Insulin resistance

[IanA123]

Hi,

Been t1 for 30yrs now. Last 2yrs after being messed about by various doctors and diabetic teams my control has gone mental. Permanently running high. Today I was running at 17.1, had 33u of humilin s and waited 2hrs before eating, was 15.2 at this stage. Ate 8g of carbs and 2hrs later I was at 17.2. Currently I take 28u insulatard at 9pm, 14u insulatard at 6am along with 16u humilin s. Breakfast is 2hrs later and is 2 slices of hovis toast with butter. Lunch will be around 12-16, so another 20u of humilin s goes in and I eat 1 apple, tin of mackerel and pkt of crisps. Then return to a high before evening meal. Have tried tresiba, was on 70u of that and bm was always around late teens. Been on glargine and levemir in past and same issues with highs.
I average 18k steps a day so keeping active isn't an issue.
Are there stronger insulins available? I am not going to take metformin.

 

[Antje77]

Have you done a basal test lately to see if your basal dose of insulatard is still correct?
Do you carb count and use different insulin to carb ratios depending on time of day?

I'm T1 for only 7 years now (diagnosed at 39), and my basal dose is a lot higher than yours, 98 to 125 units of Tresiba, but eating mostly lowish carb my bolus is lower than yours. Needing higher doses doesn't necessarily mean higher numbers.

 

[IanA123]

Have you done a basal test lately to see if your basal dose of insulatard is still correct?
Do you carb count and use different insulin to carb ratios depending on time of day?

I'm T1 for only 7 years now (diagnosed at 39), and my basal dose is a lot higher than yours, 98 to 125 units of Tresiba, but eating mostly lowish carb my bolus is lower than yours. Needing higher doses doesn't necessarily mean higher numbers.

That I have asked for, but am instead told lower basal dosages. I gained 3st in 2 months on analog regime, so also trying to lose weight. Never counted catbs, I adjust based on portion sizes or just inject even when I am eating carb free
Never had issues with insulatard until they forced me on to tresiba last year.
Will certainly ask about the basal test, thanks for this.

 

[EllieM]

A lot of people (me included) find that they are a lot more insulin resistance when their blood sugar is high, so I can see one reason why you are having issues if you are always starting at a point where your blood sugar is high.

I also find my insulin needs go up when I gain weight. In general, I do need more insulin than I did 40 years ago but I just take however much I need to balance my blood sugars. I (unfortunately) find it a lot easier to gain than lose weight, but I have found some success when I reduce the carbs in my diet and watch the cheese and alcohol. I also find that I tend to gain weight when my blood sugar is high. ( I stress that this is just my personal experience.)

There are U200 U300 and U500 insulins for insulin resistant folk who need large doses, though I'm not sure which brands have the stronger variants.

Good luck. I have to say that I feel your team have left you in the dark by never educating you about carbs though. It's very easy for them to assume that long term T1s know everything and don't need further education, whereas this can be far from the case (for me anyway). Luckily when I was a child and on fixed doses I was also on fixed carbs so learnt to cab count then, though i's only relatively recently that I've properly understood how a basal/bolus regime works.

 

[IanA123]

A lot of people (me included) find that they are a lot more insulin resistance when their blood sugar is high, so I can see one reason why you are having issues if you are always starting at a point where your blood sugar is high.

I also find my insulin needs go up when I gain weight. In general, I do need more insulin than I did 40 years ago but I just take however much I need to balance my blood sugars. I (unfortunately) find it a lot easier to gain than lose weight, but I have found some success when I reduce the carbs in my diet and watch the cheese and alcohol. I also find that I tend to gain weight when my blood sugar is high. ( I stress that this is just my personal experience.)

There are U200 U300 and U500 insulins for insulin resistant folk who need large doses, though I'm not sure which brands have the stronger variants.

Good luck. I have to say that I feel your team have left you in the dark by never educating you about carbs though. It's very easy for them to assume that long term T1s know everything and don't need further education, whereas this can be far from the case (for me anyway). Luckily when I was a child and on fixed doses I was also on fixed carbs so learnt to cab count then, though i's only relatively recently that I've properly understood how a basal/bolus regime works.

To be fair, when I was diagnosed 30yrs ago I was sent home with a bm of 47, a nurse arrived with insulatard and actrapid, have me 15mins explaining and was left with 3 pamphlets. Took 2yrs to get an apple with a diabetes clinic, gp at the time tried but never succeeded. Actually took a letter to a local paper to get me an appt.
Current team I have been with for 6 months, last lot put me on a dafne and I gained 3st in 6wks. They then realised the dafne was tailored to analog insulins and I wasn't on them. Dumped the carb cointing and dafne and lost the 3st.
Even a carb free meal which I do eat requires insulin ate carnivore for 3days a week and still needed insulin during the day.