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Insulin resistance

Discussion in 'Diabetes Discussions' started by sue57, Nov 7, 2008.

  1. sue57

    sue57 · Newbie

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    Hello all, I'm a newby here and I'm looking for some help and/or advice. I'm Type 2 diabetic on insulin, have been for 3 years. As hard as i try I cannot get my BM down lower that 9.0. Sometimes my fasting BM's are as high as 16. I have to give huge amounts of insulin to bring my BM's down....sometimes as much as 46 units before each meal, and don't even have a hypo!! I'm giving 160 units of Glargine at night. I've been told I'm insulin resistant and I'm not sure what that means for me. I used to take Metformin but it really upset my stomach....immediate vomiting to be exact. I'm now on Glucophage SR and seem to be ok with that. Anybody else out there had this trouble?? :roll:
     
  2. Jem

    Jem · Well-Known Member

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    I cannot help you out much myself hun - but it will probably be very useful if you'd describe an average day's diet ... just a normal day, amounts and general food types - as I am sure it will really help somebody to give you some advice :)
     
  3. Trinkwasser

    Trinkwasser · Well-Known Member

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    What dose of metformin are you on? For some it doesn't take effect until it's been racked up to 1500 or even 2500 mg.

    The other major attack on insulin resistance is growing and using muscle. Even regular walking can make significant inroads, the large muscles can suck up a lot of glucose.

    The other (!) major attack on IR is to get your BG down and keep it down. The fewer carbs you eat the less insulin you need so the less effect the resistance will have.

    Losing weight is also helpful but difficult until the IR is reduced.

    Have a read around here

    http://www.dsolve.com/

    obviously you will need to reduce your insulin along with the carbs to avoid hypos.

    Other dugs which address IR are Actos and Avandia but due to bad effects on certain patients (and probably price) they are seldom used nowadays: they work through a different mechanism than metformin and have been used alongside it.
     
  4. hanadr

    hanadr · Expert

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    I concur on what Trinkwasser has written. The most straighforward way to reduce insulin resistance is to reduce the amount of circulating insulin. You can do that by cutting out sugars completely and reducing the starches to as low as you can. then exercise Walking is easy and free. there are many Walking for Health groups around the country. Google them and join a good one. Some have several levels of walks, from very easy to demanding. You need to do some exercise at least 3 times per week. If you don't have a dog, offer to walk one for a friend. If you live near me, I'll lend you one.
    If you have been following the "Eat plenty of complex carbs with each meal " advice, your insulin requirement will go up and up in a vicious spiral. You need, for your safety, to get those BGs to below 7 at all times.
     
  5. janabelle

    janabelle · Well-Known Member

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    I am not a type 2, but I do unfortunately have experience of Lantus,(Glargine), after 4 years on it. I had times when my Lantus and Humalog didn't appear to work- I would have my usual dose of Lantus, and despite giving my usual pre-meal Humalog would have BS levels above 20 sometimes. I would inject more and then more Humalog and it did not work. I thought I was becoming insulin resistant too. Doctors had no explanation for these episodes or for the days when I was Hypo all day despite taking no Humalog! I changed to pork insulin from Lantus,and have not suffered any of these problems in 6 months of being on it. I still take Humalog, and it works exactly as it should. The side-effects of it are horrendous, exhaustion, muscle and joint pains, general malaise, hunger and nausea, all of which I suffered and more- come off it and you'll feel human again.
    I've had someone contact me privately with similar probs that I had, with Lantus not working and the rest. This person has also recently changed to Hypurin Porcine Isophane, and reports huge improvements. Purified pork insulin is the most similar to natural human insulin and therefore is obviously going to be the most effective. Lantus, and the new "analogue insulins" have no right to be called insulins, as they are not insulin!
    Jus
     
  6. JAD337

    JAD337 · Member

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    Strong words about Lantus janabelle!
    I am type 2, diagnosed early in 2004. My initial medication was gliclazide, metformin was added 2 years later and just over 2 months ago Lantus was added - quite a mix!

    I have to ay that I have experienced no side effects from Lantus and it has achieved exactly what my diabetes nurse intended - better BG control. My fasting BGs are now normally between 4 and 6.

    Sorry to disagree with you about Lantus. Maybe it suits some of us and not others.
     
  7. janabelle

    janabelle · Well-Known Member

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    Hi, you've only been on Lantus for 2 months-give it time!
    I, like you, thought it was working at first, and the specialist nurse assured me that it had a flat profile-I thought it would be the answer to my years of yo-yo blood sugars. It was about 6 months before first side effect of muscle/joint pains began, then came the days when the Lantus was ineffective, and other days when it was too effective.Pretty soon after,came the exhaustion.. Within 16 months my health had completely deteriorated, and it is only looking back, and talking to others who have had similar experiences that I can relate my deteriorating health and onset of symptoms, to going on Lantus-and since I've come off it my health has improved beyond what I ever could have imagined.
    I don't expect everyone to agree with me, but how many people are going to their diabetes specialist with similar symptoms that I had, and being told it's not related to their insulin? It took 4 years for me to realise that lantus was the cause of my health problems, I thought there was something else wrong with me and was referred to so many other specialists and mistkenly diagnosed with fibromyalgia and prescribed dopamine!
    I just want people to be aware of what Lantus is capable of,and as I have said before-if reading my experience can help someone else in a similar situation and improve their quality of life, then that cant be a bad thing.
    Jus
     
  8. Jem

    Jem · Well-Known Member

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    I guess like most things in life (medecines, music, blokes etc!) what suits one person well, can be a nightmare for somebody else ...

    Personally I think it is always good to hear about personal experiences so that everyone gets the benefit of shared knowledge - things to watch out for as well as thing which might be beneficial.

    I think it should be remembered that we are all unique and whilst it (sic: lantus) might be perfectly acceptable for one, it may still be a horror story for somebody else.

    J/x
     
  9. Trinkwasser

    Trinkwasser · Well-Known Member

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    Yes that's the point about this and all other drugs. Probably the number of people whose control on Lantus has improved outnumbers those who have problems manyfold, I'd guess probably a single figure percentage of users

    BUT

    if you are one of the ones to be affected, 100% of you is affected
     
  10. hanadr

    hanadr · Expert

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    Dear JAD33,
    You have increased from Gliclazide alone to Gliclazide +Metformin,to those + glargine, all since 2004!!
    That looks like someone is trying to prove that T2 is progressive.
    what are your sugars and HbA1cs like?
    What is your diet like?
     
  11. JAD337

    JAD337 · Member

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    Hi hanadr

    No, not trying to prove anything, just trying to survive as best I can!
    First thing to say was that my diabetes was not brought on by being overweight. Diabetes runs in my family and I also had a fairly stressful job, so either one or both were probably to blame for the onset of T2. One of my initial symtoms was weight loss and it left me at an acceptable weight, with a BMI of about 21 I guess.
    I did okay on 1 gliclazide a day for almost 2 years, but then I started losing weight yet again and my BGs were increasing. This was shortly after having been made redundant, so I guess that stress was a potential factor. My doctor doubled the gliclazide dose but that had little effect. I was referred to the local hospital's diabetes clinic where they doubled it again and later added metformin to get me back on an even keel. By now my BMI was about 20.
    I survived like that for a further 2 years but then started to lose weight yet again. My doctor performed blood tests in case something sinister was at work, but when nothing showed it was back to the diabetes clinic with a BMI of 18! Lantus was prescribed and I thought I might also be put on to a fast acting insulin as well, but the decision was made to leave me on the drugs.....for now.
    So.....for me, T2 has been progressive. I certainly don't like being underweight and tired all the time, so the increase in medications has been absolutely necessary. I read with interest all about the low carb dieting that our fellow T2 members seem to be so interested in, but for me it is not an option, I think I'd waste away to nothing!
    Interestingly, my brother, who is 9 years older than me and was diagnosed as T2 over 5 years ago is still controling his condition via diet alone. So whatever it is, its just me! As my diabetes nurse (for whom I have a great respect) keeps saying, "You're not a typical Type 2." - some consolation!
    Thank you for your interest.
     
  12. graham64

    graham64 · Well-Known Member

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    Hi Jad,
    Like you I had problems with weight loss, I'm 6ft tall with a BMI of 20.9 and weigh in at around 11st, pre diagnosis I was 11st 7lb, on the prescribed NHS diet I dropped to around 10st 6lb. Thankfully I managed to get a referral to a Dietitian who was up to date with the low carb issue. I'm now on a low carb high fat diet and have gained half a stone, my BG control is much improved and I feel much healthier and have more energy. The thing I'm not sure about is the effects of the increased fats on my cholesterol. I'm due for my blood tests friday so as soon as I get my results I will be posting them on the forum. Welcome to the underweight T2 club you make 3.

    Regards Graham
     
  13. Jem

    Jem · Well-Known Member

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    @ Jad337 - you sure don't sound like the "typical" Type 2 ... and it's not uncommon for the specific type of diabetes to go wrongly diagnosed ... not suggesting that because you don't fit the "average" criteria you cannot possibly be a type 2 - but it's worth remembering that there are several types which require slightly different approaches both with diet and treatments ... if it were me in your situation I'd spend an hour with google, wikipedia and a selection of your symptoms to see if there is another kind of diabetes (I forgot all the different acronyms, sorry!) which describes you better - because the treatment plan you have right now does not seem to suit you. Of course I wouldn't suggest to anyone to change meds or plan from what their HCP has advised, but you might consider asking for a second opinion and going in armed with all your newly acquired information on different diabetes types.

    all the best, J/x
     
  14. hanadr

    hanadr · Expert

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    I meant your medical team were trying to prove that T2 is progressive by the way you wwere bein traeated. Are they 100% certain that you're T2? Have they tested? the pattern ofprogress is far from typical.

    At the very last, Weight loss with T2 is unusual
    If you are on insulin, it really doesn't matter, but I would be curious.
     
  15. Trinkwasser

    Trinkwasser · Well-Known Member

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    Colour me in as another skinny Type 2. We seem to have familial insulin resistance even with athletes in the family, plus my problem is not so much with a knackered pancreas but a knackered control system, I can still produce plenty of insulin but not necessarily when I need to.

    Having said which, the speed of your progression makes me wonder if you may actually be LADA. I'd recommend you get a GAD and c=peptide test to see what your insulin production is actually like and if you are producing antibodies.

    Some Type 2s do progress about as fast as some adult Type 1s though, especially on the Healthy High Carb Low Fat diet which I'd suggest you avoid by doing this

    http://www.alt-support-diabetes.org/NewlyDiagnosed.htm

    and adjusting your diet accordingly, and your insulin as well of course.

    You could also look here

    http://projects.exeter.ac.uk/diabetesgenes/index.htm

    see if anything fits
     
  16. JAD337

    JAD337 · Member

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    Wow! - thanks for all the replies guys. I don't know where to start with my response.

    First of all, thanks to graham64, I'm pleased to know that there are at least 2 other underweight T2s out there! With regard to diet, I did alter my diet as my BG started to increase. Basically I ate less, but I did increase the amount of fat I was consuming. Sadly that had little or no effect on my weight loss, so what worked for you didn't appear to work for me.

    To Jem, thanks for your comments. I have spent many happy hour googling the subject of diabetes. Sadly, whenever one uses the words "diabetes" and "weight" all you seem to get back are sites dealing with the links between obesity and T2 diabetes! I have read information from many sites about the subject of diabetes as a whole, but I haven't seen anything that seemed to match my specific symtoms and experiences.
    With regard to my current treatment plan it actually does seem to suit me, at least at the moment! For the first time in ages I am actually putting weight on and feeling much more energetic. My hba1c readings had climbed from 6.3 in November 2006 to 8.2in August this year. My morning BG tests were I guess averaging about 10 at the start of this summer, but I am now averaging about 5. I am due to have a further hba1c test early in December so it will be very interesting to see if it has returned to an acceptable level. BUT...... I do have a concern about whether my BGs climb too high after meals and don't drop quickly enough. So.....

    Thanks to trinkwasser for the links. The first one was particularly useful for setting out a BG testing method. I will use it before my next visit to the diabetes clinic and use the results to spark off a further discussion on the whole subject.

    For the record, whilst the weight loss was bugging me no end, I did have my own theory about what was going on. Basically my BGs were rising. I tried to compensate by eating less. My body was producing less and less insulin and/or I was getting more insulin resistant. Whatever, the net result was that I was producing insufficient energy from my food intake to support the exercise I was doing. My body had nowhere else to go but to use body fat (what was left!) to find energy. Consequently I was losing weight and feeling tired. With the introduction of Lantus I now have more insulin converting what I eat and indeed there is an excess of energy that is being used to rebuild some of my body fat. As it happens, I am a fairly fit and active person.

    Final point - I regard my diet as a "balanced" diet, which for me means eating a variety of sensible foods, including some carbohydrates, but not an excess, and nothing sugary. I am comfortable with this and the dietician I saw seemed to approve. My cholesterol is fairly constant at around 4.5.

    So, thanks again for the comments. I'll see how I progress during the next few months and I'll re-open the discussion if the wheels start falling off!! Best wishes to you all.
     
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