Insulin not working to lower BG after 34+ years of T1D

Hi all ! I really need some help here...I have been T1D since 1980 just got a CGM this month...still take shots can't afford the pump & all the stuff that goes with it. So in the last week I have had nearly all readings are high, very high with no real response from any insulin I have taken. This has never happened in the 34+ years I have been dealing with this ! I have been talking with my Endo nurse & the head Dr for Endo here..of course I have tried new bottles of insulin, different injection sites..I use Novolog for meals & Lantus at night. Have raised the Lantus from 8 units up to 11 last night & my CGM read at the high of 400 in the last 12 hours,also compare with my glucose meter to keep the CGM one has been able to help me with this & I am at a loss to explain,much less treat this insane scenario !! There was no change of anything in the last week & I have had many tests run to find a cause but no answers ! I use the same ratios for carbs/insulin even adding more to my meal doses with only a minimal drop in BS ! I have always been more tending to lows than highs so this is a whole new trip for me ! Thanks for any help you all can give !

You may have developed insulin resistance. This is uncommon but possible in type 1. Our Richard had success with metformin which helps with IR. Also if you are IR then a low carb diet is the way to go. I am so IR it takes 1 unit of insulin to cover 2 grams of carb making eating carbs a non practical food source.

I have been looking into that as well..not sure how to be sure if that is the cause...I was told to see my PCP to be sure there are not other issues with my health, which is a great idea but I have been having serious issues the last 4 months with no definitive cause just it "must" be the Diabetes.. thanks for the response !

Is it possible your current bottles of insulin got left in a hot car for a little bit in hot August weather? Do you have "new always refrigerated bottles" you can try?

Sometimes when I have the flu or infection, I have to nearly double my doses to keep bg's under control.

Yes my insulin is always in the fridge also tried new bottles of both earlier this week again I have been doing several blood tests & urine tests all come back normal etc...even had an MRI looking for tumors etc...just so tired of trial & error to find any answers !

What does the BG meter say? How close is it to the CGM? I had a lot of calibration problems until I realized that it wasn't the number of calibrations--but the quality. Don't go for a run and take your BG 10 minutes later and calibrate with that. Calibrate when you've been inactive for a while.

That said, you're a veteran. There's really only a few things that could get your BG in the 400 range. You are either not getting the insulin in, or something is pushing your BG into the stratosphere. Any medication changes? Illnesses? Stress? Do you FEEL the highs? Is your BG making you sick?

Test your glucose response to a sugar source you know well. 8oz of apple juice. What does THAT do to your BG?

If I were you, I would stop using the CGM until you are sure you've got your BG down and your insulin is working. YOU don't need it to deal with whatever is going on and it will only frustrate you. Start using it again after you figure things out.

Your basal dose seems pretty low. I split my Lantus and took 8 and 8 for a long time. This summer I had to increase to a total of twenty. I suddenly seemed pretty resistant to insulin but found out I had a urinary tract infection. (I think I've had it most of the summer) After a week on antibiotics my bgs starting dropping and after another week they lowered again. So I would check underlying health issues and also increase the basal insulin.

wow this sounds super frustrating sounds like you got some good advise so far try very low carb for a while, where are you with regards to menopause?? I would keep piling on more and more insulin but perhaps there is something else going on with your body that hasn't been brought to the surface yet, does exercise help at all? do you rotate your injection sites? keep hydrating and keep us posted best wishes, amy

I guess the reason why I am asking on here is that I have been doing all the things you all are suggesting but the bottom line is I am VERY worried about lows as that has always been my biggest concern ! I am extremely sensitive to even 1 unit changes in Lantus doses also this has been going on ( my overall health issues) since May 1 this year. Again I have been tested for multiple scenarios with NO answer to what is causing the whole problem. I have been taking 10 units Novolog for each meal & it barely dents the high BGs. For the moment I am seeing it lowering some now is down to 222 per CGM & I always compare with my One Touch meter before doing any adjustments.. thanks for all your feeedback & I will check back here later today..

when is the last time you did basal testing? If you have had ongoing health issue for months then it can affect your insulin requirements. If your basal insulin is keeping your BGs level when fasting, then it is your IC ratio and correction factor that are off. With a CGM is should be fairly easy to do these checks. It will give you an idea of what you need to fix first.
When you have been that out of wack for a while it can cause temporary insulin resistance. It can take a big increase in either/or both of you insulin types. Once you make the needed corrections in dosing you may see that thing will drop back closer to the prior norm once you body get things under better control and has a chance to recover.

You have a CGM, so yo should be able to watch/catch lows if you need to drop back to you prior dosing schedule after awhile.

There are a multitude of things that can cause your insulin requirements to dramatically and suddenly increase. In case you have not yet ruled them out, some of them are:

- Any types of medications that contain steroids
- Niaspan (Pharmaceutical grade B vitamin to lower cholesterol)
- Underlying infection - gums, tooth, urinary tract, etc.
- Illness such as cold or flu, even before other symptoms begin.

I'm sure there are additional things that others in this group will be able to add.

One thing I haven't heard about is exercise. Can you exercise long enough to see if it lowers your BG? For me, it's getting a feeling for what my body is doing that usually gives me the answer--if there is one. It could just be a fluke, too. I once consumed a day's worth of carbs in three hours and my BG kept falling. My endo and I never figured it out afterward. Suddenly, my body went--hey that's carbohydrates! I think I'll go REALLY high after not doing anything for most of the afternoon!

Lots of good possibilities expressed here. One I would add is, age. I don't mean age in the geriatric sense, just that physiology changes with the passage of time. Allergies come (and sometimes go), bodily processes shift and alter for a legion of reasons, etc. It could be that your IR actually has changed.

Also one more point about Metformin: some T1's do indeed benefit from it. Although metformin helps somewhat with IR, its principal effect is to suppress liver dumps. If your liver is putting out more glucose than it used to, you'd naturally need more insulin. Just another thing to consider.

But the bottom line is, you need to discuss this with your medical team. All the ideas here are good food for thought.

Thanks for your input, funny thing is I take Niacin but over the counter not prescribed..I do take it instead of Statin drugs & changed brands last weekend..but it was the 2nd bottle that I had been taking awhile back only changed brands because I found a non-flush brand...ran out of them last week & had the other brand so I started taking those last Saturday which was the day all this went to Hell ! I didn't take my 500mg pill tonight so I hope I see better results tomorrow ! I have been tested for all germ caused illnesses as all my Drs can find no symptoms or results from testing...

Way past Menopause 15+ years . I have been drinking more water than before that seems to help . As I said I have been tested & scanned for any underlying causes no help...I have changed sites this whole week to be sure that its not the cause either. I came here because we have done all the trial & errors but no cause can be found, thanks Amy I will keep in touch here as I find anything !

I am active enough but I do not get a lot of real exercise..I understand your story as well I get the weirdest symptoms or side effects in the world that no one else ever gets ! Like I have said these highs are so foreign to me as I have always had terrible Lows ,that has been my focus for all these years plus lately they were getting much worse so that is why I got the CGM just 2 weeks ago ! I do listen to my body but no tips this time around...

I am 57, My PCP is a Geriatrics Specialist she has been involved with my health issues all this year. I am making an appt with her on Monday to keep digging !

The cgm is great to warn before lows. Quite a struggle diabetes. I’ve been D five years longer than you. Sometimes one has to take a lot of insulin. I have 90 unit days and 30 unit days. If the small increments aren’t dropping the glucose level I take an I’m getting upset dose.

Do you have a copy of either Think like a Pancreas or Using Insulin? They have good info on how to do basal testing, as well as how to test duration of insulin, carb to insulin ratios, and correction factors.

Regardless of the cause of the change in your insulin requirements, you need to work out what the new ones are. The longer you stay high the more problematic it becomes. You need to start to retest your basal, if it keeps you flat then you need to retest your rapid insulin DIA, CF and IC ratio. Your requirements for either your long acting and/or rapid insulin have changed. You won't know until you test and your CGM will help with the data needed to make changes.

Both books can be obtained in hardcopy but they also can be obtained for e-reader. They can be obtained today if you don't have a copy already.

I have found for me personally that sometimes when the trial and error tweaks we try don't work its time to get out the "bible" and do a full on basal bolus testing by the book. I usually am able to see better the pattern behind the issue and make the necessary changes to my doses to help.

Not saying this will determine why you suddenly went over the moon but will help get you back on the ground while your docs see if they can find a cause.

Hi, you've gotten great responses, another imput:
maybe novolog and lantus isn't the insulin for you to go, if possible try if Levemir (instead of lantus) or Humalog or Apidra (instead of Novolog) work better.
As mentioned, your dose seems pretty low with 11 units basal only, maybe you now need way more, in the 20 area. Just ideas.
Also, try and see if you can find out whether Metformin can help lower any insulin resistance.
take care