This works out pretty close for me
But it’s only a ballpark guess. 30 years ago the ballpark guess, BTW, was twice as high (circa 1.0 units per kg per day). But 30 years ago we didn’t have the same T1/T2 distinction we have today. In fact back then it was “juvenile diabetes” and “diabetes”. For adolescent T1’s the dose can in fact be much higher, I remember when I was a teenager taking upwards of 70 or 80 units a day, and that in fact was in line with the 1.0 unit per kg per day ballpark guess back then.
