Insulin Resistance?

Hey @SRO Reading your post reminded me of my issues with managing my type 1, I too have put on considerable weight since being diagnosed and I too get periods of what I believed was insulin resistance, so here is my take on your situation.

Firstly do you take a split dose of Levemir ? I didn't get on well with levemir, was on split doses, so went on to try Tresiba which I found much more effective in my control, it may be worth looking at doing some basal fasting tests to see if your background is the issue: http://www.salforddiabetescare.co.uk/index2.php?nav_id=1007

If you have lumps then try different areas, anywhere you can pinch an inch of skin is a good rule.

Have you checked your insulin ? Try a new cartridge if unsure. Are you coming down with anything, dental infection ? Any illness/infection will raise your levels.

Cutting down on carbs is what I personally did to help reduce the highs/lows, I still eat them, but not as much and bolus for protein too as there is no free foods with diabetes.

If you're getting frustrated with your levels try exercise, walk, gentle run nothing too extreme this will help you mentally cope better too.

I have found that type 1 can change with the weather, literally, there is more often than not a reason so try not to get down hopefully you will learn the reason why

Your immune system could be "attacking" the insulin, basically a NovoRapid allergy, in which case you could try switching insulins.

If it is actual insulin resistance, Metformin could be very helpful.

Or it could just be a weird phase. I once had to take ~25 units with lunch for around a week (normally it's ~10 units) for no apparent reason.

Agreed on the basal testing, cutting back on the carbs and asking to try the drug Metformin if matters don't improve, there's a few type 1's on the forum who take Met and have said it has helped with their insulin resistance.

Just wanted to touch on injecting in the thighs. I can't do it anymore. My legs are the thinnest part of my body, and after losing some weight they're not really fat enough to do it anymore. Every time I try to inject in them, I bruise and the insulin is only about half as effective. I mainly use my stomach or the backs of my arms when in a rush.

SRO said:

It's been a while and I've cut carbs to between 15g and 50g a day to see how I get on.
I think the resistance is getting worse.

I've asked for slow release metformin as my first option now. I've read up on what options I have and feel I'd like to try this first.

Here's hoping I see some changes once I start...

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Sorry your resistance is getting worse going very low-carb, could you try upping the carbs a bit to say 100g a day and see if the resistance improves?

However the Met should help somewhat, lets know how you get on.

I found switching to a mixed insulin gave me more freedom but also only having to inject about 50 units a day, usually 30 in morning, 20 afternoon made it more convenient if you're not into injecting more than twice a day. Not sure if you just came out of your honeymoon period so it might be your body adjusting to the pancreas not producing any more of the insulin that won't be attacked. Or it might be what you are eating, sweeteners could be throwing your body off balance as they can sometimes be disguised as sugar itself.

SRO said:

Do you think this would help? I thought the more carbs, the worse it would be?

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Not necessarily. We're all different. Some people find heightened insulin resistance on LC diets.

Maybe try a gradual increase? That's what I'd do in your situation. You've also mentioned weight, so if it was me, I'd also keep an eye on my calories.

I don't have IR but I do find walking excellent for insulin sensitivity.

SRO said:

Do you think this would help? I thought the more carbs, the worse it would be?

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Well it's worth a try if your IR is getting worse the lower in carbs you go, some type 1's find that too much fat in their diet (particularly saturated fat) can cause some IR.

Maybe try going carb free for a day and see if the background insulin works and record it all then try and adjust from there if you have really crazy levels maybe speak to your doctor and metformin may help as they do a slow release one as well

OK so I'm T2 so can't directly help you myself, but I did discover these two links which may or may not be of use to you.

https://mysugr.com/basal-rate-testing/

https://healthonline.washington.edu/document/health_online/pdf/CarbCountingClassALL3_05.pdf

I realise that some of the things said in these links will be like teaching you to suck eggs (sorry) but there may be one or two things that could help you. If not I'm sorry for wasting your time.

Also these links might be useful to others... @abigailsheree perhaps?

You beat me to it with the basal test link @zand
I seem to remember @tim2000s using it on another thread on the same subject? http://www.diabetes.co.uk/forum/threads/basal-testing-help.103729/

I would say as with any fasting for basal tests. or indeed starting a lower carb aproach to general diet? Keep a close eye on the meter results & up the amount of testing to be sure...

Lowering the carb intake thus lowering the bolus amount does help cut any massive swings in BS.. But thass jus me!

SRO said:

Thanks all - and sorry for the late reply.

I've got the hospital today, so get my HBA1C done! Fingers crossed it's below 80! That's my target.

Yesterday, I took the same amount of insulin as I did on Friday, with exactly the same food - and had 2 hypos mid afternoon!
I'm not getting it - but I'm managing.

Definitely need to cut my carbs - but harder to action than say!

Also got in touch with my DSN who suggested Metformin, but I'd like this to be an option after I've tried other things.

Fingers crossed for today, and hope this gets better!

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****. I almost forgot to add.
Metformin, as well as increasing insulin sensitivity also arrests liver dump of glycogen..?!
Though this may sound like a great option if you get DP anyway. But It's worth taking into consideration with insulin use in the event of a hypo arising?
You may find some real rapid drops if a hypoglycemic event occurs...

I would view the use of met with insulin as a double edged sword.. But it's just a view..?!

SRO said:

Absolutely. Thanks so much. Plus, @zand, sucking eggs is carb free. Haha.
I'll take any help with getting control.

Totally agree on the liver dump being affected, I'm hopeful that I will get the hang of it quickly, and get rid of some of these highs. Cutting the amount of insulin I need is so important, but not at the expense of too many lows.

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I sincerely wish you all the best sorting this one out..!