Any such thing as too much insulin ?

Mad76 said:

Hi all,

Brief background
Diagnosed last year April type 1. Hbac1 very high. 113. Put on to lantus and novorapid
Was told to adjust novorapid according to what I ate. So used around 12 units per day total

5 months later met consultant at hospital. Hbac1 down to 48. This I think was mainly because I was so scared of DKA again I really restricted what I ate.. so at this appointment the consultant basically said I can eat what ever I want when ever I want as long as I took the right amount of novorapid each time. Now for me this was great. I love food, and eat my fair share of carbs.

So as u can imagine I pretty much went back to eating what I want. My novorapid intake has increased a lot. I'm now on around 25 units total per day.


My question is
Is there anything wrong with taking increased amounts of insulin. ?
Is this a concern going from 12 or day to 25 ish in a year.
Assuming my bg levels are controlled by using the right amount of insulin is there any reason not to do this ???

I'd be really interested in you guys thoughts on this.


Thanks

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Hi,

I'm not a massive fan of making comparisons. Certainly no judgement. I'm guesstimating on a "rule of thumb" insulin to carb ratio bandied about, you could be doing 250 gram of carbs a day?

If you're holding your BGs relatively steady & have no other concerns or issues.?
Just be you...

There really isn't a too much insulin issue, you need to take what works. What is more pertinent is if you are taking too much for you personally. If you are eating more carbs than you need, hence more insulin, you will gain weight. When first diagnosed a lot are losing weight because they aren't actually properly using the food they eat because of the lack of insulin.So a lot gain weight when they start insulin because now you are actually using all that food and it was actually too much food.

As a type 1 you also have to make sure that you are taking insulin for the food you eat, but not eating because of the amount of insulin you took.

Personally Id say no , it all depends and what you eat , obviously if you go hypo you could say you’ve taken too much insulin in relation to what you’ve eaten , but that would be open8ng a can of worms with regard hypos so not going there. The consultant was right saying you can eat anything , ( which I can say along with a lot of Type 1 diabetics of over 30 years thought they would never hear) ,, but , being diabetic it’s learning to understand what “. Anything “ will do to your blood sugars. One thing I will say is that insulin requirements are totally individual, and they will change for various reasons but if your bs is under control don’t worry about the number .

I am surprised by this advice from a professional. Telling a new T1 they can eat anything and bolus for it is pretty much setting them up for having a hard time over what can be a very long period of time. As the honeymoon wears off, increasing amounts of insulin are required and eating lots of carbohydrate makes it more difficult than it needs to be. Most doctors realise this and tell patients what to expect.

I agree with @Ushthetaff . It is all about learning to take the right amount of insulin. (and the right timing,)

Mad76 said:

My question is
Is there anything wrong with taking increased amounts of insulin. ?
Is this a concern going from 12 or day to 25 ish in a year.
Assuming my bg levels are controlled by using the right amount of insulin is there any reason not to do this ???

I'd be really interested in you guys thoughts on this.


Thanks

Click to expand...

Over a period of time you'll see an increase in your weight (in my opinion) with that much increase in your bolus injections, a good rule of thumb I try and work by is that my basal wants to be around half the total amount of insulin I inject in a day, I don't think twice in eating big meals mind, and inject to suit when I do with no problems but those meals involve complex carbs (wholemeal rice/pasta/flat breads) and those carbs come slowly over a longer period of time to a trifle or such like.

Pizzas are best avoided if you're a glutton as they need ridiculous amounts of fast acting insulin not to spike you but you can eat carbs if you find the ones that work best for you.

As a T1 diabetic I like to think I eat healthily but I don’t do this because the only foods I should eat are the healthy ones . I don’t consider anything off limits , I’ve been through you can’t eat that you can eat that the list with basically nothing but lettuce leaves on it . So now that way we take insulin to what we eat , most things if not all are back on the list. Whether you chose to eat them is up to you but as with everything you now have a choice. A definite advancement for T1 I think however as always this is just a personal opinion. Having a balanced healthy diet is a life choice Which we can now be part of , too long were type one diabetics sitting in the background not eating this and not eating that, life is all about choices and it’s now good to be a part of it.
Stay safe and take care
“ that is no moon “””

Hi, I agree with many posts above. You should not feel you must restrict your diet, but in order to get to that point I had to be confident carbohydrate counting. I'm not sure if this is something you are confident with?

The libre will greatly help you see what spikes you have around meals, and so as others have said let you decide on the best bolus timing. Remember though that it will change, so for example in the hotter weather or when I have exercised just before eating, I can bolus as I have the first mouthful of food. On a more sedentary or wintery day, I need to wait up to 30 mins for it to take effect to avoid spikes.

I have been told to try and have roughly half my daily insulin coming from my basal. It sounds like from another post of yours a basal test might be useful? Do you know if you're in a honeymoon period?

I also don't know about your weight or aspirations, but as mentioned above it can be harder to lose weight as a diabetic with the hypo risk, so you may want to also consider that? When I was first diagnosed I was put on too much fixed dose insulin and spent the first 4-6 weeks hypoing at meals and then of course needing to eat more to treat the hypo. I went up 2 dress sizes. I discovered carbohydrate counting (DSN said they stopped telling people about it as people found it too difficult ) I then tried to go back to the active lifestyle I'd had before hand and started hypoing because of the exercise. My diabetes team weren't very helpful... It took me about a year to lose the weight again. I obviously don't know where you are on your diabetes journey but thought you might find it useful to know!

I now do eat whatever I want, within reason, so for example if I know I'm more sedentary I'll stop myself having huge carby meals. This not only makes glucose control easier but weight gain less likely. I don't feel I'm restricted though, and do use it as a reason to keep active when motivation is lacking but I really fancy *insert treat here*

Make sure you follow your specialist team's and diabetes nurse's advice. An interesting read:
Dr Bernstein in his Diabetes Solution suggests most people, without marked IR, will need at least half their weight in insulin units daily (0.5 x 60 kg person = 30; so you need 30 insulin units) or higher if you eat carbohydrates. (Not correct on honeymoon.) If your follow LCHF, as he suggests then you can get this down to 0.25. Which is about what I'm on, well mostly less with the exercise I do.
Of course, we all have varying degrees of IR due to hormones, weight etc. So he acknowledges this is a guide.

@Mad76 I eat whatever I fancy. Low carb is definitely a no no for me. I use 180ml reservoirs and change every 3 days.....there is usually around 20ml of insulin left in them. Weight wise I am around 78kg and have been since I can remember.

Mad76 said:

I had heard that the basal should be about half of the bolus, but tbh have not really followed that rule. My basal, which I think is tight, but I'm going to test is 10 so by that account I should be looking at around 20 units bolus daily I guess?

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Any bolus/basal ratios given are really just a start point to start people on, it does not mean you have to stay on it, and many won't.
If I was on the 50:50 ratio for basal:bolus I'd only be allowed 60 carbs a day based on teh amount of basal I have and my carb ratios, and whilst I may not have a high amount of carbs every day, I am normally a fair way above that,

The forum has some type 1's that are low carb. But the low carbers are mostly type 2's. I would say many more type 1's are not low carbers.

You take whatever insulin you need to take to control your blood sugars. I take an average of about 45 units total a day. It's what ever I need to take to cover the carbs I eat. Mine is 24 units of basal a day and the rest is 20-30 units of bolus. Don't feel bad about the amount of insulin at all. We all can vary a lot. The only problem is if you eat too much, then you take too much insulin, then you gain weight.

Mad76 said:

Thank you all for your replies.

I had heard that the basal should be about half of the bolus, but tbh have not really followed that rule. My basal, which I think is tight, but I'm going to test is 10 so by that account I should be looking at around 20 units bolus daily I guess?

I'm currently usually over this.

If I'm honest, and I feel bad saying it, because this forum is quite strongly low carb, I eat a lot of carbs.

It's interesting to see from the above it seems that amount of insulin doesnt seem to have any problems / side effects by itself. That's good to hear.

Weight gain obviously seems to be coming through as a problem. I, like many lost a lot of weight at diagnosis. Pre this illness overweight. Now heading back that way. So cutting carbs, and therefore insulin is probably the best way forward for me.

Agree about carb counting. My daphne got cancelled but I've registered on to Bertie online


Thanks so much for the great replies

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Sounds deeply sensible to me and hope Dafne gives you some further ideas (be sceptical when listening to the dietician though).
I've had this for 40 years and have seen the fashion for diabetes treatment go from:
Count everything and rigidly stick to timings for snacks and meals through to a very liberal approach eat anything you like but easy on the fats and work hard on dosage calculation ratios for your bolus. Enabled by bolus calculators on gluccometers and pumps.
Now we have an awareness of double diabetes wherein type 1s gain weight because they are getting liberal with their carbs (and hence insulin) and then need increasing amounts over time.
The availability of freestyle libre now gives another way to know how good your real time control is e.g. how much time are you spending in target range and what foods/insulin /insulin timing combos take you out of that range?
I am not sure all the clinicians and dieticians understand the contradiction for some of advocating the low fat high carb diet in which blood sugars can spike thus putting the diabetic at greater risk of the complications we want to avoid.
IN your case though there is loads of time to work these things out and find a way forward that you can live with.

Mad76 said:

Thank you

So a question, what is considered good control? Realistic ? For percentage of time in target range ? Is 100 percent a realistic expectation??

For me according to the libre I'm around 70 percent, obviously not good.
I'm interested to know if type 1 s generally achieve 100percent.

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I don't know anyone at 100% and I am certainly not!
Your consultant will be delighted if you remain under 7% but the True Grit (very low carb) types following Dr Richard Bernstein believe that all type ones have a right to 'normal for humans' control e.g. hba1c under 5%. The reason for the sweet spot being 7% is that in studies, the most risk of complications was seen at levels above this however this doesn't mean that levels below but still not normal won't have some risk. However those advocating the very low carb approach (30g per day for Bernstein followers) is that they believe that this is the only way to avoid roller coaster blood sugars as well as the only way to get a lower blood sugar overall.
I am going to recommend a book that is written by a type one and highly practical and is based on what he would have wanted to know when first diagnosed:
Adam Brown's Bright Spots and Landmines

It isn't the only book of its type but it is free or you can listen on Audible via Amazon!

Mad76 said:

For me according to the libre I'm around 70 percent, obviously not good.
I'm interested to know if type 1 s generally achieve 100percent.

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I would say very few get 100%. It would also depend on what range you have set for yourself. Mine is 4 - 10, so a 3.9 or 10.1 and my 100% is gone. I try to aim for 80 - 90 % in range