Severe Insulin Resistance

Hi - This is the first time that I have posted anything but I'm hoping that some people on here can help me. I was diagnosed with Type 2 about 9 years ago. At first I didn't have many problems and was able to control it with Metformin and Glipizide. Over the years things have just been getting worse. I eat a fairly low carb diet, I cheat once in a while but for the most part I eat as low carb as possible. I am still overweight (210) but have lost around 40lbs over the last year. The main problem is that my doctors cannot get my blood sugars under control very well. I am now up to 60 units of NovoLog every time I eat and 60 in the morning and 100 at bed of Levemir. This is hardly keeping them under 250 most days and many days I'm up around 500. I am being trained on the OmniPod (I have it on but there I just saline in it till next week) now and my Diabetes Educator told me that I have severe insulin resistance and that my carb to insulin ratio is 1:2. Does this sound right? I'm so upset with this I'm feeling like there is no hope for me. If anyone else has been through this, I would love to hear about it, I feel very alone.

Hi Leslie, I am also very insulin-resistant so I understand where you are coming from! I second Helen's comment that it isn't a competition. Some people are insulin-sensitive, some people are insulin-resistant. It's just the luck of the draw. And by the way, don't beat yourself up about your weight. You can be thin and insulin-resistant, and you can be fat and insulin-sensitive.

If you need the insulin, you need the insulin. Needing more insulin doesn't make you a bad person or a hopeless case. You need what you need to keep your numbers under control.

Having said that though, there are a few things you can do to try to tackle this. The most urgent task as I see it, is to get your blood sugar down to more normal levels. The higher your blood sugar, the more insulin-resistant we tend to be - so that's not very helpful when one is insulin-resistant to start with. I myself find that once my blood sugar is high (which for me is anything higher than 160 or so), it is stubborn and sticky, and takes a LOT more insulin to lower by one unit than it would if my blood sugar was in range.

The other thing you can do is to really cut out the carbs, at least until you get your blood sugar into a normal range. 60 units of Novolog at a 1:2 ratio means you are eating 30g of carb per meal? That is not high carb by the standards of the 'normal' world but diabetes works by somewhat different rules. Could you possibly bear to go lower carb than this? Or even zero carb? Again, this isn't for forever, but just to get your blood sugar into normal range.

Finally - and some might disagree with me here - one suggestion is that you could try changing your basal insulin? Levemir does not work very well for some people. I'm one of those people. For more than a year from diagnosis, Lantus gave me pretty good morning numbers. But then I got switched to Levemir and despite taking double the dose, I woke up high every morning. Waking up high is such an awful start to the day and pretty much ruins my mornings. I lasted two weeks on Levemir then rebelled and put myself back on Lantus.

I've also had severe insulin resistance, though I'm type 1. Or both type 1 and 2, depending on who you ask. My ratio has been 1:1 in the past, no fun! Congrats on the weight loss though!

I was on levemir/novolog and switched to omni-pod too, it helped a lot. With a bunch of strategies, I went from 80+ units novolog and 125+ units levemir a day to under 70 units total daily insulin, with better bg numbers. I can tell you all the things I did to lower my resistance and get better control, but I have a few questions for you.

If your ratio is 1:2 (one unit insulin covers two carbs), and you need 60 units to cover ea meal, that means each meal is 120 carbs? Does that mean you're taking 180 units of novolog and 100 units of levemir each day? And eating 360g carbs a day? Something seems wrong here.

How much metformin are you taking and how often? Can you give an example of what you eat in a day, and what kind of exercise you get and when?

You are not alone, and you can get this sorted out!

It's a frustrating vicious cycle. High insulin doses don't help weight loss.

Good suggestion from Lila to try lowering carbs. Building muscle mass helps lower insulin resistance.

Have you had your thyroid tested? Hypothyroidism is tied to insulin resistance. If you can get a thyroid panel, have Free T3, Free T4 & Reverse T3 tested. Most doctors only test TSH & that's useless.

I am sort of in the same boat. My TDD (total daily dose)is about 120 when on insulin only. Injecting any more does nothing and injection onto the floor is equally as effective.

Are you still on metformin? This helps with insulin resistance a lot. I cuts my TDD by about 40%.

Even more effective is Victoza at least for a while it cuts my TDD by 2/3.

As much exercise as possible and possibly in our cases extremely low carb ketogenic diets would be best.

Also what Lila writes is probable, high blood sugars make the insulin resistance even worst so you get this positive feedback i.e. a vicious circle which certainly is not positive in our cases..

Best of luck and keep us informed.

“Have you asked your doctor about Symlin? It is helping me a lot with insulin resistance. I also split my Levemir dose: 11am 9u, 11pm 14u.”

Dear Carol by how much does the symlin lower your TDD ?

Right now my ratio is 1 unit per 1 carb. I reduce my bolus by 20%, which averages out to about 1 or 2 units. So, for a 60 carb meal of low glycemic index carbs I will reduce my bolus to 4 units with a normal range blood sugar. If I am eating a high carb meal I will reduce the bolus by 1. What I find is that my post-meal blood sugar has significantly improved. My numbers are now between 120-160 as opposed to in the 200-300's when I was not taking Symlin.

Hi Leslie, You could be me, I was taking 120 unit of Levemir each day and as much or more Novolog each day. I was doing fair glucose wise but not great. I told myself that I could do better.

Those dreaded words, diet and exercise are what helped me tame the insulin resistance monster. I bought myself a copy of Dr Bernstiens book as a guide. I reduced my carbs input to less than 100 a day and tried to do better if I could. I also started a walking program, I started slowly and continued to increase my distance over time, before too long I was walking 3+ miles a day. It's my opinion that the exercise reduces the resistance more that the diet. Like you I lost 40 pounds, I still walk or ride an exercise machine not to loose weight but to keep IR at bay.

Today I'm at my ideal weight and my TDD is 60 to 80 a day. Ratio is 1 to 4 instead of 1-2. We may not be able to defeat the IR monster but we can at least tame it.

And which came first the chicken or the egg, in other words what came first insulin resistance or weight gain. I suspect we will never know the answer to either question.

Oh yeah I still cheat sometimes also


Thank you everybody that have replied I'm glad that they're others out there that can help me with this. I have only recently been going to an endocrinologist that seems to really care about my diabetes. I have mostly been treated by my primary care doctor who is very nice but had not educated me on a lot of this. I am not on any oral medicines anymore because he didn't think that it was doing me any good plus the Metformin was really upsetting my stomach. I tried Actos too but it didn't make a difference either. About the 1:2 ratios, I hadn't heard of it until yesterday so I cannot say what she meant. I know that I should do better with my diet, usually try to follow a South Beach Diet type of diet. It's hard to do a lot of exercise too, I have very bad arthritis in my hips, and my doctor told me that I am going to have to have hip replacements sometime in the next few years. I'm hoping to join a gym in January so that I can ride their bikes and do water exercises. Has anyone that uses a pump used u500? That is what my doctor is going to want me to start using in my pump next week. Just wondering if it has helped others?

Using a pump should help since you can tailor your basal needs but going on U500 I would stall until all other options are exhausted. Give victoza a try.

Leslie, I'm sorry if someone else repeated this information. I am on my way to dialysis and didn't want to forget to respond to you.

I used to take U500 insulin (5x stronger than U100) to the tune of several hundred units per day. Now some of that was my fault. I was not eating right. At that point I had given up and figured why should I fight it.

As my BG readings came in control I started using less and less. But still I was taking mega doses of insulin.

I went to see an endo here in MS that started me on Byetta. That started the transformation. I am now on 5u Humlaog before each meal and 40u of Lantus daily. A far cry from where I was 4 years ago.

Talk to your medical team about something other than Levemir.

Also, are you seeing an diabetes specialist or a regular family practice? If you are not seeing an endo...might I suggest that you look for one and see them.

When you have T1, as you lose the ability to produce insulin, you also lose amylin, a hormone helps digestion and makes you feel full. Smylin is the synthetic form of amlyn. Most T2s, unless they have lost most of their beta cell function won't benefit from Smylin. Fortunately, the GPP-1 analogs like Byetta, Victoza and Bydureon work in a similar way and are often helpful to T2s

Wow, using 60 units of rapid for a meal does seem high. And as others have said, high blood sugars and high insulin levels "cause" insulin resistance. Many people find that once their blood sugar levels normalize, their insulin demands decrease.

It also seems out of whack with your basal insulin (Levemir). I am a T2 on insulin and I also consider myself insulin resistant. So I eat a low carb diet, not a fairly low carb diet, a really low carb diet. Years ago I found Dr. Bernstein's "Diabetes Solution" book and it really helped me understand how much carbs played a role in my blood sugar problems. For me, I usually eat less than 50g/day in carbs and I bolus under 10 units for meals, usually just a few units. Compared to my basal, which is 55 units/day, my meal boluses are very small. I actually think that a serious low carb diet can be really helpful for those of us who are very insulin resistant, which by definition means we cannot tolerate carbs.

Many educators will suggest that for the recommended diet of 45-65% of calories from carbs, you will have your Total Daily Dose (TDD) evenly split (basal/bolus) at 50/50. Mine is more like 75/25 or even 80/20. Just some thoughts.

Please have faith, you can get your blood sugar under control and you can improve the insulin resistance. A pump will really help, allowing you to more safely correct your blood sugars down to normal levels

Stemwinder has it right and makes extremely inportant point about diet and exercise.

he doesnt tell this part but it has to do with glucose saturation.

As the temporary glucose storage sites on the skeletal muscles get fully loaded, the muscle cells keep down grading the insulin receptor sites of the cells to the point the insulin just keeps ciculating around blood system like water doing nothing.

Exercise - sufficient - 1 to 2 miles walking get that loaded glucose of skeletal muscle sites burned off making more room.

Room to store glucose means blood glucose kept down.

The infinite wisom of medical science has been conned over the infinite glucose storage capacity of human skeletal muscles - just add insulin and/or actos and that will keep the glucose out of blood system - good luck there. Comments in this blog suggest something else.

Decent diet 1200 calories helps prevent over loading of storage. Metformin in sufficient doses and i prefer stringing around clock rather than one or two large doses will keep liver arrested.

in past, i could watch 26 units of humalog 75/25 do nothing till walked 2 miles and the see blood glucose drop down to a 100.

best wishes and good luck.

You may not be resistant, but worsening. From what I have been reading since I have the same problems you do. I went from being prediabetic, to 1 500 metformin, to 2 500 metformin to 1500 metformin. Then to 5 different other meds. I didnt realize the side effects especially stomach issues. This was not controlling my sugar levels but the metformin was actually making me sick. Now off the metformin, finally the doctor listened, I feel 70% better than before. I started on 8 units of Levimer now on 12 units and he wants me to start a instant pill you take 5 minutes before you eat 3 times a day to stop any spikes. Besides being nervous to take it, I dont wanna be sick again. I have other issues tho. IBS, gerd, high blood pressure, and high cholesterol. I am very sensitive to any pills and the diabetes pills just don't work on me. Over-time diabetes only worsens, its proven..whether you lose or gain weight. I haven't eaten pasta in 4 months, and now trying to learn to stay away from bagels, they are making me spike and get me sick. It's a fact, medicine is just a band-aid and you have to make the life style changes to get better. It stinks right?? I am tired of fighting with my doctor's, they don't get it and like my endos secretary said pills are a big business. I am ready to try a vegan diet because its just not worth the hassle of dealing with uncredited doctors who really don't care. In the back of their mine, they are just thinking that we are unhealthy people who don't care. When in fact, we are the ones that care the most of making better of our mistakes, or its something we just can't help. My entire ancestory comes from a long line of diabetics as well. My highest numbers have been about 235. years ago it was only 120. There is always hope, and you can fight this with all of us. Never give up...and determine with your meter what foods are causing these spikes..that's what I have been doing. Veggies always seem to help

Are you still taking Metformin to deal with the Insulin Resistance? I am also very insulin resistant. I lost all the weight I can without being underweight. The best things for my IR is daily exercise 1-2 hours. I find walking 3-4 miles is best. As said above go as low carb as you can tolerate. Giving up all wheat products really helped my IR. I still have to watch carbs, arou d 10-15 carbs per meal.

I'm agreeing with several of the others' posts here. I also have severe insulin resistance and am very frustrated with the HUGE amounts of insulin I've had to take. I was taking the same amounts of Levemir as you however, I was just gaining weight. I was also taking Novolog before every meal. My last A1C was 8.4, my highest ever!!! I freaked out. My new dr. put me on a new insulin instead of Levemir. Its more concentrated (I forgot the name of it, sorry) and so I only take 20 or 25 units in the AM/PM instead of 60 or 100. It is amazing! I wake up under 100 almost everyday instead of waking up at 200-250. Since I changed I don't think I have ever been over 200 all day long.
Another change she made that I think is helping a LOT is with my Glimeperide...I went from taking 2 in the AM to taking one in the AM and one in the PM. She also put me on Victoza. These changes have helped me stay low. I have also started Exercising, which I absolutely hate but because I'm boxing instead of walking the treadmill I "kind of" like it better and can tolerate it more.
These small changes have made a world of difference for me but I recognize we are all different. I hope some of this helps someone :)
Blessings, Autumn

That matches my experience. My read is that the exercise and for me was 2 miles min walking and 1200 calorie diet - drop the grains/flours way back helps get the body working better. My read is that it is glucose saturation of the temporary glucose storage sites of the skeletal muscles and fat cells that pushes up the IR. Burn some of that stored glucose off and reduce calorie input - nee grains and voila; there is room to store more glucose - maintain regulation.

Medical Science has yet to acknowledge that the glucose storage in the skeletal muscles is finite and can saturate. The muscle sites as they fill up downgrade their insulin sensors and thusly it takes more and more insulin to force in the glucose and if one is in to jacking the stuff in - use actos.

I meant to add that metformin used in sufficient doses is critical to corral excess liver glucose release adding to the saturation.

Best wishes and good luck!

Dear Gary may I ask you how long it took u to start lose weight in 100 gm of carb and walking work out as I am doing this for three weeks but cant see any results and that kills me...I am on levemir 50 units a day splitted and Novo Rapid but stil wake up in about 250 or so and afraid to increase levemir because of weight gain, I am confused ..