Type 1.5 Insulin not effective, can anybody help me please?

[milli]

Hi there, I'm wondering if anyone has ever experienced a time where they've given themselves insulin to cover a meal only to feel really poorly 2hrs later and they test again only to find that the insulin that was given hasn't been effective and it's as if they've not given any insulin at all? ... This is what's been happening with me and it's been going on for a few weeks now possibly even a few months. I don't think it's that I'm injecting into lipo's because it's happened a lot when I've used a completely fresh site but it's really worrying me and neither my GP, The Diabetic Nurses nor my Diabetes Consultant know why this is happening ... infact when I asked my Diabetes Consultant all he did was shrug his shoulder's and say 'who knows why these things happen' ... needless to say this has worried me even more because if the top man doesn't know then who does?? ... Any advice or comments would be gratefully received

 

[azure]

Hi @milli

Is it just your fast acting insulin that seems to be not working? What insulin do you use? Have you swapped to a new batch of insulin in case yours has been damaged before you got,it?

Have you tried increasing your ratios? (I'm presuming you count carbs and adjust your doses accordingly)

 

[himtoo]

Hi @milli
welcome to the forum.
this can happen -- but there is usually a reason.

bad site , not enough insulin for carbs eaten are the 2 usual culprits.
are you returning to pre-meal level 4-5 hours after eating and bolus ??
if this is happening it may be a bolus timing issue.

as @azure says -- we are thinking that you are carb counting , adjusting your insulin doses to match your carb intake.

 

[endocrinegremlin]

What sort of food are you eating? If you are eaten things that are high in fat content it could be that the carbs are kicking in later and showing a high sugar//carb that is not wholely accurate? Splitting this injection in two by an hour may balance such issues if you are on high carb meals.

 

[milli]

Hi @milli
welcome to the forum.
this can happen -- but there is usually a reason.

bad site , not enough insulin for carbs eaten are the 2 usual culprits.
are you returning to pre-meal level 4-5 hours after eating and bolus ??
if this is happening it may be a bolus timing issue.

as @azure says -- we are thinking that you are carb counting , adjusting your insulin doses to match your carb intake.[/
Thank you for your reply, yes I am carb counting and the amount of insulin I give myself varies with each meal that I eat but because the insulin isn't always effective I'm definitely not returning to my pre-meal level after eating and bolus. Just as an example last night before I went to bed at 10.30pm my BS's were 12.0, I ate a bowl of cinnimon grahams with 250ml of semi skimmed milk and I gave myself 5u Novorapid (1:12) and 2u correction down to 7mmol but woke up this morning with BS's 27.6 and 1.4 ketones and feeling very, very poorly ... I didn't hesitate to give 10u correction and rang the out of hours GP and the community diabetes nurse at the hospital and left an answer phone message ... this is happening 8 times out of 10 these days and it is really worrying me. I try to use different site's in the hope that the insulin will work ...

 

[milli]

Hi @milli

Is it just your fast acting insulin that seems to be not working? What insulin do you use? Have you swapped to a new batch of insulin in case yours has been damaged before you got,it?

Have you tried increasing your ratios? (I'm presuming you count carbs and adjust your doses accordingly)

Hi, I've always used Novorapid and its never been like this before plus its happened with 2 different boxes of novorapid that i got at different times. When I try increasing my Lantus even by 1mmol I start having hypo's. To be honest I feel that ill with the whole thing that I leave my ratio's upto my DN to sort out because I really do feel that all over the place. I went to see the diabetic consultant to start being assessed for a pump but I really need to be able to take in all of the information that he tells me about the pump but I struggle to take it all in because of how I feel. I really appreciate that you've replied because for a long time now diabetes has been ruling my life and it's really getting me down.

 

[milli]

What sort of food are you eating? If you are eaten things that are high in fat content it could be that the carbs are kicking in later and showing a high sugar//carb that is not wholely accurate? Splitting this injection in two by an hour may balance such issues if you are on high carb meals.

Hi there, if I'm honest lately my appetite's been pretty poor but I'm really careful not to eat much fatty food and if i do i always give any insulin about 30-40 minutes after finishing the food. Thank you for your reply.

 

[endocrinegremlin]

Hi there, if I'm honest lately my appetite's been pretty poor but I'm really careful not to eat much fatty food and if i do i always give any insulin about 30-40 minutes after finishing the food. Thank you for your reply.

That seems pretty late to me. By that time your carbs will have kicked in but not your insulin so you will feel pretty terrible. I'd try taking your insulin half an hour earlier and seeing how that goes.

 

[steve_p6]

I find carbs kick in as normal and fat tends to only delay the rise die to protein, classic examples being KFC chicken, steaks etc.

What level of carbs are you taking at meals?

I would suggest getting a Libre (trial from hospital or buy a couple of sensors) and take a really close look at what is happening to the BGs after eating to see if bollussing before you eat helps.

 

[azure]

Hi, I've always used Novorapid and its never been like this before plus its happened with 2 different boxes of novorapid that i got at different times. When I try increasing my Lantus even by 1mmol I start having hypo's. To be honest I feel that ill with the whole thing that I leave my ratio's upto my DN to sort out because I really do feel that all over the place. I went to see the diabetic consultant to start being assessed for a pump but I really need to be able to take in all of the information that he tells me about the pump but I struggle to take it all in because of how I feel. I really appreciate that you've replied because for a long time now diabetes has been ruling my life and it's really getting me down.

If it was me, I'd ask for a change of insulin - ie a new type. Could you try Humalog, for example?

It's worth a try as it must be horrible to feel so awful.

 

[slip]

is this happening for every meal or just high fat ones?

 

[noblehead]

Hi, I've always used Novorapid and its never been like this before plus its happened with 2 different boxes of novorapid that i got at different times. When I try increasing my Lantus even by 1mmol I start having hypo's. To be honest I feel that ill with the whole thing that I leave my ratio's upto my DN to sort out because I really do feel that all over the place. I went to see the diabetic consultant to start being assessed for a pump but I really need to be able to take in all of the information that he tells me about the pump but I struggle to take it all in because of how I feel. I really appreciate that you've replied because for a long time now diabetes has been ruling my life and it's really getting me down.

I would go with @azure recommendation and ask for a change of insulin, over the years there's been a few threads where type 1's have experienced similar and have resolved things by changing their insulin, if anything its worth a try.

 

[milli]

That seems pretty late to me. By that time your carbs will have kicked in but not your insulin so you will feel pretty terrible. I'd try taking your insulin half an hour earlier and seeing how that goes.

Hi there, oh right I didn't realise I've just been taught to always leave it 30-40mins to have Novo after a fatty meal eg chinese etc and yes I do feel pretty awful but then I'm feeling pretty awful about 80% of the time lately due to injecting insulin before/after meals only to test again 2hrs after my meal and find that my BS's are in the late 20's I'm getting so fed up with it but I've got to find a solution because I can't carry on feeling this way. The fact that I have chronic constant pain too doesn't help either I'm on continuous morphine ... I'll try what you've advised and see if that helps. I've increased my Lantus tonight by 1mmol and had my first hypo

 

[milli]

I find carbs kick in as normal and fat tends to only delay the rise die to protein, classic examples being KFC chicken, steaks etc.

What level of carbs are you taking at meals?

I would suggest getting a Libre (trial from hospital or buy a couple of sensors) and take a really close look at what is happening to the BGs after eating to see if bollussing before you eat helps.

Hi Steve_p6, carb levels vary for each meal but always 50g for breakfast, 22g dinner and roughly 70-90g's at teatime. I very rarely eat fast food these days either and yes I have a Libre and got the two sensors with the start up kit too. Using a sensor is soooo much easier but unfortunately I can't afford to buy them regularly much to my frustration. Thanks for your reply.

 

[milli]

If it was me, I'd ask for a change of insulin - ie a new type. Could you try Humalog, for example?

It's worth a try as it must be horrible to feel so awful.

Hi Humalog, thanks for your reply that's a really good idea I shall ask my GP about changing insulin when I see her tomorrow, as you say anything is worth a try and to be honest something needs to happen because I just feel ill all of the time plus it's really worrying me now because none of the professionals I've seen seem to know what's going on

 

[daisymj14]

Hi @milli
I've been on novorapid for about 15 years, and recently I have noticed that I'm having a very similar problem. Large spikes after meals that don't seem to come down. I asked my consultant whether I was becoming resistant or something, but their advice was to get a fresh batch and discard any that I have at home.
I did actually change the cartridge and the insulin did kick in pretty quickly after I had a whole day of my insulin appearing to not be working, I can't confirm it was the batch, but I'm going to stick to fresh prescriptions from now on just in case!

 

[milli]

is this happening for every meal or just high fat ones?

Hi there, to be honest it's very strange almost like Russian roulette because sometimes the insulin's effective and sometimes it's not but lately it's mostly not effective ... so whenever I eat any meal with carbs in it I basically never know whether the insulin is going to do its job or not ... I meant to say that when my BS's go high it basically knocks me out into a very, very deep sleep which my son finds it hard to wake me up from

 

[milli]

Hi @milli
I've been on novorapid for about 15 years, and recently I have noticed that I'm having a very similar problem. Large spikes after meals that don't seem to come down. I asked my consultant whether I was becoming resistant or something, but their advice was to get a fresh batch and discard any that I have at home.
I did actually change the cartridge and the insulin did kick in pretty quickly after I had a whole day of my insulin appearing to not be working, I can't confirm it was the batch, but I'm going to stick to fresh prescriptions from now on just in case!

Hi @daisymj14, thanks for your reply and advise I will definitely ask for a fresh batch when I speak to my GP tomo. I've pretty much been slowly coming to terms with what I was thinking 'this is the way it is for me now (uncontrollable BS's and feeling really ill most of the time)' ... I'm really pleased for you that your fresh batch worked well, I've got my finger's crossed it works for me too.

 

[milli]

is this happening for every meal or just high fat ones?

Hi slip, thanks for your reply. No it doesn't happen at every meal time it's a bit of a potluck kind of situation really, sometimes the insulin's effective most times it's not, it's very strange. It's as if I'm injecting into lipo's but I've injected into a completely fresh site (my arm) and sometimes it happens there too so I really don't know what's going on ... I very rarely eat high fat food's, when I say my diet is pretty poor lately I mean in the sense that I sometimes miss dinner so I just have breakfast and tea and I don't eat a lot of fruit and veg. I've started to see a dietician to help me with this. Possibly TMI but I've had several big life changing upset's this year and with feeling so poorly with my diabetes my mood has dropped and has my appetite and diet.

 

[himtoo]

Hi @milli
your last post with big life changes could be a crucial part of this.

with big changes usually comes stress -- and stress raises blood sugars and makes it harder to keep them in control.

just something to be aware of ....................

[[[hugs]]] -- really hope you can get sorted soon