T1D- Sudden & Dramatic decrease in Insulin Sensitivity

What you re going through is the worst! I also use INPEN and love it. I never change the needles until they are dull but always prime each dose with 1-2 units to make sure they are not clogged. My vote is the HUMOLOG. It is different and think it is thicker? As suggested already, your Dr. can insist on Novolog if its the only insulin that works!
Hope things resolve soon!

ya, test for covid as well. My insulin use changed drastically after I contracted covid, I had to get a pump. Which is a pain but helped the BG and Time In Range a lot, and other stuff, like retinopathy, improved. A lot. If I relapse (long covid, yes) then I get the kind of numbers you’re getting, with the delay - soaring BG for hours, then finally it kicks in. The only thing that seems to work then is to restrict carbs down below 40 gms CHO/day, then change the basal rate and bolus ratios gradually until I’m under control again.

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My uncles had Type 2 (and no treatment back then, so they died in their 50s). I got Type 1 after varicella and was on Humalog and NPH for many years. Then (as happens after many years) I got old and suddenly the Humalog became much less effective: I was taking more and more, but my sugars were high and the Humalog worked very slowly, where before it worked quickly.
Finally, an endocrinologist suggested Metformin, and my insulin requirement dropped drastically. Still a lot slower than it used to be, but at least now I no longer need a 50 unit syringe, I’m back to a 30 unit syringe (I never need more than 20 units).

I’m sorry. I feel so bad for you. I have been having erratic numbers but I have a reason. Having Tepezza infusions for TED and hyperglycemia is a side effect. I do MDI. Next week get the Medtronic Iport so I can get all insulin through the port. Should have InPen soon. Had to research these devices on YouTube as apparently Endo never heard of. Will have to switch back to humalog from Lyumjev but don’t anticipate a problem except to remember to pre bolus. Sorry not a real answer for your situation but right now am bolusing what seems like a gallon of insulin. What does Endo say? I did hear that novolog and humalog acted differently. I do inject into muscle if goes up to high but that’s 200 for me. And comes right down.

“Marilyn6: If you aren’t changing the pen needles every time you use Tresiba, it could be that you aren’t getting insulin.”

What happens to the insulin if it doesn’t go into your skin?

It doesn’t come out of the pen.

Yes, when you prime the pen, you just “flick” the insulin drops off. It sounds to me like you got some bad insulin. That’s a good point to prime the pen as per instructions…
Have you tried talking to the pharmacy? If you get your insulin through the mail, it should be on a cool pack and at a good temperature when it arrives. Or maybe you need to go back to the brand that works for you. Insurance companies these days!!!

Good luck to you. I know it’s very disturbing when you can’t get your blood sugars down.

Is there pushback on the plunger? Does it leak out? Liquids don’t compress so the container has to give if the plunger is depressed.

The makers of the Tresiba pen told me that the needle needs to be changed after each use or you have a chance of not receiving enough insulin. I was definitely not changing the needle that often, and I thought I had bad insulin. I didn’t realize that I wasn’t receiving a full dose of insulin.

I was also using a Novolog pen. It definitely clogs up and it prevents the insulin from leaving the pen. There is pushback on the plunger.

I haven’t taken one apart but the Novo pens (I use Fiasp) are spring operated. Pushing on the cap releases the spring and allows it to eject the insulin. If there is resistance the spring won’t do anything and it is necessary to exert pressure on the cap; I suspect this just puts extra pressure on the spring. The mechanism makes resistance easy to detect and it does happen with new needles (I change every time). I inject into my Omnipod (using the pen) and failure to get the needle in far enough results in this effect.

I’ve also encountered it with MDI using Humalog pens and insulin syringes. There were just some times the insulin wouldn’t come out because something in my abused skin stopped it.

Okay. Thanks to you and Marilyn. I haven’t used a pen since I start on the pump…35-ish years ago? I was using Symlin for a long time and only changed the needle when I started a new pen. I never experienced and blockage with Symlin, at 25 doses per-pen.

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You changed it that often?

Yep, one every 25 doses. Now when I was doing finger sticks 6-8m times a day, I change the lancet when I had a hard time getting blood. Something like once or twice per year.

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Indeed, reminds me of my grandfather’s lancet:

Sometimes took a few whacks, but always drew blood. There was a lot to be said about the old tech, I’m pretty sure I said most of it.

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Haa! Very funny!

I still test at least a couple of times a day even with a CGM. I go for months using the same lancet. I am very fortunate that my skin is very forgiving.

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Sometimes it takes more than a reasonable amount of time for things to be ironed out between a patient, doc, and insurance. Perhaps you could order your preferred insulin from a fairly priced Canadian pharmacy (Marks Marine Pharmacy for example). You are doing an experiment to see if, all other things being equal, the previous insulin really returns you to good BG /A1C levels without crazy highs/lows. If not, you need to insist your doc does a deep dive, lots of lab work and looks for other possible causes. Sometimes benign tumours on or ineffective function of adrenals, parathyroids, or thyroid can be involved. Another autoimmune problem can affect effectiveness of insulin. Be patient, but persistent.

My family has a history of Type 2. I developed Type 1 in my 30s. So I have no c-peptide, but, as I got old, my insulin sensitivity dropped. Where I used to need 15 units, I needed 50. So my endocrinologist put me on Metformin, and it worked.