Concentrated insulin?

[JimBear]

Hey folks! I would appreciate the wealth of your wisdom before I start making a nuisance of myself at my GP surgery...

I am Type 2 and have been on insulin for ages now (separate basal/bolus) and have excellent numbers for a long time. I weigh everything scrupulously and calculate the amount of insulin needed with extremely accurate results. For a very long time my divisor for carbs into insulin units was a convenient 5 and correction doses worked out at 1 unit per 0.5 over my target reading.

Within the last 3 weeks my numbers have climbed to staggeringly high numbers both post and pre-meals, going over 11 on one occasion. I have used more and more insulin to combat this unexplained increase. I know my weight has steadily increased, especially during lockdown but I can't believe the relatively slow increase in weight would cause such a rapid change to blood glucose readings - but perhaps I am wrong.

However, in desperation I phoned my diabetes nurse who was at a loss to explain the sudden and rapid increase in blood glucose levels. I am now at a stage where I have started to get them back under control but my I am using a huge amount of insulin. My divisor has gone from 5 to around 2.7 (still calculating) and my corrections are around 1.5 units per 0.5 over target.

It has now become pretty common I need to inject more than 60 units of insulin for one meal (including correction doses) and I don't enjoy injecting more than once to make up the amount needed. Also the rapidity I am getting through the cartridges now means I often have to inject twice even when the dose is less than 60 as there may be a good amount of insulin left in the current cartridge which I don't like throwing out (unless less than 10 units left).

I briefly spoke with my nurse about a more concentrated insulin to lower the amount needed to be used and was told there is a concentrated version available. (I don't know if this comes in cartridges to use in my current pen or how it is supplied). Although she wasn't thrilled at the prospect of me being on a concentrated insulin, she did say that I would have to be referred to the community diabetes nurse to be allowed to go on that type. My previous experience with the community nurses was not pleasant as a) they really didn't do a lot to help me get on insulin in the first place and b) they were furious I sought out an endocrinologist to be allowed to go on the separate basal/bolus. I imagine trying to get a prescription to go on a concentrated form will be another stressful experience and almost certainly they will be hostile about my weight (and I am happy with my weight).

The only other explanation for this vast increase in insulin usage was if I had a dodgy batch that simply wasn't working effectively, but I have finished that box now and on a new box (all correctly stored, of course) has made no difference.

So my questions are, has anyone else had experience of using concentrated insulin (is it more common than I am aware?)? Can a few pounds of extra weight really make such a staggering difference to blood glucose numbers in such a short space of time or could there be something else going on I am unaware of? Or are larger cartridges and pens available that can dispense much higher doses in one go?

I would really appreciate any advice, especially from concentrated users just so I have as much info to hand as possible before I prepare to fight the community nurses. Again.

Many thanks for your time and any help you can give,
Jim

 

[Pumper_Sue]

Hello Jim,
I believe there's a U200 and a U500 insulin. I'm not sure which type or make t is though.

Just a suggestion, have you increased your background insulin?

 

[Ljc]

Sorry I can’t help re concentrated insulin but am wondering , if you use reusable pens, if the pen is faulty and not delivering the correct dose.
Their is a way of testing this, perhaps @everydayupsanddowns or @trophywench could explain.

Have you done a Basal test recently .
How to rascal test us around half way Down this page

 

[everydayupsanddowns]

Welcome to the forum @JimBear

Sorry to hear your insulin needs have skyrocketed. Sounds like this has been going on for some time, so basic practical things like ‘is it a dodgy pen’ and ‘did you inject into scar tissue’ don’t seem likely to fit your situation.

As @Pumper_Sue says there are u200 u300 and u500 insulins available (though not in all brands). Regular insulin is u100 - 1ml is 100 units. So u200 is double strength and needs a completely different pen/delivery device. U500 is 5x as strong.

HCPs are a little nervy of them, particularly in inpatient settings, because using a regular insulin syringe or whatever would be disastrous!

 

[DaveB]

Note that if T2 with excess weight (if so?) and taking insulin you are at risk of insulin resistance having a big effect. That could result in a vicious circle of needing more insulin. It is essential to make sure your carb intake is at a sensibly low level to try to break the loop and ensure any internal body fat is reduced. We all vary but 150gm/day max is a good target to aim for? Even though I am slim if I have a series of high carb meals I find my insulin needs sky-rocket for a few days.

 

[Kaylz]

Hi, haven't seen you post in ages but remember when you were being switched to basal/bolus regime

I have to ask the same as Sue, you say you've increased your bolus insulin but I don't see you mention a change in basal doses, generally that is what changes more often than bolus so I too am wondering if it is your basal needing adjustments, bolus insulin won't work as it should if your basal isn't correct and this can change a lot

Yes added weight will increase your needs too
xx

 

[JimBear]

Hi, haven't seen you post in ages but remember when you were being switched to basal/bolus regime

Thank you so much Kaylz! I don't know whether to be flattered or embarrassed you remember me from so long ago! Thankfully everything has been pretty good and settled (until now)! 🙂

 

[JimBear]

Thank you everyone who took the trouble to reply - I really appreciate this over such a complex subject.

I forgot to mention that I have been increasing my basal too, though I only use this in the evening. Previously, when I had used it in the morning, I found my after-brekkie numbers to be fine but was hypoing before lunch so I gradually reduced this to where it wasn't worth using.

I have spoken with my diabetes nurse this afternoon and gone through the situation again with her (I spoke with her last week when I realised things weren't going right). She was at a loss to offer an explanation as to why there has been such a dramatic change in such a very short space of time. I am now using double the amount of insulin to what I have been using for years - all in the space of about 3 weeks. Even taking weight into consideration, I think it is unlikely to have had such a profound and sudden change - it's not like I've gained 50lbs in 3 weeks! Anyhow, the only other explanation is perhaps my pancreas has stopped producing insulin altogether... but if that's the case, why?

Anyhow, she agreed that I clearly need a more potent insulin as I am now frequently injecting well over 60 units a time, so has referred me to the community diabetes team (joy (they didn't like me several years ago and I have a feeling that will still remain if it is the same people)) and it was suggested I also contacted my endocrinologist, whom I have not seen for about 3 years (but he was nice).

Thank you again for all your replies. I don't expect to hear back from the diabetes team for around a week, but I'll let you know how I get on once they get in touch.

Have a good weekend folks! 🙂
Jim 🙂

 

[grovesy]

Thank you everyone who took the trouble to reply - I really appreciate this over such a complex subject.

I forgot to mention that I have been increasing my basal too, though I only use this in the evening. Previously, when I had used it in the morning, I found my after-brekkie numbers to be fine but was hypoing before lunch so I gradually reduced this to where it wasn't worth using.

I have spoken with my diabetes nurse this afternoon and gone through the situation again with her (I spoke with her last week when I realised things weren't going right). She was at a loss to offer an explanation as to why there has been such a dramatic change in such a very short space of time. I am now using double the amount of insulin to what I have been using for years - all in the space of about 3 weeks. Even taking weight into consideration, I think it is unlikely to have had such a profound and sudden change - it's not like I've gained 50lbs in 3 weeks! Anyhow, the only other explanation is perhaps my pancreas has stopped producing insulin altogether... but if that's the case, why?

Anyhow, she agreed that I clearly need a more potent insulin as I am now frequently injecting well over 60 units a time, so has referred me to the community diabetes team (joy (they didn't like me several years ago and I have a feeling that will still remain if it is the same people)) and it was suggested I also contacted my endocrinologist, whom I have not seen for about 3 years (but he was nice).

Thank you again for all your replies. I don't expect to hear back from the diabetes team for around a week, but I'll let you know how I get on once they get in touch.

Have a good weekend folks! 🙂
Jim 🙂

You never know the Community Diabetes might be different or more receptive. Have you ruled out illness or compromised Insulin? may be the weight gain has pushed you over your personal threshold.
I am not on Insulin, but over the years I have had to review what I eat and how much of what I eat, and now some things I can no longer tolerate or eat regularly.

 

[Kaylz]

Thank you so much Kaylz! I don't know whether to be flattered or embarrassed you remember me from so long ago! Thankfully everything has been pretty good and settled (until now)! 🙂

😱 I just had a look at your postings and didn't realise it was as long ago as 2017! I'm good with names and faces that's the only reason as you don't spend much time around here, do keep us updated and don't be such a stranger! 🙂 xx

 

[JimBear]

You never know the Community Diabetes might be different or more receptive. Have you ruled out illness or compromised Insulin? may be the weight gain has pushed you over your personal threshold.
I am not on Insulin, but over the years I have had to review what I eat and how much of what I eat, and now some things I can no longer tolerate or eat regularly.

I live in hope of a more receptive team. But thankfully, now I am more experienced and have had (until now) such amazingly tight control on my diabetes to the point my local nurse was concerned I was hypoing on a regular basis (which I wasn't) and was using me as an example of how blood sugars should be controlled, I feel more confident I will be able to stand my ground now. When you're first sent to the community nurses, I think they feel any T2 is just a fat lazy slob who has no interest in learning. I may be wrong, but I felt I was just a burden to them and they wanted to get rid of me with the minimal amount of effort or treatment on their part.

It might be possible my weight has tipped me over the threshold, I don't know. And perhaps that varies with individuals. I would have expected a more linear increase in the use of insulin rather than the effect which I've experienced. Either way, having lost over 100lbs just over a year ago I felt truly terrible about my appearance and the way I felt. I didn't feel like me and it was something I regretted doing (even though my nurse was, of course, delighted).

 

[JimBear]

😱 I just had a look at your postings and didn't realise it was as long ago as 2017! I'm good with names and faces that's the only reason as you don't spend much time around here, do keep us updated and don't be such a stranger! 🙂 xx

That is amazing! My memory is shocking for things like this, though I suspected it was a couple of years since I was on here. I really appreciate your warm (re-)welcome. I admit I feel a little guilty asking for advice and rarely giving it, but as most of my evenings are spent on Facebook or Messenger, Twitter and a couple of other special social media sites, I run out of time lol! But I will come back and let you know how the rest of this challenge works out 🙂 I guess I ought to update my profile photo too at some point as I am a lot greyer now lol!

 

[Ditto]

Hello and welcome back. 🙂 Can't you post your menus in the relevant thread, I'd be interested to see what you eat? I'm wondering if anything's changed that might have altered your readings. Or maybe you've got new inflammation somewheres... something will have triggered it, type 2 is weird.

What did you eat yesterday?

today: Breakfast: I experimented with a different way to make croissants - they turned out less like croissants and very cheesy but still yummy. I had one with no added sugar tomato ketchup and a mug of decaff coffee for breakfast. Lunch I had two of them with another cup of coffee. Evening...

forum.diabetes.org.uk

 

[grovesy]

I live in hope of a more receptive team. But thankfully, now I am more experienced and have had (until now) such amazingly tight control on my diabetes to the point my local nurse was concerned I was hypoing on a regular basis (which I wasn't) and was using me as an example of how blood sugars should be controlled, I feel more confident I will be able to stand my ground now. When you're first sent to the community nurses, I think they feel any T2 is just a fat lazy slob who has no interest in learning. I may be wrong, but I felt I was just a burden to them and they wanted to get rid of me with the minimal amount of effort or treatment on their part.

It might be possible my weight has tipped me over the threshold, I don't know. And perhaps that varies with individuals. I would have expected a more linear increase in the use of insulin rather than the effect which I've experienced. Either way, having lost over 100lbs just over a year ago I felt truly terrible about my appearance and the way I felt. I didn't feel like me and it was something I regretted doing (even though my nurse was, of course, delighted).

For me for me I am I would say the opposite to you and have been at a steadish weight for the last 4 years. I have still had to readjust what I can tolerate.
Plus the weight is lighter than I have been for years BMI around 25.

 

[JimBear]

I have an appointment with the community diabetes nurse (yes, the same one I saw 4 years ago) on Friday next week. This'll be fun...
I'll let you know how I get on afterwards 🙂

 

[grovesy]

I have an appointment with the community diabetes nurse (yes, the same one I saw 4 years ago) on Friday next week. This'll be fun...
I'll let you know how I get on afterwards 🙂

I would take a list of questions or points you want to get across. Good luck.

 

[AndBreathe]

I have an appointment with the community diabetes nurse (yes, the same one I saw 4 years ago) on Friday next week. This'll be fun...
I'll let you know how I get on afterwards 🙂

Please do try to go with an open mind.

Right now, you need her more than she needs you, so with an open mind and a desire to negotiate to a mutually acceptable solution could be key.

I'll cross my fingers for you.

 

[JimBear]

Well I have some amazing news... I saw the nurse on Friday as planned. She couldn't have been nicer, more jovial or welcoming. She was delighted with my record-keeping and absolutely astounded I keep my blood glucose levels so tightly controlled.She also noticed I had a couple of instances of lipohypertrophy which 3 doctors had failed to diagnose (these have only recently appeared and only seem to be connected with the large amount of insulatard I have been using but I had seen the doctors about them because of how sore the area was).

Without even having to ask (and with no bullying about my weight!), she's put me on a double-concentrated insulin for both basal and bolus. The disappointing news is these aren't available in the glass cartridges to use in my nice metal Novo Nordisk pens - they're only in disposable plastic pens.

I haven't picked them up yet but have enough of the old insulin to tie me over a couple of weeks. So it seems I did a lot of fretting and worrying for nothing...!

 

[Kaylz]

@JimBear that's great news! And thanks for popping back to keep us updated 🙂
xx

 

[grovesy]

Glad you had a productive and successful appointment!