Humalog sometimes doing nothing?

Sometimes it is maddening how my Humalog does not seem to do anything. I see the BG slowly climbing, so I administer a correction shot. It maybe stops a little, but then continues to climb. Argh!

But then, mealtime bolus does seem to work.

I have no idea what this is. It is very frustrating though. This mostly happens in the morning, but sometimes also at other times during the day.

Any explanation for this? Is there something like a “fasting BG insulin resistance”?

I had some issues as well when I started Humalog. Sometimes it worked wonderfully and predictably, other times I may as well have been injecting water.

One day a 20g carb meal with 4 units to cover (I was 110ish before the meal) pushed me to 260 despite a 30 minute pre bolus. When I added a correction I noticed the dosage window didn’t “wind down” as it normally did, there was a fair bit of pressure required to push the plunger and it skipped and did a quick jump to zero. I did a bunch of air shots and roughly half the time that pen would not deliver ANY insulin.

After that episode I grabbed a new pen, and any time I gave myself Humalog I made sure to take my time and look closely at the dosage window while administering the shot. I began to notice a trend that as my pens got older (1.5-2 weeks) they began to require more pressure to get the dose out and would begin to “skip doses”. A call to the manufacturer suggested it was the needles I was using (Bd micro), though the same needles work perfectly with my Tresiba.

I didn’t have any problems with other pens I’ve used. I really preferred the click, click, click feel of my Novalog pens and Tresiba pens. Its my personal opinion that the Humalog pens are cheap junk. Unfortunately Humalog is the only rapid insulin my insurance covers…

At my last endo visit I requested the non disposable Humolog luxura hd pen that uses vials of insulin. So far I’m really happy with it. its been 2.5 months so far and it hasn’t skipped a beat. With the disposable quick pen when I’d prime it sometimes it would just dribble, others it would produce a steady stream (I always purged all the air and most days spent more insulin priming than I used for my dose). The Luxura always produces the same size stream for a 2u prime once air bubbles are purged.

So far I’m really happy with the non disposable pen and vials. The only downside is the pen is HUGE compared to the disposables, Though its worth it to me as the anxiety of wondering weather or not I received my dose was really uncomfortable. As a side note I use the same pen needles (some from the same box) on the Humalog luxura and have not had a single stiff plunger, which was becoming a common occurrence after a week and a half or so with the quick pen.

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I am using a Pendiq 2.0. These do have a good reputation, but perhaps mine is broken?

Anyway, I am observing something very unsettling. Bolus is totally broken for me!

Here is a screenshot:


Notice that I bolused without any carbs on board. BG decreased as expected, then suddenly a peak that went down, then BG stayed flat!

Just, wtf.

I cannot bolus with this totally weird behavior. What is going on here?

Did you finger stick to confirm if it was an error in the cgm reading vs a real spike? Cgm’s are wonderful devices, in my opinion the most helpful thing for my diabetes management but they are far from perfect and can read erroneously for a multitude of reasons. If in doubt, finger stick.

What time of day did you bolus? If it was in the morning it’s possible it just kept your DP at bay but won’t cause you to go lower because of DP. The rise can last from the moment you get up and for a few hours after.

Finger stick says that I’m now at 95 … WTF. It is 6 PM now, and I injected at 3PM.

I can only suspect that I am having a very aggressive counterregulatory response, meaning that the remaining beta cells shut down very quickly when the BG is below 90.

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There was an article online somewhere I read where they had discovered that there was a ton of variance in the potency of different vials of insulin, and that was the case for all the companies. Some they tested to only be 10% as potent as they were supposed to be. I notice this when I switch vials and either have drastic difference in numbers and action time.

Honestly this is just how it is sometimes. If I am stressed injecting insulin will not really lower my blood sugar and I might even see a rise. Sometimes this just happens anyway, even if I don’t feel anxious or stressed. At least with a CGM you can hit yourself with some more insulin when you see the double up arrows! There are so many variables you will never figure out which one or combination is causing this, all you can do is look for patterns and try to make educated guesses based on them.

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I should also say this is what started to happen with me when I tried Tresiba - I would start to get rises in the afternoon around the same time you are experiencing that took an enormous amount of insulin to bring down. It just got worse and worse until I switched back to Levemir, but too soon to say if this is your issue.

I use Novolog and have has the same thing happen to me. If I am stressed or something. If I do not take metformin with my insulin sometimes the insulin does not work

The problem is simply that the body’s insulin requirements spontaneously change due to changes in internal hormone levels of various substances which the patient can neither measure nor anticipate. What often seems like a technical error in the devices for lowering blood sugar is just the body being its spontaneous and ever-changing self, which would be fine if it were a real pancreas responding to blood sugar levels, but not the worst of all imitation pancreases, the wit of mankind.