• Guest - w'd love to know what you think about the forum! Take the 2025 Survey »

Fluctuating insulin sensitivity

I

Ihatehypos

Member
Messages
6
Hi, I'm new here. I was diagnosed with Type 1 eight years ago and have never attained stable blood sugar control. Recently it has got a lot worse. The problem I have is that some days I am very insulin sensitive and hpyo at the slightest hint of activity and other days I am very insulin resistant. There is no pattern. I have no way of predicting how much insulin I will need so I always have to guess. Recently my insulin requirements have been fluctuating even more wildly than usual and I am dispairing. I have tried everything. I am not overweight, I limit my exercise to presecribed times, I weigh and measure all my food and eat at the same time and the same things every day. i don't drink caffeine. I don't smoke. I don't drink. I test up to ten times a day. I am on Novorapid and Lantus. I am very sensitive to insulin - on a very insulin sensitive day I will hypo on 3 units of Novorapid taken with a meal. I increase or decrease my Lantus by half units and only take 10-11. I take it at the same time every night. Yet still I cannot function as a normal person and am incapacitated constantly by hypos or high blood sugar. Earlier this year I was diagnosed with background retinopathy. Is there anyone out there who can relate to me - who has similar problems? Are there any answers out there? Because I'm all out of things to try and now want to just give up altogether.
 
hello Ihatehypos too,

Could some of it be down to your injection sites?
As well as rotating sites properly, do you use a fresh needle at each jab?
Following this advice fixed my problem with erratic control, but it did take
several months to see an improvement.

Also, there are quite a few people who have problems with lantus. Not just erratic action,
but also a "groggy" head. I can recommend splitting the lantus 50/50 and injecting twice
daily for a more even action. If not, twice daily levemir may be an alternative.

Finally, there's nothing like the heat of summer to muck up good control.
The action of basal and bolus insulins changes in heat (quicker action, shorter duration)
and this can lead to some, frankly, bizarre blood sugars for some of us.

all the best,
timo.
 
Have u thought about changing ur insulin? U are on lantus, which is an insulin analogue-not insulin. I had the same problem as you with control- doctors threw their hands in the air and coudn't help, but critisized my very frequent testing. I had many severe hypo days that didn't relate to anything. It was my husbands suggestion last month that it could be the insulin and not me,that opened my eyes. I had been blaming my hormones, the weather, my period, wind direction( :D ), anything! I rang the IDDT(google it)and got some good advice. I have since changed to Pork insulin-which is purified animal insulin, and am still getting the hang of it, but I have not had any of the huge fluctiations that I had with lantus. I have been ID for 19 years, the last 3 and bit years since being on lantus have been hell on earth.
I'm still contemplating coming off humalog aswell. but I'll take it one step at a time. The one thing that the IDDT told me is that my control should not be the way it was, I had become despairing, and health "professionals" were as much use as a chocolate kettle. What a load of shXX us diabetics have to contend with, with garbage doctors, it's no wonder we end up depressed.
The manufacturers of Lantus, Sanofi Aventis seem to have a huge hold over the NHS -they are 1 of the 3 biggest pharmaceutical companies in Europe, You'd think that Lantus was the only blxxxx long acting insulin on the earth-and it aint even flamin insulin!! :evil:
In the old days, doctors would have found an insulin to suit you, now it's a one way trip.
Sorry to rant, but it really gets me down reading stories like yours- you need to educate yourself and then tell the doctors what YOU want. You can get a chart from DiabetesUK which tells you about the length of action of insulins and how they work- might help,and it sounds like it cant get any worse..
You really need to try another insulin.
Good luck
Jus
 
When are your hypos/hypers? as a rough and ready 'rule', if they are during the first 2 hours after a bolus then the bolus/carb ratio was to blame, if after this period then it is more probably the basal.As Timo says there may be an absorption problemin sme injection sites causing fluctuations. Insulinsensitivity/resistance can also vary because of temperature, the amount of exercise you did in the previous days, the time of the menstrual cycle, or as someone on another forum used to say because of the phases of the moons of Saurn

I know you say that you have no patterns but you also say that you have never achieved control so keep varying your basal and boluses. I wonder if your basal insulin dose is corrrect. Basicaly your basal is correct if on a 'normal' day your BS does not vary more than 30mg/dl (1.6mml) whilst fasting. Only then can you start sorting out your insulin to carb ratio properly. On MDI you really shouldn't have to eat the same things at the same time.
It may mean a change of insulin, change of dose or splitting doses. From what I read levemir is much better as a split dose insulin for people on small doses and lantus does not last 24 hours in many people .
There is some information on the different types of basals and basal testing at http://www.diabetesselfmanagement.com/articles/Insulin/Getting_Down_to_Basals/1
There are also a couple of books that you might find helpful Think like a Pancreas (G Scheiner, the same author as the above article) and John Walsh Using Insulin. (I haven't read the latter but have got hhis pumping insulin which is excellent)
Obviously you do need to discuss things with your doctor.


What shocks me about what I read here is the lack of advice given by professionals in the UK. When I was diagnosed I spent 10 days in hospital. I still think that that was over the top but they did give me a thorough 'MOT' and spent a lot of time getting insulin doses and teaching me how to manage the condition.
 
HI Everyone, thanks for your replies. I visited The Insulin Dependent Diabetes Trust website and was fascinated to read about human/analogue versus animal insulins and had already emailed my consultant asking for an apointment to discuss this. I was particularly shocked to read that Lantus is not recommended for people who suffer from loss of hypo awareness or from recurrent or severe hypos - all of which I suffer from!!! To answer your question Nellie - there is no pattern to the hypos on a bad day I generally can't get out of a hypo - I'll start a meal with a hypo and carry on for the next four hours with one despite halving my dose and taking it after my meal. I'll often have a hypo all night - despite waking up 3-4 times to take dextrose. Then the next night if I reduce my night-time insulin I wake up and my blood sugar is 20mml at 2 in the morning. That's just a typical example. Bascially what I'm saying is it isn't as simple as tweaking my insulin doses. I do appreciate your advice very much Nellie but there is no 'correct basal' amount for me - what is right for me today is wrong tomorrow and would have given me a hypo all night the night before. I guess that's why I'm starting to feel hysterical about it all! It never settles down. Sometimes 10 units of Lantus will have me in a hypo all night and 3-4 hypos during the day. Sometimes I'll have to take 3 units of fast acting during the night to prevent my blood sugar climbing above 20mml. Regardless of how much exercise I have or haven't done. Regardless of how much carb I have or haven't eaten. Regardless of where in my menstrual cycle I am. It really IS that random. But I do have a glimmer of hope now - in the form of animal insulin.
 
I've had similar problems with my basal insulin dose. To get decent results during the day, I have to up my basal dose. But when I do that I either go hypo during the night and end up munching on a hypo stop at 3am, or waking up feeling awful and having to supplement my breakfast with dumpling or something sugary to bring myself up.

I found some temporary relief by doing my basal injection at dinner time (about 6pm), but a few weeks later the night time hypos (or morning lows, depending on my bed time reading) returned. I am yet to find a solution.

I suspect Lantus may be a little more aggressive than it should be.
 
Hi Ihatehypos!
What you've said in your last posting mirrors exactly what I had been goin through with Lantus. I began to feel I was going mad, and I must be doing something wrong, It's no way to live and I know exactly how your feeling. Your state of mind will improve when you get a bit of control of your life. I felt that the day I stopped taking Lantus, I can honestly say that. My control is much more predictable now, although as i said I'm still adjusting doses 2.5 weeks in. I only changed my long-acting, thought it best to do one at a time, and my doctor agrees. I still like the rapid action of humalog, and am able to use it more effectively now- before meals, instead of to lower my BS from unpredictable highs!
As for the animal insulin- Our SarahQ on the forum, has been on animal insulin for 43 years, and still has hypo-awareness-amazing! Look up some of her postings. You could ring the manufacturers, they give helpful advice. Wockhardt for animal insulin(the only company that produce it in this country), were really helpful, and can explain things to you.
When I went to the Doctor, I went armed with loads of info I'd printed of the web, and info from IDDT.
I thought it was going to be a battle, and it wasnt.
It may not be the answer for either of us, but I thought anything was worth a try and so far, so good. Good luck
Jus
 
Hi again, ok now I feel really confused! I emailed my diabetic nurse and she reminded me of the problems I used to have (five years ago now so I had forgotten!) of high blood sugar between 4pm and 6pm every day before I started on Lantus. The long acting insulin I was on before - I think it was Humalin and before that Insulatard (it was a long time ago!) was running out before it was time to take the next dose. I definitely don't want that problem back again. I remember now that this was the reason I switched to Lantus - I was told it was absorbed more evenly throughout the 24 hours - if I am honest, I have found it very helpful in preventing highs in the late afternoon but it is just too agressive in every other respect. Having said that won't the late afternoon highs return on animal insulin?
 
Hi ihatehypos

I sympathise with your plight, I've been at my wits end in the past, haywire despite doing all the wrong things and wrongly labelled as non-compliant.

By your description of how you've been on Lantus, I'd say its worth at least trying different insulin. I had a terrible time with the early 'human' types in the 80s, very erratic BS, v.sudden hypos with no awareness, also memory problems, persistent weight loss and a temper like the Incredible Hulk with PMT :oops: All settled on switching back to animal insulin, not perfect control but much better and improved QOL. However I'm doing better than ever on Levemir, Humalog and DAFNE.

If you were generally more stable on animal insulin before, and the only issue is late afternoon hypos, perhaps you could have a small snack mid-afternoon and take slightly more insulin than you need to cover the snack, to counteract the high. A compulsory snack may not be your favourite but if everything else is stable it may be a worthwhile compromise.

Alternatively, some people do better with Levemir than Lantus. Levemir tends to have a shorter action and you may well need it twice daily - an advantage if you need a different background dose at night from during the day. Small doses doesn't last as long as larger ones, but the only way to know how long it will last you is to try it. I and others here successfully use Levemir in unevenly split doses to resolve the 'high all day/hypo all night' problem.

HTH
Sue
 
I've only a few ideas for you and I wouldn't be surprised if you've already tried them.

1. Move to twice daily basal shots to eliminate any gaps and make absorbtion more predictable.
2. Limit meal insulins to no more than 7 units a shot to improve meal predictability ( you may have several injections for a meal however)
3. Limit snacking so you eliminate insulin stacking (except to cover exercise and hypos)
4. Are your injection sites damaged? eg lipoatrophy. One pointer is that the site is painless all the time.
5. Consider animal insulin if hypoawareness is a problem.
6. Is storage of insulin a problem ? Lantus is senstive to both heat and light more so than other insulins.

You sound like you are having an absolutely rotten time.

On the second last module of the course at http://www.dsolve.com I go into a lot of depth about insulin/meal matching. Whether or not you choose to limit your carbs there may be some tips that would help.
 
Hi Ihatehypos
Didn't I say say SarahQ was worth her weight in sugar!! She's right about splitting your dose of long-acting, which is why I followed her advice and not my doctor. He had never treated anyone on animal insulin, not many doctors these days will have. I take 12 units at 9pm and 20 units at 9am-ish of Hypurin Porcine Isophane.
If you do change to a new long-acting insulin be very cautious and take a very low amount for the first few days. I only took 8 units and 6 units on the first day and I stayed below 10- I had previously been on 34-38 unit of lantus. I gradually upped my dose day by day and by staying on the same rapid-acting insuin I could tell exactly what I needed. The reason for this is because the lantus may still be in your system for at least 36 hours after you last inject it. I read that a lot of it can stay in the injection site for this time, and not insignificant amounts either!! This probably explains the unexplained hypos and hypers on lantus, which I doubt has nothing to do with your injection sites. As I said I have been injecting for 19 years.
I hope this info is helpful.
Jus :)
 
Back
Top