Insulin resistance?

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1

I am still dealing with this "insulin resistance" or whatever it is that suddenly developed over the past two months or so.

I'm taking 70-80 units per day and STILL having probably 75% of my readings above 8 mmol/L (150 mg/dl). I've been eating around 150g of carbohydrates only because if I eat under 100g then I end up taking 55-65 units a day and that doesn't look like much more than I was taking before (when I was eating around 300g per day). When I go to my endocrinologist and GP I want to be able to show them that my insulin doses have increased a LOT. At least with increasing doses my control has improved a lot. I am not having any lows to speak of and actually feel low when I get around 4-5 mmol/L (80-90 mg/dl) because I am running high so much of the time. But I am not running nearly as high as I was a few weeks ago.

For comparison, using my old doses, if I were eating 150g of carbohydrates a day, I would expect to take around 35-40 units a day ... Less if I was eating under 100g.

I am also way more sensitive to carbohydrates, in that they raise my blood sugar way more htan they used to (at least from what I can tell). Before when treating lows and such I used to treat it as 1g raising me by about 0.3 mmol/L (5 mg/dl). Now that seems to have doubled or so and even eating 1-2g without bolusing will create a very noticeable rise. I don't understand this but I think it's probably related to everything else.

I have tried doing corrections with an insulin pen, tried using Humalog instead of Apidra, tried switching over to my old Cozmo pump for a bit ... Nothing's made any difference. So I'm 99.99% sure it's my body and not something like an insulin or pump problem.

I would swear I've developed Type 2 diabetes in addition to Type 1, except that doesn't make sense because my weight has gone down slightly during the past six months, I'm eating WAY better than I used to, and I have almost no history of Type 2 in my extended family (and zero in my immediate family). Plus, this didn't develop over a few years, more like a few weeks. So that just does not seem right to me.

Yet I can't think of any other causes of insulin resistance (especially so sudden) that haven't been checked out (infection, thyroid, stress, hormones, etc.).

I don't mind taking whatever insulin I need, but I find it disturbing that this happened so fast (and so dramatically ... I'm eating fewer carbohydrates than I ever have before and taking more insulin than I ever have before). I also find it very frustrating that I starting eating fewer carbohydrates in hopes of taking less insulin and losing weight, and then this kicked in so that even eating fewer carbohydrates I'm taking just as much (or more) insulin than I was before. My weight is pretty much holding steady but I would like to be losing weight not holding steady.

I am seeing about three doctors in just over a week and am hoping that at least one of them might have some idea.

2

Good job on losing weight and eating healthier! Don't worry about the daily dose issue. Stuff changes. I dunno if I was stressing or tapering or what but in late Sept/ early October, I ended up cranking my basals way up, some times (early AM), up 50% from where they'd been before. It flattened things out and then went away. Stuff changes or drifts or whatever all the time, don't get hung up on the numbers. I noticed a lot of people running into "turbulence" when the seasons changed this year, maybe it's every year, but if stuff changes, I understand that it may be alarming but if it takes more insulin, it takes more insulin.

3

I guess "alarming" would be a good description ... I'm currently taking 50% more basal all day and and 100% more bolus insulin than I was and I'm still getting readings like 9-11 after like 20-25g meals and well into the teens if I eat anything larger. My doses have certainly drifted a bit over the years but for the most part have stayed in the same range and haven't gone to anything this extreme for this long of a period.

I guess I am happy about the weight loss but it has been like five pounds total over the past six months or so, so in my mind that doesn't really count, although I suppose I'm not gaining any which is good. It hasn't really budged at all in the past month or two. I feel like I'd be having more success if my insulin doses hadn't changed so much and I could be taking half of what I am right now. Ugh.

4

Not sure if this is helpful but the last time my insulin needs doubled literally overnight, it was because I was pregnant...

5

I know that is definitely not the case, but thanks for the suggestion!! :)

6

Have you changed your amount of exercise? Days I don't exercise require both substaintial bolis and basil increases.

7

Double Diabetes ??? If yes, can be treated by meds....I think metformin is being used . I never had heard of this , till I met a lady here in my community , who is on insulin at least 5 years longer than I ...I guess about 34 years. Upper body exercises make insulin be more effective ?

8

@michael13: I haven't significantly changed my exercise, though when I do exercise I do need to decrease basal/bolus a bit surrounding it. But even the "decrease" still ends up being more insulin than I was taking on non-exercise days before.

@nel: I don't think it is double diabetes although that's what it seems like (just developed kind of fast for that, I think, but can't think of what else it might be ...). I will be asking my endocrinologist if he has any suggestions, or if he thinks I should just keep doing what I'm doing. I am going to put my basal rates up a bit more because I'm still seeing lots of 9s, and 10s today. Would prefer to see more like 5s and 6s but only get one or two readings that low each day, the rest are still high ... At least I'm not getting 17s and 19s a few times every day like I was a few weeks ago!

9

I would say any progress towards "smoother" is good? A little more basal and a little more bolus and you might be right where you want to be? Don't be too disappointed in the 5 lbs in 6 months. To me, that sounds like great progress, particularly if you've kept it up for that long? It is really important to consider that stuff a "long term" solution, not "I'll eat pork rinds and bacon for 3 months, lose 10 lbs and then go back to the old stuff", which is what several of my Atkinsy co-workers had done. I think that developing an active lifestyle is one of the most important things anyone can do for their health, whether they have diabetes or not although I've found that having workouts on my "calendar" (which really, doesn't have much else...haircuts,..doctor's appointments and workouts. Maybe an occasional race?) is a big motivator to work to make sure my BG is where it needs to be before the workout. Then, during the workout, I anticipate the post-workout munchies so I try to keep an eye on it so a spike doesn't get in the way of that and, pretty soon, I've "achieved" about 4 or 5 hours of ok BG, just because I went running for 1/2 hour.

10

Hmm, I do exercise but for me it tends to mess up my BG rather than fix it. Well, maybe in the long-term it fixes it (and the next day is usually great), but in the hours immediately surrounding exercise it's hard to get it just right so that I don't go either too high or too low before/after.

11

Although I would agree with an active lifestyle, though for me that's been less of a challenge than the whole eating fewer carbohydrates was, mostly because I started exercising somewhat regularly years ago. Losing weight is way harder and I don't really think reflects my exercise, but I do feel way stronger/healthier when I am exercising regularly than when I go even a few weeks without.

12

I'm sorry to hear you are still struggling with this. It really sounds like something is going on which your doctors just cannot find. Something like gastroparesis. I know that at times you get frustrated with all the effort you have put into this. It may feel like it doesn't make a difference, but it does. If you hadn't made all the effort with your diet and all your blood sugar would likely be much worse. So hang in there, be persistent with your doctors and don't beat yourself up over this. In the end, what matters is not whether our blood sugar met some arbitrary target or our weight is at some point. What matters is that you did the best you could to take care of yourself.

13

I've actually looked into gastroparesis because I was looking into reasons my heart rate/blood pressure could be messed up and it mentioned autonomic neuropathy as a possible reason for a fast heart rate. But the part that doesn't fit with autonomic neuropathy is that I don't have any low blood pressure with standing or other things, just high spikes. And the spikes are sustained while the description made it sound like it would be more variable if it were neuropathy ... And the part that doesn't fit with gastroparesis is that I'm not having any random lows, just tons of highs. I've tested after meals at one hour and at two hours and I just go high at one hour and stay high at two, there is no low then high. Same with overnight (or at least I haven't been able to find anything close to low overnight testing 2-3x). It just seems like my blood sugar is constantly going high, not a combination of highs and lows.

I'll see what the internal medicine doctor looking into all this says but I might ask him about gastroparesis if he doesn't think about it, and see what he thinks.

I do agree with you totally that if I wasn't putting so much effort into this my control would be much, much worse.

14

I agree , that exercise can mess one up ...I see /have seen it a lot but none of the numbers are unsurmountable : there seem to be trends when one is consistent , I have learned from , especially what friend , Canadian Olympian Rower Chris Jarvis shared several years ago , when I did the 1/2 M ( he did the full M ) : cancel temp basal as soon as one hits the finish line , then immediately give a small bolus to avoid the HI ...it works for me too, if I do much, much shorter periods of intense movements ( as a walker ) .
Hang in Jen ...