Insulin not bringing my blood sugar DOWN?

Type 1 and LADA
1

Hello All. I'm relatively new and decided to reach out after not being able to get a solid answer on my uncontrollable high blood sugars. I'm a type 1 diabetic diagnosed when I was 15. I'm 45 now. I’ve always been in good control and eating healthy and with HBA1C of about 6 to 6.5. A few years ago I went on pump therapy for better control. I also take physical fitness seriously and I'm considered by many to be very fit and somewhat muscular standing at 5’7 180 lbs. Three months ago I started having uncontrollable high blood sugars. I would go into the 300s and not be able to bring it down with my normal insulin doses. I’ve tripled my doses, which seems to do nothing. I've talked to minimed and tried different catheters from angled to longer needles. I've even rotated my infusion sites to new areas. I added on a continuous glucose sensor for to understand if there is something I'm missing. Lots of good data but it still offered not pattern and or explanation in my high glucose levels. My last visit to my doctor was another deal breaker. My doctor said welcome to the unexplained diabetes. There was a time that I was not sure of his value as he would just double checking my dosing and now he cant really advise as to what to do as to just giving myself more inslulin. Not satisfied with his response I've even switched my insulin from HUMALOG to NOVALOG. Unfortunately, there was little if any improvement. I like most people have moderate amounts of stress. I have not been ill.

The only thing that has really helped me is minimizing my carbs to the point where I'm eating high concentrations of vegetables, legumes, beans etc. In some cases I’e eliminated regular carbs in their entirety. Because I was already eating healthy I just don’t understand what is going on.

I'm curious if others had similar challenges and what if any changes they have made for lifestyle improvements. I’m out of options and I also considered myself as a model diabetic until now.

Thanks for your help.

2

Gosh, that sounds nightmarish. Sorry!

I'm not nearly as experienced as you are w diabetes, so I hate to even throw stuff out there... but here's what I thought of reading your post:

First, I wouldn't try to bring down the highs with my pump. I try not to ever do boluses of more than around five units through the pump and I don't do many boluses at all. I think putting a lot of insulin into one site causes the site to be less reliable in terms of absorption (not sure if this is true or if I made it up, but that's my belief). So, when I correct for highs, I normal do it via syringe. Also, I have had times where I was trying to get a high down w my pump and kept doing boluses (I was only around 200-240 or so, so not doing huge boluses, just 2 or 3 units at a time) and my blood sugar was not changing, neither higher or lower. Then I felt like I didn't know if maybe it was my pump, the site, the insulin, or what. Using a syringe, I feel, takes a couple of those variables out, yk?

The other thing is that I would probably try to go zero carb for a while. I eat very low carb anyway and I have lived zero carb for months at a time before, so it's not out of my comfort zone. I understand that it probably sounds pretty radical. But I would do that if I was in your shoes. For me, it really minimizes the amount of insulin I need (I was using around 80 units a day when eating carbs, now I use around 14 units a day and eat < 15 carbs a day) and, I think, makes it a lot easier to figure out dosing. I also have had a lot better luck exercising and avoiding exercise-induced lows, which are usually responsible for my rebound highs.

Are you running high all the time or is it after eating or some other pattern?

ETA: One more thing... when I'm having trouble it always helps to keep meticulous records. I hate it and I may have completely used up whatever patience I had for it, but I do think it helps.

3

My suggestion is not as lengthy as Rub but here it is. I too have lived a long time with this disease and when I can't find an answer within my experience and my endo doesn't have an answer I consult with my CDE. I've talked to others who have experienced what you're going through and some have become insulin resistant but only the experts like Endos or CDEs....I hope one of my suggestions will be helpful.

4

Could be you have developed insulin resistance. I understand that metformin can help with this.

Vegetables and beans have carbs. What do you mean where you say "In some cases I’e eliminated regular carbs in their entirety." As if veggies are unleaded??

I hope your doc did a full lab panel check. There are so many reasons why control can go haywire. Maybe a break from pump and going back to MDI will improve your control.

5

Infections of any kind sometime will do this...?
Gums bleeding or skin irritations?
Beans high in carbs for sure.
Best of luck in finding answers.
In Peace, Health and Joy, Many Blessings!

6

Have you had your thyroid checked? It is very common for T1 diabetics to also have thyroid issues like Grave's Disease and Hashimoto's thyroiditis. If my thyroid medication is off, I have experienced insulin resistance as well. Anyhow, I think it is important to check on all your body systems as they can affect your numbers.

7

When your BG is high, that itself can cause resistance, especially if it has been for several days. I have a pump, but whenever I am over 200, I correct with a syringe, in my stomach for the best absorption.

If I'm not too high, I might also do some light exercise, which helps bring it down quicker.

Also, if your ISF is normally something like 1 unit lowers you 40 pts (in the normal range), then when your BG is high, this factor may be more like 1 unit for 20-30 pts (without exercise).

I also find that using a temp basal of +10-20% can help.

I think metformin might be something to look into too.

8

Beans also have a lot of protein (the kidney types / not the green ones), and that causes my own bg to go up later.

You said you are not satisfied with your doctor's response. I can't help but wonder what kind of results prompted the doc to say welcome to the unexplained diabetes. As drsoosie said and I suggested earlier, other things (like thyroid) should be checked. Ask your doctor about doing a full CMP and TSH, there may be something else going on.

9

Well welcome to the world of,, oh wait that response did not work so well. LOL

Yes I have been diabetic for almost 38 years and when this happened I also freaked out. Today it is the norm for me. Unfortunately there is not a good answer that i have found. I think many of us, as we age gets worse. I hope you get to a better place and I wish you the very best. For me, I had to up both bolus and basil's in order to get some sort of control.

Unfortunately, upping either or both of these by even 5% may result on more and more severe lows. So I have to carry juice boxes, test more and my wife worries more. So please be careful, if you do up it and do so under the advice of a doctor.

Rick Phillips

PS: I do understand your frustrations of talking to the doctor. It seems every time I go to the doc he says the same thing to me. It gets old quick.

10

Well as a nasty T2 who has seen this issue and unjammed it daily for 2 years,my assessment is that if one adds (gets) too much glucose backed up in the skeletal muscles, the insulin will sit their circulating in your blood system and do nothing.

My dawn effect every day would drive the blood glucose up to 238 in the morning.
Getting the mess unjammed required walking 2 miles in morning and for breakfast go low glycemic and drop calorie input. I was 26 units of 75/25 in am and watch it do nothing. One day I added a few more units and still no action.

After walking 2 miles I would see the blood glucose drop to 140 and under and injected insulin would work. Key is to get glucose burned off skeletal muscle temporary storags sites and insulin resistance drops. rest of day body was working correctly and sensitive to insulin.

I moved my diet to 1200 calories and 2 miles walking as well as ensuring very low glycemic breakfast to minimize glucose add to the system sfter bad dawn effect.

Today using metformin to stop excess liver glucose release during fasting and dawn phenominum as well as tight low glycemic diet and decent 2 mile exercise; this issue is now stopped.

My assessment is that as long as there is room to store more glucose in the skeletal muscle cells temporary storage sites, insulin appears to work moving the glucose from the blood system to storage.

11

Metformin is definitely an option for Type 1. I work in an endocrinology office, as well as being diabetic myself and we have a few type 1's on metformin.

12

Metformin reduces/stops excess liver glucose release. Yes it is thought of as type 2 as many type2's have leaky livers.( contrary to the other old wives tale that there is no such thing as a leaky liver.)

My real point was that if one gets the glucose stored loading up on the skeletal muscles so there is no room to store more glucose, one will see insulin resistance go through the roof and the insulin will work like water on the body as the skeletal muscles refuse to take on any more glucose. The human body is not contrary to the just add insulin crowd an infinite energy dump. In fact it is limited and can only store so much glucose-energy.

In my case there were three factors:

a) excess liver glucose release - use metformin.

b) dropping calorie input seriously to help get rid of excess glucose.

c) up the exercise to burn off the glucose trapped in the skeletal muscles temporary glucose storage sites dropping the insulin resistance.

Energy Balance is crucial to stopping diabetes.

Best wishes and good luck.

13

You've had some great responses here and some fit for my suggestion.
First get to an expert who will measure antibodies and look for insulinomas.
If you have antibodies, read up on them.
Now work to make your body have the most normal environment it can have: very stable basal first. Then a hovering BG around 120, up and down to 140 and back, the smallest deviation you can pull off when you eat for 3 weeks.
I'm sure you know the mgdL each gram and type of carb puts your BG up. Ensure you know what protein also is doing to your BG. This means multiple small meals and MDIs per day. Keep the CGM flat lining. Use the least insulin that will work.
Definitely give <7units in any one site for best absorption. Break up sites for >7u.
Living at the smallest deviation, say 20, makes the body cells think they're almost residing in a normal body. If body-chemistry-changing is going to happen, it will happen in the most normal environment possible. Think of it as a reset. And if you start losing weight, use protein whey.

14

I too have experienced this. I think it is bad sites from pumping (scar tissue). I read on another site this article. Only eat 1 serving of carbs per meal. That really helps me a ton. 1 serving is about 15 carbs, I usually go with 30 carbs. Breakfast and lunch is when I really spike with carbs. Dinner time seems to work out okay for me.

Ten Ways to Take a Bite Out of Blood Sugar

Simple tips you can integrate into your daily life

Wil DuboisBy Wil Dubois

Let's talk about blood sugar management today. Sounds boring, huh? Not at all, really. Because done right, taking steps to lower blood sugar is highly empowering. Sweet numbers on a blood sugar log will bring a smile to your face faster than an ice cream cone in July.

I know a lot of you who take pills for your diabetes feel powerless to change a high blood sugar, so you'd rather not know that your sugar is high. But there are things you can do to lower your blood sugar that don't involve opening your medicine cabinet. Here are my top ten tips to lower blood sugar:

Tip Number 1: Test, Don't Guess.

Of course the first step, in the mantra of dLifeTV from the beginning, is: Test, don't guess! To master your blood sugar, you first must know where it is. And if you only check first thing in the morning you're cheating at solitaire. If you want to truly master your blood sugar you should fearlessly seek out your very worst, highest numbers. That means checking after meals. Don't let that high number flashing on your meter get you down. Rejoice that you've found it. It's just a problem to be fixed, and as you roll out the rest of these tips, those high numbers, like the walls of Jericho, are going to come a' tumblin' down.

Tip Number 2: No more monochrome meals!

While there's no such thing as a diabetic diet, there's only so much your system can handle at once when it comes to foods that turn into sugar quickly. Here's my advice: Deprive yourself of no food, but limit yourself to one carb portion per meal. Carbs tend to be white in color: things made of flour (including pasta); potato; rice; and sugar. Oh, and while corn is pale yellow, it's a white food, too. If you make sure every meal has only one white food, you'll lower the blood sugar impact of the entire meal. So if you want a baked potato, that's not the meal to have a desert with. If you want some ice cream, keep the meal to a pork chop, some green beans, and some cottage cheese (along with cauliflower, the only white-colored food that isn't on the white foods list).

Tip Number 3: The "E" word

You need to exercise the dreaded E-word: Exercise. But don't freak out on me. I'm not saying you should go out and buy a treadmill or a gym membership. Rather, look for every excuse to exercise your body. Just use it whenever you can during the normal course of the day. Take the stairs instead of the elevator. Park farther from the door. Go fly a kite. On a calm day. At night, circumnavigate the couch during the TV commercials.

Tip Number 4: Totally lose it.

Lose a pound. Or four. You don't need to be super-model skinny to improve your blood sugar. If you lose 7% of your weight, you'll improve your insulin resistance. That will lower your blood sugar across the board, and dramatically reduce after-meal spikes. How much weight is that, really? Well, it depends on how much you weigh, of course. But if you tip the scales at 200 pounds, 7% is 14 pounds. You could easily shed that in six months by simply eating a few bites less per meal. I know we were taught as children to clean our plates, but it's far better to throw some food away than to eat more than we need to.

Tip Number 5: Pretend you're at a fancy restaurant.

When you eat out at a nice place, what comes first? Oh right. The so-perky-you-want-to-strangle-her girl named Brittany whose pleasure it is to serve you today. But I was talking about the meal itself. Most non-fast food meals start out with a good salad. What could be healthier? Salads are generally low in both calories and carbohydrates. That means they are good for controlling blood sugar and for controlling waist-line expansion. An added bonus: if you get filled up with salad, you'll be less hungry when it comes to the rest of the meal, so you'll eat less of the stuff that's "bad" for your blood sugar log. And eating less of that other stuff will help you with Tip Number 4.

Tip Number 6: Start Drinking.

I want you to start drinking. A lot. Of water. (Sorry for the let-down.) In fact, I want you drinking only water. Or skim milk, which tastes pretty much the same to me. Never, ever, ever drink a calorie. Stick with water and drink a lot of it. It's good for you and, like an early salad, can help keep hunger at bay. I'd also like you to avoid the diet sodas, at least on a regular basis. Although they don't have any calories, folks who drink a lot of diet sodas have a harder time losing weight. No one is sure why.

Tip Number 7: Ask your doctor if a dog is right for you.

Yeah, odd prescription, I know, but dog owners are more active than non-dog owners. Why? Well… picture those big, brown, sad eyes pleading with you: Pleeeeeeeeeease take me for a walk. Frankly, most of us have a hard time with self-motivation. We're tired, over-worked, and stressed out. But we're human beings. There's a root word of humane in there somewhere. Often we will do for others what we won't do for ourselves, and pets are the hardest to say "no" to because of the whole issue of inter-species communication. You can rationalize with your kid about why you're too busy to play in the park with her, but your dog isn't going to take "no" for an answer.

Tip Number 8: See what else is in the medicine cabinet.

You need to take your medicine, but sometimes meds for the other things that ail you can raise your blood sugar. We've got a list of them here. If you take one of more of these, talk to your doctor about whether or not there are any alternative meds that will control your other conditions without affecting your blood sugar. Remember that everyone is different. Just because you take a medication on the list doesn't mean that it raises your blood sugar, or if it does, that it raises it enough to worry about. If your doctor says it's safe to do so, you can stop taking a suspect med for a few days, carefully monitor your blood sugar and see if it improves. If you want to be a proper scientist, you should then re-start the med to see if the sugar goes up again. And don't try this at home! Do it only under your doc's guidance.

Tip Number 9: Chill out.

Back in the really old days (like in the Paleolithic) life had some challenges. Like saber-tooth tigers. What happened when your ancient ancestors encountered a saber-tooth cat? I image they threw their hands up in the air, screamed, and ran like hell. To assist in the running like hell, their bodies would dump sugar into their blood for extra energy. Our bodies, to this day, still do that. The problem is that the modern saber-tooth tiger is the overdue electric bill, the dropped cellphone call, the dinnertime telemarketer, and the annoying neighbor. You can't run away from any of these tigers. The extra sugar just sits in your body. But you can learn to defeat this ancient biological fight-or-flight response of our bodies by learning how to relax. You need to make time for you. It might be a warm bubble bath in the evening, a good book at lunch, aroma therapy candles, or even kick boxing. Take that saber tooth tiger. Bam!

Tip Number 10: Tuck yourself in early.

Not getting enough sleep will raise your blood sugar, and most Americans don't get enough sleep. But you have to. This is medicine for your diabetes, so you need to do what "Doctor" Wil tells you to. And you need to do two things to get a good night's sleep. First you need to budget enough time. That means eight hours, for most folks. The second thing you need to do is purify your bedroom, and that means getting all the electronic gadgets out. Your bedroom is a place to sleep. It does not need a TV. It does not need a computer. It does not need a cell phone.

Summary

So there you have it, ten simple things you can do to lower your blood sugar. Notice anything special about these tips? Right! There's nothing special about them at all. They aren't bizarre. They aren't difficult. You don't have to change your entire life. These are things you can integrate into the daily life you already live now. And once they become habits—healthy habits—you'll have taken blood sugar management into your own hands.

Wil Dubois is the author of four multi-award-winning books about diabetes. He is a PWD type 1, and is the diabetes coordinator for a rural non-profit clinic. Visit his blog, LifeAfterDX.

Read Wil's bio here.strong>

15

Hi flynn - I haven't quite figured that out, but I know it works ! But I only need to do that when my BG is high, or I eat a higher than normal carb meal. I think part of the reason for me is that I use my stomach for the shots, and have heard that's the best absorption. It's been several years since I've done pump sites on my stomach.

One caution is that insulin by shot doesn't get recorded by your pump as insulin on board / active insulin. So you can either disconnect and bolus the insulin on the pump, or keep track of it yourself. Sometimes I'll do .5 units on the pump, and the remaining amount by shot for the correction. Then I can check the pump bolus history for a reminder of when I did the shot.

16

Your description of high blood sugars is a little ambiguous. It is not clear whether you have these high blood sugars all the time or just suddenly after a short time of using a new site. It makes a difference. Higher blood sugars all the time might suggest an infection or something. And once you have blood sugars in the 300s, you become insulin resistant and it takes markedly more insulin to bring you back down.

But actually, the fact that shots work may be a big clue as to what is going on. If the shots work and the pump doesn't that suggests a very different level of absorption and you may be experienced impaired absorption with you pump. If changing the site also results in the boluses working, that is further evidence of a site problem. And it could just be scarring. You have had diabetes for 30 years. And if you haven't rotated enough you can build up scarring. I've heard suggestions that scarring with a pump can start to have a serious impact within ten years. So the way to explore this is to get aggressive about site rotation. Try to rotate to site that you have never really used, your butt or thigh. Or even get someone to help you put them way round back where you can't reach. If those virgin sites work well, then it is probably scarring. If you give your abdomen time to rest and rotate aggressively your should be able to heal.

Now it may not be scarring. It may be an allergic or immune reaction. If any of the materials in the infusion set cause a reaction, your body may respond causing a clogging of the area. Generally an allergic or immune reaction will result in redness, swelling, or itchiness in the region. It will also significantly increase scarring since your body will create a greater trauma. Have you really tried all the infusion set options? It is worth a shot if nothing else works.

17

Extremely common problem.

(Couple easy possibilities, couple difficult ones too.)

Lets start at the beginning... what are YOU calling HIGH?

Bad strips? Use a different bottle...
Bounce(s)? Any chance you missed a low(s) somewhere...?
Bad testing procedure? Rewash hands with warm water only...
Bad site? Switch to sites you rarely use, see if that helps.
Compromised absorption?
Bad insulin?
Unrealized/undiscovered infection?
Your pump is not functioning correctly!
Your pump is possessed >: > !!!

I'd check for KETONES whenever this happens.

I'm thinking maybe you are not eating "sufficient carbs" if so your body mistakenly believes you are "starving to death", triggers your liver, organs to start breaking down fats to generate sugar you actually do need., but are not getting enough of in your current diet... POOF magic highs disobeying the chemistry, reduction which your insulin should provide. Counter intuitive but try eating MORE carbs see if that makes a difference perhaps?

18

any update to the solution of your problem? may be it will help others in your same situation…

19

I was diagnosed with Graves’ disease a couple of months ago, and it has had a major impact on my insulin requirements. My TDD six months ago was 45-55 units a day. Now my TDD is 85-95 units a day, sometimes over 100 units, and I’m still having many highs and virtually no lows. So thyroid stuff, probably especially hyperthyroid stuff, can definitely affect diabetes control.

I’m allergic to infusion sets and this can definitely cause major problems with control, too. It took me a couple of years to figure out what was going on and find strategies to be able to still use the pump successfully (most of the time). Plastic sites would become incredibly irritated (red, itchy, swollen) after 12-24 hours and my blood sugar would skyrocket for no reason and then come down with a new site. Switching to metal sets helped a lot, though I still react to the metal sets, probably to the nickel in them, but less so. The metal sets often become irritated (itchy, sore, bleeding slightly) after 12-24 hours and at times somehow stop working even though they are metal and supposed to be reliable, but the reaction goes away within a day of removing it, instead of lasting for days and up to a week like reactions to the plastic sets.

20

Thanks so much… Are you the OP?