why does'nt my insulin work anymore??

[DTGTaylor]

Hello Munchkin1976

Congratulations, somebody else who admits to BMs in the high twenties, I thought I was alone!

I obviously do not know what your insulin/carbs ratio is but when you think about it a rise from 18 to 29 (=11) without exercise would involve surplus carbs of (in my case) 40grams. But with extra insulin and moderate exercise this seems to me highly unlikely to be a carb induced increase, more likely liver glucose.

Sorry, this is a hobbyhorse of mine but I am beginning to realise it is a bigger problem than the professionals want to admit to.

David

 

[munchkin1976]

Hi David,
Is there a high cover-up conspiracy afoot, I am not ashamed of admitting I go high like yourself and find it a real struggle getting the insulin doses right. Sometimes it is my fault when I eat a box of chocolates or have sugar in something when I shouldn't and I want to be human and naughty and don't care! When I was first diagnosed it was in the 80's and you mixed the actrapid and monotard in the same syringe and injected once in the morning and once before dinner, that was it and I had perfect readings. Now it is more complicated. They tell you initially to inject your long acting all at once in either the morning or at bedtime: it doesn't work. I have 17 units of levemir in the morning and 15 at night. I have metformin slow release 500mg - one with breakfast, one with lunch, one with dinner and one at bedtime with my levemir (this is my new strategy for combating and reducing my insulin doses). I got up early this morning at 4am to take a blood sugar test and I was as I suspected 3.1, not low enough to feel hypo but low enough to kick out sugar from my liver. By midday today I was 18.9. I have drunk a glass of water and have not injected more insulin despite wanting to. My intake of short acting humalog is 3-5 units for breakfast, 6 in the middle of the day and 7-8 for dinner. I have 40g of carb for breakfast, same for lunch and about 50-60g for dinner. The lows always make me higher than any food can and that is what is happening to the lady who needed the help initially, she is on a constant rebound high from her mixture of overcompensating with her insulin doses (as I often do) and probably the massive lows during the night caused by injecting the levemir all at once. The only other thing that makes me really high is breakfast cereals with dried fruit in them or coconut ice so I avoid them like the plague unless I'm low!!! She really needs to do a blood glucose test every 2 hours for a 24 hour period including the night (set that alarm girl!), that is the only way to know for sure what is happening to your body and is also the only way the consultants can help you through your bad times with this unrelenting, ever changing disease. I hope I am right and she reads this and does it and then she can at least eliminate my theory from her list. Good luck and I really hope I am on David's "naughty list" because I am a normal person first, diabetic second!

 

[munchkin1976]

It is 2pm and my readings have gone down to 11.0 from 18.9 in 2 hours...no more insulin than noted above and a pint of water! I also had my lunch too!

 

[DTGTaylor]

Munchkin1976
Cingratulations, I'm so pleased you're naughty and tried something different and maybe joined my hobbyhorse. Yes, I think there is some sort of conspiracy afoot but am not sure what it is - usually these things are about cash!
Your carb intake seems low to me but insulin dose about 1 unit per 10g. Perhaps yor intake is low to avoid high blood sugars? You need to count carbs accurately and maintain whatever insulin/carb ratio you determine to be right for you.
I am also finding by talking to other diabetics and these blogs that the pros are making sugar control very complicated. You for instance are taking different doses of long lasting insulin twice a day, short acting and tablets when consuming carbs. What a nightmare that must be, especially if you find that my theory is right!
Keep thinking and be careful. Changes in regime should be done slowly so that the bod can recognise changes and so that you know what effect changes are having. Long lasting insulin should be only to maintain your metabolism at a steady BM, not to alter your BM, that is what the short acting is for.
When you get the insulin/carb ratio right you can be as naughty as you like as often as you like because you then know that high BMs can be brought down with one simple short acting jab (simple because you know the ratio).

 

[munchkin1976]

Brilliant, thanks for that! I try to keep the carb content the same so I do not have to change my insulin too much as I am lazy, it is just a habit from when I was first diagnosed...they told me to have set "portions" at each meal time and educated me as to what a "portion" was ie 10g of carb. They also gave me a book with green, amber and red foods, red being higher sugar content, green being long acting carbs and amber somewhere in between. For example most slices of bread have about 15grams of carb, but multi-grain (green) is going to last you longer than white (amber). With potatoes they said an average portion was the size of an icecream scoop, so if you have 3 scoops of mash potato that is about 30g of carb. I still have the book and I think they still do it online somewhere, it made things a lot easier for me and family back then when they only just started putting carb content on food packaging. The trouble is the longer you have diabetes the more complacent you get. I do also think these new medicines they have us all on are not as good as previous ones and it is more about selling the gadgets to go with them and the expensive sticks and discs to test with, why else do they send you free monitoring equipment in the post with a form to send to the pharmacy to change your prescription?! If your readings are all over the place you need to take more and more blood tests to control it and you can get through 50 tests in ten days if you are like me and testing yourself regularly, this gives the companies around £50 every 20 days per person!!! A lot of money!
When I was pregnant they asked me to change my insulin from insulatard to levemir. I asked the consultant if it had been tested on pregnant women and he said it was perfectly safe as they had done studies for ten years and my results would also go into that study!! I refused point blank!
I hope you do find a pattern in your findings David, I'll join in for sure!

 

[DTGTaylor]

Munchkin 1976
I'm pleased to note you are a human being first and a diabetic second but please remember that tight control of the latter makes the former more enjoyable. I ve struggled with it for 63 years and its only in the last 18 months with a pump that I have felt I have some control.
My basal dose is constant throughout the day, much to the surprise of the pro's, and it doesn't matter if I don't eat or drink, my sugar level doesn't vary much the same. I know my insulin sensitivity and take bolus doses to match the carb intakes.
This has been easier to achieve with short acting insulins only but it is vital to count the carbs, even a cup of tea/coffee! The only things that upset the calcs now are stress, hidden sugars, exercise and LG. But the biggest problem is LG. (I saw my consultant last week and complained for the umpteenth time about this and he looked skeptical and said "we know the liver releases glucose but do not know when or why", I ask you!).
I got onto this trail about 5 years ago when I realised (belatedly I admit) that my BMs were rising unexpectedly and we did a lot of research using the web (couldn't have done it without the web) and came acrosss Glucagon and Glycogen. My consultant was not impressed, pooh-poohed it all and said that after so many years my pancreas was unable to release Glucagon but did not go into Glycogen.
Anyway, I could now inform him (but didn't last week) that Glycogen is released when my BMs get low. Not always at the same level and I have been trying to work out why and so far have 3 theories:
a) Too much insulin and release at around 4mmol
b) Exercise and release at around 7mmol
c) The dawn phenomenon is release in anticipation of a forthcoming "big jab"

I get around a) by counting carbs and knowing my insulin tolerance
I get around b) by reducing insulin beforehand, taking carbs during and then doing some calcs after
I get around c) by having the insulin after I have eaten (after a while of doing this the dawn phenomenon stopped).
And that's it, basically I avoid low BMs and if it goes unexpectedly high I trust that it is Glycogen, do some calcs to analyse why and if I am sure it is G then I have 10 or 20 carbs (yes carbs) and test again in 2hrs. If it was G then the BM comes down, if it wasn't G then it goes up a further 6mmol and I have a compensatory bolus. If the calcs had gone the other way then a small jab (never panic with large jabs) will decide for sure, if the BM still goes up it aint sugar.
I know it sounds complicated but it isn't really but then I have more time than a busy mum.
Stay in touch and let me know how you get on.

 

[megan]

this is really interesting!...thank you for taking the time to post....i have not been on here a while as i have been busy and poorly....your information makes a lot of sense.....my diabetes team would also poo poo anything like this....well actually they simply wouldn't pay any attention to me.

i have recently started byetta with not much information, and so i am in unknown territory .....i shall put this on a new post now as i do need to ask the questions.

i particularly like your last paragraph.....it makes sense to me, but my team would only say that i am trying to hard and need to relax because it doesn't work like that....over analysing makes it worse and you won't find a pattern!.....but then they don't have to live with it!....they expect me just to do the basics and live with the consequences!

thank you DTG Taylor

 

[DTGTaylor]

megan
Analysis is important! It won't solve all your problems but without it you won't be able to learn what happened.
You're right, the pro's don't have to deal with your problems on a daily basis. They categorise your problem(s) every few weeks, fit them into a convenient box, profer some advice and send you on your way.
Back in 1948 we were made aware that insulin dose depended on carbs consumed. Then they decided to calculate carbs on the metric system instead of imperial. Then they decide that carb quantities were not important "just look at the plate of food and inject what you think" Then it was analogue insulins, "human insulins" and Type 2's and tablets. Now its all about carbs, BMI and different profiles of different insulin brands. You know? after 63 years I have never taken part in any research so far as I know or been asked my opinion but I reckon I know a lot more than some pro's.
One thing I do know for certainty is that diabetes control is a numbers game!

 

[nigelho]

Hi Rav, insulin resistance is also a problem for me. Novorapid seems to have stopped working. My ratios have increased to: breakfast i unit novo for 1.2 grams carbs and Lunch and Tea I use 1 unit novo for 2 grams carbs...a huge amount. I've stopped taking Glucophage SR tablets...I was on 5x500mg tablets a day but my intake of novorapid hasn't reduced by much but I was having problems with hypos in the evenings/early mornings and waking up with high BSs. Since stopping the tablets the hypo problem have stopped and most morning readings have been good....now I need to sort of a better quicking insulin..seeing the consultant on Monday 10th Novomber, so hope I'll be given a different insulin..maybe Aprida to try. I did DAFNE in Sept 2013...best thing ever so I'f try and get on a course as they have more info which might get your problems sorted.

 

[Feloneius]

I have a damaged pancreas from car accident. from seatbelt, My shots only work say 30 to 40 % of time correctly...will store up for days sometimes then kick in, and drop me hard, all my organs are failing, I am suffering horribly, with idiot doctors all around me and not even pain relief..! I have had diabetes for around 12 years , diagnosed for 5, P.S. I was shot in my heart when I was 8, Witch caused a chemical imbalance, from dying 3 times, So I am diagnosed, with many things, Like anxiety(severe) and Bi- Polar, also I have been in 3 car wrecks and motorcycle wreck, among many others, i have sometimes took 4 times the amount of insulin, and blood sugar went up 250 points, have tried lower amounts, same...doesn't matter, Did any of you hear about Forcing Niacin into your pancreas..? I think the problem with me is, my pancreas works off and on..! But anyway, why is this epidemic spreading so much...Its defiantly a result of food or water tampering, Something they use in abundance nowadays, i am thinking a preservative of some sort..! God didn't make the pancreas to fail, But i am sure humans make stuff that causes it to fail ,that we ingest..!

 

[LaineyK]

Sorry to hear bout your terrible incidents and condition Fallon, how difficult it must be for you. I find your last comment interesting, you could be onto something there. Mmmm food for thought (excuse the pun). I've been diagnosed type 1 for only 2 weeks, and they said I caught it early, only had symptoms since mid jan this year, but what the heck causes type 1,, no one can tell me why I got it a few weeks ago?!! Frustrating!!

 

[LaineyK]

Sorry, Felon , not Fallon