Insulin Sensitivity in Type 1

[commit]

I have been diagnosed with DM Type 1. My doctor has mentioned to me on several occasions noting that my insulin demand is much higher for a person like me (19 y.o., 59kg BW, 1.72 m). To put it into perspective, at a fasting BGS of around 4.0-5.5 mmol/L, I have a slice of bread with some vegetables, eggs and cheese. I would inject 7 units of insulin to have my levels be around 6-7 mmol/L. During lunch where I would have about 3-4 carb ex. worth of carbohydrates, I would need about 11-12u of insulin, which averages out to be around 29 units of insulin daily. Top it off with 12 units of basal insulin at night brings it to about 41 units daily, which is more than my daily requirement of insulin, no? Could this be because I am insulin resistant? I’m not sure if it can occur in Type 1 diabetics and would like ur opinions on this. Thanks.

 

[Robin]

I have been diagnosed with DM Type 1. My doctor has mentioned to me on several occasions noting that my insulin demand is much higher for a person like me (19 y.o., 59kg BW, 1.72 m). To put it into perspective, at a fasting BGS of around 4.0-5.5 mmol/L, I have a slice of bread with some vegetables, eggs and cheese. I would inject 7 units of insulin to have my levels be around 6-7 mmol/L. During lunch where I would have about 3-4 carb ex. worth of carbohydrates, I would need about 11-12u of insulin, which averages out to be around 29 units of insulin daily. Top it off with 12 units of basal insulin at night brings it to about 41 units daily, which is more than my daily requirement of insulin, no? Could this be because I am insulin resistant? I’m not sure if it can occur in Type 1 diabetics and would like ur opinions on this. Thanks.

I notice on another thread, you said you were thinking of restricting your carbs. If you’re doing that, you may find your body is converting protein into glucose, and maybe fat into glucose too if your carbs are very restricted, and you may need more insulin than a straightforward ratio of carbs /insulin because of that.

 

[commit]

I see. Had I ate how I ate back then, I would need upwards of almost 18-20 units each meal. Isnt that alot? And I know that the carb content SHOULDNT be that high (a bowl of rice, vegetables, eggs, some chicken that can be sauced or fried)

 

[Inka]

Yes, Type 1s can be insulin resistant @commit but sometimes the resistance is ‘innocent’ and has a known cause. Examples of this are during pregnancy, where it’s normal and nothing to worry about, and during periods of growth.

Are you sure your basal dose is correct? That would be one thing to check to make sure your bolus (meal) insulin isn’t compensating for too little basal insulin. We don’t use carbohydrate exchanges, just grams of carbohydrate. How many grams of carbohydrate is in one of the exchanges you refer to?

 

[commit]

For us they say 1 carb exchange is equivalent to 15 grams of carbs. That means my average lunch SHOULD be about 45-60 g of carbs (could be more due to the hidden carbs). How would I know if my dose of basal insulin is too little? Im 19 so I guess u could say im still in a period of growth, which can technically make me slightly insulin resistant? Idk man I’ve heard some type 1s need only like 4-5 units of insulin per meal (they told me they were very physically active). How about ur daily insulin needs?

 

[Thebearcametoo]

My kid is 14 and has about 21 units of basal (it’s through the pump so less than when he was on injections when he had about 27 units of tresiba). With his meals he usually has somewhere between 17 and 21 units but it does vary and he has quite a lot of carbs. His control is very good and his HBAIC is very low.

 

[Sally71]

Everyone is different, I think my daughter needs quite a lot of insulin compared to some people. You need whatever you need to keep your blood sugar under control. I think her basal is about 37 units per day at the moment (on a pump not injections, she’s also in a wheelchair so can’t do much in the way of effective exercise). Insulin resistance can occur in type 1, but things such as hormones (growing, puberty etc) can really play havoc with it.
Might be worth doing some basal testing to make sure that is right, I found this one, maybe someone else has a better link: https://diabetes-support.org.uk/basal-testing-in-diabetes/
If your basal is correct it should keep you level when you’re not eating, if that’s wrong then your bolus doses might be making up for it. If you get your basal correct (as close as is possible) then everything else becomes a lot easier.

 

[Inka]

For us they say 1 carb exchange is equivalent to 15 grams of carbs. That means my average lunch SHOULD be about 45-60 g of carbs (could be more due to the hidden carbs). How would I know if my dose of basal insulin is too little? Im 19 so I guess u could say im still in a period of growth, which can technically make me slightly insulin resistant? Idk man I’ve heard some type 1s need only like 4-5 units of insulin per meal (they told me they were very physically active). How about ur daily insulin needs?

Ideally, your basal insulin would hold your blood sugar steady and in range in the absence of food. Nobody wants to starve themselves for 24hrs to check that (and that would be a bad idea anyway) but you can split the day into segments and skip one meal at a time over a period of days.

Here’s some information below, but if this seems too complicated or you don’t feel up to it, don’t worry. It’s a fine-tuning thing:

How To Successfully Test Your Basal Rate

Are you looking for basal rate information and testing instructions? Perfect! You're in the right place!

www.mysugr.com

Your insulin doses don’t seem horribly high. I wouldn’t worry about them. Concentrate on control (well, as much control as we can have of Type 1 - perfection is impossible) and keeping healthy. Eat well and take the insulin you need 🙂

 

[commit]

I see. I did (unintentionally) do a basal testing and found that my blood sugar levels did rise at around 1pm from 4-8 mmol/L. So does this mean the basal dose is too low? I’m not sure if its supposed to last throughout the night only or for 1 entire day.. Moreover, is there a point in trying to lower my insulin needs? My doctor kept stressing that my insulin demand is quite high. Is that bad? Should I work to lower it? Moving past that, is there a point where high insulin doses actually become a problem?

 

[Inka]

What basal insulin do you take @commit ? Some are designed to be taken once a day, some twice a day, but they’re supposed to cover you for both day and night.

Your insulin doses aren’t high 🙂 People should take the insulin they need to control their blood sugar. There are plenty of Type 1s who take more insulin than you - some a lot more. Don’t dwell on what the doctor said. There is no “daily requirement of insulin” chart. You take the insulin you need.

Out of interest, you say you have a slice of bread, cheese, eggs and veg for your breakfast and take 7 units. How many exchanges are in your breakfast? And when do you get the blood sugar of 6 or 7, ie an hour after breakfast, two hours after, just before lunch?

 

[commit]

What basal insulin do you take @commit ? Some are designed to be taken once a day, some twice a day, but they’re supposed to cover you for both day and night.

Your insulin doses aren’t high 🙂 People should take the insulin they need to control their blood sugar. There are plenty of Type 1s who take more insulin than you - some a lot more. Don’t dwell on what the doctor said. There is no “daily requirement of insulin” chart. You take the insulin you need.

Out of interest, you say you have a slice of bread, cheese, eggs and veg for your breakfast and take 7 units. How many exchanges are in your breakfast? And when do you get the blood sugar of 6 or 7, ie an hour after breakfast, two hours after, just before lunch?

I use toujeo for my basal insulin (12 units each day)

The reason I’m worried about my insulin doses is the fact that doctors kept telling me that high insulin doses can lead to some complications, and I should work towards slowly reducing my insulin needs. Based on my blood tests, my body produces basically 0 insulin anyway (C-peptide level of 15) so I guess that could be why.

So for my breakfast, heres what I have:
Bread (wholemeal) (15-16g)
Cabbage
Eggs
Mayo (negligible sugar)
Spices (no sugars)
Vegetable oil (olive oil)
Chinese Lao Gan Ma (contains a negligible amount of sugar)

Based on these ingredients, I would say there’s about 22-23g of carbs/sugars in this meal.

I do quite abit of readings after the meal (cuz im bored in class) but I usually take note at the 2 hour mark or right before my lunch (next meal)

 

[Inka]

Prolonged high blood sugar can cause complications over time @commit so you should take the insulin you need. Thank you for listing your breakfast. I think your carb estimate is probably slightly high. Your dose of 7 units is a reasonable amount for what you’re eating, but when I was around your age, I’d take between 8 and 10 units of insulin for breakfast, so it’s not hugely unusual. When I was pregnant (remember I said that pregnancy causes insulin resistance), I had to take 20 units for breakfast. I hope those things make you feel better. Again, your insulin doses aren’t madly high.

My thought is that perhaps some of your breakfast insulin is covering what we call Foot on the Floor. This is a rise in blood sugar when you get up. For me, that rise can be 5mmol or more. You might not see the rise if you eat soon after getting up (because your breakfast insulin ‘hides’ it) but it’s a possibility.

Have you tried varying your breakfast slightly - keep the carbs the same but swap food items. Some people find certain foods cause a higher blood sugar rise than they’d think. I know some people find eggs more difficult and have to count them as ‘carbs’ even though they’re not, and use insulin to cover them. Also, some breads can cause higher rises than other breads of the same carbs. It might be worth a little experimenting.

You’re slim and your BMI is healthy, so that’s good. Another thought is that you could try a different basal insulin. Twice daily insulins work better for some people, as they can vary the morning and evening doses separately (eg they might need more during the day, less at night, or vice versa). Other people find the very long acting Tresiba suits them.