Type 1 Insulin Resistance.

[Betty98]

Hi all.
I'm 28 and have had T1 for around 3 years, recently I have had a bit of a burn out and stopped taking long acting insulin.

During this time my blood sugars were higher than usual as expected but insulin would always bring it back into range. This was around 4 weeks ago.

I started to use my insulin properly again and was almost always in range. About a week ago I noticed that my blood sugars were high (15.2) I wasn't eating this was my morning test so i took my usual basal and also corrected with 3.5 units of FA.

Since then I have not been lower than 11 and the ratios I usually use don't seem to be working.

Could I have developed some resistance? I have put weight on in my 3years diagnosis but nothing dramatic.

Could anyone advise?
TIA Beth

 

[Engineer88]

2 things I would suggest, 1) you might have finished a honeymoon period and you're insulin needs may have increased, 2) its less than 1/2 a stone personally that causes insulin resistance (9.5 stone to 10) so it doesn't take much I'm afraid.

 

[SamJB]

When this happens to me, it's usually because my basal is incorrect. I've found that my basal changes much more than my carb:insulin ratio. If your basal dose is wrong, your ratios will be too; so it's the foundation of getting good numbers.

I use the method in Gary Scheiner's Think Like a Pancreas book: don't eat food or inject bolus within 3 (ideally 5) hours of bed, then take the difference between your pre-bed and pre-breakfast readings and for every 1.6 mmol/l change, adjust your basal by 10%.

Depending on my exercise regime, I have to change my basal every day. I've relied on this technique for years and it works really well.

 

[novorapidboi26]

When your body has high blood sugars and indeed when you have been running higher for a while, you will see an increased resistance......and so what you should be thinking about is adjusting your sensitivity/correction factor in order to give more per mmol drop.....

this should only last a short while though.....

how many mmol is one unit dropping you currently...?

 

[Betty98]

2 things I would suggest, 1) you might have finished a honeymoon period and you're insulin needs may have increased, 2) its less than 1/2 a stone personally that causes insulin resistance (9.5 stone to 10) so it doesn't take much I'm afraid.

The resistance seems to have started all of a sudden and my weight gain has been gradual. Does this seem possible?

 

[Betty98]

When your body has high blood sugars and indeed when you have been running higher for a while, you will see an increased resistance......and so what you should be thinking about is adjusting your sensitivity/correction factor in order to give more per mmol drop.....

this should only last a short while though.....

how many mmol is one unit dropping you currently...?

Before the resistance 1 unit would drop me 3mmol.
Thanks.

 

[novorapidboi26]

Before the resistance 1 unit would drop me 3mmol.
Thanks.

Before the pump I was seeing a drop of 2.5 for every unit......and in fact used a different correction between 6am and 1130am, I used 1 unit:1.5mmol......

So you can have different levels of resistance at different times of the day, even during periods of good control....

you should try and go carb free for a few meals and record what the corrections you have given are actually doing in terms of the drop in mmol...

 

[Betty98]

Before the pump I was seeing a drop of 2.5 for every unit......and in fact used a different correction between 6am and 1130am, I used 1 unit:1.5mmol......

So you can have different levels of resistance at different times of the day, even during periods of good control....

you should try and go carb free for a few meals and record what the corrections you have given are actually doing in terms of the drop in mmol...

Thank you for your advice. I'm not on the pump but i will deffo try the no carbs x

 

[db89]

I would suggest some basal testing - you said that you stopped taking your basal insulin for a while. It's possible if you did have any endogenous insulin production left after these few years that by stopping taking your basal any remaining cells that could have been helping out were put under more pressure.

That and before you make adjustments to bolus ratios and correction doses throughout the day based on sensitivity it would be useful to be sure your basal dose is now right. This then gives you a foundation to work on the bolus doses. I have previously used the article from MySugr successfully to do this. It talks about rates for pumps but quite rightly says the principles can be applied to MDI. Their values are in mg/dl so use the converter on this site to convert to mmol/l as needed.