My insulin is not working.

donnellysdogs

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Oh and I had horrendous highs and lows whilst having everything with body going wrong and eating was a nightmare..

However, take heart, things do improve but you need to find time for you each day.


You may well be logging stuff down but you need to really record everything
and this definitely helps to take control back.
 

Catsymoo

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Hi @Catsymoo unfortunately you are having to deal with a huge amount of stress on top of your type 1, this will have a negative impact on your control as stress hormones will increase insulin resistance. I think you doing everything you can and are still finding that the negative impact of the stress in your life is making control difficult.

Firstly just try and take it easy, so one day at a time, your boss needs to understand what stress you are under and make reasonable allowances for you. Call up your DSN first thing explain what's going on, you need a day to day game plan to help minimise the stress and impact of your control on your mental health, things will get better but the yo yo effect of high/normal bg control will only get better once you get some support and a plan on how to deal with this, ask for a CGM or to loan a Libre, something to help you see patterns and speed/direction of your bg levels, running high isn't healthy for you mentally as it will impact on your anxiety levels so a Libre would be ideal to help you see a better picture of your carb/bolus effect, you all need to gain confidence in maintaining regular 'normal' levels too as your hypo anxiety will be helped hugely by using the Libre, you have a good case to get one from your trust so try this route with your DSN.

Sadly when I asked my DSN for a CGM/Libre she said no, apparently extreme anxiety over hypos and stress causing highs isn't enough to be eligible :(
 

Fairygodmother

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You’re carrying a HUGE load even without T1, @Catsymoo so I’m not surprised your bs are in tornado mode too.
The only part I know anything about is the damages claim by the landlord. If the landlord took a deposit then by law it should be registered with a deposit scheme such as the TDS. Any disputes can be handed over to them to sort out. See if there’s any paperwork. If not then Citizens Advice may give you some help on how to deal with it.
 

Catsymoo

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Yeaaaah, I'm back up into the 20s again. And I'm completely flabbergasted. I've eaten a salad today with 2 eggs and a cup of tea. No sugar. Under 15g of carbs and I injected... ***?
 

Fairygodmother

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Is there a decent diabetes team at your local hospital?
 

Catsymoo

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Considering I saw a nurse about high sugar levels last week and she sent me away with nothing but ''test more'', I'm going to say no. They've gotten worse since I saw her. Seeing 20s has always been rare for me, now it's happening every single day for the last week. I'm not eating anything particularly sugary, and I'm purposely eating low carb meals/being very careful to try and get it under control.
 

Fairygodmother

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Do the 20s tend to happen at the same time in every 24 hours?
 

Fairygodmother

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Another thought: ask your GP to refer you to the nearest big teaching hospital diabetes dept.? You may have to take time off work, and it may be a bit of a journey, but it could be worth it in the long run?
 
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Catsymoo

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I'm seeing the 20s a lot during evenings in the last few days. But I just don't understand how it's happening. I've left a message on my DSN clinic answering phone and called 111 for short term advice as I had 0.5 level ketones in my urine and yesterday it was 0 so it's a bit concerning. I would rather be safe than sorry.
 

Catsymoo

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I understand you are more resistant to insulin when your sugar is high... but how long does that take to wear off once they return to normal levels?? I got down to 11 this morning and had half a slice of rye bread before I left for work, I injected 3 or 4 units as it's very low carb. I came home, all I've had is sugar free drinks. I made a salad around 6pm and injected a couple of units because I had a cup of tea. I wouldn't be so shocked if it was 12-15 but in the 20s!? Come on.
 

Fairygodmother

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What basal are you using and when do you inject it?
 
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Catsymoo

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What basal are you using and when do you inject it?

Lantus, I generally take 30 units at around 5-7pm every day. I've upped it to 35 now as I'm probably resistant at the moment. 30 units is usually perfect, my waking blood sugars before this week were always 3.9-5mmol.
 

Fairygodmother

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I had trouble with Lantus that began last November. I wondered why. I found it hard to control blood sugars, so much so that I ended up in tears.
The consultant authorised a switch to Levemir and it’s been easier to get a grip on bs since then, though Levemir’s not perfect.
 
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ickihun

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Hi @Catsymoo , I hear you - periods like that can be very very frustrating!

Don't know your age, weight and normal insulin intake, so wont and cant offer specific advice. But you certainly have my sympathy as your subject header text was catching my attention as think most Type1s have experienced situations where we ask ourselves exactly that same question: "WTH, is my insulin no longer working or what is going on here???"

And in your description above I can see a few things at play here, that all contribute to keeping you in that unfortunate bad catch22 situation.

1. High blood sugars makes you less insulin sensitive
When our bg is below 10-12 mmol/L we are typically the most insulin sensitive. E.g. 1 unit will drop my bg with 3.3mmol/L.
When our bg gets in the 12-18 range, we become less insulin sensitive. E.g. 1 unit will drop my bg with 1.8 mmol/L.
When our bg gets above 20 and up, we become even less insulin sensitive. E.g. 1 unit will drop my bg with less than 1 mmol/L.
So like with your strawberry situation above, I would have had to bolus 3x the normal units if my bg was already up in the 20-range compared to if my bg was down below 10mmol/L.

2. Stress increases our bg and can keep it high despite you inject insulin
Bodily stress that impact our bg levels can be of various kinds: Emotional (aka anxiety, worry, or depression), physical, nutritional, chemical, etc. So stress can be triggered by many things like physical pain or illness. Or a personal situation like an accident, the death of a friend or relative or even confrontations with other people. And when we get stressed our adrenal glands release hormones in response to this stress to help us deal with it. These two hormones are pinephrine (adrenaline) and norepinephrine. The main purpose of norepinephrine is to keep your blood pressure up and have limited impact on our bg. The adrenaline however is an important bg regulating hormone! Its the same that helps with a liver dump if you go hypo. It is the hormone that catalyzes the conversion of glycagon into glucose, which you have stored in your muscles and in your liver.
So even if you take some insulin to get your bg down, your stress will release more adrenalin to release more glucose as your body is in 'escape & run' mode and wants to keep your bg high.
E.g. this last week I was out traveling with my job to support some critically ill patients through some high risk procedures with some new technologies being piloted. Non-stop stress, limited sleep, no appetite so didn't eat much, ... And still my bg went up into the 15-25 range. Very unusual for me! I kept taking my basal as always. And still just hardly eating anything but my bg just kept staying high and higher... So could pose the question: Is my bolus insulin no longer working? Had I exposed it to a too high temperature for too long, or what is wrong with it??? I switched to use one of my other bolus pens just to be on the safe side, but it didn't change anything with regards to getting my bg down. And it wasn't until I left the last hospital yesterday at noon, got into the plane to fly home that I could relax. I even felt hungry for the first time this week. :)And within next 6-8 hours or so my bg started coming down to be below 10 mmol/L.

3. GERD is unfortunately a frequent companion to Diabetes Mellitus
The GastroEsophageal Reflux Disease is a typical high risk complication of years with diabetes. Reason being that the gastroparesis is a type of neuropathy that affects the digestive tract and this increases the risk of GERD. With gastroparesis your stomach may be slower to empty as a result of nerve damage. And the longer term sustained pressure within your stomach subsequently cause your lower esophageal sphincter to relax. That then allows reflux of your stomach contents into the esophagus. I have had a few years in my past where I had this reflux syndrome. Very uncomfortable especially as it happened while laying down sleeping/going to sleep. And due to little sleep/stress etc it was mainly just acid coming up, giving me severe throat infections right away needing antibiotics every single time, as my throat and mouth mucous tissue and membranes got burned away non-stop. That unfortunately meant I had to be more serious about getting the sleep I truly needed and also having to give up the late night snack I had enjoyed since I was diagnosed. And to make matters even worse: No wine or chocolates after 10pm at night. Darn, I loooove dark chocolates...... But I no longer have the reflux, no sore throat infections non stop, no antibiotics non-stop.

So I have just to ensure I enjoy all those small pleasures in life before 10pm at night, so my stomach has sufficient time to digest and empty before going to bed and laying horizontal. :)
Most important for me has always been getting the basal right. When you have that set then the rest is all about matching the insulin to your food and bg levels. (easier said than done...)

So yeah, its a crazy world and its not always easy being a diabetic. Keep the faith, never give up.
There is always a way through the mess even though it can look pretty dark when in the middle of it. ;)
@Celsus. I just want to thank you for your post. It has helped me enormously, even thou a type2 on insulin which is being difficult with my GERD, IBS and stomach/gut INFECTION recently.... Not to mention iron deficiency anaemia and irratic hormones due to stopping metformin temporarily.
Thank you for your reassurance.
 
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Juicyj

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Sadly when I asked my DSN for a CGM/Libre she said no, apparently extreme anxiety over hypos and stress causing highs isn't enough to be eligible :(

Ask again as their policy may of changed, you have to keep pressing on your DSN to get support (sadly) as it's only until they can see you are really trying hard yet struggling can they really start to be more pro-active and if they can't give you a libre then they should have a CGM they can loan you, in a nutshell, don't accept no for an answer.
 

Catsymoo

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I had trouble with Lantus that began last November. I wondered why. I found it hard to control blood sugars, so much so that I ended up in tears.
The consultant authorised a switch to Levemir and it’s been easier to get a grip on bs since then, though Levemir’s not perfect.
I might try that as Lantus doesn't last the full 24 hours. The thing is, my sleep schedule changes a lot and I mostly sleep 8am-3-4pm. I don't work night shifts per say, but my Lantus is given generally 2 hours after I wake up, and you'd think if the Lantus wearing off was the issue, my sugars would be problematic around 3-4pm upon waking, but they aren't.

I've tried injecting in my upper stomach about 2 hours ago and I've dropped from 21 down to 13. Thank god. I rotate my injection sites but I might need to inject a bit higher for a while. I don't have lumps in my hips or legs. 111 doc has put me down for a home visit overnight tonight, so no sleep for me.. gonna get a call later to see how my sugars/ketones are, and hopefully they will normalise by then. The doctor was shocked and appalled at the 111 physician I spoke to yesterday morning and the horrible advice I was given.
 

Fairygodmother

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Good luck with the visit, and yes, the highs don’t concur with Lantus wearing off. Hope the doc’s home visit results in a positive and proactive way of making things better for you.
 

Engineer88

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Lantus, I generally take 30 units at around 5-7pm every day. I've upped it to 35 now as I'm probably resistant at the moment. 30 units is usually perfect, my waking blood sugars before this week were always 3.9-5mmol.


Hey Have you considered changing insulin? I would suggest trying maybe Humalog I find it much better than Novo.

secondly maybe instead of more random testing a structured approach might be better? could you test every half hour for 2-3 hours of an evening before and after an evening meal or when you typically get these highs?

I would also second going to a teaching hospital.
 
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Catsymoo

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Just wondering if anyone knows anything about the effects of stopping Metformin as a type 1 on insulin. Was wondering if it could be the culprit. I've been on one 500mg tablet a day for 5 years, could stopping it cause the liver to rebound release glucose kind of like how GERD medicine works (when you stop your stomach overcompensates with more acid)?

I got my sugars under 10 this morning before bed, 9.8 after food. Woke up at 10. Had a low fat/sugar iced coffee (15g carbs), I injected 3 units in my upper abdomen and 2 hours later I'm sitting at 11. I'm kind of afraid to eat carbs right now. I'm thinking of taking Metformin again to see if it helps, but I stopped taking it and my stomach/acid reflux stopped the next day. I'm afraid of it coming back. I was under the impression that type 1s don't need Metformin and it shouldn't be effecting me like this if I'm on insulin.