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Help with sudden insulin resistance??

S

Suzannah_wilson

New Member
Relationship to Diabetes
Type 1
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She/Her
Hi all,

Myself F23 type 1 for over 10 years, on Medtronic 780 pump system is having some issues with insulin not working.

Yesterday I started noticing that my normal doses of insulin weren’t working.

I went out for breakfast and bolused 30min before my meal, my blood sugar then spiked to 22 and took 3 hrs to come back down, which is very unlike my normal spikes which never go above 10-12 with right carb counts and pre bolusing.

It eventually came down many rage bolus later to around 9 and hasn't budged since.

I have changed my site twice thinking maybe a kinked cannula or scare tissue. Used three different vials of insulin (Novorapid) in case they were maybe bad, and given manual injections as well as keeping my pump on and nothing has worked.

I normally only take a couple of units for a meal so the amount of insulin and the fact it isn’t really working is quite concerning.

I tested for ketones last night and was 0.2 so fine in that regard.

Am just incredibly nervous to eat anything as I’m scared that it will just shoot my blood sugar back up.

I have never had anything like this happen before, and so am wondering if anyone has any advice on the situation before I get in contact with a doctor.

Thanks 🙂
 
Do you feel well in yourself? It could be that you’re coming down with something and the additional load on your body means you need more insulin. How are your hormones? Any chance you could be pregnant?

In the short term you need the insulin you need so please eat and give an increased bolus. Once you go high it often takes more insulin to bring you down so it can feel like you’re taking a tonne of insulin but it’s just what you need.
 
Thebearcametoo said:
Do you feel well in yourself? It could be that you’re coming down with something and the additional load on your body means you need more insulin. How are your hormones? Any chance you could be pregnant?

In the short term you need the insulin you need so please eat and give an increased bolus. Once you go high it often takes more insulin to bring you down so it can feel like you’re taking a tonne of insulin but it’s just what you need.
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I feel absolutely fine. Definitely not pregnant haha.

There hasn’t been any changes in my life that would make me think it would have an effect on my blood sugar.

But thank you for the advice🙂
 
Suzannah_wilson said:
No, I am on contraceptive but it hasn’t changed it years so it won’t be that :(
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Ah okay, hmmm... Have you been anywhere that's been quite hot/cold? The heat has affected me, it's not as hot where I am at the moment/I have got used to the heat.

It might be worth contacting your DSN anyway? I have heard before that sometimes the body ends up needing different insulins at different points in a diabetic's life. Have you always been on Novorapid? I have been on a few different insulins since I was diagnosed at 5 (21 years ago!) and I have settled on Novorapid and Tresiba, so maybe it could be something like that? Worth seeing what your DSN says anyway 🙂
 
@Suzannah_wilson Highs like that are almost always due to site problems, but occasionally to ‘off’ insulin as Tom mentioned above. I’d open a new box of cannulas/sets if you have one, in case the current box is faulty somehow. I’d then get a fresh vial or batch of insulin. In the meantime, I’d do all my boluses with an insulin pen because a) you know the insulin is getting in, and b) removing pump boluses helps you work out what the issue is. I would also consider doing a temp basal increase to make up for any missed insulin. I’d do this for a few hours during the day.

Also, check your pump for leaks or cracks, and check all connections. Finally, consider where you’re placing your cannulas. Some body areas can ‘wear out’ almost overnight, so think carefully and strategically when you put a new one in.
 
How are your BG now?
If it is still around 9mmol/l, that suggests your insulin and site is now fine as your basal dose is keeping you stable.

It may have been a site of insulin problem previously and just took a long time for your BG to come back down. As others have said, we can get very insulin resistant when high.
I don't know insulin you use but I find Fiasp shocking for reducing any highs if I get them. I tend to increase my basal for a few hours as well as rage bolusing.
I don't know if HCL takes this insulin resistance when high into consideration. I suspect not.
 
Tom1982 said:
We had a similar issue a couple of weeks back. Tried 3 different vials from the same box but they must of been stored incorrectly before they got to us. Opened a new box and vial and all back to normal.
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Ah that’s interesting @Tom1982 - glad you managed to get it sorted in the end!

Sorry you had such a dreadful time recently @Suzannah_wilson

Like others, for me levels like that would suggest non-delivery of insulin (scar tissue, bad site, leaky cannula), or ‘off’ insulin. Sounds like you did all the right things trouble-shooting the situation, and trying to sort it.

How have things been for the rest of the day?
 
Innocent question on this. Could it also just be that your sensitivity level has just changed for some reason? I’m not suggesting it has but wondering because it just feels like T1D is fickle enough already so might well have another string in its bow
 
Sorry that you have had these issues @Suzannah_wilson

Are you using the 780 in a closed loop (Smartguard) or in the manual system?
I know that if I go very high the closed loop does take some time to get me down. In such cases I would do all the things that you have done : change site, cannula, insulin (new batch in case of it going faulty before you got it) , ketones, …. Once those have been checked I will switch to manual and do my own corrections, on a pen but tell the pump about it so that when I switch back to Smartguard the system is aware of what insulin I have on board. I still find it hard having to wait for the insulin to get through and to get going. I even set an alarm in order to avoid me checking again too soon to avoid over correcting.
Once back in range I then switch back to Smartguard.

Our diabetes certainly likes to keep us on our toes.
 
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