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Insulin resistant ?

H

henners48

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1
Any help / comments appreciated...

I have been a diabetic for about 4 years now...70 yrs old... good health... 11.5 stone fairly active... very cautious on diet... familiar with low GI diets ...etc.

3 months ago started acute left leg pains diagnosed as neauropathy ..prescribed painkillers and Amitriptyline. Pain reduced recently ...down to using 1 500gm Naproxen tablet at night.....not taking the Amatriptaline at present.

Last HaBc1 result was 65...struggle to reduce this further.

Been on the basal -bolus diabetic routine for past 2 years....about 20 units at night for long lasting insulin and about 20 to 25 units of Humalog at each meal based on diet and carb counting.

I can got to bed with a reading of 7 for me which is good and wake to find a reading of 15 is quite commom. If I take more Toujeo lantus type of insulin I tend to get a hypo about 2 to 3 in the morning. Have tried splitting Toujeo dose am and pm ...seems to make little difference.

Recently (with horrid cold) I find despite usual diet and usual dosaged my insulin level has shot up to double digits...cut out cough medicine etc to ensure this is not the cause..

Any suggestions on way forward apprciated
 
I do not understand what you mean by "very cautious on diet" especially as you are carb counting. Sometimes its not the amount of the carbs you are taking but the frequency.A Basal Bolus Insulin routine us usually undertaken so that blood sugar levels are kept stable during periods of fasting. You are giving this at night, presumably to keep your sugars stable whilst asleep and you are fasting without knowing it. Similarly the Humalog is a fast acting insulin which you obviously use to reduce sugars immediately after a meal.

I am not a doctor, but that indicates to me that you have constant very high BS levels, although that is not reflected in your HbA1c reading of 65, which is only borderline diabetic. The neuropathy is a by product of constant sugar in your blood. If your not careful retinopathy (damage to the eyes) may not be far behind. Have you discussed with your doctor your level of internal body fat. Giving you more insulin to get your organs to feed off the BS can only be a short term solution as the high insulin interferes with your normal body functions, including and particularly the liver and encourages fat build up, the very thing that might be aggravating your T2D. The insulin simply stores the excess sugar in and around your organs as fat. You may also have long term fat deposits around your organs which are adding to the insulin resistance, hence the need to constantly overdose you on insulin to get your organs to take up the sugar and eat, because if they don't eat they will eventually fail.

If you are already on a low carb diet and fairly active, have you considered the number of times you are eating during the day. If your eating too regularly, even on a 'healthy' diet, you may not be giving your pancreas time to recover and it may be constantly producing insulin, which, with the added external insulin source will in the long term exacerbate the problem.

Are you fasting? If your not, then I would strongly urge you to consider the same. You can start slowly, 3 or more times a week, give yourself at least 14 hours between meals. Skipping breakfast will usually do it. If you eat dinner at 7 or 8 pm and skip breakfast, there will be a natural 16-17 hour gap until lunch the following day. Do that a few times and your body and liver will start to use up excess sugar and work towards taking its energy source from your internal fat. When you body feeds of your fat, by converting it to ketones, you should see a dramatic improvement in your BS levels. By skipping breakfast, your craving for carbs, particularly refined sugar, should subside and it will be easier to go longer without anything sweat or likely to give you an BS and accordingly insulin spike. But, you must not eat anything at all during this time and restrict fluids to water, non-sugared tea of coffee. Now is the time to discover the variety of herbal teas available. Even a very small quantity of food, such as a sweet, a single biscuit, a small glass of orange juice, etc., will trigger insulin production in the body. A walk in the evening after dinner will help BS levels, particularly during your sleep. T2D is all about diet and lifestyle changes. If you are going to stop an increasing progression into ill health and reduce some of the symptoms of neuropathy, you need change your habits. My father is 83 years old, fairly fit, despite being a lifetime smoker, and diagnosed in his 60's with T2D. He has been off his meds for the last 2 or so years. I was diagnosed with T2D and neuropathy at 56 years of age. I thought then it was hereditary and no one told me otherwise. My BS is now within normal range (whatever that means) and my neuropathy considerably more bearable. I am not cured by any means and the road to reversing the disease considerably longer, but I have made and start and so should you. Your age and or health has nothing to do with adapting to what you and your body needs to get off this merry-go-round of insulin related diseases.

At all times keep an eye on your BS levels. My GP was reluctant to prescribe to me Test Strips and needles, preferring the annual blood test, which I know now was nonsense and probably more to do with the Surgery's budget. Because I am fasting I want/need to know by BS levels at any given time, especially after I eat, so that I can see what adversely effects me and my progression.

Good Luck.
 

An HbA1c of 65 is nowhere near "borderline".
 
Hi and welcome @henners48
Have you ever had a fasting insulin or c-peptide test?
If you are getting very very high sugars and a relatively high HbAc whilst injecting insulin I would be trying to check on my diagnosis. It sounds like you may not be producing enough of your own insulin or must be very insulin resistant indeed. Thee are different treatment regimes depending on those results so it could well be worth trying to get them tested first.
I'll also tag in @daisy1 for the intro pack to the forum.
 
Unfortunately, if you are insulin resistant and using insulin, the resistance will worsen over time as more and more glucose is forced into your body's cells. The sugar isn’t removed from the body, it is merely removed from the bloodstream.The eyes and nerves are often among the first systems to suffer.

If this were the case then the only solution is extreme carbohydrate restriction and fasting. As stated, this assumes insulin resistance to be true.
 
Hi @henner48,
Welcome to this site. We are friendly, interested in helping and supporting all people with BSL troubles
and usually quite sane !!! Apart from myself at times, but I have an excuse called
the occasional low blood sugar (hypo) !! And being an Aussie has no bearing whatsoever !!!

To help sort things a bit further with your excellent post:
Are you diagnosed as a Type 2 diabetic or LADA?
And what type and amount of food are you eating for your meals and any snacks?
Has these high morning readings been a long term thing?
And this above and below is from experience as a long-term Type 1 diabetic on insulin, not as a health
professional:
I certainly find I need to increase my insulin doses during stresses like a cold so maybe you need to
discuss management of this with your doctor?
And anything in a cough mixture like pseudoephedrine, a 'drying-up' agent, can raise BSLs, plus some are
pretty sugary, so glad you stopped this elixir.

As to the pesky first thing in the morning high morning BSLs themselves, if you look up Dawn Phenomenon,
or DP for short, by typing it in the question box, Home page, upper right of page - you will see a description
of the beast - and its possible causes.
It get the impression that Toujeo is not going to work to deal with this DP, if that is in fact the problem.

And of course, a low BSL at night sometimes causes a rebound high blood sugar as the liver releases stored up
glucose to combat the low BSL - so i guess doing some BSLs at say 12 mn, 2 am, 4 am, 6am may catch a low
blood sugar (but not invariably) plus a rise after say, 4 am, might help nab the DP beast !!

Apologies about the loss of sleep - the only other way is to be fitted with some form of continuous glucose
monitoring gizmo which can record BSLs as you sleep. That is a bit more complicated and your GP would
need to advise on the pros. cons and feasibility of that.

A hypo as cause means adjustment of long-acting insulin.

DP as cause - as you will see in the Home page information is trickier to solve and you will need your GP,
nurse and yourself as the Sherlock Holmes trio to solve it. ? different long-acting insulin, ?getting up at 4 am
to give a small dose of Humalog etc.

Ultimately a specialist may need to be involved as well if all else fails and an insulin pump is put forward as
a possibility.
I gather there are various hoops to jump through to obtain a pump but it can be programmed to deliver some
extra insulin in the early hours to suppress the DP beast whilst one sleeps (think of a guard dog)!!

Best Wishes for you in getting the help you need to manage these troubles and
obtain even better readings over all.
 
@henners48
Hello and welcome to the Forum Here is the Basic Information we give to new members and I hope you will find it both interesting and helpful.

BASIC INFORMATION FOR NEW MEMBERS

Diabetes is the general term to describe people who have blood that is sweeter than normal. A number of different types of diabetes exist.

A diagnosis of diabetes tends to be a big shock for most of us. It’s far from the end of the world though and on this forum you'll find well over 147,000 people who are demonstrating this.

On the forum we have found that with the number of new people being diagnosed with diabetes each day, sometimes the NHS is not being able to give all the advice it would perhaps like to deliver - particularly with regards to people with type 2 diabetes.

The role of carbohydrate

Carbohydrates are a factor in diabetes because they ultimately break down into sugar (glucose) within our blood. We then need enough insulin to either convert the blood sugar into energy for our body, or to store the blood sugar as body fat.

If the amount of carbohydrate we take in is more than our body’s own (or injected) insulin can cope with, then our blood sugar will rise.

The bad news

Research indicates that raised blood sugar levels over a period of years can lead to organ damage, commonly referred to as diabetic complications.

The good news

People on the forum here have shown that there is plenty of opportunity to keep blood sugar levels from going too high. It’s a daily task but it’s within our reach and it’s well worth the effort.

Controlling your carbs

The info below is primarily aimed at people with type 2 diabetes, however, it may also be of benefit for other types of diabetes as well.

There are two approaches to controlling your carbs:

  • Reduce your carbohydrate intake
  • Choose ‘better’ carbohydrates
Reduce your carbohydrates

A large number of people on this forum have chosen to reduce the amount of carbohydrates they eat as they have found this to be an effective way of improving (lowering) their blood sugar levels.

The carbohydrates which tend to have the most pronounced effect on blood sugar levels tend to be starchy carbohydrates such as rice, pasta, bread, potatoes and similar root vegetables, flour based products (pastry, cakes, biscuits, battered food etc) and certain fruits.

Choosing better carbohydrates

The low glycaemic index diet is often favoured by healthcare professionals but some people with diabetes find that low GI does not help their blood sugar enough and may wish to cut out these foods altogether.

Read more on carbohydrates and diabetes.

Over 145,000 people have taken part in the Low Carb Program - a 10 week structured education course that is helping people lose weight and reduce medication dependency by explaining the science behind carbs, insulin and GI.

Eating what works for you

Different people respond differently to different types of food. What works for one person may not work so well for another. The best way to see which foods are working for you is to test your blood sugar with a glucose meter.

To be able to see what effect a particular type of food or meal has on your blood sugar is to do a test before the meal and then test after the meal. A test 2 hours after the meal gives a good idea of how your body has reacted to the meal.

The blood sugar ranges recommended by NICE are as follows:

Blood glucose ranges for type 2 diabetes
  • Before meals: 4 to 7 mmol/l
  • 2 hours after meals: under 8.5 mmol/l
Blood glucose ranges for type 1 diabetes (adults)
  • Before meals: 4 to 7 mmol/l
  • 2 hours after meals: under 9 mmol/l
Blood glucose ranges for type 1 diabetes (children)
  • Before meals: 4 to 8 mmol/l
  • 2 hours after meals: under 10 mmol/l
However, those that are able to, may wish to keep blood sugar levels below the NICE after meal targets.

Access to blood glucose test strips

The NICE guidelines suggest that people newly diagnosed with type 2 diabetes should be offered:

  • structured education to every person and/or their carer at and around the time of diagnosis, with annual reinforcement and review
  • self-monitoring of plasma glucose to a person newly diagnosed with type 2 diabetes only as an integral part of his or her self-management education

Therefore both structured education and self-monitoring of blood glucose should be offered to people with type 2 diabetes. Read more on getting access to blood glucose testing supplies.

You may also be interested to read questions to ask at a diabetic clinic.

Note: This post has been edited from Sue/Ken's post to include up to date information.
 
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