Insulin not doing much, Type 2.

[Zammo]

I am a huge guy, at 30 stone, and I started insulin around a month ago. I went from 18 units and now am up to about 46 (going up every 3 days). 1 dosage a day. But it doesn't seem to be giving me any lesser blood sugar results than without it (I am also on Metformin and it is still the same as with just that). I speak to my diabetic nurse every 2 weeks, we are just seeing how things go. But 46 sounds a lot of units, but is it for my size ? Could it literally just be my size that is stopping it working ? I do wonder how it gets in to my system given it is a 4mm needle and I have a lot of blubber.

How normal is this ? I am a 45 year old male. Been diabetic for approx 2 years, was on Metformin alone until last month. Levels tend to be around 13 to 17 when not just eaten, sometimes higher if I am naughty with bad food. 18 units is also giving me the same results as 46 units. Odd.

I am seeing my diabetic nurse again tomorrow, other than the obvious "why isn't it working", is there anything else I should ask or suggest ?

Thanks !!

 

[PatsyB]

are you on a slow acting insulin at night which helps bring your levels down a little ?

 

[sgm14]

But 46 sounds a lot of units

I don't know how common it is, but the instructions for my insulin pen (which dials up to 80 units) tells you what you need to do if you need more than 80 units at any one time and I did read someone on this forum mention they needed to take three injections.

As I understand it, the amount of insulin you need is very much up to you and one of the symptoms of type 2 diabetes is 'insulin resistance' which means it does not work as well as it should, so you need a lot. There is no way that the doctors would know in advance how much you are going to need and so they start you off with a low dosage and keep increasing it slowly.

I do wonder how it gets in to my system given it is a 4mm needle and I have a lot of blubber.

I think that is OK as the insulin is supposed to be injected into the fat between your skin and muscle and so presumably the needle only needs to be longer than the thickness of your skin.

 

[JoKalsbeek]

I am a huge guy, at 30 stone, and I started insulin around a month ago. I went from 18 units and now am up to about 46 (going up every 3 days). 1 dosage a day. But it doesn't seem to be giving me any lesser blood sugar results than without it (I am also on Metformin and it is still the same as with just that). I speak to my diabetic nurse every 2 weeks, we are just seeing how things go. But 46 sounds a lot of units, but is it for my size ? Could it literally just be my size that is stopping it working ? I do wonder how it gets in to my system given it is a 4mm needle and I have a lot of blubber.

How normal is this ? I am a 45 year old male. Been diabetic for approx 2 years, was on Metformin alone until last month. Levels tend to be around 13 to 17 when not just eaten, sometimes higher if I am naughty with bad food. 18 units is also giving me the same results as 46 units. Odd.

I am seeing my diabetic nurse again tomorrow, other than the obvious "why isn't it working", is there anything else I should ask or suggest ?

Thanks !!

Insulin resistance may be the problem here, as you're a T2. We make so much insulin we become insensitive to it. Basically you're adding fuel to the fire, adding in more insulin and likely making the insensitivity to it that much worse. But, like @sgm14 said, you're injecting the insulin where it should go; Blubber, as you put it. (The bacon, as my doc's assistant would call it!). And you haven't been on it long enough to have worn a spot out with scar tissue or something, to inhibit the uptake, I don't think... But I don't do insulin myself, so that's just a guess.

Have you, by any chance, tried a low carb diet? You mention the weight being an issue and your insulin resistance seems rather strong, so that might be a way to tackle both some. https://josekalsbeek.blogspot.com/2019/11/the-nutritional-thingy.html might help a little get a grip on either or both, anyway.... If you're interested on going that route. Just be careful, because if your sensitivity to insulin does improve, you could get hypo's on a low carb or keto diet, so do be careful and test loads if you hit the ground running with that one.

As for suggestions for your nurse: You could ask for long acting and short acting insulin, maybe...?
Good luck!
Jo

 

[Zammo]

Thanks everyone. I am the "I" insulin, which I believe is intermediate.

If I am insulin resistant, could this be why I have to pee every 40 minutes quite urgently ? Is the insulin making this worse ? As I didn't have to before taking the insulin (although I did still need to pee urgently, just not every 40 minutes). If I am insulin resistant, does this mean there is no point in injecting any of it, or do I just need a lot ?

Also, how best to avoid jab pain ? Sometimes I insert the needle and feel nothing at all, but todays really stung and hurt. I would go in the same place that doesn't hurt all the time if I could, but the nurses say alternate, so I go each side of body rather than the same place.

 

[JoKalsbeek]

Thanks everyone. I am the "I" insulin, which I believe is intermediate.

If I am insulin resistant, could this be why I have to pee every 40 minutes quite urgently ? Is the insulin making this worse ? As I didn't have to before taking the insulin (although I did still need to pee urgently, just not every 40 minutes). If I am insulin resistant, does this mean there is no point in injecting any of it, or do I just need a lot ?

Also, how best to avoid jab pain ? Sometimes I insert the needle and feel nothing at all, but todays really stung and hurt. I would go in the same place that doesn't hurt all the time if I could, but the nurses say alternate, so I go each side of body rather than the same place.

No idea why you need the bathroom so often now.... If blood sugars are high, you're more prone to a bladderinfection, so if something changed recently... No harm in getting a pee-sample checked for bacteria, as they do love glucose-filled urine. (And an infection could also drive blood sugars up!). As for the resistance, you might just need a truckload more than another would. If metformin and insulin are the only things you're doing now to get your blod sugars down, you're not actually doing much to combat the insulin resistance. Metformin might make it a smidge better, -that's what it does, improve sensitivity somewhat and make your liver dump less glucose- but it doesn't sound like you're noticing much of that? Hence the dietary suggestion, it's the most effective thing I can think of, really...

Just, you know. Get the urine checked. If something changes and you need to go urgently, there might be something going on that requires antibiotics or somesuch. (And since bladderinfections can travel up to the kidneys, and you really do NOT want that to happen... Better safe than sorry).

Take care of you, eh.
Jo

 

[catinahat]

If I am insulin resistant,

If you are T2 then it's almost a given.
Have they done any tests to determine how much insulin you produce?
Insulin resistance usually starts way before we are diagnosed, our bodies resist the insulin meaning we need to produce more to clear the glucose form our blood. More insulin means our resistance to it increases
Eventually so much insulin is needed that the pancreas can't keep up with demand and our blood sugar levels rise to above the diabetic threshold.
If your pancreas is producing normal amounts of insulin then adding more is making your insulin resistance worse. And because insulin is also the hormone that controls fat storage, you will find it even more difficult to lose any weight.

 

[EllieM]

How normal is this ? I am a 45 year old male. Been diabetic for approx 2 years, was on Metformin alone until last month. Levels tend to be around 13 to 17 when not just eaten, sometimes higher if I am naughty with bad food. 18 units is also giving me the same results as 46 units. Odd.

Just checking, as you are moving to insulin relatively quickly, but have you had a cpeptide test to measure your insulin production? This would hopefully confirm whether your issues are insufficient insulin because of insulin resistance rather than insufficient insulin just because you aren't making much...

And they make double and triple and quintuple strength insulin specifically for people who need a lot (usually but not always T2s) so I wouldn't say that 48 units is a lot at all. The article below says severe insulin resistance occurs when you need over 200 units a day or 2 units per kg body weight.

Treatment Approach to Patients With Severe Insulin Resistance

In Brief Patients with severe insulin resistance require >2 units/kg of body weight or 200 units/day of insulin. Yet, many patients do not achieve glycemic targets despite using very high doses of insulin. Insulin can cause weight gain, which ...

www.ncbi.nlm.nih.gov

Patients who require >1 unit/kg/day are considered to have insulin resistance, and those requiring >2 units/kg/day have severe resistance (3). Alternatively, a total daily insulin dose of >200 units is commonly considered to be evidence of severe insulin resistance.

The problem is that if you take too much insulin you go hypo (not fun and potentially very dangerous) so they have to just increase the dose gradually till you hit the sweet spot, which can vary dramatically from person to person.

 

[EllieM]

Insulin resistance may be the problem here, as you're a T2. We make so much insulin we become insensitive to it. Basically you're adding fuel to the fire, adding in more insulin and likely making the insensitivity to it that much worse.

Jo I can see the logic that says you need more insulin if your insulin resistance gets worse, but have you got a link to say that it works the other way round, injected insulin makes you more insulin resistant? I'm not convinced that that is the case at all, but I am not T2 on insulin.

 

[JoKalsbeek]

Jo I can see the logic that says you need more insulin if your insulin resistance gets worse, but have you got a link to say that it works the other way round, injected insulin makes you more insulin resistant? I'm not convinced that that is the case at all, but I am not T2 on insulin.

That's what I gathered on here over the years, no specific link I can provide... Feel free to edit it out as you see fit, I might be getting it wrong...

 

[TheSecretCarbAddict]

I'd recommend checking out Ben Bikman's work on insulin resistance. My understanding is that insulin resistance develops because our pancreas secrete increasing amounts of insulin to deal with excess blood glucose levels. Initially increased insulin levels work to reduce blood glucose until cells become desensitised to this new level and the cycle repeats again until the pancreas are maxed out. This is where the prevailing glucose centric approach to treating T2 says you need to start using extreneous insulin, but the insulin resistance cycle continues the same way. Changing the source of additional insulin does not fundamentally alter the mechanism of insulin resistance. I'll try and dig out specific references when I get back to my laptop later on today.

 

[catinahat]

have you got a link to say that it works the other way round, injected insulin makes you more insulin resistant?

I've copied this from here https://my.clevelandclinic.org/health/diseases/22206-insulin-resistance
It gives at least one reason why extra insulin could increase insulin resistance in T2's

How does insulin resistance affect my body?​

The development of insulin resistance typically increases insulin production (hyperinsulinemia) so your body can maintain healthy blood sugar levels. Elevated levels of insulin can result in weight gain, which, in turn, makes insulin resistance worse.

 

[Antje77]

Elevated levels of insulin can result in weight gain, which, in turn, makes insulin resistance worse.

"Can" is the keyword here I think,
I've been on relatively large doses of insulin for years (100+ of basal, plus bolus), and I haven't gained weight despite pretty much perfect glucose levels.

 

[catinahat]

"Can" is the keyword here I think,
I've been on relatively large doses of insulin for years (100+ of basal, plus bolus), and I haven't gained weight despite pretty much perfect glucose levels.

Of course @Antje77 no absolutes with this diabetes malarkey, nothing always applies to everyone.
For many though, especially insulin resistant T2's, treatment with insulin results in weight gain.
I was replying to a post that doubted if injecting insulin could make insulin resistance worse.
The original post has T2 in the title so we're not talking about everyone with diabetes here, just those of us who are insulin resistant . It seems from the quite informative article I linked to it is indeed a possibility