Glucose levels will not go down, what is the next step?

[Cornflake57]

I am on 95 units of insulin twice a day, 2000 mg of SR metformin and 160mg of glicazide, and for two years i have not been able to get my glucose levels below 16. I follow a low carb and sugar free diet. I'm type 2 acquired through genetics. What would the doctors be able to advise to improve my glucose control?

 

[mikeyB]

Hello Cornflake, welcome to the forum.

From your post, it would seem you have a very high level of insulin resistance. You are taking more insulin than most of the type 1 folk on the forum, the gliclazide tablets are squeezing insulin from the pancreas, and the Metformin is hardly effective in insulin uptake.

Are you under the care of a Diabetes consultant? The reason I ask is that this needs a hospital based approach to treatment. No one on the forum can give you any advice, at this stage, and certainly no GP. (I know this, I used to be one). You need to be seen by a specialist who is experienced in insulin resistance.

If you don’t get those BG numbers down, you will be heading for complications, so the sooner you see someone who knows what they are doing, the better.

Sorry not be more helpful.

 

[Radders]

I am on 95 units of insulin twice a day, 2000 mg of SR metformin and 160mg of glicazide, and for two years i have not been able to get my glucose levels below 16. I follow a low carb and sugar free diet. I'm type 2 acquired through genetics. What would the doctors be able to advise to improve my glucose control?

Hi Cornflake, how very worrying for you. I definitely agree with Mike that you need to be seen by a specialist. In terms of what they might try, perhaps changing to a basal/bolus insulin regime might help, but something’s not right with your current cocktail! Good luck in getting it sorted, you must be feeling pretty rough.

 

[Davein]

The National Severe Insulin Resistance Service is based at Addenbrooke's Hospital in Cambridge. Perhaps MikeyB would know if it's possible to get a referral to them.

 

[everydayupsanddowns]

Yes, like @Radders I was thinking that would be a good thing to ask. Having a separate mealtime and background insulin regime does mean more injections, but it allows you to tailor your insulin more accurately where you need it most.

Additionally there may be some more concentrated insulins (eg Toujeo or Deglugec 200u) which would allow the same doses to be delivered in a smaller volume.

In the meantime it might be helpful to post a typical day's meal plan to see if any of our low/moderate carbers have any suggestions. One of the things about 'low carb' is that there are no absolute definitions - for some people it means less that 120g carbs a day, while for others anything more than 30g gets them in bother. It sounds like you are doing all you can, but it might be helpful to have a few more pairs of eyes on it?

 

[DaveB]

Hi. As another post has said changing from mixed insulin to Basal/Bolus almost always helps control. It may not directly help with insulin resistance but anything that helps with tighter control may help. Knowing your typical daily carb intake would be useful to know. BTW having Gliclazide with insulin is a bit unusual as insulin should be doing the job. I had to remind my lovely DN to stop my Gliclazide when I started insulin which she readily agreed with.

 

[Cornflake57]

Hello Cornflake, welcome to the forum.

From your post, it would seem you have a very high level of insulin resistance. You are taking more insulin than most of the type 1 folk on the forum, the gliclazide tablets are squeezing insulin from the pancreas, and the Metformin is hardly effective in insulin uptake.

Are you under the care of a Diabetes consultant? The reason I ask is that this needs a hospital based approach to treatment. No one on the forum can give you any advice, at this stage, and certainly no GP. (I know this, I used to be one). You need to be seen by a specialist who is experienced in insulin resistance.

If you don’t get those BG numbers down, you will be heading for complications, so the sooner you see someone who knows what they are doing, the better.

Sorry not be more helpful.

Hello MikeyB
Thank you for your help and advice. I think I just needed confirmation of what I was thinking. I used to be a biochemist in pathology. After a five week wait I managed to see my GP, stood my ground, and will be seeing the diabetes team in Exeter in two weeks time. Also, they've upped my insulin again! Thank you, take care, Kay

 

[Cornflake57]

Hi Cornflake, how very worrying for you. I definitely agree with Mike that you need to be seen by a specialist. In terms of what they might try, perhaps changing to a basal/bolus insulin regime might help, but something’s not right with your current cocktail! Good luck in getting it sorted, you must be feeling pretty rough.

Hello, thank you for your reply and support. After standing my ground with my GP I have an appointment with the diabetes team at Exeter hospital. It is a very frightful disease and draining. My father died at 57 due to diabetes and I have two brothers who have it but no one close to discuss it with. Thank you, Kay

 

[Cornflake57]

Hi. As another post has said changing from mixed insulin to Basal/Bolus almost always helps control. It may not directly help with insulin resistance but anything that helps with tighter control may help. Knowing your typical daily carb intake would be useful to know. BTW having Gliclazide with insulin is a bit unusual as insulin should be doing the job. I had to remind my lovely DN to stop my Gliclazide when I started insulin which she readily agreed with.

Hello, thank you for your reply and support . I to question the glicazide but the diabetes consultant who visited me in hospital when I had sepsis said stay on it. I am seeing a new diabetes team in a few weeks, so fingers crossed there will be some changes. Thank you, Kay

 

[Cornflake57]

Yes, like @Radders I was thinking that would be a good thing to ask. Having a separate mealtime and background insulin regime does mean more injections, but it allows you to tailor your insulin more accurately where you need it most.

Additionally there may be some more concentrated insulins (eg Toujeo or Deglugec 200u) which would allow the same doses to be delivered in a smaller volume.

In the meantime it might be helpful to post a typical day's meal plan to see if any of our low/moderate carbers have any suggestions. One of the things about 'low carb' is that there are no absolute definitions - for some people it means less that 120g carbs a day, while for others anything more than 30g gets them in bother. It sounds like you are doing all you can, but it might be helpful to have a few more pairs of eyes on it?

Hello, thank you for your help and support. My carb intake is low, no pasta, maybe potatoes and bread once a week, no rice etc, I avoid carbs where possible. Anything that contains sugar is either reduced or replaced with plant based sweetener. And no chocolate since the start of lent. I'm not sure how I can reduce it much further however, I didn't eat for 24 hours and got it down to 8.9. My only failing is exercise, I don't enjoy it. I will discuss it with the diabetes team in a few weeks Thank you, Kay

 

[Cornflake57]

The National Severe Insulin Resistance Service is based at Addenbrooke's Hospital in Cambridge. Perhaps MikeyB would know if it's possible to get a referral to them.

Hello, thank you, I will look them up and ask the diabetes team when I see them in a couple of weeks. Thank you Kay

The National Severe Insulin Resistance Service is based at Addenbrooke's Hospital in Cambridge. Perhaps MikeyB would know if it's possible to get a referral to them.