Insulin injection quantity increasing Type 1

[Zohaib]

I am 30 yrs old now. My diabetes was diagnosed back in 2015 when I was 22.

I started with Humalog mix 25 (12 units morning and 8 units evening) and Humalog Lispro 6 units in Lunch.

Recently, the requirement for Insulin injection has increased dramatically like I inject 40 units morning and 24 units evening. Even then my Fasting reading today was 267 mg/dl.

Is there any way to reduce injection? Is there any alternative medicine that anyone can share? Has the Insulin stopped working?

Everytime I go to the doctor, he just increases Insulin units.

 

[EllieM]

Hi @Zohaab and welcome to the forums

It sounds like you are on fixed doses of insulin and have to have fixed amounts of carbs for each meal? If you haven't changed what you are eating then it sounds to me that your insulin resistance may have gone up, but there can be a number of causes for this (including weight gain, change in exercise, stress, illness.... ) Maybe you've had covid recently : there are all sorts of reports about changed insulin needs after covid.

Insulin may not work as well if you inject in overused sites. Are you rotating your injection sites?

Personally I find life easier with a long acting insulin and a short acting insulin before each meal. More injections, but it gives me flexibility over when and how much I eat and also allows me to inject a correction dose if I run high. But as a T1 I depend on insulin to live, there are different brands with different time profiles, but there isn't an alternative.

If increased insulin resistance is your issue (and I'm not saying it is) then spme T1s find metformin helps as an addition to their insulin. (Though as you were on initially what seems to me quite a low dose of insulin, I'm not sure whether your doctor will regard insulin resistance as relevant). I genuinely don't know whether your issue is increased insulin resistance or whether your internal insulin production has reduced, or something else. (Some T1s produce some insulin for ages).

In any case, my insulin needs have changed quite a bit over my life : it's not always obvious why.

Honestly, you need to take up your concerns with your diabetic team. Yes, changing insulin brands is an option, which may or may not help.

Once more , welcome, and good luck.

 

[plantae]

I'm technically probably not allowed to post here because I'm type 3c. But my treatment is exactly the same as T1 so...

EllieM mentioned injection sites. I think that's a good thing to bring up because if I inject into my legs the insulin doesn't work as well (I was on Clexane for a year and always injected that into my thighs. The fat in my thighs has big hard lumps in it from that and I think that's why the insulin doesn't work well there). I've also been told to use the smallest needle I can (4mm) but I don't know why

I don't know about increased insulin: my problem seems to be the complete opposite. I seem to need less now. Much less. It's a nightmare. Maybe our bodies just adjust?

The point about Covid is interesting and I've been reading a lot of reports about that lately. Something worthwhile to consider for sure.

Anyway, good luck

 

[Zohaib]

Hi @Zohaab and welcome to the forums

It sounds like you are on fixed doses of insulin and have to have fixed amounts of carbs for each meal? If you haven't changed what you are eating then it sounds to me that your insulin resistance may have gone up, but there can be a number of causes for this (including weight gain, change in exercise, stress, illness.... ) Maybe you've had covid recently : there are all sorts of reports about changed insulin needs after covid.

Insulin may not work as well if you inject in overused sites. Are you rotating your injection sites?

Personally I find life easier with a long acting insulin and a short acting insulin before each meal. More injections, but it gives me flexibility over when and how much I eat and also allows me to inject a correction dose if I run high. But as a T1 I depend on insulin to live, there are different brands with different time profiles, but there isn't an alternative.

If increased insulin resistance is your issue (and I'm not saying it is) then spme T1s find metformin helps as an addition to their insulin. (Though as you were on initially what seems to me quite a low dose of insulin, I'm not sure whether your doctor will regard insulin resistance as relevant). I genuinely don't know whether your issue is increased insulin resistance or whether your internal insulin production has reduced, or something else. (Some T1s produce some insulin for ages).

In any case, my insulin needs have changed quite a bit over my life : it's not always obvious why.

Honestly, you need to take up your concerns with your diabetic team. Yes, changing insulin brands is an option, which may or may not help.

Once more , welcome, and good luck.

Thanks for your responses. My weight has remained around 70kg for past 5 years so that hasn't affected insulin dose and I never had covid so that isn't a case either.

I inject insulin on Belly (rotating left and right).

My c-peptide level was less than 0.1 nmol/l back in 2017 so my body doesn't produce insulin.

I will discuss insulin resistance with my doctor as that might be the case.

 

[Marie 2]

I'm thinking when you say fasting level you mean first thing in the am? If it's just in the am it could be DP or Dawn Phenomenon. It can start at any time and turn around and stop anytime too. It can even be off and on. But our bodies release hormones while we are sleeping to get us ready for the day. It causes a release of glucose from the liver to supply us energy. A "normal" automatically makes insulin to deal with it. Since we don't, we wake up with a high blood glucose level. It also will cause more insulin resistance for a few hours after you are awake. One way to tell if it is DP, which usually hits around 5-6 am, set your alarm to wake up at 4 am to see what your blood sugar is at. If it is in a more normal range at 4 am, but then really high when you wake, it's a good chance it's DP.

Another thing could be a rebound effect of dropping too low from too much insulin. Then your liver dumps glucose as a response. A lot of us lose the ability to have a glycogen response after time, some people keep it for years. That ones harder to nail down as you would have to know if at some point during the night you are dropping too low and then suddenly shooting up, that part happens pretty quick in a short time. During the day we are likely to have more food, but at night we are sleeping and not. The mix you are on has a longer lasting effect that can be causing some weird peaks and valleys at night. That has a tendency to be more erratic, not necessarily daily, but you never know. You could try testing your blood one night at 2 am and another night at 4 am to see if you could nail down if it's a more sudden increase or steady.

A cgm is one of the best things to know what happens at night! I would push for one. It makes our life so much easier!

I also really recommend starting to learn to carb count. That way you can learn to give the amount of insulin that you are closer to needing and vary it as needed. Just taking set doses, means your levels can go up, or you will need to eat because you are dropping too low. But you would then need to switch to a straight fast acting for meals and corrections, and a separate long lasting to meet your basic basal rate. And the two insulins mixed together in a blend are notoriously harder to control. They have weird peaks. So you have to eat a certain amount of carbs at a certain time and then it can still vary. It's just much more controllable to be able to vary your fast acting doses to what you eat and what you need.

If it's an all day, exercise can make us use insulin better, if you have stopped being as active, your insulin needs could go up. Being stressed can also make your needs vary.

Or as @EllieM has said. Insulin Resistance.