NovoRapid resistance and alternatives?

Shannon27 said:

Hi everyone!
I know that insulin resistance does exist. I've used NovoRapid injections for about 12 years, but over the last couple of weeks I've been getting ridiculous highs, mainly after I've eaten (I'm using my normal carb/insulin ratio so this shouldn't be happening). My normal dose of insulin doesn't seem to be bringing me down at all! I don't want to increase my background insulin (Tresiba) as I do drop slightly overnight, but I can predict this and plan accordingly.
Do you think it's likely that I'm developing some resistance to the insulin? And if so can you suggest any alternatives?
Thanks!
Shannon

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Shannon I experienced that just recently but put it down to having to reduce my bolus and basal for a very painful period. I'm not saying this could be your circumstances but has there been any stress for you recently?

Did you start a new pack of NovoRapid recently?
I experienced something similar once and after changing my pens and starting a new pack of insulin, it went back to normal.
I concluded the packet of insulin was not stored properly before I got it.

Injection sites?

Hello Shannon
I went through the same recently with the novorapid (13 yrs now) and I was frustrated as I couldn't know the reason behind and lasts for few weeks. I switched to Apidra and my numbers didn't went high as it was. But overall levels were not satisfying to me as I couldn't get comfortable with the Apidra action profile.

As @helensaramay mentioned, I doubted the packs I've got from the rapid. So,I was on a trip abroad and I thought to give the rapid another shot. And surprisingly it worked very well.
Was it the packs?, specific body conditions? I don't know.

My advice is:
- try to get the rapid from different pharmacies.
- Measue ur BG before the meal.
- take the rapid ~ 20 mins before the meal (as some ppl take it just before the meal)
- take another reading 1 h and 2 h after the meal.
- If u r not already doing this, try to walk for 30 mins at least 3 times weekly as this increases the insulin sensitivity.

Do this for all the meals for a couple of days before switching to other medications.

Good luck

Can't say as I don't know and everyone is different, so you may or may not. Worth a go trying a different site completely though.

You say you've changed cartridge packs, do you know if the new box was from the same batch/script as the previous one, you wouldn't be the first or the last to get a dodgy batch.

Also you're not coming down or suffering from an infection/cold or the like? I had a cold/sinus infection for 2 weeks early last month and suffered some horrendous highs.

Cheers Shannon I'm fine and my numbers are well back to normal.

Insulin is susceptible to all manner of things especially in transit - who knows where it's been!

I've read that some type1 diabetics respond to Metformin for sensitivity

Hi @Shannon27 As mentioned by others 'insulin resistance' can be caused by many factors, I have a checklist of things I run through when I don't feel my usual bolus works.

So firstly change insulin, then check sites, and rotate. Next infection so colds, bugs or even dental infections can cause levels to run high, in women menstruation and hormonal changes cause insulin resistance.

I generally find when my levels run above 12 that I need an extra bolus to my correction dose to get levels down, and I also drink more fluids than normal. They are blips fortunately so will pass but test more regularly and keep an eye on it. I did try metformin a few years ago and didn't find any benefit in taking it and it affecting my BG levels, however we are different, it might work for others.

Insulin resistance isn't resistance to novorapid, one type of insulin. It's resistance to insulin, as a whole. So if swapping to a different rapid acting solve it, it wouldn't be insulin resistance it was solving, but a problem with the previous rapid acting just not suiting you.

Insulin residence isn't guaged by a few highs after eating. It's guaged by your total daily dose of insulin being very high. I think there are a few calculators online that work out the average total daily dose for someone with your body weight so you can see whether you really are insulin resistant.

You say you're using your usual insulin/carb ratio. It might be a bit optimistic to expect your I:C to be an entirely static thing. The weathers changed, the days are getting shorter. That's often a trigger for people to need to change their basal or their I:C ratio. If you ratio isn't working as you would usually like it to, then you might need to consider assessing whether your I:C needs changing.

When considering that, it's probably also worth experimenting with pre-Bolusing. I need to bolus 30 minutes before eating to be sure the insulin is in the right place and working when I eat. I have a CGM, so I can see when a bolus starts curving my line down. If you don't have a CGM/libre you can bump the bolus back 5mins at a time to see what difference that makes to your post prandial results. If you find the sweet spot timing wise for a pre bolus this can reduce your I:C ratio because if the insulin is already in there and ready to go when the food starts raising blood sugar it can deal with the raise as it happens, rather than having to work really hard to climb a massive high wall of high blood sugar caused by the food before it can even start doing anything. So a good pre-bolus can work really well at avoiding post prandial spikes.

@Shannon27, as posters write above, I wouldn't be worried about NovoRapid resistance based on your experience as you described it. Think most T1s have gone though many such 'weird periods' over the years. As a lazy boy traveling frequently in warm countries, I still keep my fast-acting pen in my front pocket. And at times experiencing exactly the same as you described. Likewise as well with the unfortunate 'bad batch' of pens in a box that for unknown reasons most have been exposed to some heat or other thing that neutered the insulin to limited efficacy for lowering the bg. Suddenly having to inject 2-3 times normal number of units to counter the glucose intake. Taking a new pen from a new batch fixes that.

But next to this, there are of course the myriad of personal situations that also impact how much insulin you need to take to keep the bg in check. What at times still surprises me are when you are under stress without you might be consciously thinking about it that way. Or when you have some pain of any kind or some inflammations, e.g. a sprain ankle etc from doing sports. And the classic: Days in advance before you feel you get a flue, your body is already in the fight and needs more insulin to counter the glucose intake.

The reverse is also happening!
Despite having had Type1 for many many years, I can still go on honeymoon once or twice per year (without my wife)!
Its like I go hypo just when looking at my pen. So taking zero or just 1-2 units max for an exotic meal (read: "carbos an mass") and the bg stay consistently low or even too low. I am quite insulin sensitive though, e.g. 1 unit for 58mmol/L bg change, so don't need much.

Which just reminds me of a last but important point I was not so conscience about in my younger days, as the need was less apparent also: When injecting the fast acting insulin, take your time after pushing the plunger down. Wait typically 10 seconds before pulling the pen/needle out of your skin. Alternatively small droplets of the insulin may/will seep back out. When I only need 3 units in total for my main meals, just a few drops seeping out can result in halving my total dose left in my body. Rushing this is therefore a bad thing, but must admit I have fallen in that pit many times.

And if you remain suspicious about that NovoRapid, then many equally good alternatives exist on the market.
So despair not!

I don't think Type 1's develop insulin resistance, that's a problem with Type 2's for sure though. I've used Humulin, Humulog, and Novorapid for many many years and nothing's changed. But an illness for sure can bump your blood sugars. And FWIW flu shots won't change your odds of catching a common "cold". Only an influenza viral infection which is a different animal altogether.

Agree with @Celsus especially on his last point, re-evaluate your injection technique!

Hi,

I had the same issue. After all these years I suddenly started to go off track. My doctor offered Metformin but i declined. I started from scratch again and important above all went extremely low carb. And now 2.5 month later I am back on track again. I know it is frustrating when you can't get it right but 'rebooting' the whole thing is the only answer and be patient.