Insulin Resistance?

Okay so I just started fast acting insulin Humalog almost a week ago now after being diagnosed with type 1.5. I am not on a basal insulin yet since my fasting bg is so good. First of all my endo told me to eat 15 carbs per unit but I am more like 10 carbs per unit even though I am extremely active and only 100 lbs. Secondly, I tried to lower a 3.5 hour post prandial of 217 by testing my correction factor and taking 1 unit of insulin…it did not lower my bg!! Does this mean I am very insulin resistant or could there possibly be something wrong with my insulin pen? I have been sick with bronchitis, does this affect your insulin resistance or insulin needs? I know everyone is very different but how much does one unit typically lower your bg?

Your blood sugars can go up when you are sick especially when you are fighting an infection. It’s key to stay hydrated because having prolonged blood sugars over 240 can cause you to spill keytones as well as being dehydrated. Am assuming you are still in the honeymoon period so your insulin needs will likely change from time to time. If it continues you can call your doc and ask what to do and if it still happens even after your are well then you just might need a little basal insulin.



When I am sick I need more insulin, but I gradually increase it and try not to take too many large corrections on top of each other. That’s called stacking. You can end up swinging the other way and having a bad low. I also need a little more of a correction when I am over 200. I am small like you and my correction factor is 1 unit lowers me 120 points. But I take about 1 unit to lower me 90 points when I am over 200. When I am correcting, I take my bolus (injection) and check in one hour. You should see it coming down and it will continue to come down. If you don’t see a change, check it in another hour (2 hrs after injecting). You might see it come down then and then take a much smaller dose to help it the rest of the way down.



I hope this helps. Feel better.

Insulin resistance is a relative term. Your endo started you on a conservative insulin to carb ratio of 15. I basically started at 5. If you are having better results with 10, that is fine. You may at a later time need to adjust that to 15.

It is very common to find that your blood sugars are elevated when you are sick and that attempts to use normal corrections to bring those blood sugars are not very effective.

Everybody is very different, and don’t be assuming you are insulin sensitive or resistant based on initial results and how you react when sick.

A 1:15 ratio is conservative & the one people generally start with.

Often when a correction doesn’t bring down a high it could be because BG is stil climbing upwards, so the correction may not have appeared to work but it kept it from going higher. Some insulin leaks from pen injections. WIth one 1 unit, you may not have actually gotten the full 1 unit dose.

One unit Apidra lowers my BG 60 points & it takes about 1-2 hours for me to know the full effect. I weigh only a few more pounds than you. You’re right that you can’t judge your ratios by anyone else’s.

Neither of these mean you’re insulin resistant. After one week using insulin, it’s hard to tell anything.

Illness, injury, infection, antibiotics, exercise, hormones, stress all effect insulin needs. When I’m sick, I take small corrections doses (1-1.5 units every 1-2 hours). This works better for me than taking mega doses.

Another issue could be the type of food you had eaten. High-fat foods metabolize carbohydrates slowly and can cause extended highs if you don’t delay your bolus accordingly. And, as others have said, it takes awhile for rapid-acting insulin to produce its affect. How long after taking the additional unit did you test?



Gerry

P.S.: glad to see Dr. Koch put you on insulin to help manage your diabetes!

Finally they gave you insuliin. Thank goodness. Some of us were awfully frustrated for you.



15 units/carb is a typical starting point. You should have to go up or down, but your endo should have given you instructions.



I am type 1, so different, but I have different insulin to carb ratios at breakfast, lunch, and dinner. If you are still eating pretty low carb, then your high protein diet is also raising your bg. If your doc didn’t give you information about figuring insulin for your protein, you should read some information from either Using Insulin, or Dr Bernsteins Diabetes Solution. They are pretty inexpensive to buy, or you can probably check ot one or all of them at your local library. I can download Bernsteins e-book for 3 weeks for free at my public library.



Allergies and illness that affect my sinuses raise my bg. It is like you have an infection yoru body is trying to fight. Dehydration and infection raise bg, so try to stay hydrated, or you will likely get a double wammy of bg raising factors. Also, when your bg is over 200 or 250, you insulin will work less effectively than when it is lower. Not sure why, but it happens, so if you are 217 and you inject 2 units that only drop you 50 points in 2 hours, that is not necessarily your i:c (insulin to carb ratio). Until you kick the bronchitis, you probably won’t be able to nail down a carb ratio, just play it by ear.



There is a really good chart that Dr Bernstein created called the glucograf that puts all info on a sheet in a logical manner so it helps the docs out a lot. U can find recreated versions online, or Bernstein sells them on his website.

Sounds to me most likely, that you need a basal insulin.

Insulin doses always need adjustment, on top of that.

No need to invoke “insulin resistance” just because the first (blind) guess at insulin doses isn’t right. In fact, adjusting insulin doses is a never-ending process.

One week is just not long enough to zone into what will ultimately be your insulin regiment. However, it looks like you have an astute understanding of insulin intake. Communicate your information to your endo and he will get you there.

And yes, illness will effect your BG. I caught a bug from my kids this weekend and I’ve had to adjust my correction factor to stay within my goals.

Good luck!

When your are sick it makes the action of the insulin much less than normal for many people. 1 unit per 10 grams of carb is about par and not particularily insulin resistant. In my case 1 unit of insulin would do absolutely nothing.

Well , I’d give the Log 3 hrs and then test… It can peak btwn 2-4 hrs and I found 3 is mine…
Goal Being not more than 120 -140… ( 90’s is best) by that time…

  1. Test B4 eating… SB btwn 80-110’s anyhigher and your reg. bolus for the meal and BG will end up higher ( If higher than 100 B4 eating, have to take a CB or Correction Bolus to treat that issue as well. )
  2. Test at Hr #3… B btwn 90-140… 90 is ideal
  3. Then test at Hr #4 just to make sure your still not going down too much ( 90 min)

You have 3 meals a day and No Snacks? Then after 2-3 days and 6-9x meals and you are still too high?
I’d lower my Carb in 10% Increaments… in your case from 1-15 to 1-13, etc. and do it again for the next 6-9 meals and see how things go

And just keep doing this until you see yourself ending up in that golden range of btwn 90-130’s 3 hrs after eating…consistianly.

I assume your also testing At Bedtime and when you 1st get up and are staying under 140…If not? Tell your Dr…a Basal Insulin maybe warranted…
1st Ultimate goal is to do the best you can at staying at or below 140 max at all times, but in most cases is all but impossible all the time…

Keep the Faith…

I assume you looked up Humalog and how long it lasts on the Ave, etc…?
And I would get the Book> Think Like a Pancrease… and read up on it for further preperation as well.

FYI? Bakery Goods and Pasta take longer to digest…But At your weight I would be more watchfull for going Hypo vs Hyper… I hope you have a bottle of Glucose Tabs and keep also the smaller Tube of them with you at all times… 1 tab is 5carbs and ave 25 pts… can be +/- 5 pts…

My starting BG before my correction bolus of 1 unit was 217 same at 2 hours it was 210 then at 3 hours 178 but that includes unpacking a car and going up and down the stairs after our family vacation. Seriously?? It seems like I’m injecting pure water here!! I have had a fever and felt really bad though, hope that has something to do with it!

Oh and after my 3 hour test of 178 I rode the bike for 35 minutes because I just could not stand my bg being high any longer it has been up for days…and after my bike ride my bg was 109! So exercise works better than insulin!?
Oh and I have read Using Insulin and Think Like a Pancreas about 3 times each.

My fasting is 100-135

Thats what I was thinking but it’s just frustrating trying to figure insulin out while being so sick and not knowing if my illness is affecting the insulin.

Yeah had bronchitis now I believe has turned into sinus infection…yay for diabetic immune systems! I have been chugging water 24/7 bc i feel so bad. So maybe when you are over 200 you are more insulin resistant perhaps?

Thanks! Me too!

Didn’t consider these things…when I gave the correction dose I had not eaten in almost 4 hours. How do I keep the insulin pen from leaking? I’m counting to 15 already…

Thanks! I’m hoping my bg is just high from being sick.

Yeah stacking is a concern for me as this is so new to me, I as even worried about taking a correction bolus 3.5 hours after my first bolus of only one unit at lunch lol. Saturday morning I decided to bolus for the first time before breakfast, my bg starting was 130 and my bg at 1 hour was 255 which in Using Insulin states to stop the insulin to carb ratio test and take a correction bolus but I was too scared to because I have not been explained how this all works and insulin stacking etc so I did not and it took about 6 hours for my bg to come down.
Thanks, I hope I feel better soon as well I’ve been sick back to back with diff things since New Years!

Sorry, I don’t know how to prevent the leaking other than what you’re already doing. Between the bruising I had with pens & the leaking, I tossed mine out. I found pens bulky & wasteful. Easier for me to put a couple of syringes & vial in my metter case than tote around a pen.