Type 1: Ever Increasing insulin

[LWA]

Hi,
I have been Type 1 diabetic for nearly 30 years and always managed to keep well balanced.
Over the last couple years I have noticed my body calling for a lot more Basal (Levimir). I used to take 20units at night which would see me through 24hrs. I now split my dose which initially gave me better control, however my body seems to require more and more and I am now injecting 32-35 units twice a day!
I also notice that I need more bolus (Novo rapid) to balance my meals - despite not eating more or being any less active than previously.
I would like to hear from people with similar experience's as to the way you deal with the changes - is it a case that over time we need to increase insulin or do we look for another insulin regime?
.
A specialist told me that whilst its clear i'm taking too much Levimire (nearly 70 units per day) it was extremely rare that the increase in insulin meant I was no longer responding - however I believe it can be the 'only' reason! - I have carried out fasting tests to check Basal intake
I had requested to change my Basal insulin to Tresiba as I have read good reports...if things don't improve its something I will pursue

 

[alaska]

My first thought is: sounds like you're developing insulin resistance.

If this was happening to me, I'd look first at whether I was following a very healthy lifestyle.

If you're not, this might address things.

If you are already on a very healthy lifestyle, then another factor may be at play. For example, some medications and some other medical conditions can result in or be accompanied by insulin resistance.

 

[azure]

I thought of insulin resistance too @LWA

Has anything else changed that might explain the increase eg your weight or exercise regime, etc?

 

[LWA]

I thought of insulin resistance too @LWA

Has anything else changed that might explain the increase eg your weight or exercise regime, etc?

No nothing has changed - I am of average size and build and in good shape - I eat little and and have no other medical issues

 

[azure]

No nothing has changed - I am of average size and build and in good shape - I eat little and and have no other medical issues

In my totally unqualified opinion that does suggest insulin resistance possibly.

There are Type 1s here with IR. Some take Metformin to help.

 

[alaska]

Note that it is possible to develop insulin resistance despite not being overweight.

If you are having refined grains, regular fruit and fruit juice, regular sugar to treat hypos, this might be enough to result in insulin resistance.

However, again, there could of course be other factors at play.

One thing the DAFNE course told me was that when many people with type 1 lower their basal insulin down to 24 units per day, they have improved control.

Note that this is many/most people so may not apply across the board.

Another consideration is that statins can cause slightly raised blood sugar.

 

[noblehead]

I had requested to change my Basal insulin to Tresiba as I have read good reports...if things don't improve its something I will pursue

That seems a sensible thing to do.

Some years ago I briefly switched from lantus to levemir, despite increasing the dose time and time again I couldn't get my bg levels down, when speaking with my DSN about this she said it was quite common for levemir users to be using a third more basal than those using lantus, don't know how true this is but that is what they said.

Although it's a type 2 drug some type 1's on the forum with IR have been given Metformin by their consultant to help matters, maybe worth discussing this option with your diabetes team if things don't improve @LWA

 

[Daibell]

Hi. My initial reaction was to assume some weight gain and insulin resistance. It might be worth you having one of these fat scans that can show up hidden visceral fat. If you're not taking Metformin as well as the insulin it may be worth adding it as it does help a bit. What is your BMI although I know it's not a very good measure?

 

[LWA]

For some time i have been taking daily Omega 3,6 & 9 Essential Fatty acid substitute as i believed (via other research) these to be the best supplement for all round well being.
Following further investigation i note that eating large quantities of fat directly blocks the action of insulin in muscles and liver, hence a potential trigger for Insulin resistance.
Throughout the week i generally eat salad, meat/fish and small carb intake which sustains good control - but i enjoy a roast dinner on a Sunday, however annoyingly this generally spikes my levels.
As a first step I am going to come off the supplements altogether and reduce fat

 

[azure]

I take Omega 3 @LWA. I wouldn't have thought such small amounts would cause IR.

 

[noblehead]

As a first step I am going to come off the supplements altogether and reduce fat

I can't see the supplement making a difference (but who knows), I've taken a daily High-Strength Cod Liver Oil supplement for years now and not experienced IR, but we are all different so worth a try anyway.

If your eating a large amount of fat in your diet I think its wise to cut-back and see if it makes a difference, we've had type 1's on the forum before say they've encountered IR when following a high-fat diet, the following member found that cutting back on the amount of saturated fat made a big difference to the amount of insulin they inject, have a read:

http://www.diabetes.co.uk/forum/threads/saturated-fats.48599/#p438010

 

[LWA]

I can't see the supplement making a difference (but who knows), I've taken a daily High-Strength Cod Liver Oil supplement for years now and not experienced IR, but we are all different so worth a try anyway.

If your eating a large amount of fat in your diet I think its wise to cut-back and see if it makes a difference, we've had type 1's on the forum before say they've encountered IR when following a high-fat diet, the following member found that cutting back on the amount of saturated fat made a big difference to the amount of insulin they inject, have a read:

http://www.diabetes.co.uk/forum/threads/saturated-fats.48599/#p438010

Thank you for your replies - this really is a fantastic forum that's helps so many people!

Regards my issue - i can confirm i eat hardly any fat - only that found in BURGEN bread - i really do eat very little and what i do eat is generally the right stuff. i am partial to alcohol - although not in very large quantities and certainly not every day - however maybe i consumed more over the xmas break and that has contributed to my my liver not functioning exactly how i would like it

 

[azure]

Another thought is that possibly it might be an absorption issue @LWA

 

[Kristin251]

Saturated fat does make me IR. I need much more insulin and still see higher numbers. The effect can last for days. This is why I don't eat cheese, cream, fatty red meat, chicken skins, butter etc. Grains will do it too for me. My diet is. 80% fat but it's mostly mono fats such as avocado, olive oil, olives an drew nuts as well as pumpkin seeds. All my carbs are from above ground veggies.
Have you looked at your protein intake? Excess protein can turn to bs. I need to eat only modest amounts.

 

[noblehead]

i am partial to alcohol - although not in very large quantities and certainly not every day - however maybe i consumed more over the xmas break and that has contributed to my my liver not functioning exactly how i would like it

Quite possibly, I only enjoy a drink on a weekend and don't notice any IR, but again we are all different so worth dropping the alcohol for a while to see if it makes any difference.

I think @azure makes a good point above about insulin absorption, maybe get your DSN/Consultant to check your injection sites next time you see them, but I would definitely be looking to change your basal insulin to Tresiba, it does get some positive feed-back on the forum.

Best wishes and good luck.

 

[smc4761]

I seem to be a little similar to the OP, type 1 for 35 plus years, I am a little overweight, but do not drinka great deal. I recently changed from Lantus to Levemir and my dosage has gone up from 32 Lantus to 40 Levemir

I take Metformin as well and statins

Even my bolus has gone up slightly recenyly

Its bl00dy complicated this diabetes lark

 

[LWA]

Absolutely - very complicated !!..I would rather avoid Metformin due to the potential side effects - Including hair loss!
I do not experience issues or soreness, so feel comfortable with injection sites to which i regularly change.
The specialist did suggest lowering my levimir dose and running levels slightly higher for a few weeks, suggesting a possibility that the body may re-adjust to lower intake, however accepting this after spending 30 years of trying to balance levels within the correct range is not an easy one to deal with mentally!