Does Anyone Think A Change Of Insulin May Help?

ThePenguinPimp said:

I have been T1 for 30 years.. When I was about 15 I had such severe insulin resistance and my diabetes team changed my insulin (they should have told me to reduce carbs but that is another story). I have had extremely brittle diabetes always.. I now know this was insulin resistance and have stopped having fits and by the virtues of a very low carb diet I have not had a fit for a year and a half.

I just had a salad from subway and the only carbs coming from a couple of slices of tomato and sweetcorn (no sauce) and my blood sugars shooting up from stable 7 (all day) rapidly to 13 and rising (with now 4 units of insulin on board). I am wondering if changing my insulin might give me a chance of regaining some extra sensitivity.. or maybe going on metaformin or something I've heard of other of my T1 friends being on the T2 drugs as well as insulin to help control their blood sugars.

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Im a type 1 who takes metformin with my breakfast and tea insulin due to insulin sensitivity on the odd occasion i have forgotton metformin my bgs shoot up very high and takes loads more insulin to correct

ThePenguinPimp said:

Thank you.. given the tremendous difficulty I have always had with my blood sugars I am a bit annoyed noone suggested I went on it before.. I can't carry on like this.. I hate myself when my blood sugars high but itll shoot up for really stupid things and today I just kinda snapped and thought there has to be something else!

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Sending hugs i have only been diagnosed for just over a year and was pput on the metformin on my 2nd month i was 50 when diagnosed so its been a shock hope you get something sorted x

Sweetcorn has quite a few carbs, that may have been the problem. I tend to think we should change insulins every few years, I'm a big fan of doing that. I have just been reading that our bodies can build up antibodies to the different brands, this is particularly true for what is known as insulin naive patients, which is what you would have been when you were first diagnosed. Which might explain what happened.

I just think it's a good thing to change every few years. But don't be persuaded to try an over engineered one, keep it simple.

ThePenguinPimp said:

Thanks.. yeah I can't remember life without diabetes.. counting carbs will become second nature!



I cannot wait for my appointment on monday.. I want to change insulin and go on tablets now but do you think a change of insulin might make a big difference on its own? Ive been in tears I feel robbed that I've had to even come up with this myself.. I was referred for another partial toe amputation and I'm on a pump only eat healthy low carb home prepared food and am still losing the plot im so unstable..

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It might work, but obviously I'm not an expert in any way. I was just reading about Toujeo, and how people were more likely to develop immunegenicity on it, and I had no idea you could be immune to insulins, but apparently it's like other medicine, and we can. I switched from Lantus to Levemir recently, because although Lantus had worked for a while, it just seemed to have become more unreliable, and I've often found that with insulins.

So maybe a switch might help, alone, but the tablets might be an extra help. I'm not sure.

But I do think we should switch insulins regularly.

I had my bolus insulin changed from apidra to fiasp which has worked a bit better for me and basal lantus ti tresiba

ThePenguinPimp said:

Thanks.. yeah I can't remember life without diabetes.. counting carbs will become second nature!



I cannot wait for my appointment on monday.. I want to change insulin and go on tablets now but do you think a change of insulin might make a big difference on its own? Ive been in tears I feel robbed that I've had to even come up with this myself.. I was referred for another partial toe amputation and I'm on a pump only eat healthy low carb home prepared food and am still losing the plot im so unstable..

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If you change two things at the same time you won't know which one did the good, if any. Metformin is often prescribed for T1s and it sounds like it would be a good idea to trial it, probably before you change insulin if you do.

I think showing your HCP your BG data and a food diary over several days at least would be useful. If it's a one off have you considered there might be an asymptomatic infection brewing somewhere? I was caught out by that recently.

I know what it's like to find out about a treatment option that you should have been offered years ago and weren't. This has happened to me dozens of times in 30 years of managing multiple conditions.

Your anger is totally justified. But if you don't process it and eventually accept what happened and move forward, the stress will eat you up and will certainly mess with your BGs. I speak from painful experience over many years.

If venting about it to someone helps, I am here for you, whether in public or by PM. You have had a more difficult journey than many T1s have, and you haven't been given the acknowledgment of that by your HCPs.

When I have been able to explain or ask directly, my HCPs have agreed with me about it and that has helped tremendously. I've had four separate cases of this in just the last month. My GP is awesome, he knows exactly how I feel about delayed diagnoses and treatment options and he helps me deal with it.

I wish you well! I think you are on the right track and things will improve now that you have some extra tools.

I think @Jenny15 makes some very valuable points in her comment.

I would, however, disagree with her order of change. I would change the insulin first, because there is no option not to use insulin, so it seems like the first place to start.

Then, depending how much difference it makes, maybe think about Metformin. Because Metformin is not essential, but may, or may not, work as an extra medication, best to change the essential medication first.

But I think Jenny lays out a very good strategy here.

Alison54321 said:

I think @Jenny15 makes some very valuable points in her comment.

I would, however, disagree with her order of change. I would change the insulin first, because there is no option not to use insulin, so it seems like the first place to start.

Then, depending how much difference it makes, maybe think about Metformin. Because Metformin is not essential, but may, or may not, work as an extra medication, best to change the essential medication first.

But I think Jenny lays out a very good strategy here.

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I don't think there is necessarily anything wrong with the current insulin but IMO Metformin is likely to be very beneficial. That's what's behind my reasoning. I don't know what interval between the two changes would be needed. I think if changing the insulin was going to be of benefit then the results would be seen faster than the results of starting Metformin, which is more like 2-3 weeks, in my experience. Hopefully the doctor will be able to recommend a good plan.

ThePenguinPimp said:

I can see where you are coming from but as I have my appointment on Monday at Kings there is no way my doc would have given me a different insulin as they are the experts. It will take some time for the metformin to get into my system (you only start on 500 a day and end up on 2000 a day) so over next couple weeks I'm going to be adjusting everything. My pump and cgm will make this easier I hope. Ultimately the least insulin I can take the better so if the metformin is going to mean a reduction in whatever kind of insulin I take this can only be a good thing with diabetes as brittle as mine (I cant go lower carb without going zero carb and cutting out veg).



Thank you for your comment last night I read it just before switching off my pc and was too tired to reply. I am pretty sure this isnt anything like an infection its the story of my life my diabetes has always been so unpredictable.

I got the doc to give me some metformin tabs today.. will take advice off the diabetes specialists on Mon but am going to request a change of insulin aswell and take advice on which one (but I agree about the simpler the better).

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On a pump, the changes of insulin are limited..... theres only so. Many types of quick acting to use....
Yes, it is worthwhile asking though,but please be aware that its not like the options for varying basal insulins..

I wonder whether your acting time and offest timings are set up to your bodies needs...Consultants and DSN's tend to overlook these factors....

Hopefullt the metformin will be helpful to you.

Hi @Thepengiunpimp,
I too know how up and down BSLs can be even on a pump. And after 51 years on insulin if never gets much easier, except by reducing stresses and sudden changes.
But I wonder whether in your meal from Subway included the bun ? The bread is something I avoid like the plague as it seems to send my bsls up quickly. Also there are times when I think my insulin sensitivity changes from day to day.
After all that is why insulin pumps have adjustments for bolus doses based on things like Insulin Sensitivity Factor and I;C ratio. which can be programmed for different levels at different times the day. Do they perhaps need more adjustment?
Having not personally used Metformin I can only say that it sounds possibly of use given its described use and action. Your doctor will be the one to ask.
I know that a bolus of Novorapid does not always match the BSL rise after a meal so I either take the Novorapid earlier, like one hour before or I try to delay the BSL spike of the meal by keeping to low GI and GL food and less quantity. Adding in a little cheese, olive oil etc helps. Indian food seems to cause a bSL peak nearer 2 1/2 to 3 hours.
Whether Fiasp is a better option, who knows?. If you could demonstrate to your doctor that 2 hour post prandial BSLS seem to spike > 9 mmol/l AND bsls drop too low or almost too low at say 3 to 3 31/2 hours after the meal you might be able to argue that Novorapid is ineffective and Fiasp has a more favourable action profile to solve this issue.
Keeping stress levels in check is also paramount. I suppose some CGM might help spot patterns and help offer solutions too,
Best Wishes and Good Luck with this tricky problem !!