why does'nt my insulin work anymore??

Things to think about

Practical
Is your needle working - ie do you shoot some units first to make sure its coming out
Do you need to change needle size
Are there any problems with the site areas which might be preventing absorption

Insulin
Is the Novorapid spoiled, maybe change the cartridge and make sure(its only meant to last a month out of the fridge, though some find it lasts longer
What time do you inject - maybe you need to experiment with this so that your novorapid hits your bloodstream at the same time as your food. Some DNS say have it after youve started eating, some take it 15 mins before.

Is your basal (Levemir) set right? Do you split it. Sometimes if doesnt last the full day or its set wroing and then you are having to prop it up with novorapid. If you are going hypo during the night then is this because your basal is wrong, or because there is a delay in novorapid hitting your food, only you can tell this?

Try keeping very close watch and record it all. Maybe post a day or two here, or get to your Nurse - then you can show them that youre not being irresponsible! Thats a very high A1c and you are right to want to tackle it

If all else fails, Novorapid isnt the only rapid insulin around so ask about others

Perhaps ask Doc to try Metformin for a while.

Hi Rav

Sorry to hear you are having major difficulties. This calls for you to do some detective work to try and suss out what might be happening!

I totally concur with advice given by lilibet & gbtyke

The action profile of your basal analogue Levemir varies considerably in users – although its marketed as a fairly flat profile analogue lasting 24 hours there is some anecdotal evidence form the University of Kentucky Chandler Medical Center with Levemir
Onset 3 – 4 hours
Peak between 6 – 8 hours and scarily
Duration between 6 – 24 hours :shock: – which is a huge variation for users.
Taking the above into consideration does the profile action of Levemir correspond with any of the difficulties you are experiencing i.e with the nocturnal hypos or potentially only lasting 6 hours?

Have you tried splitting the dose? Possibly a larger dose expecting it to cover 24 hours is not want your body is happy with. The large dose may be a potential cause of the hypo at night which a smaller split dose might alleviate.

Have you tried taking the Levemir in the morning – did it make any difference?

How long have you been on Levemir and what other insulin’s have you tried – was it a change of insulin that brought about this deterioration in control or something else?

Have you carried out a BG profile i.e. testing your BG’s every hour whilst awake and then 1 – 2 during the night so you have an idea of what your BG’s are doing – Its not about proving to anyone that you are checking your BG’s but having a written record its then often easier to spot where potential trouble spots are and thus change things accordingly.

Consider the ratio of carbohydrate to bolus insulin dosages you are using. Is this meeting your needs?

Have you got some insulin resistance – can happen with the longevity of being diabetic and sometimes with the dosages of insulin being injected. Metformin as suggested by gbtyke can help.

I believe Thyroid can be a problem – Thyroxine can elevate blood glucose (BG) as well as lower BG's and in order for the Thyroxine to be metabolised effectively it needs a good insulin (what I mean by that is an insulin that is working for you) and with metabolism under control the insulin is then better metabolised – hope that makes sense.

Are your lipid/cholesterol levels ok?

The GM Synthetic Analogues you are using are not suited to every diabetic. There is no doubt that many users achieve excellent glycaemic control with the analogues but many do not and are better suited to animal insulin or human synthetic insulin.

If you have tried all the suggestions posted to date then we will need to go back to the drawing board!

Best wishes

Txx

I am amazed and thank you for your post seriously because the same exact thing is happening with my
novorapid.

Have high reading for the whole entire day and as soon as I take my night dose I hit a hypo.
So depressing so I am the one other person thats going through the exact same thing as you are and when my diabetic nurse looked at my reading she only takes notice of the hypo when in fact I am glad to see that low reading in my entire day.

I have sent u a message I hope it makes you feel a little better that your not the only one going through it.

hi there i was just wondering if you change your injection site regulary. i got into the habit of doing mine in the same place and it became lumpy, then it holds the insulin and distributes it at a differant time hence causing the hypos and high sugars.

Same thing happened to me just a couple of days ago. Fine in the morning, then high for lunch and all day and night it didnt go down. I couldn't work out why either, checking needles and sites. It might be scar tissue from previously over injecting in one area by mistake. It holds the insulin in, so im told.

It could well be insulin resistance: it' something I've been experiencing for the last couple of years. I have been an IDD for 22 years now and whilst my HbA1s have been very good at or below 6% I have gradually over the years increased my dosages of insulin. It's not unknown for me to take 80 units of Novorapid over the course of the day and 20 units of Lantus at night.

Recently (over Christmas), I suffered a period of illness which prevented me from eating much for 5 days (I literally wasn't eating anything, but still needed to take significant doses of insulin to maintain my BG at reasonable levels). Once the illness had passed and I started eating again, I found that I needed to take much less insulin than before - ie it would appear the resistnace had lessened. I have noted that my doses are increasing back up to their previous levels however.

The suggestion to use Metformin is very interesting - it's certainly not something I had considered before (and definitely not something the diabetes care team has raised before). Would it be something I might then need to use from that moment onwards, or would it be a short course after which I wouldn't need to use it again?

i have been insulin resistant for a number of years...my diabetes team unfortuntely were not able to help me very much. I did my own research and eventually asked for metformin...I was told no on the grounds it will make type 1's sick.

I have not seen my diabetic team in over two years now. other information that came to light showed me and my family in alarming ways that they were not up to date enough to be able to help me.

so having gone it alone for some time now...I managed to find an endocrinology clinic that whislt they cannot accept me as a patient..they could give me some over the phone advice. so between that and my gp I got my metformin. I gradually increased the dose til I got to 4 tablets a day split between my breakfast and my dinner.

at a similar time I went on to prozac.

there was some improvement. The biggest being what I believe the prozac did. I hardly suffer anymore from IBS, recurrant UTI's and vulvodynia.....its great!!

I am also on 175 thyroxine.....but my diabetes is very hard to control.....I am always worried about taking too much as my old team always told me not to so I could avoid weight gain.....

well now I am normally on 44 units levemir split morning and evening at 22 units each time. then 1.5 to 2 units per 10 grammes carbohydrate. so its about 65 total insulin units at its smallest and about 80 + at the other end.

have gained weight .....feel I am most definately insulin resistent......still on same metformin,, am a bit alone on getting further advice as no one seems to be able to help. cannot afford the pump.

but I feel that everyone is so different. that if you get the opportunity to try metformin under the dr's guidance....then it may well work for you........I wish I had a diabetic clinic to go to . I would love to not feel so isolated from help.

I am having the same problem, It's been happening for about 5 years now, just once a year, usually a few weeks after a really stressful busy season at work! However, I escaped that this time, but it has now hit me a few months after it usually does!

After years of using different long acting insulins I'm now back on animal insulin (porcine) I combine this in a syringe with my novorapid and can't get anymore in the syringe! (25 units of each twice a day, plus 20ish units of novorapid from a pen at lunchtime) My blood sugars are still SKY HIGH!!!!
I thought it was a post stress type thing, but I've not been stressed since October! Weird!

I have type ! for over 30 years now, my main side effects being problmes with my eyes, which happens when my blood sugars go from high to low rapidly and visa versa. It's a nightmare! My colesteral is 3.4 and my thyroid Ok as far as I know. The so called "diabetic teams-Ha!" have been near to useless all my life!

It's not any of the other mentioned things i.e. needles, injection sites etc.
How can so called "insulin resistance" be treat?
I feel like I'm ballooning up with all these extra steroids! I'm already well overwieght, even though I go for long dog walks every morning!
Can anyone help??

Are you taking any steroidal drugs ?

When a type 2 diabetic is insulin resistant then we advocate reducing and counting carbs.

The same thing can work for an insulin resistant type 1. A small reduction in carb intake leads to a small decrease in injected insulin. It is the large amounts of injected insulin that causes you to put on weight which in turn causes the insulin resistance.

There are many type 1's on here who reduce their carb intake so that they can also reduce their insulin intake and lose weight as well.

This of course,would have to be done carefully to avoid hypos but a small but steady reduction in injected insulin plus weight loss from reducing the carb intake could lessen your insulin resistance.

heypapatooni
I think that the steroids may well be the culprits, it's a pity that you don't have more help from your team.
I don't have any personal experience of mixing insulins but I found this leaflet that may be of some help (sorry it's actually a 'doc'' but I've linked to the html version)
http://66.102.9.132/search?q=cache:...rapid+mixing+porcine&cd=6&hl=en&ct=clnk&gl=uk

Hi papatooni.

Have you read the responses to your previous post ? Mixing of your Insulin's ?

Thanks for the advice, but i only experience this about once a year, over about 3 weeks usuallY! So it can't be anything to do with mixing them together!
By the way, my so called team!! (Our specialist retired, they got a new one, he left for a better job, they didn't replace him for over a year....blah blah!!) So theres a new the new one, with a team of others, I never seen the same one twice! They seem to think humans are robots!) :shock: ANYWAY! they didn't suggest it! It was suggested by Diabetes UK helpline,( I called in desperation after this had happened a couple of years ago!-that proves it ISN@T THE MIXING!!!)after speaking to me on an advice line, I explained how things were going backwards with diabetes reserach when I was now on 5 injections a day! I said that I used to mix them together as a youngster, thus only needing 2 a day instead of 4! (I only take novorapid at lunchtime) They said why not try? The porcine is not available in vials, so I just draw it out of the small bottles meant for pens.
IT IS CERTAINLY EASIER TAKING 3 INJECTIONS A DAY THAN 5!!! AFTER 30 YEARS IT STILL HURTS!

I'm gonna attempt to really cut back on my carbs, this will be difficult as I'm also veggie! I tried this a few years ago, I kept a food diary for the dietition, I ate NO bread potatoes/rice/pasta for over 3 months. I lost 3 pounds only!!!!! They washed their hands of me!! I have never been invited to see them ever since! (they are both size 8 and can eat whatever they want!!

When I said steroids i meant the insulin! It is an anobolic steroid, I found this out accidentally, a chap who does Britains strongest man was working with me, he told me that they all injected insulin to bulk themselves out! Another friend who injected in her arms was asked by a body builder how often she worked out!
They only other medication I take is my mini contraceptive pill!
Sorry for ranting and rambling! Good luck to everybody out there! :mrgreen:

Steroids are notorious for playing havoc with blood sugar results!

Sometimes, you get days when it doesn't matter what you do, it always seems wrong. When when those days are adding into a week, a month, a few months to a year or more, thats when you know something has to be done.

I've had IDDM for 16years now. In the last 10years, my HbA1c has hovered around 10% give or take a little. I tend to pick up infections very easily (I think I have a reduced immune system) and thus have spend more time than I care to remember, in hospital.
Insulin resistance has been mentioned for me. I was given Metformin, but with no joy. Over Christmas I suffered a bad cold and since then have NOT been able to stablise my BM till yesterday when they hovered around the 6mark. Woohoo? Not quite. I still feel like they're really high. Like when you get up in the morning and you're groggy, tired, thirsty and you think, 'Oh no, it's high again'. Then you test and are shocked by a 6.4 reading. Before anyone asks, I regularly check the control solutions for my meter (Aviva Nano) and have never had an issue with it.
I'm currently waiting on the issue of a pump. I've had all my final Okay's from the Prof, my consultant specialist nurse etc. So why am I still waiting? Good question, one which I've asked numerous times and the only answer I get is, 'I'll look into it'. That's nice of you, now anychance someone can get back to me and let me know what the hell is going on?
My diabetes team, in the past, have been awesome. But lately I feel very let down by them. I have, on more than one occassion, expressed emotions of inability to cope with the instability of my diabetes. Given that I have a history of reoccurring depression (numerous psychiatrists, psychologists, anti depressants, mood stablisers) which is situationational (currently in remission, but not so sure) you'd think they'd make a better effort and follow up on their promises!

Most of us who've replied on this thread have been doing this for a fair number of years. We're not stupid (despite the way some Dr's would like to make you feel). We know how to adjust insulin, we know we need to rotate injection sites, change the needle every time, check our BMs everyday, keep taking our insulin even when sick etc etc etc. So when things aren't going the way they should, why do they automatically assume we're doing something wrong? Something we shouldn't be. Like eating too much, not taking our insulin properly (oh yes, I've heard this a million times - everytime I go to A&E the question of 'have you been taking your insulin comes up - yeah, because I WANTED to be here in this busy, smelly and totally un private and somewhat unsanitary hospital, feeling like ****, wanting to vomit, having needles shoved into my arms, hands, feet because my peripherals are shutting down due to the dehydration) Ever wanted to just yell at them? I would if I had the energy. (I was also once told by a nurse I wasn't allowed anything to eat or drink because, 'Your blood sugar is too high'. What the hell? not even a drink? Are you STUPID! I'm dehydrating and you're refusing me fluids??? - in my defence, I had a sandwich because I hadn't eaten in 2 days and I was starving for the first time I actually wanted to eat, and the ******* took it off me)

It's brutal. I'm the only diabetic in my family. Most the time, they think I'm just lazy because all my energy is zapped and I can't make it out of bed quite as fast as they'd like. My mother always yells at me for going back to bed and therefore made me feel guilty about it and so Itry to stay up. (I'm nearly 26) But then I have so little energy I don't want to do anything like housework and homework (I'm a student). It really gets me down. I don't even have any friends who I talk to often enough who have diabetes. One of them just mocks me for being so unstable because he's always had a perfect HbA1c, so I just don't tell him when I'm not doing good. I've got the start of diabetic Eye retinopathy now. Scary as hell since I'm terrified of being blind.

Wow, I really did have a good rant... but I think I feel better for getting it off my chest. Knowing others are going through something similar, really helps.


Jen

You said alot of what I feel! When I was diagnosed (AGE 11), it was a week before Christmas, I had had flu for weeks and my mam knew there was something more wrong with me, she dragged me to the docs 3 times, knowing i was either anorexic or had diabetes, after past experience with a friends daughter. eventually they decided to test my urine, BINGO!
I was taken to town for my "LAST" cream cake and a new dressing gown, then wisked to hospital.
They tried over 30 times to get blood out of my veins. they had to give up, i seemed to have none! :shock:
This has happened numerous times over the years! Usually resulting in me feeling really faint and having to lay down for a while afterwards, something to do with all the tight straps they tie around your arms until they nearly drop off! :shock:
Anyway, to cut a long story short, they told me I would need an injection every day, I was in hospital for about 4 days and then they let me out for Christmas.
IMAGINE MY SHOCK WHEN A NURSE CAME TO MY HOME TO INJECT ME WITH INSULIN!!
THEY HAD NOT EVEN EXPLAINED THAT IT WAS FOR THE REST OF MY LIFE!!!! :evil:
i HAVE NEVER BEEN GIVEN ANY SUPPORT/HELP/ETC.
I joined the BDA back then and was a member on and off for years.
I cancelled a while ago as I was sick of their sugary sweet outlook of diabetes!
Full of happy, fit people, running marathons and rising money for research!
IT'S NOT LIKE THAT IN THE REAL WORLD!
they even did a massive feature on a transexual with diabetes??????????????
WHAT ON EARTH HAS THAT GOT TO DO WITH ANYTHING???????
No offense at all, but eh???
The hospital staff do treat us like complete idiots sometimes! After years of trying to control my weight/blood sugars a diabetes nurse over the phone once asked me it i had tried leaving the skin on my potatoes before baking them? IS THAT THE ANSWER!!!!!!!!!!!?????????? :idea: