Increasing doses of Actrapid.

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Gladden

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I am 70 and have been type 1 since 1962. I am relatively stable and have no, as yet, evident complications.

I self trained to carb count around 30 years ago and was been adjusting doses according to blood results and circumstances.

I have worn a Freestyle Libre since 2016 (I was fortunate to be part of a research project at one of the London hospitals before it became a prescribed item).

For the last couple of years I’ve noticed that both my Insulin/carbohydrate ratio and correction dose ratio have reduced. Currently, the former is 1:1, or even 1.5:1 and the latter 1:1

I am only monitored at the GP practice, by the DSN (annually). On enquiry I was referred to the very Specialist Diabetes Nursing Service, where after waiting for 4 months I had about three telephone consultations.

What I asked was related to whether there was any experience of growing insulin insensitivity, and attempts to modify that by using a different brand? There was no interest in pursuing this. As far as the nurse was concerned I was operating at a gold standard level.

For the record, there have been recent occasions where my total insulin intake (both long acting and actrapid) has been around 170 units/day. Also for the record, from Freestyle Libre App, time in target figure for last 90days, <3.9mmol/l = 0

I’m interested to learn if other long standing type 1s have such issues?
 
You could enquire with your GP whether it’s worth considering metformin to help with the insulin resistance?
 
Could it partly be poorer absorption @Gladden ? You’ve had Type 1 an impressively long time. Poor absorption can lead to increasing doses. You only mention the Actrapid. Has your basal dose increased too? What basal insulin do you take?
 
Yes, I’ve always had a combination. Presently long acting is Tresiba, dose 60 units and has been this quite a while.

It’s very frustrating for no other reason than it hampers planning. For example tonight we ate a home made steak/kidney pie with green vegetables, water to drink, no pudding. Estimated carbs were 34, my dose 38. Current blood is 9.7.
 
It would be strange (but possible) for insulin resistance to appear after all this time @Gladden That’s what makes me wonder about absorption. I’ve only had Type 1 30 years and I have areas that aren’t so good for absorption where the insulin hardly seems to work.

Have you considered a pump? When people go on to a pump their total insulin dose usually reduces. Mine reduced by 25%, which I was told was pretty normal.
 
Hi and welcome and many congratulations on 60+ years of Type 1, especially with no obvious complications.

A bit of a personal question and no need to answer it if you are not comfortable to do so, but are you putting on surplus weight and are you perhaps less active as those two things can cause increased insulin needs.
Which basal insulin do you use and have you checked that it is holding you steady in the absence of food and bolus insulin by doing a basal test. I find if my basal insulin is a few units short I need significantly more bolus insulin both with food and corrections to keep my levels in range. Sometimes I can be injecting an extra 15-20 units of fast acting insulin when an increase of just units of basal will sort it out, so that would be what I would check first. How many units of basal do you inject and if it is a large dose, do you split it into two in 2 different sites..... So for me, I take 22 units of Levemir in the morning and I consider that quite a large dose for me and I don't think it is particularly healthy for that all to be going into one spot, so I split it in two and inject 11 units into each buttock. I use the same needle with no ill effects and it only takes 30 seconds longer and what's another injection when you have probably had hundreds of thousands over your lifetime. It also means that if you do hit a spot with poor absorption the whole dose isn't going into that spot, so it is a bit like not putting all your eggs in one basket or backing a horse each way.
It might also be worth considering a different, possibly virgin injection site if you tend to use your stomach or thighs mostly.
 
Inka said:
The OP takes 60 units of Tresiba @rebrascora so splitting the injection between two sites sounds sensible.
Click to expand...
Normally I point out to those suggesting splitting their Tresiba between am and pm that this is a pointless strategy. But, in case poor absorption is a fundamental problem after 60 years .... splitting 60 units between am and pm and using 2 sites for each am/pm may just be the change needed to disrupt a potential established problem? More faff certainly, resolution possibly?
 
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