Insulin Resistance/Appetite change

Hi all!
I have had T1 diabetes for....16 years now? Somewhere around there anyways! Recently I have developed major insulin resistance and am doubling or tripling my doses to get sugars into normal range. I also have gained a bunch of weight recently and had some trouble regulating my thyroid for a few months. My newest issue is that I never seem to feel full!!! Has anyone else experienced this with insulin resistance or thyroid troubles? My endo is a "your sugars are bad come back in 3 months and do better" type dr. Feeling frustrated!

I've been a T1D for 30 years. I had gained about 25 pounds over a 10 year period and I was completely surprised by the insulin resistance. I thought it was a T2D thing and that I must have had something radically wrong with me, like cancer.

I did several things together that broke the resistance. I limited carbs in my diet to less than 75 grams per day. This means that I eat a high fat, medium protein, and low carb diet. The high fat part of the diet provides abundant satiety. I don't feel hungry in between meals.

I weighed all the food I ate at home to calculate the nutritional content. I bought a pedometer and started walking 2-4 miles every day. I consulted with a certified diabetes educator to refine my insulin program, particularly the basal rates on my pump. I tested my BGs 10-15 times per day and uploaded my meter, CGM, and pump into a web-based program called Diasend.

Over a three month period in 2012, I lost 23 pounds, cut my total daily dose of insulin from about 80 to less than 40. My BG control improved with much less variability. My average BG went from about 135 to about 110 and I now spend only 5% of my time less than 70 and 80% of my time in my target range.

I have hypothyroid but my endo did not think that had anything to do with my insulin resistance. I know the thyroid can wreak havoc with one's metabolism so you should at least rule it out.

Your endo is typical. What you want to do is not an unreasonable goal. I know that there are medical professionals who would just dig right into your case and help sort things out but these people are few and far between. I suggest that you start making some moves on your own. The only way to overcome your frustration is to take meaningful action. I wish you the best of luck. You can do it.

I was reading that eating high fat can cause insulin resistance. I have been eating low carb, high fat, and medium protein but I have been having to give more basal insulin. Did you have to increase your basal insulin as well?

No, I cut my basal rates as I shed my weight. Basal needs do change over time. I've even noticed and uptick in basal needs one week and then a return to lower basal needs the following week. I've read that woman will adjust their basal rates to their monthly hormonal cycles.

As to high fat causing insulin resistance, I don't agree. I think when PWD consume a high fat and high carbohydrate meal, like pizza, the mixing of the high fat and high carb slow down digestion substantially. This can often be compensated for with an extended mealtime bolus. Since this is often an exception to the regular diet, not many people can get that unusual insulin dose done well.

True insulin resistance is marked by significant increases in total daily insulin as well as poorer BG control. It's a longer term trend and not a one-off episode.

Just one question, by any chance is there type 2 in your family? Just because we have type 1, doesn't mean we are necessarily immune to a genetic propensity to type 2.

I have that hungry feeling a lot I tried symlin for that which helped but it made me go low too much so I stopped. Eating high fat, low carb has helped and also not trying to always stay in 80-100 range. I don't correct now unless I go higher because as soon as I inject insulin I start to get hungry again. I don't have your other issues or thyroid issues. I would find a new doc who will help you figure this out.

Hi Terry, this is kind of off topic, but is 20 pounds enough to greatly affect insulin resistance? I've lost almost 20 pounds over the past two months, between dietary restrictions (and therefore not being able to eat most junk food), snacking less, and exercising more. My insulin requirements have gone from 70-80u a day to 30-40u a day. It's not just that I'm eating fewer carbs (in fact I'm not eating fewer carbs because I can't eat nuts, cheese, or eggs which makes it hard to eat a lot of protein), it's that my insulin sensitivity has actually dropped a lot. I'm using less basal, less insulin to cover carbs, and less insulin to correct. My overall average blood sugar has come down, but variability hasn't improved much, probably because I find it seriously challenging to eat fewer than 30-40g per meal, and also because I'm still having daily lows (I think part of the drop in insulin requirements is the warmer weather, too). I was trying to figure out why, as I didn't think 20 pounds was enough to make that much of a difference. I have quite a bit more weight to lose, so I didn't think 20 pounds was that much.

Jen - My 20+ pound weight loss was concurrent with my greatly reduced need for insulin. You appear to have experienced a similar thing. Based on my experience, my weight loss positively influenced my sensitivity to insulin.

I still need to lose weight, too. I think 10-15 pounds would be ideal. Perhaps the initial weight loss that both of us experienced was enough to get us below an important personal threshold for insulin resistance.

I have a lot more than 15 pounds to lose. :) But I would be surprised if my insulin requirements keep dropping so much - otherwise I'd be cured by the time I'm done!

It appears to be a non-linear factor. Good luck with your ongoing efforts!

is 20 pounds enough to greatly affect insulin resistance?
I'm not Terry, but I can answer: You bet! I speak from direct experience.

Even as little as 10 lbs can make a difference, particularly if you're a T2 with IR and Metabolic Syndrome. I can't say this is generally true for all T2s, but for this one typing right here my adipose tissue is very sensitive to how "fat" it is in terms of it insulin sensitivity.

I gained 20 lbs after starting insulin a year ago. My IC went from 1:5 to 1:4. I struggled mightily about 6 months ago at the +10lb mark when the lack of tenths in the IC setting on the Omnipod made getting dosing calcs right.

All I needed to solve that was putting on another 10 lbs of pork, which I happily did over the last six months. Now I'm 1:4.

Saw my endo friday (the absolute best endo in the entire multiverse -- that's right, folks, not just this universe, but all of 'em), and she was surprised. Told me to get it off, and the insulin sensitivity would come back. Take off the other extra 20 and I'd probably see my IC pop up to 1:6-8. Skinny my self down to triathalon-winner BMI and I might see the IR go away entirely.

Ha, I don't even consider a change from, say, 1:6 to 1:8 to be that big of a change ... my insulin requirements change that much just from monthly hormones. :) This time around my ratio went from 1:7 to 1:13, and my basal and ISF had similar changes.

I see my endocrinologist in about an hour, so I'll be curious to see what he says.

Keep in mind the lower the ratio, the more significant changes are to TDD. Going from 5 to 4 is a 20% increase. Going from 4 to 3 is a 25% increase.

So, when you've got IR and your dealing in rather significant amounts of insulin to cover carbs, the ability to set fractional values becomes more important.

All that said, whoah, my IC never varies like yours! Maybe this is another "good to be a guy" type things like being able to easily relieve oneself just about anywhere there's a tree?

Well, according to my doctor’s scale I only lost 0.7 kilos (about 1.5 pounds)!! So who knows! By my home scale I’ve lost over 10 pounds.