Type 1 DSN suggested GLP's...

[kimrooney89]

Morning all

My DSN suggested a GLP may benefit me due to my insulin resistance. She said I'd inject it once or twice per day, it'd slow the release of food from my stomach helping to limit the impact of food on my BG levels and also making me feel fuller for longer.

Does anyone else inject a GLP? If so, how do you find it? The side affects do not look pleasant!

 

[GrantGam]

Morning all

My DSN suggested a GLP may benefit me due to my insulin resistance. She said I'd inject it once or twice per day, it'd slow the release of food from my stomach helping to limit the impact of food on my BG levels and also making me feel fuller for longer.

Does anyone else inject a GLP? If so, how do you find it? The side affects do not look pleasant!

I was under the impression that incretin-mimetics were not for use with T1? I suppose though, if you have double diabetes then it may be of help for you @kimrooney89.

Can you tell us a bit more about your insulin resistance? How much basal are you taking and have you tried alternatives? Also, what is your I:C ratio?

 

[kimrooney89]

The information booklet I was given is directed at T2s, however my DSN said that they are now prescribing it for T1s too.

I seem to be insulin resistant until around 2pm, 1u of novorapid doesn't even lower my BG by 0.5 a mmol. I then become more sensitive to my Novorapid, with 1u lowering my BG by roughly 2mmols.

I also have Dawn phenomenon, I go to bed between 5-7mmols and wake (6.15am) anything between 15-19mmols. I chase my tail taking corrections at breakfast and lunch and usually manage to be between 7-8mmols by 4/5pm.

My Levemir is split at the moment (rise & rest) I take 14u at 6.30am and 10pm.

I'm actually following a LCHF eating regime so have very little carbs. Previously when I done the DAFNE course I was advised to take 4u of Novorapid per 10g of carbs.

 

[GrantGam]

The information booklet I was given is directed at T2s, however my DSN said that they are now prescribing it for T1s too.

I seem to be insulin resistant until around 2pm, 1u of novorapid doesn't even lower my BG by 0.5 a mmol. I then become more sensitive to my Novorapid, with 1u lowering my BG by roughly 2mmols.

I also have Dawn phenomenon, I go to bed between 5-7mmols and wake (6.15am) anything between 15-19mmols. I chase my tail taking corrections at breakfast and lunch and usually manage to be between 7-8mmols by 4/5pm.

My Levemir is split at the moment (rise & rest) I take 14u at 6.30am and 10pm.

I'm actually following a LCHF eating regime so have very little carbs. Previously when I done the DAFNE course I was advised to take 4u of Novorapid per 10g of carbs.

Have you addressed the concept of pump therapy with your clinic? Your DP certainly ticks one of the larger boxes in terms of eligibility.

Also, have you tried Levemir as a non even split? As in, more for the evening rather than during the day?

Tresiba is apparently an excellent insulin (the basal I'll be requesting in 3 weeks at my next appointment) - I'm yet to hear any contradicting opinions on its weaknesses over Levemir. You may also want to look into that. Allegedly, it has a 12 hour peak, so is a lot easier to manipulate a counter against DP than Levemir (which usually peaks around 5-8 hours post injection).

Since you've been LCHF, have you been bolusing for protein? I found (through my short stint on that dietary approach) that I required bolus doses for protein and fat - so all in all, it was actually more complex to manage than a moderate cab intake of 130g-180g per day.

 

[kimrooney89]

I did mention pump therapy and was advised it could be in the pipeline once I do the Adapt course which I'm on the waiting list for.

Yes I used to be on 10u Levemir at night but my DSN advised to increase both am and pm to try and lower the impact of my DP.

My DSN is having a meeting with the consultants in Tuesday regarding the GLPs and a possible switch to Toujeo which is apparently more potent and may benefit me...I'll definitely look at Tresiba as an alternative too.

Yes I do bolus for protein and fat too, I know some people don't have to, but I definitely need a few units with every meal

 

[Daibell]

Hi. It does sound like your diabetes is proving difficult to manage. 4 units of Bolus to 1g carbs is surprisingly high as it's normally around 1 unit but it sounds like you may need it. How were you diagnosed with high insulin resistance?

 

[catapillar]

When you were advised 4:10 on DAFNE were you low carbing? I think low carbing can impact on the ratio you need, pushing it up.

What's your total daily dose like?

 

[kimrooney89]

Hi @Daibell yes it is being very tricky, it's frustrating having poor control for most of the day when you're doing all you can to try and get your BG levels stable and between 4-7mmols.

My DSN has had me do several things including:

A fasting BG check with nothing to eat after 7pm and drinking only water.
A 3am and 5am BG check, followed by a carb free breakfast.
A correction with breakfast, aiming to bring my BG under 10mmols. This was done 1u at a time with hourly checks to monitor the impact of novorapid on my BG levels. This is when it was discovered that up until mid afternoon 1u of novorapid had little or no impact on my BG levels, hence the insulin resistance.

 

[kimrooney89]

When you were advised 4:10 on DAFNE were you low carbing? I think low carbing can impact on the ratio you need, pushing it up.

What's your total daily dose like?

I don't follow DAFNE, I done the course around 6 years ago and was on a 4:10 ratio but still had very unstable BG levels, constantly above 13mmols. Out of the full group who done the course, I was the only one on a 4:10 ratio which seemed to baffle the team running the course. They didn't seem to know what to do with me thereafter and were insistant that I must've been miscalculating the amount of carbs (although I literally weighed everything and even took kitchen scales with me if I was eating out anywhere). So through trial and error I ended up working out what insulin I needed for certain meals. Since then I've transferred to a different hospital for my diabetes care and find them much more helpful and supportive.

For doing LCHF, I feel that my doses are high, my DSN also agrees with this. I have corrections with both breakfast and lunch in an attempt to combat the DP and insulin resistance. I do end up back in range by dinner time but the cycle starts again the following morning. Waking up so high and chasing my tail all day to get back In range is utterly exhausting

 

[catapillar]

What are you eating for breakfast and lunch? I just wonder if it is a correction, or just a manual extended bolus to deal with protein. Protein will raise blood sugar much later, so 2 hours or so after eating maybe, it might be longer if it's eaten with fat. If the protein is raising you, it makes sense that a 1 unit correction doesn't move your blood sugar.

 

[kimrooney89]

I have 3 eggs either boiled (in a cup with butter added) or scrambled with butter and milk for breakfast.
Lunch is salad (lettuce, cucumber and onion) with chicken or tuna, avocado and mayo

 

[catapillar]

I find eggs hard to bolus for and would usually need to bolus again 2 hours after eating.

I find avocado hard to bolus for, mainly because I don't have the patience to weigh it once I've managed to get the stone out. And it can send me much higher than the carb count leads you to expect.

Really I'm not sure you are insulin resistant - it might just be what protein does to you?

It sounds like you've got dawn phenomenon. Have you done a basal test to see if your pm levemir can take going up a bit? Have you looked into the timings of the PM levemir to see if that does anything to help? Do you do a dawn bolus (this sounds rubbish, but if your basal testing show you DP starts at 4am you could try doing a bolus then to stave off the rise)? Obviously pump therapy would let you deal with DP with a bespoked basal rate, but those things might help in the interim.

 

[kimrooney89]

I have the same period of insulin resistance (from I wake until mid afternoon) whether I'm doing LCHF eating or having carbs such as toast etc. Doing LCHF means I have slightly better control but nowhere near what I should have considering I barely eat any carbs.

For the past few weeks I even tried only having a correction in the morning and skipping breakfast, I have dinner around 6pm and havent been eating until 12.30 the following afternoon, which still didn't improve my BGs either. The corrections I've been having at breakfast have little or no impact, 1u of novorapid had only been lowering me by 1/2 a mmol which most people could put down to the meter and not actually the insulin having an impact...

Yes I do have Dawn phenomenon, I always have had since diagnosis. My Levemir used to be taken at 7am and 7pm, now it's rise and rest as soon as I wake and just before bed so that there's a smaller window between my injections. I also used to only take 10u but it had been increased to 14u PM which has had no improvement so far.

I tried a 5am correction but due having 2 young children and being at uni full time I was finding it exhausting as I can't get back to sleep once I've gotten up for the correction.

 

[GrantGam]

I too agree that your insulin resistance is bizarre... Those who have double diabetes will be insulin resistant for the whole day, albeit a bit more in the morning. You "appear" insulin resistant in the morning and are fine for the rest of the day, using a typical I:C ratio after 2pm that any other non insulin resistant T1 would.

I think it's entirely possible that you have a harsh case of DP combined with possible Symogyi effect and the addition of a fairly hefty "waking rise". Have you ever used the Libre or a form of CGM to monitor your overnight BG levels?

Personally, I was taking far too much evening Levemir and the result was huge morning sugars and symptoms that manifested as "insulin resistance" till well past midday. It's actually the reason why I joined the forum, I thought my insulin wasn't working as I'd inject loads of Novorapid and my BG would barely move...

Since trying the Libre, I seen that I was dipping low overnight (3ish or below) and then getting rebound highs (Symogyi effect) which would run on past lunch time.

So what I found , and what I feel you may have (albeit way worse) is the following:

-Too high an evening basal dose causing the symogyi effect (rebound hyperglycaemia).
-DP
-A waking rise.

I found the best way to minimise my DP was to eat moderate carb, so I try around 130-180g per day - it seems to give the best results. Also, the earlier I wake up, the lower my morning BG is. I then take the relevant amount of bolus to correct any DP - and a further two units to correct my morning rise. I also don't eat breakfast, but you may find that eating something with carbs (and bolusing for it) can help stem any further BG rise - we're all different.

I hope some of this makes sense and hope its also applicable to you...