Running High (Is there such a thing?)

It’s been a while guys and gals!

Hope you’re all well?

Quick fact check for you guys:

Age: 39
Race: Caucasian
Gender: Female
BMI: 62
HbA1c : 8.5%
Insulin: Humalog Mix 50
Dose: 70 units x 2 per day

So I was wondering if you (or anyone you knew) “ran high”? It’s a new thing to me, I overheard someone saying that many type 2’s “run high” as they age and no matter what they do it doesn’t change.

The reason I ask is because I’m simply unable to regulate my levels in any way, shape or form. The fact is I can eat, starve, exercise, lay in bed all day, do anything you like and my sugar levels do not reduce appropriately.

It is my understanding that 70 units of Humalog Mix 50 is quite substantial, however, I cannot find proof of this anywhere on the great interwebs and it doesn’t matter what my intake of insulin is I simply do not read less than 11.0mmol/L (as a fasting reading upon wake-up) it’s not Hasimoto’s though because I take random readings during the day, before bed, before lunch etc etc and not once in the past 6 months have I read less than 11.0mmol/L at anytime.

My usual bedtime is between 13.9mmol/L and 16mmol/L and if I hit 11mmol/L then I am starving!!! It’s like the equivalent of a low for me!! I get trembly, light headed and so very hangry!!

Any thoughts?

I can respond to this bit confidently enough: the BG level at which that “hypo” feeling kicks in is very individual, and very dependent on your prevailing BG level. I don’t know if there are studies on this but there are plenty of anecdotal reports from people saying this changed for them dramatically after getting their A1C to a lower level. So yes, if you’re used to running around 16mmol (300mg/dl), then 11 (200) is going to make you feel low and shaky, even though it counts as a pretty high BG in itself. Numerous people report that getting down to a lower average BG also lowers the point at which you feel hypo. It really seems to be very much a relative, not an absolute factor.

As for Humalog Mix 50, I’m not familiar with it per se, and I do know insulin dosages don’t line up between type one and type two, but from my perspective as a T1, yeah, 70 units does sound like a lot.

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Seventy units per day sounds like a lot but not for a T2. What I would take issue with is the Humalog mix that is the insulin. To get the best results from insulin, one has to take an appropriate amount for basal and an appropriate amount for bolus, depending upon the number of carbs one is eating. I would suggest that a mix that is locked in on the amount of fast and slow insulin is not matching your needs. I would suggest that you get separate basal and bolus insulins and work out what your basal needs are. Then learn how to count carbs as accurately as is possible and work out what your carb-to-insulin (c:i) ratio is. Then dose them separately and see if the results improve.

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I completely agree with this. I can’t sense low BG’s anymore because my control has been very good and my BG is consistently between 100-120. My Endo told me I could run my BG around 300 for a couple weeks and that should bring some hyper awareness back, but he knew I wouldn’t like doing that.

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There are many more options for your treatment before accepting this false statement.
Do you see endo or does primary doc provide diabetes care? There are many other treatments for type 2s that can reduce insulin resistance, and improve how your insulin works. Changing insulins and timing may also help.

What does your doctor tell you?

Not really, 70 units of insulin can be a low amount for a Type 2. When its said that 70 units is high they are most likely thinking of Type 1.

Insulin resistance is the culprit when it comes to T2 and insulin, sometimes it takes considerably more to achieve the same outcome, 200+ units is not unheard of for T2 diabetics. When I started insulin I was concerned about the seemly high amount I was taking, I asked my doctor how much was too much, he replied that there is no maximum amount as long as you avoid going low.

It is essentially a low, Sometime being low is relative to your usual glucose levels. If your body become accustomed to high glucose levels then anything below can be felt as a low.

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I’m a T1 and take about 70 units of insulin a day because I’m overweight. My endocrinologist said that’s a “perfectly reasonable” dose to be taking. So, especially for someone with T2, I don’t think it would be a high dose at all.

I agree with what everyone else has said. The problem with running high constantly is that research indicates that it leads to serious long-term complications. So, if you want the best chance of avoiding those complications, you need to try to be as close to non-diabetic numbers as you can. There are a lot of new insulin and non-insulin options that you could discuss with your doctor.

I’m with @Willow4 that you need to consider changing insulins to a basal/bolus regime. Use a basal (lantus, levemir, tresiba,…) and a bolus insulin (humalog, novolog, apidra,…) with an insulin to carb ratio.

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You may want to consider looking at a solution such as:

https://www.virtahealth.com/

They would address both your BG based on your insulin usage as well as your BMI since they are interrelated and you should end up with a much quicker, better, long term solution.

Just a thought. - I have no financial or any other interest in this company but have seen and heard of remarkably quick, long term results from using their protocols.

Thanks for the response-makes sense what you’re saying!

Thanks for the response. I think (to be very honest) that my GP knew I had what is called “psychological insulin resistance” - basically it’s where negative beliefs about insulin treatment permanence, restrictiveness, low self-efficacy, personal failure, and illness severity keep stopping the patient (me) from adhering to the required treatment (read injecting myself).

I was barely able to accept the thought of a twice daily injection with an “easy” method (the kwikpen) and to even consider a full-on insulin calculation based on carbohydrate intake per meal and using “real” injections scares the hell out of me!!

BUT

I think you are right that this mix is not effective :slightly_frowning_face:

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I am on a very low benefit medical insurance here in South Africa so my dear GP is trying his best… he is struggling and admitted that he is at his wits end with my treatment… we are trying to find a reasonable priced Endo now in the hopes that one appointment will be all I need (as it’s all I could afford).

I think I have to try sort something different though cause both my GP and I can’t keep guessing like this!!

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I’m relieved to finally hear that because I have so many people reacting with “OMG - how much!!!” when I tell them.

I must admit though that the swelling in my feet and the weight gain are my biggest concern at the moment. The studies all state that it is a confirmed side effect of insulin usage and it is incredibly disconcerting for me.

This is my biggest fear! Of late, I’ve been experiencing serious edema in my feet and lower legs, neuropathy as well (my feet and calves are on fire permanently). My eyesight is blurry most days and I’ve got shockingly high CRP levels (along with high white blood cell counts) that are not attributed to any other physical illness.

I think this is why I’m starting to panic.

The only issue I have with the Keto diet is the fact that even one little slip-up has serious repercussions. I am very weak mentally (my biggest challenge) when it comes to sticking with a diet. Of all the problems I have this is most likely the worst one.

I am a type 1 but before my pump I took about a 90-100 units of insulin a day. Now I take around 50 because I can dose more accurately with a pump.

Personally I have heard that no dose is too high or low, because it is based on whatever you need to keep your BG in a proper range. There are people that take 100’s of units a day to control their BG levels. That is rare, but it happens.

Weight Gain from insulin however is a sign of too much insulin. So I really as previously suggested you separate the Basal and Bolus insulin so you can actually use the more proper doses. When you take the two together you are tied to a certain basal dose to control but can’t raise the bolus as needed.

Think of it as a coffee coming premixed, some people might like it, but for most it’s either too much sugar or too much creamer. (or both)

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Makes perfect sense! I think I have to force myself to find an Endo and get a script change. I wish my medical insurance covered a pump but I reckon I can adjust to “real” injections. I have to do it!

That is why I suggested you work with a company such as Virta that will work with you one baby step at a time and would not recommend you try a keto diet on your own, at all. The company would give you a lot of positive mental reinforcement and stick with you throughout the process.

You will also get a lot of support from members on this board. We really, really do care about helping each other out.

You know you need to do something to reverse your deterioration. It sounds to me like proper coaching and follow up would be your easiest potential toward success.

I would love to join but at $199 converted into South African Rand it is simply too expensive. Thank you though and please know that if my financial limitations weren’t so strict I’d be there immediately!!

There are people that have great control without a pump. You just have to pay more attention than I obviously did. I admit I was sloppy on shots. I would take a bigger dose to cover a meal and a snack. I since I was taking it before I would guess at an amount and then sometimes have to eat more to make up for too much insulin because I didn’t want to bother with an extra shot. My control varied around 6.8-7.0 A1C on shots.