Type 1 and insulin resistant?

[LizzieP]

Hi there,
Wonder if anyone knows what's going on here...My lunchtime and b'fast insulin : carb ratios have doubled since March this year. Back then, I was a 1:8. In June this shifted to 1:6 and now, I seem to be a clear 1:4. Is this just going to carry on until I'm a 1:0??? :shock:
I've only been diagnosed since May 08 so I am suprised at this rapid deterioration (is it a deterioration?). I have certainly finished honeymooning now so it could be that. My evening ratio remains unchanged at 1:13. My total daily carb intake is about 60grams and I avoid pototoes, bread, pasta, rice; all the usual bad stuff.
I have had to increase my Lantus from 11 units to 12 this week, also, although I *think* this is quite a low dose of basal.
Does anyone think a 1:4 ratio is odd for a T1? I am pretty much low carb and my lunches for the last two weeks have been a bit of salad, ham, cherry toms and a plain yoghurt total carb 13.8.
I'm finding it a bit depressing as it's getting worse so quickly and I'm pretty sure there's not much I can do to get back to being 1:8.
I know I shouldn't feel like a failure for my requirements increasing so much, but I do.
Any advice welcome. Many thanks.

 

[hanadr]

Not a T1, but married to one.Need for insulin can keep going up. T1 husband has halved his by reducing carbs. He'd got to the silly numbers.( around 180 units per day)
this could have led to needing U500.
The insulin dose increase also gets people into the weight gain spiral. More insulin puts on weight, which increases insulin resistance, which leads to more insulin and so on. I've met a couple of U500 users, who were Large. I'm big myself, but I'm T2 non-insulin.

 

[Iambackwards]

Insulin resistance is directly related to life style choices. Things that increase insulin resistance are a lack of exercise, high sugar levels, weight gain and high levels of insulin. Things that improve your sensitivity to insulin are eating foods with a lower GI, exercising more and losing weight. It is also important to not have a very high dose of insulin, as this leads to a lot of problems.

I have in the past had to up my insulin:carb ratio due to an increasing resistance to insulin, so I read a lot about why some people are very sensitive to insulin. My advice is to start exercising regularly, as this increases your sensitivity a huge amount. 11 units of Lantus isn't too small an amount, I only take 1 unit of levemir per day as I exercise a lot and eat a very low carb diet.

Research has shown that people who live the longest generally produce only a small amount of insulin. High insulin levels cause you to age faster, increase triglycerides, increase bad cholesterol, blood pressure and rapid weight gain. It also causes a huge hormonal imbalance, as other hormones don't produce as much when there is high levels of insulin in the body, which can even affect you negatively emotionally.

hanadr, wow 180 units per day is huge. At my worst point, I was taking around 60 units a day and felt terrible. I gained weight quickly and my health was deteriorating every single day. Cutting down on carbs will help reduce the amount of insulin you take, but one of the most important things that many T1's forget is that exercise is so important and I believe your husband could improve his sensitivity to insulin and get down to 20 units of insulin or less a day, while eating the same foods.

 

[jopar]

Does seems to be an odd ratio I must admit but could be several reasons for it

insulin:carb ratios can change at different parts of the day, this could be due to the bodies resistance to them, or caused due to the troughs and peaks of the basal line...

If you injecting background insulin once a day, this could mean that you are not getting 24 hour coverage and the insulin is tailing of near the end... Also it could be that your liver is increasing the amount of glucose it is putting into the blood, a tale tale sign for this, is if you increase the background, you have a hypo one part of the day, but are high at a another part!! Might mean that you may get better results with changing either the time or even splitting your background into 2 injections a day...

In your case there might be another thing to concider and take a look at, you say that you only eat around 60g carbs per day, so I'm assuming that you are following the low carb diet, where you increase your protien and fats... The higher ratio at dinner time, I wonder if this is the protien/fats that are comsumed during the morning catching up with you, so not only are you covering the carbs amount that you are eating for lunch, but also having to cover the lag time for the protien to turn into glucose in the blood???

 

[phoenix]

many T1's forget is that exercise is so important and I believe your husband could improve his sensitivity to insulin and get down to 20 units of insulin or less a day, while eating the same foods

Thoroughly agree with this and though I run, the thing that lowers my levels fastest and increases my sensitivity for the rest of the day is swimming. This is something, given easy acess to a pool, that could help many people even if they have problems that prevent long walks.
(sometimes too much, my levels dropped to 2.8mmol after a 400m swim yesterday (with no insulin from pump during the swim). I didn't take enough account of the hypo with my dinner bolus so at bedtime was back in the 2s)

edit to add, I agree about the exercise but quoted more than intended, insulin doseage will always be variable

 

[janabelle]

HI,
I doubt many type-2s on this forum would welcome a statement that suggests insulin resistance is all down to life-style choices! Especially when there are type-2s diagnosed when they are not overweight.
I'm a type-1 of 20 years who thought I was suffering insulin reistance while I was on Lantus. It wasn't, the Lantus just didn't work.
Changed to Porcine insulin,problem solved.
For some people analogue insulins do not work, and while doctors remain reluctant to change the medication of people having trouble with Lantus & Levemir, I can see how people conclude they are becoming insulin resistant.
Jus

 

[Iambackwards]

I meant insulin resistance in type 1's, type 2 is a very different disease, but people with type 1 can change a lot of things in their life to reduce their insulin resistance.

 

[janabelle]

Hi, I'd be interested to know more, where did you get the info about insulin resistance in Type-1s?
Jus

 

[phoenix]

Just one of many references
http://www.ncbi.nlm.nih.gov/pubmed/19183305
Some people with type 1 develop so much resistance that they have both type 1 and type 2 ie double diabetes http://www.sciencedaily.com/releases/2003/04/030425071101.htm
I on the other hand have 1.5 and had some of the features the metabolic syndrome ( age and I would admit lifestyle related) coupled with an autoimmune attack on the beta cells . My insulin sensitivity definitely varies both through the day and from day to day.
Diabetes is probably more of a continuum than we think.

 

[kewgirl]

I think this wide sweeping statement “Insulin resistance is directly related to life style choices” is not helpful in assisting people who are seeking help, support & advice via this forum.

It is well known that the longer people take insulin that there may be an associated risk of insulin resistance yes maintaining a “healthy lifestyle” with exercise, good nutrition, lowering blood pressure, lowering lipids etc can support lower insulin requirements HOWEVER

Genetically modified synthetic analogues have not been examined or been in use
long enough to see the effect it may have in contributing to insulin resistance in some diabetics.

Before high purification it was thought that people taking animal insulin might develop antibodies to insulin & thus develop some insulin resistance. Whether people taking human insulin and GM analogues are developing such antibodies, which may be a contributory factor to insulin resistance, is unknown.

I changed back to Porcine Insulin from those ghastly GM analogues partly due to horrendous side effects & I have already seen a significant reduction in insulin requirements without any change to diet or exercise levels. This is not just a coincidence.

The complexities of Type 1 on the metabolic function of the body are very complex and as already mentioned individuals with Type 1 diabetes can develop Type 2 diabetes.

This forum is not a competition to see who is on the least amount of insulin to survive/function – anyone with Type 1 diabetes is a unique individual and as such need unique insulin requirements.

T

 

[LizzieP]

Thanks everyone. I should maybe have said that I exercise twice daily (2 x 45min sessions), 7 days a week. I am not in the least overweight and my bmi is in normal range. My TTD is 17 units of insulin.

 

[janabelle]

Hi
Sounds like you're doing everything possible to keep yourself healthy Lizzie, you sound very disciplined,well done you
On the point of insulin resistance; in type-2s it's the body's reaction to natural human insulin.
Lantus, Levemir,Apidra, Humalog or Novorapid are not natural insulins. If the term 'Analogue Insulin Resistance' were to be used instead, it may put it in a different perspective. For instance if you were taking the contraceptive pill, and a particular brand caused you side-effects or generally didn't work for you, you would consider changing to another brand of pill or a different medication. You would not automatically blame yourself and your body for the problems.
Jus

 

[LizzieP]

Yes, I'm doing my very best and my last HbA1cs have a been 5.8, 5.6, 6.2. Trying to get back under 6 this time round. Doing what I can to protect any remaining beta cells.
Just wondering how the porcine insulin is administered. Can you get it in prefilled pens like the Lantus?
Thanks very much for reply.

 

[janabelle]

No problem,
Hypurin Porcine or Bovine insulins are available in both vials and pen cartridges, not sure bout pre-filled pens, I'm a syringe lover!. You can contact Wockhardt UK, who can provide you with all the info, number is on their website.
Best of luck, and hope you get your BG control back by whatever means.
Jus

 

[kewgirl]

Hi Lizzie P

Just to pick up on a couple of points:

YOU ARE NOT A FAILURE.

All individuals with diabetes that’s you, me, we, us need to be given the best possible tools to enable us to optimise (to quote a medical phrase!) the control of our diabetes.

If the tools are not appropriate for us then we should switch tools – I am at a loss as to why there appears to be (and I am making a generalised statement here) that a large majority of health professionals involved in diabetes care will not support us to try alternative’s to analogues be it animal insulin and/or human synthetic insulin.

To pick up on janabelle’s excellent point – all medication available whether it be asthma drugs, heart pills, painkillers, antibiotics, etc etc – there is variety and if one type does not suit an individual you try another.

Why this reluctance to suggest trying an alternative to analogues is beyond me.

If you try animal insulin as an example and it doesn’t improve diabetes control then at least you have tried it and you haven’t really lost anything by giving it a go.

Porcine & Bovine Animal Insulin is available in either 10ml vials for use with insulin syringes as janabelle prefers or 3ml cartridges for use with the Autopen Classic – which I prefer – see we are all different – diabetes teams please take note.

Hope you get things sorted.

Wishing you all the best

Txx

 

[goji]

Just to look at this from another angle..... are all your other hormones okay at the moment?

High levels of cortisol can increase insulin resistance. We can produce higher levels of cortisol when under long term stress. Also our natural cortisol rhythm means that we produce the most cortisol in the morning and less in the evening which would fit with your pattern of insulin resistance.

Also insulin resistance can be associated with other conditions like PCOS.

I'm finding it a bit depressing as it's getting worse so quickly and I'm pretty sure there's not much I can do to get back to being 1:8.

Your not a failure at all. There is bound to be a reason for why this has happened that doesn't relate to anything you've done. Have you thought about supplementing with chromium/cinnamon/ALA as all of these can promote increased insulin sensitivity.

 

[janabelle]

Kewgirl,
You're so right-there has been a huge push for type-1s to be on analogue insulins, and a sheer reluctance to take people off it-even when they are reporting problems.

The long-term safety of these insulins is unknown.

How many people are aware that while Lantus appears to be prescribed freely to pregnant women, it has not actually been proven safe in pregnancy, and was only tested on rats and himilayan rabbits! The prescribing information on the website of Sanofi-Aventis Pharmaceuticals states the following "Because animal reproduction studies are not always predictive of human response, this drug (Lantus)should be used during pregnancy only if clearly needed".

Also Sanofi-Aventis says Lantus is safe for children over the age of 6,but states "administration to pediatric patients <6 has not yet been studied". Are children under 6 put on Lantus? Probably.

Based on my own experience with Lantus, BG control problems took a few months to make themselves apparent, I thought it was working ok,and when it wasn't I blamed myself.

The clinical studies of Lantus in Type-1 patients, adult and child, were carried out over relatively short periods - 28 weeks was the maximum.

I'm glad I'm not a human gineau pig any more!
Jus

 

[hanadr]

Iambackwards
T1 husband has 2 Charcot feet, destroyed by Neuropathy and most exercise isn't possiblefor him. Even stationary bicycle is difficult.
Also, I have to confess he has no motivation to exercise. He's been diabetic most of his life and got used to it. It wasn't untill I absolutely put my foot down that I got him out of the clutches of the "take some more insulin" grip of our local Consultant. I've managed to get him to cut his carbs, seriously. It started whilst he was off sick fom work due to SEVERE anaemia, probably caused by nephropathy. He was at home, so I was in control. He's now back at work and I can do nothing about what he eats in the canteen..
His worst problem is his own wooden headedness. He might have been better had he had better care in the earlier stages.
All I can do is nag and not cook carbs