Insulin resistant

Spablauw_

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Type of diabetes
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Hello,

I'm a 18 year old boy and just like everyone I like to have a treat once in a while, so yesterday I had chips with meat and fat sauce.
My normal diet is quite low in fat and I might have exaggerated a bit last night with the french fries and sauce, I had the normal amount of carbs with the normal amount of insulin (around 70) and after dinner I was at 92 mg/dl so that was all right.
In the afternoon I went for a run since I knew that fatty meals cause a delayed spike and make you insulin resistant etc... hoping that the exercise would counter my delayed spike.

I checked 4 hours after my meal and I was at 115 mg/dl, I took my normal basal insulin and I went to bed.
Another 4 hours later I woke up feeling "hyper" (you all know how it feels....) so I checked my sugars and they were at 243 mg/dl !
I tried to get them down with rapid acting insulin so I took 4 units (1 unit brings me down around 50 but I find I need more insulin to bring down "delayed spikes")
I thought I did wel and I went back to sleep for another 3 hours of sleep. However, when I woke up I was feeling better but when I tested my BG it was still at 181 mg/dl.
I haven't been able to get down my BG to a normal level ever since so I'm wondering what it could be.

I'm wondering if it isn't any sort of "insulin resistancy" because of that fat meal yesterday?
I have to say I've got more of these moments, not always necessarily after having a fat meal.
The only relation between these moments I can think of is that it happens when I'm concentrated or when I'm excited about something, normally I'm quite a stressful person and those are the days my BG's are normal?

I now took 7 units while at 247 that will hopefully bring my levels down, right now it's been 1,5 hour I took them and nothing changed....

Hopefully someone can help me!
 
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There are a few things which may have caused this such as
- insulin not working properly. Try changing your insulin.
- pen not working properly. Try changing you pen
- your body is fighting off some bug. Keep an eye on your BG and take corrective doses
- remaining fat from last night's meal delaying the absorption of the carbs. I would expect this to have gone by now.
- you forgot to take your basal insulin. That is not a criticism just a fact of life occasionally when we are enjoying ourselves too much. This is a challenge to manage. Some people take a small covering basal dose and others just use corrective bolus until their next basal is due.
- you are getting stressed by the high BG. Try some of the techniques above to reduce your BG and try not to stress (haha)

... if it was me, I would start by changing my insulin and, if possible my pen and then lots of testing.
 

Spablauw_

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52
Type of diabetes
Type 1
Thanks for your answer, I'm quite confident I didn't forget my basal, however it might be either my Lantus or NovoRapid that isn' t working, I'll change it directly and see what it does.

I find it very hard to say if I'm ill, stressed or calm.
I know all of these three have influence on my BG but I keep finding it very hard to identify them.

I agree with you regarding the delayed absorption of carbs but couldn't it cause some insulin resistance for the day after?
 

Juicyj

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Agree with the great advice by @helensaramay and also add that if i'm above 12mmol/l or 220mg/dl then I need an extra shot of quick acting to bring me down, I hit my insulin resistance level at this point and corrections seem to take longer, so by doing an extra shot then I test each hour until I am back in range, I was up yesterday morning at 2am with a blocked cannula on my pump and spent the next 2 hours taking a correction each hour until I was below 12, then woke at 5.2mmol/l in the morning.

Fat will normally delay carb absorption but should only take around 4-6 hours, changing your insulin is the no. 1 priority when running consistently high with no signs of illness present, keep also drinking plenty of water to help flush the extra glucose through.
 
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TheBigNewt

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IMO this in no stretch of the imagination is indicative of insulin resistance. This sort of stuff just happens to us. And there's no reason for you to have insulin resistance is there? Sometimes the usual insulin regimen results in something unexpected. Just roll with the punches and it will probably just be some weird passing event. And it'll probably happen again.
 
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Spablauw_

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Okay, thank you for the advice.

Just for the record, can this sudden higher need of insulin caused by stress? how do you guys deal with stress or how do you react to it in terms of BG?

I will change my insulin right away, I came back from 240 to 180 after 7 units!!! of rapid acting insulin.
This really shocks me knowing that my normal ratio is around 50-60 mgd/dl
 

TheBigNewt

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Stress is pretty vague, but infections such as a cold, the flu, etc will do that. I agree with trying a different batch of bolus insulin. I don't think I've ever had a pen that I though had ineffective insulin in it, but I've sure had instances when XX units did not lower my BS as much as I expected. I usually blame it on the food not the insulin. Or maybe the injection site just didn't absorb it right. We've all had instances when it seems like we "mainlined" a bolus right?
 

EllieM

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Honestly, sometimes my blood sugar goes up and I never really know why. (Though a significant factor for me was that I was using injecting sites that had become over-used - I now spread my injections much further up my tummy!) It's very easy to keep injecting extra insulin, with no apparent effect, and then find everything crashes too low :(. But you could be coming down with a cold or something which would definitely up your insulin needs. You just have to keep testing, I'm afraid. Good luck.
 

Levy

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I get episodes of this every now and then and have never been able to find an explanation. Sometimes it genuinely feels like I'm injecting water and no matter how much I correct they will not come down (or if they do, it goes much slower than usual and I need a much bigger dose). From experience, these don't last so like @TheBigNewt says I just roll with them and manage them best I can. Don't feel like there's much else I can do.
 
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Spablauw_

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Type of diabetes
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Thank you for all the help,

I now got back to normal levels with the usual units of insulin I take.
I guess it was just one of those moments you can't really do anything about it... I have no clue on what the reason might have been.

I have had more of these moments lately (about once a month) and it really discourages me... especially after struggling for a long time to achieve good levels. Every time this happens I get scared that I lose control again.

I now learned not to panic and not to change my basal insulin and continue daily activities.
Previously I always changed my basal straight away when I woke up high or low, I changed my basal like every 2 days or so...
That really caused me to lose control over my Diabetes.

I'm now doing much better than before, mainly due to the Libre that I managed to get, it helped me to understand patterns especially at night. I was waking up high in the morning before so I thought I had to increase my basal but after the first night of wearing the sensor I saw that I was bouncing back from a low... and so I took less basal instead of more.

My HbA1c has dropped to 6,6 from 7,1 in less than 3 months and now my Libre is showing me an average of 6,3! (last time it was quite accurate)

I guess I should accept that being perfect is impossible and pay less attention to these moments before it affects my way of living!
 
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Juicyj

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I have had more of these moments lately (about once a month) and it really discourages me... especially after struggling for a long time to achieve good levels. Every time this happens I get scared that I lose control again.

I know it's easier said than done, but do not let these episodes discourage you - you are already doing an amazing job in managing this so see them as minor hiccups as this is all they really are, and in the long term they are helping you build your knowledge and confidence in managing your T1.

Believe me when i say none of us are perfect, perfection is too high an aspiration to have with managing a condition like this unless you have a closed loop system the best most of us can hope for is simply 'coping' with each day as it comes and giving yourself a massive pat on the back when you have a good day :)
 

TheBigNewt

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I haven't changed my Lantus/basal dose (25U) since they started making it. Before that I took ultralente probably about the same dose.
 

bhk

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Hi there,

There is nothing much to do, fatty meals kind of block the effectiveness of insulin from 3 to 12 hours after the fatty meal...
That is not a question of stress, virus or any other crazy explanation, this happens to me also and you can find more and more studies assessing this "fat" phenomenon.

The best thing to know is always to monitor the fat that you eat (along with the carbs, which you probably already do) in order to have an idea of what is your "average" fat intake when your insulin "works normally".

And whenever you plan to eat fattier than usual, i recommend taking an extra dose of basal insulin, try to see with trials and errors which dose is best - but always stay on the safe line in order to avoid lows...