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why does'nt my insulin work anymore?

Question:
Hi all,

I need HELP!!! with a capital 'H', for the past 2 years now my control is totally out of control. i've been IDD for 26 years now, and i never had any really issues untill these last 3 years or so.

My insulin does'nt work anymore, my sugar level have hit the roof, my last HBA1c was 11.6%, thats disgusting!!! . My doctors never listen to me, they think that i'm abusing my diabetes, and not taking my insulin, HEY!!! thats a joke!! I ask why after having 3 healthy kids, no complications, great life and happy family, would i want to damage myself, and not take my insulin .

Anyway, ive noticed that when i take my novorapid, nothing happens my sugar levels keeps rising not fast, just slow, and by the time its lunch time i take the next dose, but i have to take extra cos my levels are so high, the same thing happens. This is repeated through out the day, and then during the night after ive taken my levermir b4 bed, i end up having a massive hypo during the night. What is going on with my body!!!!

I also should add, i have a underactive thyroid gland, and this was diagnoised at the time when all these problems started, i don't know if thats got anything to do with it, i thought i mention it. My dr's don't tell me anything, all they do is change your insulin type, trying eatting hour after your insulin, 'are you taking your insulin'?, are you eatting the wrong foods? GOD!!!!

Please help there must be someone out there with the same problem as me, i'm sure there is a logically reason for this to happen.


VERY DISTRESSED

Rav
Answers:
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
Answers:
Perhaps ask Doc to try Metformin for a while.
Answers:
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 每 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 每 4 hours
Peak between 6 每 8 hours and scarily
Duration between 6 每 24 hours 每 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 每 did it make any difference?

How long have you been on Levemir and what other insulin*s have you tried 每 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 每 2 during the night so you have an idea of what your BG*s are doing 每 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 每 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 每 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 每 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
Answers:
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.
Answers:
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.
Answers:
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.
Answers:
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?
Answers:
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.
Answers:
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??
Answers:
Are you taking any steroidal drugs ?
Answers:
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.
Answers:
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!!!! [quote]

Hi. I'm not a Type 1. However, I think the insulin does not work because you cannot mix the analogue insulins in the same syringe as animal insulin.

Have you been instructed to mix the two in the same syringe ? You have probably deactivated the Insulin by doing this !
Answers:
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!!!!quote]

Agree with Ken-you should not be mixing analogue and animal insulin together in the same syringe!!l Your diabetes clinic really are crxp! Not surprised, most doctors these days don't offer animal insulin, let alone know how to advise about it.
You can take animal insulin alongside a rapid-acting analogue, but they must NOT be mixed.

Novorapid is what is says on the tin-analogue insulin'. it's a copy, and quite a good one, as is Humalog. Been on both and had no probs
However long-acting analogues are a differenct story. Spent 4 miserable, uncontrolled years on Lantus feeling like death. It did not work for me, and like previous posters I blamed my rapid acting.
It was only coming off it in 2008 and switching to Hypurin Porcine Isophane that proved it.
I stayed on Humalog and had great control with both. I've now switched humalog for Hypurin Porcine Neutral-much smoother action resulting in less hypos.

There's a few people reporting 'insulin resistance' on this forum, who are on analogue insulins. I don't know if you can have insulin resistance to something that's not really insulin. Maybe someone with more knowledge can answer that.
However if you were prescribed a medication that you couldn't tolerate or didnt work for you, for whatever reason, you would consider changing that medication. Glad I did, before I was considered 'insulin resistant'-was starting to think I was. I was also mis-diagnosed with Fibromyalgia; turned out to be side-effects of lantus.

I recently met up with a diabetes consultant (not my consultant), who when I told him the probs I'd had on Lantus, informed me he had more problems with his patients controlling BGs on Levemir.

Jus
Answers:
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)
Diabetes Mellitus Type
Diabetes Nursing

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