Severe insulin resistance - past 48 hours

[Catherine4188]

Hello all,

I wanted to ask for some advice as in the last 48 hours I have been suffering with severe insulin resistance. I usually use 35-45 units a day through a T-Slim pump but for the last 2 days I have used around 130 units a day and have been permanently above 18m/mol. I have been injection double ratio for food and then every 30-60 minutes trying to correct with 2-3 units. Nothing is working. Yesterday I was measuring high on my CGM for 18 hours as I was above 22m/mol. I took finger pricks to check and was at 33 at one point. I’ve been topping up with cold insulin from the fridge in a pen as it is a heat wave in the UK right now and I know this can affect insulin potency. But it’s making little difference. When I take the insulin my arrows drop for about 30 mins after it kicks in, I then level out and climb again, even if I haven’t eaten anything. I have checked Ketone levels and I am hovering between 0.4 and 0.7.

Does anyone have any idea why this is happening or any further advice? Thanks so much for any advice you can give. X

 

[rebrascora]

My guess would be an occlusion or cannula failure. Have you changed your cannula?
The fact that your pump delivers basal as well as bolus means that if there is a problem with delivery of the insulin via the pump and cannula, then whatever small corrections you are doing with a pen are likely not enough to deal with that lack of basal cover as well as the correction itself. This is likely why it comes down after a correction and then rises again. Change your cannula would be my advice and use a fresh site in case it is an absorption issue at the current cannula site.

 

[martindt1606]

Hello all,

I wanted to ask for some advice as in the last 48 hours I have been suffering with severe insulin resistance. I usually use 35-45 units a day through a T-Slim pump but for the last 2 days I have used around 130 units a day and have been permanently above 18m/mol. I have been injection double ratio for food and then every 30-60 minutes trying to correct with 2-3 units. Nothing is working. Yesterday I was measuring high on my CGM for 18 hours as I was above 22m/mol. I took finger pricks to check and was at 33 at one point. I’ve been topping up with cold insulin from the fridge in a pen as it is a heat wave in the UK right now and I know this can affect insulin potency. But it’s making little difference. When I take the insulin my arrows drop for about 30 mins after it kicks in, I then level out and climb again, even if I haven’t eaten anything. I have checked Ketone levels and I am hovering between 0.4 and 0.7.

Does anyone have any idea why this is happening or any further advice? Thanks so much for any advice you can give. X

Hi Catherine, I haven't experienced anything that long lasting or that high but perhaps once every 6 - 8 weeks I have a period where my blood glucose rises for no reason and multiple additional boluses will initially halt the rise but the increase starts again after 30-40 minutes. I have a number of steps i follow in the sceanario:
1. Is the pump set to Base Profile (I have an Exercise Profile with 0 Basal, if I forget to switch back to Base I get similar behaviour)
If I am using the Base Profile:
2. how old is the insulin vial (if there is one refill left change the vial)
3. where is the infusion site? due to historic operations I have areas where absorption could be compromised
4. smell check - I ask the wife to see if the site is leaking.
5. Has blood glucose increased across 2 meal times / is it close to bed time?
6. change infusion site and strongly consider changing the cartridge as well.
7. the last time that the Blood Glucose continued to rise despite the standard blood glucose management I went to the GP and was prescribed antibiotics (i'd picked up a bug that was going round the area). Do you have any other symptoms?

Final thought have you increased the amount of water you are drinking?

Note - I am using Lyumjev Insulin and the TrueSteel Cannula

 

[Catherine4188]

My guess would be an occlusion or cannula failure. Have you changed your cannula?
The fact that your pump delivers basal as well as bolus means that if there is a problem with delivery of the insulin via the pump and cannula, then whatever small corrections you are doing with a pen are likely not enough to deal with that lack of basal cover as well as the correction itself. This is likely why it comes down after a correction and then rises again. Change your cannula would be my advice and use a fresh site in case it is an absorption issue at the current cannula site.

Hello, thank you for your reply. I have changed all my pump over since the issue started and it has persisted. I called 111, they have told me to go to A&E, so just sitting waiting now. Fingers crossed it’s a quick sort.

 

[Catherine4188]

Hi Catherine, I haven't experienced anything that long lasting or that high but perhaps once every 6 - 8 weeks I have a period where my blood glucose rises for no reason and multiple additional boluses will initially halt the rise but the increase starts again after 30-40 minutes. I have a number of steps i follow in the sceanario:
1. Is the pump set to Base Profile (I have an Exercise Profile with 0 Basal, if I forget to switch back to Base I get similar behaviour)
If I am using the Base Profile:
2. how old is the insulin vial (if there is one refill left change the vial)
3. where is the infusion site? due to historic operations I have areas where absorption could be compromised
4. smell check - I ask the wife to see if the site is leaking.
5. Has blood glucose increased across 2 meal times / is it close to bed time?
6. change infusion site and strongly consider changing the cartridge as well.
7. the last time that the Blood Glucose continued to rise despite the standard blood glucose management I went to the GP and was prescribed antibiotics (i'd picked up a bug that was going round the area). Do you have any other symptoms?

Final thought have you increased the amount of water you are drinking?

Note - I am using Lyumjev Insulin and the TrueSteel Cannula

Hello, thanks for your reply. I’m at A&E now as 111 recommended it given the length of time Ives been high. No occlusion on the pump as I’ve changed it all since the issue started. I’ve also moved my site to somewhere I haven’t previous used. I’ve increased my water due to extreme thirst and I don’t have any infection symptoms that I can’t tell. The insulin bile was only first used at the start of the week and had been kept in the fridge. I’ve changed my whole set 3 times in the last 3 days. Thanks again for all your suggestions. I do appreciate you taking the time to reply.

 

[helli]

If your insulin vial was changed this week, it sounds suspiciously coincidental that your insulin resistance happened soon afterwards.
Whilst you may have kept the insulin in the fridge you cannot guarantee it was not left out prior to you receiving it.
Have you tried another vial?
Don’t worry about wasting insulin. That is irrelevant if it helps you resolve the problem. Or even rule out another potential contributor.

 

[rebrascora]

Good luck getting sorted quickly. I don't envy you a hot Saturday afternoon in A&E. Please let us know how you get on and if possible what caused it, just for future reference.

 

[Inka]

Sounds like a pump site issue or degraded insulin to me @Catherine4188 I had similar this week but didn’t go as high, although it happened overnight which was a pain. Whenever I get pump issues like that, I always, always use a pen for my corrections and a pen for my boluses too. That way I can see the pattern that shows it’s a site issue, which it normally is. I stay a bit high because I’m not getting my correct basal from the pump, but at least the pen keeps things under control.

It’s a scary thing to see. I hope you’re ok and getting the treatment you need. Hopefully, they’ll stick you on a drip to get some insulin in and to rehydrate you.

Wishing you a quick return to normal blood sugars.

 

[Catherine4188]

Hello all, my levels have managed to come down to 13 after having just an IV to treat my dehydration. They want me back in the morning when the diabetic consultant is in so they can look over everything. Bloodwork was all fine, they suspect it’s a mixture of hormones (I always get some insulin resistance at this time in my cycle but never anywhere close to this) and heat. I’ve upped all my basal insulin rate by x2 and my bolus by 2.5. It seems to have taken the very high highs away, however I also haven’t eaten for 8 hours so it may spike again when I eat. We shall see, but it’s looking better. Thanks everyone. Xx

 

[rebrascora]

Really pleased to hear they have got your levels down a bit and that you will see the consultant tomorrow to assess why it has happened. Hope you have a more stable night and get some decent rest.
Do you have different basal profiles for different times of the month?

 

[martindt1606]

Hello all, my levels have managed to come down to 13 after having just an IV to treat my dehydration. They want me back in the morning when the diabetic consultant is in so they can look over everything. Bloodwork was all fine, they suspect it’s a mixture of hormones (I always get some insulin resistance at this time in my cycle but never anywhere close to this) and heat. I’ve upped all my basal insulin rate by x2 and my bolus by 2.5. It seems to have taken the very high highs away, however I also haven’t eaten for 8 hours so it may spike again when I eat. We shall see, but it’s looking better. Thanks everyone. Xx

Catherine, good to here that you have made progress to get the Blood glucose down. Once you have eaten and feel that things are back on track don't forget you have changed your ratios.

Important reminder for all of us when the weather gets hot - we need to increase our drinking and stay hydrated.

Hope all goes well with the consultant.

 

[Inka]

Great news @Catherine4188 I hope your blood sugars behave now. It’s unbelievably stressful when pumps/insulin mess you around as things can change so quickly.