Insulin not responding normally?

[Becki84]

I have struggled with maintaining any kind of normal bs levels since diagnosis. More recently I tried to radically change my diet, as even a daphne course had had no impact. I am now eating extremely low carb, huge salads with nuts etc... My diabetic dietician was happy with my calories, and nutritional content yet I still cannot get my sugars down below 20 for most of the day. I exercise daily, and am not overweight... Could I be resistant to insulin?
Recently increased my lev emir , have double the doses and for 30g of carbs I need 10units of humalog. Is this usual? I've changed my injection sites, given up any processed foods and sweets, gluten etc am at my wits end!! I visit my clinic every two weeks but no one seems to have a clue.


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[diamondnostril]

I have struggled with maintaining any kind of normal bs levels since diagnosis. More recently I tried to radically change my diet, as even a daphne course had had no impact. I am now eating extremely low carb, huge salads with nuts etc... My diabetic dietician was happy with my calories, and nutritional content yet I still cannot get my sugars down below 20 for most of the day. I exercise daily, and am not overweight... Could I be resistant to insulin?
Recently increased my lev emir , have double the doses and for 30g of carbs I need 10units of humalog. Is this usual? I've changed my injection sites, given up any processed foods and sweets, gluten etc am at my wits end!! I visit my clinic every two weeks but no one seems to have a clue.


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Hi Becki . . .

Apologies in advance if you already know/tried what I say/suggest below!

If you are now using a Low-Carb strategy then you need to consider what your body will do with the Protein and Fat that you are eating.

When the body is able to get all the energy it needs from Carbs, this is what it does. Carbs are the easiest form of food energy to process so if it can take all energy needs from Carbs, this is what it does. If not enough Carbs are available to supply all energy needs, then it turns to Protein and Fat. In this case, up to 50% of the Protein that you eat (and even up to 10% of the Fat that you eat) can be converted to Glucose.

So for a Low-Carb meal try recalculating your Insulin dose on this basis:
100% of the Carbs will be converted to Glucose by your body
(Up to) 50% of the Protein will be converted to Glucose by your body
(Up to) 10% of the Fat will be converted to Glucose by your body

It may be that when you make this calculation, your required Humalog dose makes sense. I use a Ketogenic (LCHF) diet. Usually I need 7 or 8 Units of Rapid Insulin for a meal containing less than 10g Carbs.

If all of the above is already known and tried then I have 1 more idea to float . . . I can return with that idea if wanted

Regards,
Antony

 

[robert72]

Hi Becki and welcome.

I am much the same - taking about 10-12u of Novorapid for around 30g carbs per day and need to account for protein and fat as Antony suggests above. My basal went down a couple on units when I started LC, but I guess we are all different.

 

[Becki84]

Thanks for the ideas, that's helpful as I visited the dietician again today who said I shouldn't be injecting for a piece of chicken, an egg etc. I'm not quite sure how to calculate the glucose content of protein...are there any sites online that discuss this??


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[robert72]

You could sign up to http://www.myfitnesspal.com but ignore the weightloss bits if you don't need them.

It also has a phone app which lets you scan barcodes if you want to add foods to your diary

 

[Becki84]

I have it already!! What a dope. Thank you, please let this be th solution!!


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[robert72]

Carbs and Cals is another useful app - well worth the price (wish I was on commission )

 

[Becki84]

I have that too, just been listening too much to my DN and dietician. Apparently I don't need to inject for lots of things that are spiking my sugars. Guess I just have to figure this out through trial and error!


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[smidge]

Hi Becki,

I agree with what the others have said re: injecting for protein. Take a look at Dr Bernstein's book 'The diabetes solution' for a good explanation.

A couple of other things for you to consider:

Are you sure both your insulin pens are working properly? I recently had a pen that was failing to deliver a consistent basal dose. It took me months to sort out why my readings were all over the place.

Hormones - the lead up to my period gives me bad insulin resistance and when the period starts my BG drops like a stone. If you have any kind of hormone imbalance get it investigated.

Infection - tooth or gum infections play havoc with BG control. Even slight infections can keep BG high.

Beyond that, try a different insulin - sometimes a particular insulin just doesn't suit you.

Good luck

Smidge

 

[robert72]

Also, regarding the huge salads - have a look at the 'Chinese Restaurant Effect' on this page (scroll down a bit):
http://www.diabetes-book.com/cms/ar.../2922-richard-k-bernstein-md-face-facn-fccws-
Sometimes you have to adjust your bolus for the bulk of food. A black art but you will develop a sense of it in time.

 

[ElyDave]

I have that too, just been listening too much to my DN and dietician. Apparently I don't need to inject for lots of things that are spiking my sugars. Guess I just have to figure this out through trial and error!


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Yes, they told me on my DAFNE course that lentils and pulses don't have carbs

 

[nigelho]

I have struggled with maintaining any kind of normal bs levels since diagnosis. More recently I tried to radically change my diet, as even a daphne course had had no impact. I am now eating extremely low carb, huge salads with nuts etc... My diabetic dietician was happy with my calories, and nutritional content yet I still cannot get my sugars down below 20 for most of the day. I exercise daily, and am not overweight... Could I be resistant to insulin?
Recently increased my lev emir , have double the doses and for 30g of carbs I need 10units of humalog. Is this usual? I've changed my injection sites, given up any processed foods and sweets, gluten etc am at my wits end!! I visit my clinic every two weeks but no one seems to have a clue.


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Hi Becki84. I did DAFNE at Addenbrookes about 8 months and a new diabetes team, also at Addenbrookes, and I now follow DAFNE info. Had different insulin, now on novorapid and insulatard and most of the time things are great as my HBA1C has improved to 7.2%. I used to be on novorapid and levemir then lantus ..nearly killed me. Switched to procine for a year to get the lantus out of my system and to recover. DAFNE tought why things react to ME re:carbs/activities and why I need to adjust my ratios for each meal depending on what I'm doing in the next few hours to come as activities can muck up my BSs, which my old team didn't understand and I was all over the place..hypo etc.. My ratios, when not at work, is approx 1 unit novorapid for 4 grams carbs. At work my lunch ratio can be 1 unit to 10grams carbs or sometimes Idon't inject at all. I now stick to the 4-5 hour testing that DAFNE recommend as novorapid takes that long to work for me. I don't use a DSN, at the moment, but e-mail my DAFNE nurse, as it seems that most diabetes people don't use DAFNE info....but it works for ME. Sorry DAFNE didn't help you but now knowing why/how things work on me I manage well most of the time. I only measure the carbs and I allow for what carbs I eat. Good Luck.

 

[Dzialo]

First make sure you ONLY inject in your stomach and if it still doesn't work try some other type of insulin

 

[spaceman]

I have struggled with maintaining any kind of normal bs levels since diagnosis. More recently I tried to radically change my diet, as even a daphne course had had no impact. I am now eating extremely low carb, huge salads with nuts etc... My diabetic dietician was happy with my calories, and nutritional content yet I still cannot get my sugars down below 20 for most of the day. I exercise daily, and am not overweight... Could I be resistant to insulin?
Recently increased my lev emir , have double the doses and for 30g of carbs I need 10units of humalog. Is this usual? I've changed my injection sites, given up any processed foods and sweets, gluten etc am at my wits end!! I visit my clinic every two weeks but no one seems to have a clue.


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im on novorapid / lantus insulins and never had any problems but my partner was having problems with Levimuir and hes now been taken off all insulin and hes been given 1 injection a day of victoser and glitraside hes type2 and im type 1

 

[Applenerd81]

Hi Becki . . .

Apologies in advance if you already know/tried what I say/suggest below!

If you are now using a Low-Carb strategy then you need to consider what your body will do with the Protein and Fat that you are eating.

When the body is able to get all the energy it needs from Carbs, this is what it does. Carbs are the easiest form of food energy to process so if it can take all energy needs from Carbs, this is what it does. If not enough Carbs are available to supply all energy needs, then it turns to Protein and Fat. In this case, up to 50% of the Protein that you eat (and even up to 10% of the Fat that you eat) can be converted to Glucose.

So for a Low-Carb meal try recalculating your Insulin dose on this basis:
100% of the Carbs will be converted to Glucose by your body
(Up to) 50% of the Protein will be converted to Glucose by your body
(Up to) 10% of the Fat will be converted to Glucose by your body

It may be that when you make this calculation, your required Humalog dose makes sense. I use a Ketogenic (LCHF) diet. Usually I need 7 or 8 Units of Rapid Insulin for a meal containing less than 10g Carbs.

If all of the above is already known and tried then I have 1 more idea to float . . . I can return with that idea if wanted

Regards,
Antony

Appreciate this is an old thread but can you advise where you got this guidance (100%,50%,10%) from? I'm low carbing and having some struggles with BGs... TIA

 

[robert72]

Appreciate this is an old thread but can you advise where you got this guidance (100%,50%,10%) from? I'm low carbing and having some struggles with BGs... TIA

It's a good starting point, but you might need to adjust it based on your own experience. Most people seem to vary on protein.

 

[jack412]

Appreciate this is an old thread but can you advise where you got this guidance (100%,50%,10%) from? I'm low carbing and having some struggles with BGs... TIA

everyone is different but if you google, TAG total available glucose, it will give you more info too