Hunger and insulin

[SB.25]

Hello all,

Ive recently started taking insulin in the evenings before bed (initially 6 units and moved up to 8). I think this is going to be increased shortly to a higher amount after my check up later this week.

When I began taking the insulin the DSN told me I needed to eat more carbs to avoid the risk of hypos and so I have increased my intake.

Well since taking the insulin, I have been so hungry all of the time!

I wondered whether this was common when first starting insulin at all? Alternatively I wonder whether eating the increased carbs is making me more hungry.

Any comments, advice or personal experience would be much appreciated!

Thanks

 

[slip]

More information about you and your condition (T1,T2, or some other form?) and any other medication, assuming the insulin you're on is a basal type insulin as well?

 

[SimonCrox]

Sorry, but insulin does stimulate the appetite. Many of my patients on rapid analogue insulins found that they just boosted the appetite for that meal dramatically. One of my friends trialed insulin plus/minus metformin in standard NHS care; over 1 year, those on metfomrin gained 6.1 Kg and those on placebo gained 7.6 kg [ https://www.ncbi.nlm.nih.gov/pubmed/15842521 ].
So one has to take care, unfortunately.
Levemir might be less likely to produce weight gain than other basal insulins, and bedtime insulin seems to produce less weight gain than other regimes in T2DM eg Yki-Jarinnen's work (sorry - I spell her name wrong half the time)
If you have T2DM, have you considered a GLP-1 RA such as liraglutide instead? These drop glucose as much as insulin, but no hypos per se, and lose weight and decrease risk heart attack/stroke.
Best wishes

 

[SB.25]

More information about you and your condition (T1,T2, or some other form?) and any other medication, assuming the insulin you're on is a basal type insulin as well?

Sorry thought the information was on my profile.

Currently unclear diagnosis, waiting on peptide and islet tests to come back which are due in February. I am also in 2000mg metformin a day.

I’ve been put on basal insulin at night as a measure to try to stabilise blood sugars until i have the correct diagnosis.

I’m only 26 and have a low bmi and I am very active which I think is why they are carrying out the other tests.

Thanks

 

[SB.25]

Sorry, but insulin does stimulate the appetite. Many of my patients on rapid analogue insulins found that they just boosted the appetite for that meal dramatically. One of my friends trialed insulin plus/minus metformin in standard NHS care; over 1 year, those on metfomrin gained 6.1 Kg and those on placebo gained 7.6 kg [ https://www.ncbi.nlm.nih.gov/pubmed/15842521 ]. So one has to take care.
If you have T2DM, have you considered a GLP-1 RA such as liraglutide instead? These drop glucose as much as insulin, but no hypos per se, and lose weight and decrease risk heart attack/stroke.
Best wishes

Thank you for the response. I may sound silly but what is liraglutide which you refer to? Is that another form of tablet or injection? I haven’t been told about that.

My consultant said he didn’t want to put me on any other tablets as he wanted to preserve any working cells which I still have. I assume that’s why he put me on insulin whilst I’m awaiting results.

Thanks

 

[SimonCrox]

Thank you for the response. I may sound silly but what is liraglutide which you refer to? Is that another form of tablet or injection? I haven’t been told about that.

My consultant said he didn’t want to put me on any other tablets as he wanted to preserve any working cells which I still have. I assume that’s why he put me on insulin whilst I’m awaiting results.

Thanks

Sorry to muddy the waters. Liraglutide is not insulin and is a jab for type 2 diabetes but not for type 1 diabetes. I have undoubtedly jumped the gun here, and as you say, you want to find out if you have type 1 or type 2.

 

[SB.25]

Sorry to muddy the waters. Liraglutide is not insulin and is a jab for type 2 diabetes but not for type 1 diabetes. I have undoubtedly jumped the gun here, and as you say, you want to find out if you have type 1 or type 2.

No worries thanks for your time to reply anyway

 

[slip]

What sort of BG numbers are you getting now you're on insulin? I thought it a bit counter intuitive of your nurse to say eat more carbs now you're on insulin - I assume your BGs were high hence going on insulin, and the insulin would help bring those numbers down but in a controlled fashion, just added more carbs would slow that process down.

 

[kitedoc]

Hi @SB.25, Sorry to hear your life has become more complicated. As a T1D, not as professional advice or opinion:
do you have a glucose meter to monitor your blood sugar levels (BSLs)? That way you can gauge what the addition of this long-acting insulin is doing to your BSLs.
If not, since you are prescribed insulin, I believe the GP can order the strips and meter for you - but I bow to others' experience on this. (I assume you live in the UK)
As the nurse mentioned, the insulin you are now taking could lower your BSLs. If you go to the Home page and Type 1 diabetes there is a topic called hypoglycaemia (hypo- = low, -gly- glucose, -aemia - in the blood, or hypo for short).
You will see that hunger can be a symptom of hypos, so ideally doing a glucose meter reading (from a drop of blood gained by fingerprick) at the time of feeling hungry, or most hungry can give you an idea about whether your BSL is low or not.
Definition of low BSL is a reading of either less than 4 mmol/l or less than 3.6 mmol/l.
Sometimes people experience feelings of a hypo at higher readings like 5 or even 6 so if you are not sure you could always repeat the test say 10 minutes later.
The article on hypoglycaemia also mentions what to do in a hypo, if you should ever experience symptoms as well and have a low reading.
There are a number of long-acting insulins: one lasts in its BSL-lowering effect for 12 to 20 hours or so, another for 20 to 24 hours, and others longer. A number of these have a fairly even effect on BSL over the time they work for but others can tend to have a mild peak on BSL-lowering ability partway through the time they are active. If your insulin has such a peak, that may tend to be the time when a low BSL may be more likely to occur.
So please let us know here what insulin you have ben prescribed and ask your DSN what effect your particular insulin is likely to have on your BSLs in terms of time after its injection.
As others have suggested you will need to wait for the blood test results before knowing more about whether insulin is the best next thing or some other treatment. Best Wishes

 

[SB.25]

Hi @SB.25, Sorry to hear your life has become more complicated. As a T1D, not as professional advice or opinion:
do you have a glucose meter to monitor your blood sugar levels (BSLs)? That way you can gauge what the addition of this long-acting insulin is doing to your BSLs.
If not, since you are prescribed insulin, I believe the GP can order the strips and meter for you - but I bow to others' experience on this. (I assume you live in the UK)
As the nurse mentioned, the insulin you are now taking could lower your BSLs. If you go to the Home page and Type 1 diabetes there is a topic called hypoglycaemia (hypo- = low, -gly- glucose, -aemia - in the blood, or hypo for short).
You will see that hunger can be a symptom of hypos, so ideally doing a glucose meter reading (from a drop of blood gained by fingerprick) at the time of feeling hungry, or most hungry can give you an idea about whether your BSL is low or not.
Definition of low BSL is a reading of either less than 4 mmol/l or less than 3.6 mmol/l.
Sometimes people experience feelings of a hypo at higher readings like 5 or even 6 so if you are not sure you could always repeat the test say 10 minutes later.
The article on hypoglycaemia also mentions what to do in a hypo, if you should ever experience symptoms as well and have a low reading.
There are a number of long-acting insulins: one lasts in its BSL-lowering effect for 12 to 20 hours or so, another for 20 to 24 hours, and others longer. A number of these have a fairly even effect on BSL over the time they work for but others can tend to have a mild peak on BSL-lowering ability partway through the time they are active. If your insulin has such a peak, that may tend to be the time when a low BSL may be more likely to occur.
So please let us know here what insulin you have ben prescribed and ask your DSN what effect your particular insulin is likely to have on your BSLs in terms of time after its injection.
As others have suggested you will need to wait for the blood test results before knowing more about whether insulin is the best next thing or some other treatment. Best Wishes

Thanks for your very in-depth response.

Yes I have a meter and have been testing. My levels seem to go between 6-14 and the average stats on my meter say I average an 11.4 over the past 2 weeks

My levels are fairly erratic and I have sometimes found that actually eating a few more carbs has bought my levels down rather than raise them!

I’m cautious I don’t want to put on weight (I lost almost a stone since diagnosis). I will try testing when I feel hungry tho check levels then, as I had just been testing before and then 2 hours after the meal.

The insulin I am on is Abasaglar and was initially on 6 units then put up to 8. I found since increasing the units I have been more hungry but I also found that the increased insulin has made my levels better..:

 

[DCUKMod]

@SB.25 - The weight you have lost since diagnosis, was that by trying to lose weight, because you modified your diet to try to bring your blood sugars down, or did it happen irrespective of what you did?

Weight loss can sometimes be triggered my blood sugars being out of control, but that's more common in T1.

Thankfully, your Doc is doing some additional tests to try to clarify things. I know it's difficult when in limbo, but I'm thinking, were I in your shoes, that I'd try to do what I needed to do to bring the numbers towards range, and not worry about the hungery/weight issues until I knew what my proper options would be. Once your numbers are in a safe range, it'll maybe be easier to balance the medication/hunger/weight issues.

I totally take in on board that it's all too easy for me to say when it isn't me!

I'll get my coat!

 

[kitedoc]

Thank you @SB.25 , you are a fine example of a responsible, well-educated diabetic!! gold stars +++++++++++++++++++++
Again, not as professional advice or opinion: Only guessing but it may be at times that you eat a bit more carbs your pancreas gland might make an extra effort and put some insulin into the blood stream. That hit and miss response from your pancreas gland at this stage could have something to do with the chaotic BSLs you describe and the confusing better effect of extra carbs on your BSL. That is not to say unfortunately that your pancreas can necessarily cover all your carb intake without medication.
The weight loss might have been due to the higher BSLs earlier on.
If you search for profile pictures of Abasaglar (or under its other brand name Lantus) who will see that there is a bit of a flat hump in BSL-lowering activity ? from 5 to 6 hours after injection to maybe ? 12 hours afterwards. Not a real big hump like with short-acting insulins in their profile.!!
That slight hump in the Abasaglar profile may be when lower BSLs might happen, especially as doses increase. Some of that time is overnight, when we are usually not awake to test. and have last eaten hours ago. So perhaps discuss with your DSN about testing sometimes in the early hours and certainly if you feel hungry or have any other symptoms. The profile also suggests the Abasaglar's BSL-lowering effect lasts 24 hours.
The big proviso is that charts like these are made after research by the insulin manufacturer and may not reflect each person's actual response to Abasglar. So you may be asked to check your BSL just before the next evening dose is due to see that it is still keeping BSLs in range and not running out early (and a google of the official Abasaglar site reads that the length of action increases a bit with higher doses).
I would suggest you also ask your DSN what happens in the rare instance that some Abasaglar happened to be accidentally injected into a blood vessel under the skin. And if this applies to other long-acting insulins or just glargine (the drug name of your insulin). Please keep 'doing good '!!!

 

[SB.25]

@SB.25 - The weight you have lost since diagnosis, was that by trying to lose weight, because you modified your diet to try to bring your blood sugars down, or did it happen irrespective of what you did?

Weight loss can sometimes be triggered my blood sugars being out of control, but that's more common in T1.

Thankfully, your Doc is doing some additional tests to try to clarify things. I know it's difficult when in limbo, but I'm thinking, were I in your shoes, that I'd try to do what I needed to do to bring the numbers towards range, and not worry about the hungery/weight issues until I knew what my proper options would be. Once your numbers are in a safe range, it'll maybe be easier to balance the medication/hunger/weight issues.

I totally take in on board that it's all too easy for me to say when it isn't me!

I'll get my coat!

Thanks for the response. Yes I am trying to get the bloods under control, but it’s so hard when they seem to do whatever they want. They have come down from daily 17/18s though so I have had some improvement - trying to be as positive as possible lol!

I’m still eating reduces carbs but obviously as the DSN told me to eat slightly more, I have increased them slightly.

I have been impressed with the care I have received so far and I know not much else can be done until the tests come back which can take some time. Just wish I would stop being so hungry lol!

 

[Daibell]

Hi. I might challenge the DN's advice to increase the carbs with insulin. I'd like to understand the science behind that advice and it sounds a bit more of the bad NHS 'have plenty of carbs' advice. There is no reason I'm aware of to increase carbs when on insulin to avoid hypos. The way to avoid hypos is to keep the insulin dose down as low as possible consistent with maintaining a good BS level. I've also never heard of insulin use increasing appetite either but I guess for some people it might particularly if you push your BS down near to the hypo region. It sounds like you may be LADA/T1 or another form of diabetes so the test results should help. I would suggest to minimise hunger that you have enough fats and proteins as these keep the stomach full for longer than when having carbs

 

[SB.25]

Hi. I might challenge the DN's advice to increase the carbs with insulin. I'd like to understand the science behind that advice and it sounds a bit more of the bad NHS 'have plenty of carbs' advice. There is no reason I'm aware of to increase carbs when on insulin to avoid hypos. The way to avoid hypos is to keep the insulin dose down as low as possible consistent with maintaining a good BS level. I've also never heard of insulin use increasing appetite either but I guess for some people it might particularly if you push your BS down near to the hypo region. It sounds like you may be LADA/T1 or another form of diabetes so the test results should help. I would suggest to minimise hunger that you have enough fats and proteins as these keep the stomach full for longer than when having carbs

I’ve obviously just been doing as the Docs have been telling me. I did just get a letter in the post tonight which says I need to get an appointment to discuss my results. I think the only results I have which are outstanding are the c-peptide and islet ones so hoping it’s about that and then perhaps I can get a formal diagnosis! ...... well fingers crossed anyway.

 

[Circuspony]

I only started insulin on T1 diagnosis 18 months ago and although it didn't make me hungry I did have a serious "sugar detox". My bloods had been running high for months and were in high 30s so in the weeks after diagnosis when they brought me back down i felt awful.

I did crave sugar and it was one of the consultants who said it was like treating an addict - an unintentional addict!! It might be your body craving sugar that's making you feel hungry.