Insulin Resistance

For those of you that are very insulin resistant, what have you done, or been recommended to do?

I’ve got a basal rate between 14-16 per hour, and use a syringe to bolus / correct.

I can keep my sugars in line, but I would really like to decrease my insulin intake.

You may want to explore taking a small shot of Victoza with your Dr. The Victoza group here on TU is a great resource.

14 - 16u per hour?

Yeah, per hour.

Is your basal rate 14-16 units an hour, or 14-16 for the whole day?

My rate is 2 per hour. It has been as high as 8-10. My solution if you can call it solved was multifold. First I started with exercise walking 3+ miles a day. Then I read Dr Bernstein book and started to eat lower carbs. I started logging as a way to tell what I was doing right or wrong. And lastly I started visiting TuD almost every day, I still do, because it gives me inspiration, strength and focus.

Gary

That's quite a lot. I would second the advice of looking into Bernstein. I generally follow his diet.

I was told that I was insulin resistant many years ago, by my doctor. My control was bad, and was taking a lot of insulin. Taking more didn't help much.

Now my basal is about 1u / hr.

If you are severely insulin resistant, whether T1 or T2, it is appropriate to talk to your doctor about medications that improve insulin sensitivity. Metformin and Actos are the most commonly known and these can be taken in combination.

A low carb diet as suggested can help with the blood sugar rise after meals.

But I'd also like to suggest two things for you (ok, actually three things). First, if you are regularly experiencing poor control, this can lead to increased demands for insulin. High blood sugars cause insulin resistance and high insulin doses also cause insulin resistance. If you can truly "normalize" your blood sugars you may find that your insulin requirements drop markedly.

Second, it is possible that your insulin resistance is in fact some sort of systemic infection or inflammation. You should work with your medical team to make sure you don't have something like gum disease or an infection.

And third, don't give up, keep working on this. Have faith that you can make progress against this. We have members here who have had severe insulin resistance, had to switch to U-500 insulin and through hard work they have been able to really improve their control and reduce their insulin requirements.

Physical activity can lower your basal insulin, reducing your body fat is a big help and even if you are not obese you could have fat build up in your liver and other internal organs, I'm not assuming your over weight, I'm insulin resistant and my BMI is normal but I have some fat around my mid section and my scan's show some around my internal organs.

A low carb diet will help especially if your liver is continuously dumping sugar into your blood stream....


How much insulin do you bolus every day?

If Brian's and other non-med suggestions don't work, here is what I did. Or what my endo did. I am type 1 on a MM pump. I was using up to 75 units a day a few years ago. My endo put me on 500 mg Metformin bid about 3 years ago now. I just looked at my daily totals and they are ranging from 40 to 50. If something other than adding a med will help I would recommend that. Met does have some side effects, more for some than others. The name brands are often better than generics re side effects if you can take the cost.

These are the comments that suggest to me that:

a) insulin resistance is a proper part of the skeletal muscle cells protocall that have ability to down grade the insulin sensors on the cell surface to reduce the input transfer - storage of glucose into the said cells. As the cells fill up with glucose, the resistance goes up. In a distributed storage system as represented by skeletal muscles; there simply has to be a method to cut off transfer of glucose to those muscle cells filled - doing little versus hard working cells that can take more.

I see science on the wrong orbit around the wrong planet on this issue.

b) exercise/walking of sufficient quantity helps unload the skeletal cells making more room for more glucose and heightened insulin response.

c) reducing diet/carbs helps to reduce the energy input and stop overloading the cells in first place and saturating them ( maximum insulin resistance)

d) in the end, one is moving to better energy balance so that energy in is netted agaisnt burn and prevents cells getting saturated from constant net excess glucose and saturating skeletal muscle cells and fat cells.

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Is U500 still available in the US? I tried my mail order pharmacy, 2 local pharmacies and ended up chatting with a gal at Walgreens and she had said it was discontinued due to incorrect dosages in hospital / care facilities.

My pump rep had mentioned it to me a few weeks ago and i was really excited at the idea of not having to change cartridges daily. Then I couldn’t find a place to buy it.

It varies from day to day. Yesterday was just under 45 bolus units for correction and carbs. Yesterday was a good day where I could bolus, wait for the Dexcom to indicate start to slowly drop then I eat. Blood sugars ranged from 94-138 at fingerstick with Dexcom showing similar. Yesterday was a very good day with a packed lunch, lower carb contents,etc.

I carry most of my excess weight at my midsection unfortunately.

Thanks for the info. I had taken Metformin while still type 2. I couldn’t handle 500mg of the regular, but tolerated XR fine. I didn’t realize it as an option as a type 1.

Thank you. I joined the group and will be asking my doctor at my next appointment.

Would you recommend The Diabetes Diet - 2005 or Diabetes Solution - 2007?

IT's ok to give a try to Metformin or similar, but first of all try hard to improve physical activity.
It lowers insulin resistance, lower your weight and makes you feel and be better.
Try it hard, every day, starting "little" and improving step after step.
That's the first thing you should do. Diet and meds follow, as an help and if needed.
Just my opinion.

Well of course exercise and dropping weight and lowering carbs will help, but I have heard of Amylin helping some people. It is a second hormone that is made my beta cells and prevents the liver from dumping glucose into the blood stream. I know that lack of Amylin can cause the liver to make a steady stream of glucose and not store it and drop when its needed. Making it difficult to control.

Personally I have very low insulin basal rates, I don’t have any over 0.9 units per hour.

my total daily insulin is about 38 units per day, and I really don’t limit carbs too much.

Im 6’3 and I weing 195lbs. So I’m no lightweight.

A year ago my doc suggested Amylin but I declined because I didn’t see the benefit. I have never had any trouble with insulin resistance. 26 years and my basal rates are pretty much the same.

U-500 is still available although I believe one of the suppliers left the business. Pharmacies should be able to order it although it is expensive.

Unless your basal rates are really set up wrong, your dosing just seems off. A basal of 14-16/hr corresponds to 336 - 384 units per day. And if you are only taking 45 units/day in bolus, that is at least a 90/10 basal bolus ratio. If you really had an "insulin resistant" problem, your bolus requirements would be much higher.

I really think you need to look at whether you have something systemic going on. Have you had your CRP (or even better hsCRP) checked, that will tell your doctor if you have inflammation? I'm just sayin.