Delayed Insulin Response

[John Kennedy]

Since taking early retirement in June, I have had a LOT of problems controlling my extremely erratic blood sugars and recently had a sensor fitted for several days. This confirmed that my short-acting insulin (Humalog) was not performing as expected: there seems to be a considerable delay in my body's response to it. For the first three (and sometimes even four) hours after the Humalog is administered, it seems to have relatively little effect. A reading taken four hours after the injection will often show sugars in the 10-16 range - but in the following hour, (when the insulin should theoretically have stopped working), my blood will crash eight to ten points, often resulting in hypo. (Because of their frequency, I have stopped getting much in the way of hypo-warnings.) Often, the steepest decline in sugars occurs between the fourth and fifth hours after "quick-acting" insulin was administered.

Prior to getting these sensor-results, my consultant's assistant had recommended that I run my sugars high for several weeks to avoid hypos and thus regain some symptom-awareness - but because it has now been confirmed that my blood so frequently tumbles eight to ten points in an hour or less, (and because my dinner-time insulin is still active when I go to bed, leading to the possibility of nocturnal hypos too), I'm beginning to think that the "hypo-free month" required to restore warning symptoms will always be beyond me.

Does anyone else here have experience of delayed reaction to insulin? I've been Type 1 for seventeen years - and if anyone can make any suggestions, I'd be so grateful.

 

[grovesy]

Welcome.

 

[mikeyB]

Hi John, welcome to the friendly gang.

There are lots of reasons why there may be a delayed response. I assume you are changing the site of your injections every time, because if you use the same general area you can get patches of fibrosis that can delay the release of insulin unpredictably. This sort have thing is more likely the more years you have been doing it, so the first thing to try is injecting into more remote areas and see if that makes a difference.

Having said that, I've been using Humalog since the year Tony Blair was first elected PM, and over the last year or two, wherever I inject, I cannot time the boluses at all. I've tried everything. Half an hour before eating, an hour before eating (that one got me eating jelly babies before dinner) at the time of eating and just after. Nothing seems to get it right. I haven't the first idea why it's like this, but I'm rapidly coming to the past caring stage, because I'm getting a pump, partly for that reason. Perhaps a less demob happy member could help. Just hang around for more advice🙂

 

[trophywench]

Well I'm in the demob happy group myself having had a pump for over 6 years and I've never actually tried Humalog so dunno how it would behave for me if I did. Sadly (because of their history of being the people who brought purified insulin to the man in the street in the very first place almost 100 years ago which makes me think 'we' should always try and support Eli Lilly insulins, so I regret not being able to) I've never got on well with any of their insulins I used in the past. Novo Nordisk ones have been and still are, the opposite for me.

However - assuming that the sites you are using ARE okay - I'd be asking to try a different fast-acting insulin than Humalog, so AFAIK that would be either Novorapid or Apidra. The latter is anecdotally alleged to kick in quicker than other brands - but I couldn't afford it to be much quicker than Novorapid, which starts working for me within approx 10 minutes normally.

Plus - and I often still wonder about this - with the old animal extracted insulins - it was perfectly possible to sort-of become 'immune' to them to one degree or another after years of use - so if you were on bovine they'd swap you to porcine or vice-versa. I'm aware of this simply because it happened to me - I was really scared - it was like I was injecting water - but was assured that 'It sometimes happens - so don't worry!'

Can this also occur with manufactured insulins for the unlucky few?

 

[John Kennedy]

Hi John, welcome to the friendly gang.

There are lots of reasons why there may be a delayed response. I assume you are changing the site of your injections every time, because if you use the same general area you can get patches of fibrosis that can delay the release of insulin unpredictably. This sort have thing is more likely the more years you have been doing it, so the first thing to try is injecting into more remote areas and see if that makes a difference.

Having said that, I've been using Humalog since the year Tony Blair was first elected PM, and over the last year or two, wherever I inject, I cannot time the boluses at all. I've tried everything. Half an hour before eating, an hour before eating (that one got me eating jelly babies before dinner) at the time of eating and just after. Nothing seems to get it right. I haven't the first idea why it's like this, but I'm rapidly coming to the past caring stage, because I'm getting a pump, partly for that reason. Perhaps a less demob happy member could help. Just hang around for more advice🙂

 

[John Kennedy]

Thanks, mikey and Jenny.
The injection sites seem fine - no lumps or bumps that I can feel; but I'm wondering about both the pump and a change of insulin. I was asked about a pump several years ago by my consultant but I was a little hesitant at the time - being a regular at a gym with communal showers and being in any case a bit of a technophobe. It hasn't been mentioned again since but my control is now so poor that I'm wondering whether I ought really to reconsider.
cheers both
John K

 

[trophywench]

Some pumps are showerproof, but there again if you shower with it plugged into you - which bit of you are you going to attach it to? (No, not there, silly, cos they don't even make hook accessories! LOL)

The tubing comes from the pump and then attaches to the outside bit of the cannula with a clip thingy. To unattach the Roche ones you squeeze both sides and pull off the attachment thingy. Have your shower, sort yourself out, then reattach the pump.

Pumps are a dreadful problem for any number of blokes though, since as we know the concept of "reading the instructions" is alien to quite a lot of them.

Funnily enough though - pumps give diabetics info using words and concepts they are already familiar with - eg 'Bolus' 'Base Rate' and 'Blood Glucose' 'Carbohydrate' - oh and a Clock.

It ain't Rocket Science - and it doesn't involve any Apps! (unless you want them to, in which case, some can LOL)

And the best news about pumps?

Apple don't make them so they don't go obsolete overnight and refuse to accept new instructions; they aren't fashionable so there's no pressures on anyone to update uprate or replace them, until they reach the end of their intended natural lifespan - some are 4 years and some are 5 years. And - the helplines normally actually HELP !

 

[Radders]

Apidra is the only insulin that could be described as fast acting for me, and I did try humalog and novorapid. It still lasts longer and takes more time to work than it's supposed to. In your place I would be asking to try Apidra as I don't think there's meant to be much difference between Humalog and Novorapid, although everyone's different.
I generally bolus 30 minutes before eating carbs and try to exercise shortly after to try and limit the impact.

 

[Pumper_Sue]

Have you done any basal testing? It might just be that your basal insulin is working to well at some points of the day and not others thus your bolus is acting as both which makes you think it's not working as it should. Just a thought for you to consider.