Insulin Issues Question

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Robertius

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Type 2
I am a type 2 diabetic. For most of year 2021 I pretended I didn’t have diabetes and my blood sugar levels were dangerously high - usually in the range 20 to 30!

I saw a doctor in October and she recommended I commence on insulin to get my sugars under control. I am using novonordisc basal insulin (22 units) and short acting insulin before meals (typically 6 to 8 units). My numbers have come way down and are now 90% in the range of 4 to 10.

However I feel awful. Weak. Lacking energy. Low mood. Sleeping poorly. Often feel nauseous. Just feel rubbish!

My question: Is this a thing when on insulin? Will everything go back to normal soon? Or should I go see a doctor and get extensive tests done?

My doctor is saying that due to my sugar levels coming down dramatically there has to be a period of adjustment for my body…

Grateful for any advice / thoughts.
 
Insulin wouldn't normally have those effects but the big change in your BS and probably weight may be the cause. If it doesn't resolve then see the GP but the cause might be something else
 
Thank you for your advice / thoughts. It’s very helpful.

I did read one or two other posters comment that when starting insulin they had gone through some tough times… but I may have misunderstood. I’ve been in insulin for about three months now and so would expect my body to have adjusted…
 
All it probably is is that your body will be used to higher BGs and it will take a little while for it to stop feeling hypo-type symptoms at normal BG
 
Sorry to hear you are having a tough time since starting insulin @Robertius - it does seem to take a while for the ‘glucose thermostat’ to reset, and weakness and extreme tiredness are fairly common symptoms of low glucose (which can be triggered at ‘normal’ levels if you have been running high BG for a while).

Are things any easier if you are towards the top of your current range, 8s-10s rather than in the 5s-6s?

As others have said, some of your symptoms don’t seem so immediately BG related, so if things remain unsettled for you it might be worth discussing how you are feeling with your GP.

And welcome to the forum!
 
Hi and welcome.

Can you tell us a bit more about your original diagnosis with Type 2. You mention that you ignored your diabetes for most of 2021.... was that just after diagnosis or have you been diagnosed for several years. How did that original diagnosis come about? Were you symptomatic or was it identified through a routine blood test? Do you know what your HbA1c reading was at diagnosis? This is the blood test used to diagnose and track your diabetes management.... I am guessing that it had increased significantly if your GP started you on insulin in October. If you don't mind me asking....Are you particularly overweight and had you lost or gained any weight during that time?

It is generally advised to lower BG levels gradually either through diet or medication because if the body has adjusted to your levels being very high for a long time, it can really stress your system if you drop them too quickly but I would have expected that a reaction to false hypos would have resolved by now so I wonder if there is something else going on....

Are you using Metformin as well as insulin? Metformin can cause a Vitamin B12 deficiency, which can cause fatigue, particularly if it is used over a long period..... which is partly why your length of diagnosis may be relevant and if you mean by ignoring your diabetes, you mean that you didn't take any tablets or that you took the tablets but didn't make any dietary/lifestyle changes.

The insulin itself should not be causing you to feel like this but it can take the body time to recover from uncontrolled diabetes however it is also possible that something else is responsible, like a vitamin B deficiency or anaemia, so if it persists you might be wise to ask for those to be checked out. Unfortunately, if the Metformin is causing absorption problems with Vitamin B12, taking a supplement may not help as the Metformin will still be restricting the absorption and some people need regular Vitamin B12 injections to get it directly into their system.
 
I was diagnosed with Diabetes Type 2 in 2018. I controlled my sugars initially through very strict diet, intermittent fasting and a lot of hiking / running / cycling. In Year 2022 that all broke down and my sugars went really high.

I am slim build - 188cm tall and about 75kg. Yes I’m skinny.

I am only taking insulin - not metformim or any other medications.
 
Since you are "skinny" and needing only moderate doses of insulin, then I wonder if you might actually be LADA (Latent Autoimmune Diabetes in Adults) which is a slow onset form of Type 1 diabetes. There are many of us late onset Type1s here on the forum who were originally assumed to be Type 2.

You mention your levels being in range now 90% of the time.... Do you have Freestyle Libre sensors to monitor your levels to get that info. I am just wondering if you might be hypoing overnight and that could be causing you to feel unwell...
The 22 units of basal insulin.... When do you take that and what is the name of it? I know you said NovoNordisc, but that is the manufacturer and I think they make both Levemir and Tresiba. If you are taking 22 units of Levemir at night, that might be causing you problems, but Tresiba has a longer profile so would be less likely to cause you hypos overnight.
Can you post a photo of your Libre graph if you if ythat is what you are using so that we can perhaps spot a problem, although if you are achieving 90% Time in Range then it can't be too far amiss.
 
Thank you for your detailed reply. I use Libre for continuous monitoring. I take a shot of Tresiba at night (22 units) and during the day I take fast acting insulin before meals.

I’ll try to share a screen shot for you a little later showing my daily sugar graph.

The consensus seems to be that I’m tired / out of energy due to false hypo syndrome which should gradually disappear. However there may be other issues which are leading to my poor sleep / nausea and other symptoms - I will get this checked out ASAP…

Thank you to everyone for your kind help!
 
OK so probably not actual hypos causing you to feel tired. I would have expected false hypos to have stopped by now if you have been on insulin for 3 months and managing your levels pretty well as sounds the case.
It does very occasionally happen that the odd person is allergic to a particular insulin and that can exhibit as fatigue and nausea I believe, but it is very rare indeed. There are other insulins that can be tried if that is suspected. Is there any pattern to when you feel like this? Perhaps just after a meal or is it random? It might be worth keeping a diary of when you feel rough maybe along with a food diary just to see if there is any pattern.
 
Robertius said:
I was diagnosed with Diabetes Type 2 in 2018. I controlled my sugars initially through very strict diet, intermittent fasting and a lot of hiking / running / cycling. In Year 2022 that all broke down and my sugars went really high.

I am slim build - 188cm tall and about 75kg. Yes I’m skinny.

I am only taking insulin - not metformim or any other medications.
Click to expand...
Similar story to my own , diagnosed type 2 at age of 43. I’m also skinny. I’ve had some testing that showed borderline positive antigad 65 which is associated with type 1. So diagnosis changed to LADA. However I’ve had an awful time on insulin. Digestion etc horrendous. I’ve trialed it 3 maybe 4 times but each time I’ve gone about a month tops before having to quit and go back to low carb. Doctors/nurses don’t believe me as plenty of type 2’s taken insulin with no issue. People just say, oh why don’t you just take your insulin and eat proper food, every part of me would love it to be that simple. I also hit the training hard to try and keep sugars down. What with that and the diet it’s been real tough
 
Just so you don’t lose hope with the insulin though i would like to add that the symptoms your feeling could totally be down to the sharp drop in blood sugars. I wish you all the best and yes get some further testing done. C peptide and antibodies
 
Thanks to everyone for their thoughts and suggestions. This is an amazing forum.

I consulted with a specialist back in my native Scotland on my insulin difficulties. He believes I am late onset type 1 LADA.

He was honest enough to say that despite very long experience in the diabetes field - he hasn’t encountered the difficulties I have been facing with taking insulin and much lower blood sugar levels - but that taking everything in context he is not that surprised I have hit difficulties given the significant change in my blood sugar levels (from an average of 25 to an average of 8 or so.)

He suggested that I target higher blood sugar levels over a three month period in order to allow my body to adjust. The problem with going all out to 4 to 10 m/mol target levels is that it seemed to shock my body and I just couldn’t seem to move on or progress from there. I was stuck. Nausea. Poor sleep. Felt cold. Constipated some of the time, diarrhoea some of the time. Weak. Low mood. Low energy. Nerve pain (sometimes excruciating).

The good news is that the Scottish consultant’s recommended approach is working. I’m still not right but 6 weeks in to my suggested programme and I’m feeling human again and am much much better. No nausea. More energy. Better sleep. Much better digestion. Better mood. I still feel a bit cold and some days I get random nerve pain.

For the mathematically inclined my consultant recommended:

Month 1: 8 to 12 mmol

Month 2: 6 to 12 mmol

Month 3: 4 to 10 mmol

The other thing different I am doing is exercise and I believe this is helping. No doctor asked me to do this, but it’s my belief that being fit and body strong is helpful when the body is struggling to cope. Almost every day I go for a strenuous hike up a steep hill for 30 mins to 1.5 hours. I’ve also stayed clear of alcohol as much as possible (now I’m feeling better it’s creeping back in in a managed way).

I trust this is helpful. For Emma I wonder if this gradualist approach might help you to stay on insulin. I completely understand your issue - the last 4.5 months have been the most challenging of my life. I felt absolutely rubbish, couldn’t work, spent lots of days eating and lying in bed unable to do anything.

But insulin treatment is transformational, essentially for type 1s and Ladas, moving our life expectancy to that of a normal person rather than losing a decade or two without it… not to mention the stress of attempting to manage a serious condition without the key medication…

I’ll write more at the 3 month mark. Happy to share details of my Scottish consultant - who is very good and has helped me a lot - if anyone wants his details.
 
@Robertius - glad things are getting much better for you now. It certainly sounds like you have a good consultant there and it is brilliant that they are considering T1 / LADA, but regardless of classification it sounds like you are getting the right treatment and a sensible approach to slowly reducing your BG levels.
 
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