Yeah, unfortunately I can’t really manage stairs with the SPD.
I didn’t want to mention the pregnancy in the original post because I knew people would latch onto it. But it’s a problem I have regardless of whether or not I’m pregnant.
I mean, I know that insulin resistance skyrockets during pregnancy – I’m living it (for the second time!) But it still strikes me as strange, pregnancy totally aside, that 10 U when I’m at 140 will immediately send me down to 100 or below, where as 10 U when I’m at 240 will do . . . nothing, essentially.
But what some have mentioned upthread, that insulin resistance increases with higher BG – that I did not know (I feel like someone should’ve explained it to me at some point over these many years!!), and it really illuminates a lot of issues I’ve had. The body is a very strange thing. I wonder what the evolutionary advantage (if any) is of increased insulin resistance with higher BG. Then again, I could wonder what the evolutionary advantage of having a busted pancreas is, and I wouldn’t get much of anywhere. 
I’m on various topical steroid medications for my allergies (nasal spray, skin cream, asthma inhaler, swallowed steroids) and I’ve read and been told that they don’t get absorbed into the bloodstream like shots or pills and hterefore shouldn’t affect blood sugar that much. But, I must admit, I do wonder if that’s part of the reason I have such problems with my blood sugar. Well, that in addition to monthly hormones, thyroid madness, allergies and stress, activity and weather changes…
Interesting to read about more insulin resistance at higher BG level. Sometimes it does seem like it takes forever to come down. With MDI, I’ll switch to a fresh cartridge if #s won’t behave. Sometimes the potency of the insulin deteriorates.
I think this is one of those YDMV things, an individual variation, like so many other aspects of this physiological crazy house. I don’t detect much difference based on the meter reading. Like Terry, I favor IMs for fast corrections and even in the 300s, It seems to work about the same, i.e., the amount that I calculate should return me to normal, usually does.
That’s definitely frustrating. When we think about insulin resistance, it will effect both bolus (meal + correction) and basal. I’ve found that a well-calibrated basal dose is necessary for a bolus dose to do its job. So, let’s say your insulin resistance starts to ramp up. It leads you to delivering an increased bolus in an attempt to overcome the resistance. What that dose fails to do is to provide a sound launching pad for it to act appropriately. The intended correction is busy trying to backfill the hole left by the basal insulin that has built up over time.
What I would be tempted to try in a situation like this is to ramp up the basal rate (a +temp basal in a pump or an additional long acting dose if MDI) and once the increased basal is in place, attempt another correction. Does this make any sense to you? There will be some trial and error to this so it would be safest if you were not distracted too much. Keeping notes helps a lot.
This speculation on my part is the result of struggling with insulin resistance for several years before discovering the magic of carb limits to break the back on my insulin resistance. Good luck!
I have an idea about the evolutionary advantage of insulin resistance. Premise: blood sugar is low, you die; if your blood sugar is mildly high, you likely won’t notice and it will hurt you but not immediately. In a food scarcity situation being insulin resistant is advantageous because you are unlikely to die from a low blood sugar while foraging (and basically starving). So, you can starve for longer on a high blood sugar than a low. I think this is a flexible trait: therefore if you’re in a situation where your blood sugar needs to be high to avoid a sugar crash in a starvation scenario, your insulin resistance is higher; and if you are in range/lower end your insulin resistance lowers as well because the “starvation scenario” is not being triggered.
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Hmm. Intruiguing theory; intuitively appealing in several ways. Only hesitation that occurs right off the top is, if you are in a true “starving” scenario, how would BG get to be high in the first place, unless your body is cannibalizing itself? (It won’t be coming from nutrients consumed when there aren’t any.) Not a recipe for long- (or even medium-) term survival.
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I like your idea of it being evolutionary in nature. I had always thought of it as the body being over-saturated in glucose–so when you are trying to bring it down–it’s kinda like if you had a sugary cup of water, dumped it, and filled it with distilled water. There would still be remnants of sugar left over. This is likely an oversimplification, I admit.
I’ve found that for highs that will not budge, as in exercise, insulin, carb restriction, nothing will bring it down, that the cause is almost always either hormones (cycle, stress, thyroid) or that my infusion set isn’t absorbing properly. Sometimes a set is still partially working but not totally working, which results in highs that just stay flat for hours on end, no matter how many corrections are delivered. For me, if an infusion set is working and the cause isn’t hormones, a correction brings down even extreme highs with one correction (e.g., last night I woke up at 21 mmol/L in the middle of the night and did a correction and within four hours I was back in range).
This is a real thing, and it has a name!
Glucose Toxicity
Glucose toxicity means a decrease in insulin
secretion and an increase in insulin resistance due to chronic
hyperglycemia. It is now generally accepted that glucose toxicity is involved in the worsening of diabetes by affecting the secretion of β-cells.
Hope that helps… 
I find all this to be true as well. My question is what do you mean by " the first thing I do is inspect the pump site"? I can’t tell anything from looking at my site, and hate to replace an infusion set early if it’s not the cause. Is there any way to really know if it’s the site itself? Thanks!
I’ve loved reading all these responses and have a variation on the problem: lately, for no apparent reason, I’m having highs (~180) at night that don’t respond to corrections, but they don’t go higher than 180-200 either. They just seem to be stuck there. I do corrections every 2 hours (with more insulin than daytime or for lower BG) when my CGM alerts me that I’m still high, and since I don’t go down, I’ve also tried a temp basal increase to 120%. This combination is working better, but still not ideally.
The odd thing is as soon as I wake up, still ~180, and take a bolus for breakfast with a correction, I drop super fast! As though all the insulin I’ve taken at night is finally being absorbed… I wonder if it’s bc I take such tiny amounts (.5 unit for 180)? and while sleeping it’s not getting absorbed? Anyone else have this issue?
It’s new for me and not consistent, so I can’t simply increase my basal every night. Thanks!
I wear a medtronic pump and use the quick-sets (type of infusion set). I have had them literally leak where I can rub my shirt with my hand gently; smell my hand and it smells like insulin; if I push on the site and its tender that is also a dead give away. Also if I remove the connector from the top of the site and I look at the adhesive disc around the plastic nipple; if I see leakage around the cannula; I can see the adhesive circle discolored and lifting from the center out; or sometimes you can see blood under the disc or even in the cannula.
I sometimes will change the site if I start having problems if the site is over 2 1/2 days old.
Your night time highs could be in part do to absorption issues if the site has age on it. But it sounds like you will just need to play with your basals until you fine tune it. I go to bed at 11pm and raise my basal around 3:30am and keep that basal rate till right after breakfast. But everyone is a little different so you will have to tweak until you find the perfect combo.
I find pump site changes usually work best for me if I do them after I shower or 2 hours after breakfast or any other meal for that matter. I try to avoid changing at night before bed. But if I suspect a dead site in the middle of the night I will change it. Usually giving a correction in my arm via a syringe before fooling with changing the pump set out.
Another thing I started doing recently that seems to help with the weird drops; that sometimes happen after a site change. If I change my pump site out and the old one is not infected (tender to the touch) I will leave it on my body for 4 or 5 hours. I have found removing it right away can make any insulin that was not absorbing all of a sudden absorb. Giving me a case of the lows; which we all know is the pits.
Good luck.
Ed
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Are these highs on your CGM? Do you confirm them with your meter? I just started on the Dexcom by found that if I sleep on my sensor I can get spurious readings.
ps. If you are injecting 0.5 unit, you may not be getting any insulin at all. Basically no pens support injecting a half unit. You might be able to get 0.5 unit by being careful with a syringe.
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There are syringes with half-unit markings that make it pretty easy. With minimal practice, you can dose down to 1/4 unit using them.
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I have had this issue. I’ve been struggling with overnight highs for a few months now. I can’t point to any one factor that caused this scenario but I’ve found maintaining my daily walk schedule, resisting evening snacking, and a recent bump up in my overnight pump basal rates appear to be doing the trick. For the last three days I’ve had very good overnight BGs.
Like you, I’ve also made small overnight corrections to a 180 level BG and it resists moving downward. Once I get up and take a correction, it quickly comes down. I’m on the right path now and I think avoiding the evening snacking together with the increased overnight basal rates have worked well for me. It’s taken me like three months to sort this out!
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I’ve noticed this as well. It almost seems as the the ratio is different with small vs. large boluses. I can give many small boluses with little effect–whereas one large bolus (equaling the many small boluses) seem to do the trick. I have found that I need to give a large bolus–then catch it before it goes too low. Very frustrating indeed.
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Thanks Ed! Great info. I’ve never smelled, smelled or felt insulin leaking from my site, but I have been having trouble with my sites getting very tender and then big red bumps when I change it, and this could be part of the problem. HOWEVER, during the day my numbers are great! And it doesn’t seem to be related to whether it’s the first day of a set or the 3rd day. I have been using Mios, and just started trying Quicksets, which may be better, not sure yet. Lots of factors to consider…
Thanks!
Thanks for your response Terry. It is somehow comforting just knowing I’m not alone in this! I don’t think I’m snacking in the evenings, but having lows around dinnertime does seem to correlate with the nighttime highs. But nothing is totally consistent! I think I’ll just increase my basal at night for a bit, even if it means some nights I have lows. I"m so tired of waking up every two hours to do a correction bolus!!
Thanks everyone! (sorry about my many replies and edits, I’m slowly learning how to use these forums 
)
Good questions Brian. Yes, these are on my CGM and I sometimes confirm on my meter. They’re very close often enough that I do bolus based on the CGM numbers, and since I’m not going low, I’m confident that it’s accurate enough.
I use a Medtronic pump these days, so can give in .10 units, which seem to work fine in very small doses during daytime, but not at night! This is the main reason I switched to a pump, since I am usually so sensitive to insulin and love being able to take tiny amounts…