Insulin sensitivity

[Zinadane]

There has been quite a bit of talk lately on insulin sensitivity issues and seems like a subject difficult to get to the bottom of.
I am also lately having problems with my Tresiba/Fiasp mdi.
50+ years now of T1d but healthy and pretty fit.
Anyway, my insulin sensitivity has dramatically reduced over the last couple of months with no other change in lifestyle.
I now need about 50-80% more insulin than I used to take. Daily Tresiba has gone from 14u up to 20u, but still not enough.
It has been quite a slow adjustment process of a little bit more at a time, because you never actually want to suddenly take a load more!
Also, when I do get high it can take 20-30u sometimes of fiasp, whereas as previously 10u would always do the trick.
Admittedly, I only use my abs to inject, always sharp needles and good rotation, however some signs of lipohypertrophy, but not proper lumps as such.
I am quite skinny muscular, with no excess fat anywhere else.
Of late my hba1c has slipped from around 43 up to 50, which makes me unhappy!
The worrying thing for me at the moment is that it seems to be a never ending process, the more I take the more I need!
I'm not quite sure what the answer is, but just wondering what other people are finding/experiencing?

 

[Juicyj]

Hello @Zinadane Insulin sensitivity can change with the weather, I find summer vs winter mine changes, Summer tends to open the blood vessels more, allows for quicker insulin absorption, winter does the opposite, sometimes it can be highly noticeable and sometimes not - however then combine that with an insulin whose efficacy has diminished and this is more pronounced, it may well be that Fiasp isn't as effective now as it's been previously, but that's a chat with your team to review as they may well want you to try a different insulin.

I tend to chase stubborn highs with exercise as that get's things moving for me as well as lots of fluids. I also get that your disappointed with your HbA1c but mine is around 53 despite getting a time in range of around 75-85%, my DSN seems to feel pleased with my TIR and not so bothered about my HbA1c, so I have taken my foot of the gas in regards to using HbA1c as my guide and use my TIR more now.

 

[himtoo]

this might not be what anyone wants to hear but i have found that i am needing more insulin just as part of getting older ..... I am 66 and been type 1 for 52 years.............my needs are not horrendously high but ..............28.5 to 29 units daily on my pump as background and insulin to carb ratio is about 1u to 4.5 carbs and i eat generally around 80 to 100 carbs per day .....

 

[sninge]

It is an interesting topic. I too am noticing the need for more insulin and most of my type 1 friends are complaining about how resistant they are now when they go high. I agree that it is probably age related, I'm early 50s, 42 yrs diabetes. Things I wonder about are that we are now ( thanks to cgms ) so much more aware of what our sugar levels are doing and just how slowly they are taking to come down. Like Juicy I have noticed movement helps speed things up so yes seasonal would make sense as generally people are lass active in the winter.
I have just requested to try some 8mm cannulas, I have been using 6mm cannula/needles for yrs, I can remember many yrs ago during ' pen days ' my nurse telling me there was shorted needles available, I'm am now, no doubt a touch chubbier, so I am wondering if deeper needles will help! I will keep you posted, might work for some of us!

 

[Gardevoir]

I now need about 50-80% more insulin than I used to take. Daily Tresiba has gone from 14u up to 20u, but still not enough.
It has been quite a slow adjustment process of a little bit more at a time, because you never actually want to suddenly take a load more!
Also, when I do get high it can take 20-30u sometimes of fiasp, whereas as previously 10u would always do the trick.

This has become a problem for me as well. Taking 2 units at 9.0 brings me to 5-6 mmol/L but when I go beyond 10.0, my sugars will shoot up to 14.0 and beyond regardless of how much insulin I give myself. I just let it go to 9.3 and injected 2-3 units of Fiasp (using my pump). Fast forward 1,5 hours later and I'm now at 15.4 with 11 units on board and it hasn't budged. It's a bit scary and I'm not sure how to tackle it yet. Looks like we're in the same boat

 

[Chris24Main]

I'll tread very carefully. There are rules about not cross-posting between T1 and T2 for a good reason - however in my case I was treated as T1 for about a year, and therefore have something of a foot in both camps - but please understand that I'm a type 2.

However - what you are all describing is the fundamental building block of T2 - becoming more resistant to the effect of the insulin. This is usually far (and I mean FAR) less of a concern for the typical T1, because this process can have been going on for decades before someone is diagnosed as T2. We are already well well down that slippery slope - whereas, of course it's impossible for anyone to come to Type 1 diabetes with too much insulin.

but - essentially, insulin is a very powerful hormone, and over time, you can find that you need more to have the same effect. It's only inevitable in the sense that anything powerful over time, the body will develop a resistance to it - antibiotics, coffee, heroin, alcohol, exercise - whatever.

I won't make any recommendations - as a type 2 I'm probably already outstaying my welcome, but this behaviour of needing more insulin over time to have the same effect is what insulin resistance is.

[just reading that back to myself - I want to be totally clear that I'm not suggesting anyone HAS Type 2 - only that this behaviour is what insulin resistance is]

 

[Fairygodmother]

I, too, need more insulin than I did when I was younger. My take on it is that I’m less active than I was when I was running after toddlers, going on long hikes, working, working and working, going to festivals, dancing, swimming . . .
I still have outbursts of energy, going on long walks, moving fast, and on those days I know that I need either to reduce basal or stuff a bag with hypo treatment.
Fifty-five years Type One, retired for twelve of them.
Oh, and I’ve always needed more insulin in cold weather.

 

[becca59]

Have had similar issues myself @Zinadane and am on the same insulins. HbA1c has also crept up to 52 (though I have had ridiculous amounts of stress the past year) my TIR is good though and like @Juicyj says that is considered the important goal these days. In frustration I did a couple of fast days. With just my usual low carb breakfast. This seemed to do the trick and I’m back where I am happy. Might be worth a go.
Also I would strongly recommend moving your sites. Years ago on the DAPHNE course it became apparent that one of the participants needed to change injection area. The nurses were so concerned about a bad hypo they slashed her basal drastically before letting her try elsewhere. They were right to do so, the insulin was not being absorbed properly.

 

[Zinadane]

The age thing is interesting, I wonder if their is any medical info to back this up.
I'm not sure about the analogy with alcohol, coffee etc where where the body needs more as you take more, but worryingly it maybe possible of course.
Or maybe it's a T2 phenomenon
Interesting theory @Chris24Main
I haven't noticed seasonal before but I will certainly start considering this now.
CGM has definitely made us much more aware , I certainly don't remember such problems before, but again maybe just my time with T1d and my age (57).
Battling the highs down though, seems to need so much more fiasp lately!
Fiasp was great when I first went to it, but I wonder if its an immunity sort of thing.
Btw, my TIR has dropped from around 75 to 70%.
I will sort it though

 

[Tony337]

Hi @Zinadane and others
A 50 years a type 1 here hba1c 39 and take less insulin now than ever before......
As usual everything i seem to do is topsy turvy to everyone else...lol

I get resistant every now and again but only for a day or so but last year i went away for 2 weeks and followed a v low carb diet.
Not for any particular reason it was the type of food on offer at the hotel combined with the Spaniards inability to cook potatoes.
I had hardly any novorapid for 2 weeks.

Get this ....

As soon as i got back to the UK i started on the potatoes again blow me i became resistant for over 2 weeks!!
Not used to this so what to do.....

My body loves to be moving not exercising as such just activity and this generally works well with novorapid.
I studied this to the nth degree when i got a libre around 7 years ago.

Add to this i suffer with coelics and another stomach problem that i won't go in to.

My solution to the resistance worked a treat but it is probably peculiar to me because of my stomach issues.

I reduced my eating to just once a day .....plenty of activity during the day but no carbs bar an odd brew.
At 6 pm each evening i then pigged out and took insulin accordingly yes i needed more than usual but i also went walking to help.

After 2 weeks of this my resistance disappeared and i went back to normal and i went back to eating during the day.

I lost half a stone ( im 5 ft 7 and weigh 11 stone) so this did not trouble me.

I find not eating very easy.
I experiment on myself safe in the knowledge of having a libre and 50 years of experience without seeing specialists or a DSN.

I know my own body and what makes it work so wouldn't advise anyone to do what i did i only wanted to offer my own view.


I hope i have not gone on and i wish us all the luck in the world

Tony

 

[sninge]

I am finding this a really interesting thread, it does make you think!
I like Chris's take on the type 2 idea, I know a long time ago one of my diabetic friends was wondering if type 1s can develop type 2 unnoticed! We know that type 2 ' can ' be reversed so yes Tony's trick of going low carb/eating once a day could in theory help as would the fact as several people have said simply moving more.
The main take home message that I love about this forum is that so many people don't just complain and accept ' what is ' but ask questions, share thoughts and try to make a change to help.
I am going to trial a longer cannula and I am now also going to consider cutting the carbs again ( I have done this in the past ) and even the possibility of one meal a day for a couple of weeks.
Thank you all for sharing your thoughts and for starting the thread!

 

[Chris24Main]

Apologies for anyone thinking that insulin resistance is an interesting theory that only affects T2 - it's a fundamental metabolic process currently estimated to affect the majority of the population.
It's simply that there are many processes that result in the production of insulin - for T1, of course; it's only coming from your doses. You are much less likely to develop this, but are still bound to the same fundamental principles, that the body will resist repeated elevation of insulin, so you are not immune.

Anyone thinking that I am really talking from ignorance should check out the work of Richard Bernstein, he was the first person to take charge of monitoring his own blood glucose levels, he was a Type 1 diabetic, basically fed up that despite doing what he was being told, his dosage was increasing, and that his general health was getting worse - all the use of the terms basal and bolus come directly from his work - but the main thrust of his research was that lowering carbs was the key to control - if you lower the requirement for the dose, the control is better. Law of small numbers.

It was the most infuriating thing for me while I was treated as type 1 - "what is it that I'm trying to achieve?" and you are told over and over that it's all about matching carbs with insulin, without ever being told that this gets more and more difficult the more you are trying to dose for, and the inevitable trajectory of insulin resistance.

After all - if you achieve an (impossible) level of control of 100% that of a working pancreas, you are only as good as the general population, and therefore equally at risk of developing insulin resistance.

 

[CheeseSeaker]

from the original thread post "some signs of lipohypertrophy" might be key to the issue.

To rule it out, try injecting somewhere you don't use (sides, bum etc) and see if you get a different absorption - just be ready for your current insulin volume to work 'wildly well'.

If it does - gives you a starting place.

50 years using the same bits (even good rotation) can cause resistance to build up - I have those same issues

Other option would be to try an alternative insulin (for fast acting) and see what happens - but I'd try a completely different site first (as its easy)

 

[Tony337]

I really have found this thread absolutely fascinating and cannot wait for somebody else to add their experiences.
" a good idea is a good idea and it doesn't have to be your idea"
A line from my favourite author Terrance *****.

Tony

 

[Zinadane]

A couple of thoughts:

Lipohypertrophy - I obviously need a new site in order to prove this 100%.
But at the moment my 12"x 4" abs slab with slight signs, gives me consistent results all over, surely if this was my problem I would get some variations of insulin resistance within the area.

Previously when I've gone through phases of having to increase insulin quantities. It has always been typical to finally hit the required dose for a day or so; to then find the 'tipping the scales' scenario, where I end up having to back down again on my doses! Tbh, this always happens to me, there must be some explanaition here.

 

[Tony337]

Previously when I've gone through phases of having to increase insulin quantities. It has always been typical to finally hit the required dose for a day or so; to then find the 'tipping the scales' scenario, where I end up having to back down again on my doses! Tbh, this always happens to me, there must be some explanaition here.

Not an explanation but a silly analogy.....

If i'm resistant i think my insulin is hiding behind a blood vessel and then when it decides to come out it runs at such a speed because of the amount thats been hiding it goes into overdrive and opens all the gates all at once to deal with the glucose thats not been dealt with......

Ridiculous i know but it explains illogically why i stop eating ......theres little or no glucose to deal with......


Tony