Insulin Resistance of a different kind

I find that I have insulin resistance that is of a mental/emotional nature, too.

That is, sometimes I just can’t inject enough insulin to cover my food.

This usually happens when I over-eat and the calculation on my carbs/insulin kind of floors me. I still binge from time to time, and when I calculate and discover that I need to inject 80 or 90 IU to cover the binge I just…can’t do it. I’ll inject 45 or 50 instead, scattered around in three or four injection sites (twelve here, fifteen there, etc.)

I’ll inject half of what I should and tell myself, “I’ll test later and correct.”

As I’m a T2 and still make some insulin despite being on MDI of Lantus and Novolog, I can “get away” with a bit of this. That is, if I’ve been walking daily, eating fairly well and regularly doing my basal/bolus, then if I have a rare binge and fail to cover it all, my sugars will go up to 280 – not 480 – as my body kicks some in to help cover and my insulin resistance doesn’t fight me as hard.

However, if I go back to my bad old ways and do this nonsense more frequently, the base-line will creep up and up over a period of days and it will take me a week of perfect vigilance to get leveled-off back at a good place again.

I wish I could just STOP this nonsense, but if I put on my scientific observer hat I think it’s fascinating that I’m sitting here with the Novolog pen in my hand and the cold, hard facts of my carb consumption right in front of me and I can’t inject what I should. I just…balk. I’ve no idea why. It’s like a mental block or temporary insanity that goes with the mentality of binging. It’s almost as if injecting what I should makes the binge more “real”…or something like that.

Human beings can be weird, and I’m no exception…sigh…

Do you ever resist injecting the right amount of insulin for mysterious emotional reasons?

Nope. I might inject MORE and catch up with food later? To me, that’s an easier fix.

Now I am not a therapist but it sounds as if you have a love and relationship with yourself. You have a weight issue that you can not get a hold of, we all do on some level, but its to the point where you were thinking of major operations to help. You binge eat which is emotional eating, I am so guilty of that myself. It seems from what I read from your comments often on here that you are NOT happy with yourself or at least your weight and you may binge eat to punish yourself. Maybe you feel guilty or angry about something on going internally, I do not know and only you would know. I do know weight is always a outward expression of something inside, including under eating. So maybe using the proper amount of corrective insulin counter acts the punishment you just dished out on yourself… I could way off base here but that is what it sounds like to me…Just something to think about…

I think I do this a lot when eating out. I know I’m having X amount of carbohydrates, but I decrease the bolus anyway. There was a time when I wouldn’t bolus more than 10u because I thought it was too much and I might go low. I figured I’d rather go high and correct it later on. Don’t do that anymore, though.

Of course, when eating out it’s almost impossible to overestimate … Usually I am fighting highs for hours even when I look up the nutritional information and know I’m bolusing correctly!

Just now I’m eating sushi (I know, bad, bad!) and cringed when I saw my pump show 13.6u as a bolus. (I know to you that’s not a lot … for me I don’t often bolus over 10u unless I’m ridiculously high or eating something I shouldn’t!) However, I just delivered it.

I also find I don’t like upping my pump settings as much as I like lowering them. I’ve been running high the past few days for some reason so have been upping everything. But I will easily leave highs for two or three days before changing settings, while lows I will change after one day if I have more than one mild one.

Thanks for your very thoughtful reply, Rye. I will think about what you said. No doubt my relationship with food is complicated (!!!) and there are lots of snags under that murky water.

As somebody who suffered from an eating disorder for 30 years, I don’t consider binging “nonsense” or being “hard-headed”, or “stupidity” or any other self-blaming adjective, anymore than I consider having diabetes my fault. I’m not saying this is the case with you, and lots of people overeat who don’t have eating disorders, but if the binging is a symptom of an eating disorder it can be treated: by therapy, joining a twelve-step or ED group and possibly medication. As for the reluctance to inject the “correct” amount of insulin…:::shrug::: I think it’s normal to be hesitant to inject twice as much insulin as we are used to. Or it could be related to the binging. I’ve got 16 years recovery from my ED and that was way before I got diagnosed with D. I wish I’d gotten recovery sooner. If this doesn’t apply to you, just take what you need and leave the rest. If it does feel free to send me a message.

Maybe a BIG bolus feels shameful? Like admitting defeat in the war on Big D? Logically it shouldn’t – it should feel like taking out the big guns and blowing D away, but to me it doesn’t. It’s feels more like, “I can’t believe I have to do this again.”

ar23, I loved it when you said, “set my phasers to kill” regarding a big bolus.

I wish I could feel like I was shooting to blow away alien invaders: pow! pow! pow!

Instead I feel more like jumping up on the couch and screaming “eeeeek” at the ugly little buggers.

I’m thinking about what you wrote, Zoe. I have a history, shall we say. However, there is something biochemical going on, too. Something that is not unlike how people feel in the four or five hours after a bad hypo – only I have felt that way very, very often over the years (note: I was diagnosed with reactive hypoglycemia in my early 20’s, almost 30 years before my T2 diagnosis.)

I’ve had this inexplicable “vacuum up the fridge into my mouth” thing going on for years – and damned if I can’t bring it on reliably now with a hypo.

I am shooting at the aliens, since some parts of my hardware don’t work with BG > 120 or 140 or 150 or whatever I shoot them.

A big bolus can be a defeat in the battle against a pantsometer but if you are eating big food, the bolus should match.

I think it’s like I posted above, eating sushi (or whatever) is “bad.” We spend so much time trying to be “good,” but no one can keep that up forever, 24/7 (or at least I can’t!). And especially lately when I’ve been trying so hard, it just feels like defeat falling off the wagon again, even though I know tomorrow I’ll start over again.

So it’s like I eat this stuff and then feel guilty for eating it. So, yeah, I think the bolus just contributes to that guilty feeling.

There have been dark times in the past (even the not-so-distant past) where I’ve just gotten so sick of the whole diabetes thing that I’ve just gone, “Forget it!” and not covered a meal at all. Several times I even missed two or more boluses in a row. But sending my blood sugar to 600+ like that does nothing but harm and makes me feel like utter crap, and logically I knew that, but I still did it.

I think diabetes in general is a very, VERY emotional/psychological disease. Maybe I get too emotional about it. Some people are all logical and engineer-like. I really admire them. I am trying to be more like that, but after 20 years I still have lots of emotional reactions towards diabetes. Not sure how to overcome that. I tend to be kind of emotional/philosophical in general, so I think it’s just part of my personality. It’s kind of weird, though, because I was diagnosed as a kid and it wasn’t really until my 20s that the whole emotional, “How can I keep this up forever?!?!” stuff hit.

I really like what people on this site say about taking it one day, or one meal, or one test at a time. I’ve been trying this lately and it helps. I don’t get so overwhelmed with trying to be perfect forever … just for this one decision, and I’ll think about the next one when it comes up in a few hours.

I agree, Jean, that Diabetes definitely adds layers to food issues, both physically and emotionally. But for me, when I first got into recovery from my ED (without Diabetes to complicate things) I had to accept that there was a biochemical thing going on there too. I was physiologically addicted to sugar, and it took me awhile to accept that fact, and it wasn’t until I went some time (30-60 days) without any at all, that I recognized how much easier it was and why. Now 16 years later, I have zero cravings…none at all, which is truly amazing after 30 years of binge eating, weight loss/weight gain, bulimia, etc, etc.

You do sound like you have a loop going with your physical D reactions and your emotional food issues, and it can be hard to figure the whole chicken and egg thing. My suggestion is just to grab a loop somewhere and pull which eventually will disentangle the whole knot. One way to start is getting help, another (since you seem very much a self-starter which I understand too well!) is to determine which foods you binge on and try eliminating them completely for 30 days (yep, I know it’s HARD!) and see what happens as well as do some reading on ED’s.

Here’s me taking out the big guns for sushi … big combo bolus plus increased basal rate for eight hours. Let’s hope it works!

I’m trying to learn to avoid this stuff 99% of the time, but bolus for it in a way that doesn’t leave me high for hours when I do want it.

Well, the good news is: you’re right.

The bad news is: I have gone over a year without eating any sugar or refined carbs or other trigger foods (several years in fact, over the years) and then something would happen (usually involving surgery, extreme pain, severe stress and short doses of prescription pain pills, i.e. dislocating my shoulder or finding a melanoma lesion that had to be cut off with a whole bunch of stuff around it, or the shocking death of my beloved brother from kidney cancer) and I’d be right off the wagon again.

I recognize that it’s a neurotransmitter, insulin resistance, glucose metabolism, emotional distress, etc. Bermuda Polygon, but recognizing and doing don’t always go hand-in-hand, do they?

Meanwhile, I’ve developed insulin-dependent T2 diabetes and how does one treat a hypo, exactly, without sugar? I had to call the paramedics once when I was at 36 mg/dl and had no sugar in the house; I learned that lesson. Now I try to keep only “sugar I don’t like” in the house, but a low when I’m at work or out driving will sometimes result in several days to a couple of weeks off the wagon.

Not proud of it, but there it is: cookie crumbs all over my whiskers and me with the Novolog pen in my hand inexplicably afraid to just SHOOT IT DOWN already.

Absolutely: one thing at a time. One test, one bolus, one calculated meal, one pill. I can’t think of those things stretching out in front of me “forever” or I go a bit mad. On my best days I’m all “get it done and move on”. Very business-like and no more emotional about it than I am about brushing my teeth. Who feels like a failure when they have to brush their teeth before bed? You just do it and move on. You don’t fret about having to do it for the rest of your life, right?

But D is fraught with emotional undercurrents for sure, all this “was I bad, or was I good” stuff.

T2 especially is prime “beat yourself up” territory, especially in a culture that is swamped with debates about “good” vs. “bad” foods and “ugly” vs. “pretty” BMI’s and “those darn obese people are destroying everything from air travel to the medical system” diatribes.

Unless I operate from an almost clinically detached place within myself, I feel like a failure no matter what I do, because it’s never perfect and it’s never “enough”. I can go there (putting on my proverbial white coat and getting out my clipboard and my fine-point pen) but I’m more of a roll around in the back of the VW van playing “Me and Bobby McGee” on my beat up old guitar while we drive out to the creek to swim and have a bar-b-que kind of girl.

God, I miss just being able to sit cross-legged on the sand with wet hair and a sunburned nose, eating watermelon with my buddies and never, ever thinking, “I wonder how many carbs are in this?”

Those were the days…

You go, Jen!!! Aim for the center and keep shooting till it’s down! LOL

I’m going to go test and bolus a bit more in your honor. ;O)

I hope you don’t mind if I become an acidrock23 groupie? Tell Mrs. ar23 that we’re basically harmless and that no stalking will be involved.

I’m just in awe of your courage with insulin. I try to be brave but I have nowhere near your resolute will to evaporate highs.

I totally get what you say about big boluses being shameful.

It’s double shame. Because first you feel like a failure because your body can’t do something so simple and basic that almost everyone else’s body can do automatically. (E.g. a friend of mine commented when hearing of my dx, 'How can you not be able to metabolize a croissant? That’s crazy!)

And then doubly shameful because you then need extra extra help at the scene of the crime, so to speak.

I am currently on an insane insulin regimen due to being pregnant. It’s particularly bad in the morning, when I need a couple of units just for oxygen. Then another couple of units for a cup of decaff tea with a splash of milk and no sugar. This morning, 1/8 of a bagel with a bite of egg and a strip of bacon required 12 units of insulin. (That’s on top of what I need for the oxygen and the tea hahaha.)

Do I feel like a failure for needing this much insulin? Yes, all the time. But I so hate highs that I go the opposite way and set my phasers on high.

Heh, yeah, didn’t quite work out … I was 220 after an hour and a half (bolus!) and 238 after two hours (another bolus!), so I’ll have to be even MORE aggressive next time (whenever that is)!!!

Crazy, considering I don’t think of sushi as that unhealthy, aside from the white rice part …