Insulin Not Effective

[ElkBond]

I haven't had any major problems with my treatment really, other than my varying sensitivity levels but tonight I am having a pickle. SO I thought I would come to the place where these things are solved.

I am sat at 10.2mmol and have been since 7:30pm, I don't do well when my numbers are past 7.8 never mind double digits - luckily this is rare.

All day I have been nice and steady in the 5s (Dexcom) and for tea tonight I had 30g carbs in new potatoes with fish, a usual low carbish tea, which hasn't played up before. Just as I was bolusing and was putting out the food I creeped up to 7ish. I thought no bother so I added an extra top up to accommodate for the 7.

Now here is the odd thing, I waited 10-15 min with FIASP and ate. The 7 kept creeping up which is odd as it's been hours from last food/snack) and kept creeping, then to 11.4 (potentially the potatoes contributed here, also my highest in months). After a while of stress, full on rage bolusing all the time and I have 10 units IOB now (which is more than most days all meals). An hour passed..nothing, no dip nothing. So I get a new vial of FIASP and put in a new Pod (expires this eve anyway) and boom into arm and 3 more units. Nothing..not even a dip, however it has just levelled off now. So I rush about doing housework to get me moving and my dex is slowly coming down to 8.4mmol, grand, perfect finally the new pod is a success. Test on meter, 10.2mmol. No idea where Dex got the drop from then.

I have never taken so much insulin in one go, especially as there is not a lot of working carbs in my body, I am honestly at a loss.

Weird thing is, last night I had an odd incident again, I was at 6.9 before bed, ok bit higher I will just pop a bit in and snooze. Dexcom buzzing, 6.8, 7.0, 6.9 this went on for all night til 5am (yes I am knackered) and in the end I must have bolused 3-4 units for what is normally .3 to bring me down in range. Then today, all is normal, no basal change, carb ration for lunch was perfect...no changes, its like it didn't happen.

So thoughts.

Honeymoon ending in splutters? It has been a year +
FIASP water effect (seen by @tim2000s ?) even with a site change and new vial.
Potential illness cropping up? I feel 100 percent, and no colds coming around in office as yet, but it may be a warning.

There are no secret carbs due to weighing items.

So anyway, I am now trying to calm myself as stress is just gona raise the situation, but never in my small time as a t1 has my body shown any resistance to insulin, normally it is scarily quick to react and very sensitive. I will update - hopefully below 7 prior to bed with a health bedside table of lucozade, in case it suddenly goes shooting down.

Edit: casually did a ketone test to see if the mountains of insulin are being lost but its 0.1 so its definitely working.

 

[tim2000s]

@ElkBond I have seen this kind of thing happen with Fiasp, but first a couple of questions.

How high were the carbs in the meal compared to your last five days total carbs? If they were substantially higher, then the reaction your body had is understandable and quite common (and the reason that people are advised to eat carbs for a couple of days before an oral glucose tolerance test).

If they were within normal range, then how long have you been using Fiasp?

I saw this type of thing happening after two to three weeks, and eventually tracked it down to needing to change pump site every 90-100 units of insulin (which worked out at roughly two days). As you say you were getting towards the end of your pod, it may be linked to something similar.

Dexcom buzzing, 6.8, 7.0, 6.9 this went on for all night til 5am (yes I am knackered)

I think I'd have set my high level somewhat above that if it was buzzing at these levels overnight - there's no need to worry about that as being "high", especially if you need the sleep .

 

[ElkBond]

Hi @tim2000s

30g carbs in this meal, ones previously were the same or higher, monday had 70g for a meal. I tend to hover around less than 60g for most meals. I have noticed this higher ratio to carbs when I have gone for a meal out. In fact my lunch for the day was the same carbs and that was fine. The bit that gets me is the rise before I have even eaten... the last food was a slice of burgen with insulin (11g) hours previous.

Using FIASP for a few months now, never had a water-like issue before. However it did start working later on (1am) as I was woken by lows, and to be honest I expected worse from all the units given.

In regards to the pump site change, that also didn't seem to have any effect, I mean it stopped going up at 11 so i mean the insulin from before and after the pump change must have helped?

Theres lots of food for thought on this, to me, I still find it odd where the units have disappeared too as The only time I have breached 10 units was a Indian takeaway and that was more successful! I may have to put it down to random honeymoon/ body being silly.

And yer I turned my high off last night, usually a .2 brings me back in range from 6.9 so I thought not a problem it will come down, but it just didn't. But yet again I had a whole day since this event with basal and carbs ratios fine until eve. Suppose an eve basal test may have to be conducted just to rule one more thing out.

Thanks for the tips and help

 

[tim2000s]

Using FIASP for a few months now, never had a water-like issue before. However it did start working later on (1am) as I was woken by lows, and to be honest I expected worse from all the units given.

There does seem to be some sort of "topical insulin resistance" that sometimes occurs. For me it's nearly always linked to age of set, and I've found that when I switch to another one, the larger bolus that has gone into a site partially acts almost like pooled insulin, resulting in unexpected later lows. this always seems to happen into day 3 of a set though.

 

[iHs]

My thoughts on this is that it could be the basal rate settings that are not quite right anymore. I often get changes to bg levels at different times of the day but I usually wait for 2 days in a row for the same pattern to occur and if necessary, I tweak the offending basal rates and keep bg testing to get the amounts correct.

 

[steve_p6]

All day I have been nice and steady in the 5s (Dexcom) and for tea tonight I had 30g carbs in new potatoes with fish, a usual low carbish tea, which hasn't played up before. Just as I was bolusing and was putting out the food I creeped up to 7ish. I thought no bother so I added an extra top up to accommodate for the 7...
.

Have to go and check my sources [Bernstein or Think Like a Pancreas] but am sure that there is some mention of the anticipation of food being enough to trigger a BG rise.

 

[ElkBond]

Have to go and check my sources [Bernstein or Think Like a Pancreas] but am sure that there is some mention of the anticipation of food being enough to trigger a BG rise.

Ha yes there is, its similar to drinking a non sugar sweetened drink as your body anticipates a sugar rush but to audio and visual cues. Off topic but its the same as chewing gum, makes you feel hungry as your body preps your stomach for food but gets none.

But that aside, I don't think its that. Good idea though thanks.

 

[ElkBond]

My thoughts on this is that it could be the basal rate settings that are not quite right anymore. I often get changes to bg levels at different times of the day but I usually wait for 2 days in a row for the same pattern to occur and if necessary, I tweak the offending basal rates and keep bg testing to get the amounts correct.

Thanks for the tips my eve basal is due a test, my fasting and lunch are tested frequently as some days I skip breakfast and treat it as a fast and sometime have a no- lo carbs lunch or skip/ delay it due to busyness.

But tonight my tea was flat, no extra shot for carbs as it was less than 10g (not low carbing its just one of our non carb meals) and i am 5.2 now, highest reached was 6.2.

 

[ElkBond]

There does seem to be some sort of "topical insulin resistance" that sometimes occurs. For me it's nearly always linked to age of set, and I've found that when I switch to another one, the larger bolus that has gone into a site partially acts almost like pooled insulin, resulting in unexpected later lows. this always seems to happen into day 3 of a set though.

So news, sorry its late (I can be nocturnal) lunch was a disaster today - 11.9mmol max today with 46g carbs (even lowered my i:c ratio!) then had a very low carb tea with no extra insulin and it was flat (6.2 max!)

So ruled out basal, the meals differed one bread, one potatoes but similar carbs. 99 percent sure that carbs were right due to weighing and these meals have been had multiple times. However as I knew the score I jabbed a lot more that working it up like last night and it came down after the two hour post meal. It did low me later however, so it kind of seems like as you said a delayed bolus, possibly down to pooling (even with a new vial and new set). I will continue to see how it goes and update. I really hope I don't have to go back to nova as FIASP has really made a massive difference to my positive mindset due to reduce waiting times and more spontaneous eating. O and quicker corrections!

 

[ElkBond]

So update as I am about to change my pod, this pod has been in since the last change stated above. It seems to have returned to normal, I lo-zero carbed for the next few meals and tempted myself with a 40g+ meal today, not an issue (*bearing in mind two meals at 30g/40g were the previous problems), not even a rise - and this has jam in the sauce! (blame the meal plan!).

I am going to have to put it down to random bodily changes, lets just blame the honeymoon and not FIASP just yet.

See todays Dexcom.

 

[Sideburnt]

Having used Fiasp for around 5 months For the last month or so I've experienced the same thing. A sudden drop in the effectiveness of Fiasp. It also seems like food is spiking me much more than it normally would and that in addition to onset taking up to an hour and a half now (from within 15 mins) that I need much more to bring my levels down. 3 units used to bring me down from 8mmol/l to an acceptable 5mmol/l . Last night and on many other occasions throughout the day I inject 3, see no change after over an hour take 4 more then another 4 and finally 3-4 hours after the initial spike I see a slow decline in BG into a good range. I can see this in Xdrip+ on my trend graph and it;s depressing.

I thought I might be ill or coming down with something but I think 5 weeks is long enough to be in the healthy club. I've tried fasting for 24h and keto for 5 days to reset insulin resistance but that didn't work. @ElkBond did your hump with Fiasp end or are you still having problems?

 

[ElkBond]

@Sideburnt I haven't really had an issue recently with this. There has been the odd time I have needed more to bring me down but the other day I read a really interesting article on how the concentrations of insulin vary by the bottle, greatly!

I will try and grab the article and paste it in an edit.

EDIT: https://www.ncbi.nlm.nih.gov/pubmed/29268624/

It does mention that it is the US, but if it is the same here it would be interesting. I mean surely even if the brand name is different its from the same manufacturer? I have only skimmed it.

 

[Sideburnt]

@Sideburnt I haven't really had an issue recently with this. There has been the odd time I have needed more to bring me down but the other day I read a really interesting article on how the concentrations of insulin vary by the bottle, greatly!

I will try and grab the article and paste it in an edit.

EDIT: https://www.ncbi.nlm.nih.gov/pubmed/29268624/

It does mention that it is the US, but if it is the same here it would be interesting. I mean surely even if the brand name is different its from the same manufacturer? I have only skimmed it.

I read the same article through a link on Reddit. It would be really hard to single out if that is the root cause. I have been exercising more and that seems to have made a bit of difference but as to whether it's fixed the natural absorption onset or whether I'm just seeing the effect of exercise on any insulin is hard to say.

Fingers crossed, I might just have an underlying infection that isn't very symptomatic.

 

[JaneC]

Have been using Fiasp for 6 months in a pump but have just switched back to Novo Rapid 4 days ago and finding it processes food much better. I seem to be following the pattern in that post meal spikes have increased and take longer to correct than they did initially, I don't high carb much but when I do Fiasp doesn't seem to cope. I'll keep the penfills with Fiasp for corrections and see what happens. It's a shame as it's hard to pre bolus again, the joy of Fiasp is being able to bolus when food is on the table, c'est la diabetique vie I guess.

 

[NoKindOfSusie]

I am not using either a pump or fiasp (I would love to) so this is a theory question.

If this happens to me I go for a very very quick run, less than ten minutes often, just round the block a couple of times, and it is very hard to really tell what is going on but I get the feeling it sort of "triggers" something and it all starts working.

Of course you need to have the life flexibility to just go and do that. And I can barely run anyway. But still.

Am I crazy?