Resistance, is it a futile battle?

[Andrew2018]

Hi, I have been Type 1 for over 35 years, and for over the last 10 on metformin to counter insulin resistance. I am on a combination of Novorapid and Levermir, and have noticed within the last 12 months insulin reaction is unpredictable and seemingly less efficient. I am even wondering on occasion if it works at all. Part of the issue was different sites producing different reactions. All sites are as good as they can be in terms of no underlying "grissle" but of late injections to stomach and legs produce a reaction in the form of a bump and feeling sore as if bruised but with no bruising visible for about 24 hours. I'd be interested to hear from anyone who has been, or is currently in the same situation and what their clinic have suggested. I see the GP for a diabetic check next week, and as it happens the hospital diabetic clinic ( who do the real work) the next day. Any insights would be very useful to prompt discussions at the clinic.
( Also have issues with a reverse dip hypertension, hypotension on occasion, stage 3 CKD, and sleep apnoea, so life isn't simple, indeed it's getting increasingly depressing ! )

 

[Tony337]

Hi
Type 1 of 50 years here on levimir and novorapid 56 years old with hba1c of 39...

I get resistant from time to time and developed my own personal way of dealing with it.
I emphasize that it works for me and me alone.
I don't see a DSN or specialist as we all end up disagreeing and i'm of an age where i fear i have become a pompous old git!!!

I only get odd days of resistance generally but last year i returned from a 2 week holiday and ended up resistant for over 2 weeks!

This is what i did/do...


Instead of increasing my insulin i reduce food intake to just 1 meal per day.
I can easily go 24 hours without eating and i'm that preoccupied by keeping my levels in the 5s i look at my libre whether i'm resistant or not and if i'm in the 5s i often refuse to eat.
I find it easy.

Going back to the 2 week bout of resistance i lost half a stone but it worked.
Equally i'm aware it might have got back to normal on its own .lol

I don't take big doses of insulin unless going high carb but because i'm old school if i take above 10 units in one go i split the dose to avoid lumps and bumps.
4mm needles are fantastic compared to the harpoons i used to use and don't feel a thing unless taking a high dose.

I giggle a bit at the thought if i pop 6 units in one leg and 6 in the other they might join forces and work more efficiently!!

I hope you don't think me smug quite the reverse as i'm in my 50th year of it still working and driving i want to prolong my life which is why i do what i do and never ever take things for granted.

I wish you well

Tony

 

[CheeseSeaker]

As @Tony337 says - its a personal way of dealing with resistance (51+ years using SDI, MDI, Pumps, closed loops).

Was on Novorapid and Levemir for 25+ years - managed to over-inject in my legs and got massive resistance. Still can't absorb insulin on the old sites (15 or more years on).

Now I find site rotation is essential (using Ultrafast insulins) to give them a break between cartridge changes.
Swapping insulins might help - but chances are you need to look at site rotation first, then if you still get sore from the new sites (but insulin works ok) consider swapping to an alternative insulin.

Fiasp is Novorapid with stuff in (to speed it up) - but tends to be more resistant than standard Novorapid for lots of people.


A like-for-like might be Humalog - but you'd need advice from a DSN to make a change.

 

[Juicyj]

Hi @Andrew2018

Just my thoughts.. but have you considered changing insulin at all ?

I was on novorapid, just wasn't working efficiently, time in range was 65% and felt like the insulin was hitting the wall, have changed to Ljumjev which has speeded things up as it starts working straight away and TIR is now around 80-85%, also on a pump so just using one insulin, but also found from experience that Levemir when I was on this, again wasn't working the full 24 hours so switched to Tresiba which lasts around 36+ hours with no tail off, was more stable. Also use your backside for basal if not already doing so, finding new sites is vital for absorption, lumps will cause resistance.

Change one thing at a time, but do speak to your team about trying different insulins as I am sure you can nail it with better results.

 

[IanA123]

T1 for 32 years, only insulin resistance i had was when they forced me on to analog insulins, ended up at one point on more than 80u of tresiba comapred to the 28u of insulatard i was taking previously. Same for when i was given apidra and then humalog to go with the tresiba, insulin dosages more that 7x what i was on when on humilin s. Me and analog insulins do not mix, 25yrs ago Glargine and novorapid were the cause of sleep seizures(not hypos as sleep study proved i did not drop below 7 when they occurred). Still get times when i notice a high for what may seem has no cause, but just ignore this and adjust meals/dosages after to drop back into range.
I also have sleep aponea, so worst thing is the libre alarm going off for a low while asleep and having to remove mask to turn off alarm and treat, hence low range is set to 3.0mmol when i go to bed as the dawn phenomenon always kicks in at 3am so any low before that is quickly rectified.

 

[Andrew2018]

Thanks for the responses. I already rotate sites as much as possible. I have been told several times that the regime I'm on is the best one for me, having changed insulins several times over the years. Reducing food intake makes no odds, as recently I have found levels staying up and not felt hungry so skipped meal ( usually lunch ) completely. Of late I don't even snack, something I always used to have to do. I have a strong feeling that the cardio issue isn't helping as I have been told that like infections any form of system stress will influence the blood glucose control. One thing is certain, retirement isn't much fun when you cannot do much.

 

[IanA123]

Thanks for the responses. I already rotate sites as much as possible. I have been told several times that the regime I'm on is the best one for me, having changed insulins several times over the years. Reducing food intake makes no odds, as recently I have found levels staying up and not felt hungry so skipped meal ( usually lunch ) completely. Of late I don't even snack, something I always used to have to do. I have a strong feeling that the cardio issue isn't helping as I have been told that like infections any form of system stress will influence the blood glucose control. One thing is certain, retirement isn't much fun when you cannot do much.

Cortisol will spike your bm's like crazy. Found magnesium helps

 

[IanA123]

Hi @Andrew2018

Just my thoughts.. but have you considered changing insulin at all ?

I was on novorapid, just wasn't working efficiently, time in range was 65% and felt like the insulin was hitting the wall, have changed to Ljumjev which has speeded things up as it starts working straight away and TIR is now around 80-85%, also on a pump so just using one insulin, but also found from experience that Levemir when I was on this, again wasn't working the full 24 hours so switched to Tresiba which lasts around 36+ hours with no tail off, was more stable. Also use your backside for basal if not already doing so, finding new sites is vital for absorption, lumps will cause resistance.

Change one thing at a time, but do speak to your team about trying different insulins as I am sure you can nail it with better results.

Tresiba lasted if lucky 6hrs with me, so did tail off massively for me, doesn't work the same for everyone. Glargine worked better but that stuff caused other issues. Insulatard may be old school but it works fine for me and the costs work out cheaper than using tresiba as I take a third of the dose I was when on tresiba and hba1c is sitting at 50.
GP says they would like to see me at 45 but consultant is happy at 50. So GP is ignored as I do not see them for my diabetes care, they just get the results from the hospital.

 

[Juicyj]

Hi Ian, I haven't come across anyone else saying that Tresiba's duration wasn't the full 36 hour duration before, Tresiba or Degludec has a profile which lasts 36 hours, it's one of the longest and most stable basal insulins, how long did it take for you to ascertain this and did you do any basal fasting tests to confirm the 6 hour duration ? When I started tresiba I was really disappointed and I was high and couldn't get my levels down, it took around 4-6 weeks to get the dosage adjusted and from there it was a game changer after using lantus and levemir, both of which didn't work for me, but as you're the first to say this I am curious to find out more ?