Insulin Resistance - Type 1

I’m a Type 1 diabetic, and i’ve recently seen my insulin needs dramatically increase. I’ve gone through a very stressful past two months, to which I was attributing this change. However, things have calmed down the past couple weeks, and it seems very strange to me that I’m still having such huge insulin needs. I was already quite thin and lost another 10 lbs probably from the stress. I would think that the opposite would be true, that I would be even more sensitive to insulin and need less. To give you an example, I’ve had to increase my basal rates by 50%, and it’s still not quite enough. I’ve also had to increase my insulin to carb ratios from 1:10 to 1:7. Has anyone else had a similar experience with Type 1 Diabetes and going through periods of sudden insulin resistance?

Is it possible you could have unnoticed infection? Like a yeast or bladder infection?

I was very resistant to Lantus. I was taking a total of 70 units dailyus w/e humalog i needed. Then now that I am on the pump I take no more than 60 units of humalog a day. So everybody differs. But it might be an underlying problem as well…good luck with finding out what’s wrong =)

Stress can create insulin resistance. So can lack of sleep, hormonal changes, and any number of other variables. I become incredibly insulin resistant a week before my period, for instance. And if I’m really stressed out.

I have a term for this which I call “insulin interference”. For example, other hormones can compete for access to the cells, therefore the insulin does not work properly. This is a fundamentally different situation from a chronic state (which type 2 diabetes is) and is often temporary in nature. As others have mentioned, stress hormones can be a cause, and many women find that monthly menstrual cycles can also interfere, kids in puberty also have these issues. However, this is not a permanent state, and your insulin needs may be reduced at some point in the future. You might also consider whether it is an immunological response to the particular insulin variety you are using. Some doctors can test for this, but many are not familiar how to do it. In this case, a switch to a different type of insulin can often resolve the issue (instantly) and reduce your insulin needs. You might consider asking your doctor if you could try a different insulin and if he/she has any samples to see if it makes a difference. Finally, do not rule out the possibility that your vial/cartridge of insulin has expired … the general time limit after first use is only 28 days, although some can last longer, in some cases, it won’t. As with anything with diabetes, there are so many possibilities, it is often a task of detective work and trying different things to see if the issue is resolved.

Hi Laura,
I am really with Scott on this idea of an immunological response to the type of insulin you are using. My doctor first started me on one kind of fast acting insulin and it became very obvious i needed very large amounts to get me through. But the amounts just didn’t make sense. I talked to my doctor and he said we woudl try a different insulin.and it was the right move to make. I am now using Humalog and Lantus. But I don’t think any one insulin is the answer for everyone. I think you should uise whatever the doctor has samples for until you find the one that works best for you. When you find the one where you can use reasonable insulin to carb ratios then stick with that one.

Hi Laura,

I’m glad you raised this because I’ve been experiencing the same thing & haven’t been able to get a handle on what’s going on. I’ll eat the same thing, in the same portions & need to take more insulin to cover it. My insulin (Apidra & Lantus) hasn’t expired & nothing stressful is going on (well, not any more stressful than usual). I’ve only been on Apidra & Lantus for 3 months, if this is long enough to have developed an immune response. Like you, I’m Type 1 & very thin. I’m trying to gain weight, which is hard on low carb. Since this recent development of needing more Apidra & Lantus, I’m concerned about eating more & not knowing how much more insulin to take. In addition to needing more Apidra, it also seems that the Apidra doesn’t last as long. Have you noticed this also?

I add metformin for some of my patients type1 who are on one and half or more unit/kg/day total insulin,as insulin sensitiser,to see if it will improve control based on study published.It helps in some especially overweight girls.None of my patients are on pumps.Metformin helped some of my patients but they have to stop it if sick and continue on insulin only ( metformin can cause lactic acidosis during sickness).

I have several other hormone issues that interfere with my insulin absorption. I’m on cortisol and progesterone (all natural, not synthetics) that have pretty much gotten rid of the problem.

I was having insulin resistance maybe once or twice a month where I would have to increase my basals by 50 to 70% in order to run in range, but now I rarely need to increase. In fact, I’ve decreased my basals multiple times since starting these treatments. The 2 weeks of the month that I’m on the progesterone I can even set a basal pattern about 20% lower than normal.

You might have someone take a look at other “symptoms” that could be an underlying condition. Also, look at diet changes, prescription changes, etc. that can all cause insulin resistance.

I’ve always wondered about doing this since I have PCOS. I talked to my endo and he didn’t seem to think it was a good idea (maybe because I have hypo unawareness and am more susceptible to lows). Do you know of any specific studies that have been done for this?

I am wondering what happened, because I am currently experiencing the exact same symptoms. I have gone through a fairly long stress period of several weeks. But it has largely passed. My insulin needs have been both really high at times (essentially tripling my usual basal dose) and quite varied. I am using a dexcom monitor which has been very helpful, but I find myself adding bolus after bolus to try to keep my BG down.

I am also experiencing the same dramatic increase in BG from carbs. I usually have been at 1:12. I have no clear idea what it is now - I have been trying to keep my carbs way down, but maybe 1:6.

So, if you received any good advice, I would love to hear it.

I wonder if long term stress leads to some longer lasting metabolic effects that continue after the end of the stressful period - long term increase in adrenaline or something like that.

Yes. We are dealing with puberty. We have to increase insulin sometimes up to 100% from the hours of 7pm through 3am at the latest. But not every night.:{ So it is crash and burn. We test every hour when we have to do this. I would say it is one to two weeks out of the month. There are some times we have to change the basal way up, then at some point she will start dropping (this period has lasted as long as three weeks at a time). For an adult, I would add 30 minutes of walking or easy exercise into my daily schedule and see if that helps (it’s supposed to). Not extreme exercise. But whatever your body needs at the moment, whatever the reason you need more insulin, I would just give the insulin and not stress out too much about how much/little you are using. It is not easy being a pancreas. Since we don’t really know if the body gives one set standard amount of basal insulin for normal, non-D people (I doubt this; I think insulin needs change, sometimes radically), why worry about temporary increases and decreases?

Thanks, I like your approach. It is why I use a dexcom cgm, even though I get no insurance coverage.
and it is a pretty big monthly price tag.
While I have an average daily dose and an average daily basal, the variation around the average is
a lot and very hard to predict.

Hi, I posted elsewhere that I see dramatic differences in my insulin needs that I correlate with stress. I’m a college professor and I noticed that when school began in the fall, I had more insulin resistance and my blood sugars elevated. Then my blood sugar came down at Christmas vacation, then went back up when classes started, then came down when school got out. Now I have my summer research students arriving Monday and my sugars came back up, I think in anticipation. I am learning self-talk to help myself with stress. For me, having external expectations is stressful. What helps is not yoga or anything like that but a reasoning in my mind of “well, what’s the worst that can happen?” and “I can only do my best” and “This is a difficult task but I’ll take it step by step.”

Best wishes to you,
Maria