Very High Insulin Dose...HELP!

Hi everyone,

I have searched and searched and searched the web for a phenomenon that has plagued me since the age of 12.

I seem to have a total daily dose that is 1.5 times my body weight in KG. This works out to be about 4.2mml per hour BASAL via my pump. Yes MASSIVE !! I have tried different site.

I am 80KG and my typical TDD is 125. Now although my A1Cs have always been between 5.7 and 6.4 virtually for all test since I was a teenager (now 38) I have recently noticed the TDD is going up even more, my carbs are only about 220 per day (some times only 180). The main issue is I am gaining weight but dosage reductions make me hyperglycaemic !!

I use Novo ASPART (Novo Rapid).

Can anyone help or have notice this with long term Novo insulin usage ? I have also had the same issue with multiple daily injections so its not down to pumping.

KDC, You’re doing great with your A1c! Congratulations on it! Are you an active person? Run around a lot?
Are you willing to try lowering your carbs while you increase your protein each meal to keep away hunger? I’m not suggesting you all of a sudden lower the carb grams to a low carb diet. Just reduce them by 1/6. That means reducing your insulin by 1/6 as well or you’ll be hypoglycemic. You’re an engineer so figure the proportions and reduce insulin accordingly. Try 1/6 lower grams each meal. Add some ham slices or a hard boiled egg to a meal to keep yourself satiated so no snacks are needed. (You’ll still have energy, don’t worry!)
In another two weeks, lower 1/6 of the grams again.
Finally in two months, lower again by 1/6. Now you should be eating 110 to 90. Treat these stages as required medical transitions in your mind even though you’re doing it yourself. You’re getting older. You don’t need as much. Protein will enable you to do this without knowing you’re eating fewer carb grams.
At 2.5 months you can reassess your situation and determine if you want to do more lowering. 110-90 is not a low carb diet. If you lose some weight, fine. If you don’t, try lowering 1/6 a fourth time.
And keep us all informed. Best wishes. It’s well worth a try!

Increase your exercise, too, as a means to lower resistance if any. This is more trial and error on the reductions of insulin needed, so exercise increase has to be done in small doses.

Thanks Leo2,

No terribly active but as this problem existed since an teenager, I really have only been migromanaging it since I added a CGM.

I used to just take high doses of insulin and be of the opinion that if the A1C was good, I was fine. Recently the weight gain and further TDD increase has made me question if I have developed some sort of resistance to the Novo Aspart (Novo Rapid). Has anyone noticed this or with Homolog ? I had developed this issues with Apidra
insulin 18 months ago and when I swapped back to Aspart, the dosage fell by about 20 units per day. Problem is there are not really many short acting preps so I am running out of options.

I agree more exercise and perhaps further reductions in Carbs although recently I have started to add more protein but no real change.

Will follow your advice. Certainly worth a try…

One option is to combine your treatment with Metformin. Your liver is constantly releasing small amounts of glucose. For these amounts you will need basal insulin. Metformin will moderate the release rate of the liver down. As a result less basal insulin is needed or in other words the sensitivity for insulin increases. Metformin has a good safety record. On the downside it can have some unpleasant sideeffects: bloating, stomach issues. But this is very individual and depends on the dosage and is in some cases only a temporary effect. It is worth a try. If you go this route you should increase your test frequency to prevent lows - especially with your high TDD of basal.

Thanks Holger, my Endo suggested this a while back but it seemed a little drastic and was wondering if something natural could be used as he seemed to want pt avoid it owing to my lack of hypo awareness.

You have hit the nail on the head, even though I bolus low amounts (subject to eating of course), a Basal of 4.2 units per hour is very high for an 80KG person, suggesting my liver and muscles are releasing glycogen causing this.

do you know the half life of Metformin ? If I forgot to take a pill one day, will my basal rate jump massively or is it gradual ? My fear is becoming even more dependant on another drug where if I missed it wold end up hyperglycaemic !!

KDC, you may have been on insulin long enough to develop insulin resistance. If you do have it, then 125 is not an unusually high TDD for someone who is insulin resistant. In the U.S., many endos are putting Type 1’s on Metformin to help use the insulin better and reduce the resistance. I am on it, as one example, and there are many others on this forum. I am on a pump and was on MDI. Resistance has
Nothing wrong with trying what Leo suggested, but if you are insulin resistant, you may need more strategies than simply reducing carbs and insulin and increasing activity.
If you have an endo, I would suggest asking whether he/she thinks you would benefit from a trial with Metformin. Or perhaps wait until you reduce your carbs a small amount at a time as Leo noted, and see if that works. I definitely agree with the suggestion to not drastically reduce the carbs at once because that way leads to failure.

Um… thanks very much. perhaps I am approaching the 30year type 1 milestone and with it comes this sort of issue ? I thought this was a symptom of being over weight.

I had not realised it was a common treatment to mix metformin with insulin in type1’s. Did you ever try and different insulin preparation, say Humalog ? Did this reduce the resistance at all ?

How many times a day do you take metformin ? How long does one tab last in you before your insulin requirements jump up ?

Thanks for your help

There are a number of reasons one can be more insulin resistant than normal. Certainly one reason might be insulin resistance that occurs in your body because of weight gain, high blood sugars, high insulin use, being sedentary and these might be addressed by a drug like metformin. Another possibility is that you have become immune to the insulin where you body produces anti insulin antibodies. Some people have this occur with some of the analog insulin’s (like aspart) or older non-human insulins. And finally there are also genetic variations and it may just be that you use more insulin than average.

And I’m not even sure you are “that resistant.” I use 65-70 units a day and weigh 205 (93 kG). And I eat far, fewer carbs than you.

Metformin has several actions, it increases insulin sensitivity, reduces liver production of glucose and blocks the absoption of carbs. The effects on insulin sensitivity really build up over a period of 6-8 weeks, but the other effects are faster acting. You might notice missing a pill, I never did.

thats a very good point. Insulin Anti bodies !!! voila !! perhaps I should try the only other remaining insulin…humalog !! I am not sure I an insulin resistant either. All I know is that a basal rate of 4.2-4.5 per hour works out to be about 60 units per day and thats massive Thats if I eat nothing. This was only 2.8 -3.2 per hour about 1 year ago and has gone up and up.

My BASAL rate on MDI was around 48 at it’s max. On the pump it was around 38 and has just crept up over two years.

Sensitivity is set to 1.5 and bolus ratio 5.5 suggesting its an unusually high Basal that is my problem.

I think I certainly have a genetic predisposition to need more insulin as this has been the case since I was 11-12yrs old when I used analogs. Do you know and good sources of info concerning insulin antibodies as I used Apidra for three months and kit got to the point when even taking 180 units one day it just would not help and the climbing dose eventually convinced me and the endo that it was not working in my body. Perhaps Novo Aspart is suffering the same albeit at a much smaller rate?

You endo can order a test for insulin antibodies, a high level would suggest an active reaction. Insulin antibodies are the bodies allergic/immune reaction to what is perceived to be a foreign insulin. They will attack the insulin rendering it ineffective. I don’t really know of any good sources. The condition was much more prevalent in the era of animal insulin’s.

Thanks I certainly recall Apidra was rendered useless after only three month usage but actually was more more effective than Novo Aspart (novo rapid) in the initial 3 weeks) after that things went down hill. I switch back to Novo and hey presto my dosage came down. only one left to try !!!

In addition to Metformin, you might want to investigate using porcine insulin. You’re fortunate that it’s available in the UK. Proponnets believe it has many advantages. From what I’ve read, developing antibodies to animal insulin is quite rare. I wanted to use pork insulin, but it doesn’t exist in the US & importing it is beyond what I can afford.

Hi Gerri can it be used with a pump ?

Good question. I was wondering about that as soon as I wrote it. Something to ask your pump manufacturer. My guess would be probably not, but I don’t know. There’s a wonderful UK animal insulin advocate organization. I’ll look for their link to send you. They were very helpful when I asked questions about how to use this.

KDC, here’s the link….

hi Gerri thank you so so so much. I really hope it can be !! I’ll let you know.

Hope so, too.