Type 1 novo rapid seems to suddenly be not working

[Liz Gale]

Hi, Ive just joined this forum. I’m type 1 diabetic of 30 years. Diagnosed age 40 following a severe flu. so Lada. I’ve had great control up till recently and was always on a 1 to 10 g carb ratio. Over past months it’s as if the novo rapid is having no effect! Ive gone from 10 - 15 units a day to double that. It’s still a low enough amount I know, but I eat very low carb diet, so just can’t understand the sudden change ?? I’ve tried all the suggestions e.g changing injection sites, new batch of insulin, really counting carbs, exercising, but nothing seems to be making a difference. There are 2 things I’ve done differently recently : reduced needle size to a 4mm needle, I’m quite slim and increased statin medication from 10mg to 20mg. Does anyone have any experience of either of the above having an impact on blood sugar levels? Thanks in advance!

 

[rebrascora]

Hi and welcome.

Sorry to hear things are not going smoothly at the moment for you and you are needing more insulin.

Which basal insulin do you use and have you checked that your dose(s) of that is(are) holding you steady. I often find that if I need lots more bolus insulin, a couple of units of extra basal will usually sort things out and put me back to where I was before, especially if my bolus needs increase across the whole day. I find it odd that I might need 10 or even 20 extra units of bolus insulin when just a couple of extra units of basal will sort it. It is like the basal insulin has super powers.
Some statins can affect your BG levels a bit and that could just be enough to change your basal needs.

Are your sites lumpy at all? Another possibility is that they have become damaged over the years and the longer needles were going deeper, beyond the damage and the new shorter needles are causing the insulin to get trapped in damaged tissue.
Where do you generally inject your NR? Have you tried an unused site maybe your arm or thigh to see if that helps any.

 

[everydayupsanddowns]

Welcome to the forum @Liz Gale

Sorry to hear your well-established diabetes management system isn’t working as you expect at the moment.

Sounds like you are being methodical, and doing all the right things. If those haven’t worked, and if this has been going on for long enough that it seems unlikely to be illness / increased stress etc then I can see that it would be very frustrating.

Do you have any leftover needles at the previous length? What did you use previously? On injections I never wen’t shorter than 8mm (I’m also fairly slim), but I know many these days get on perfectly well with 6’s or 4’s. If that’s a change in insulin delivery… perhaps your body absorbs differently from that depth? (I have no evidence for this, it’s jyst a hunch, and in your shoes I’d fancy going back to the previous length to rule that physical factor out.

Statins have been known to raise BG in some people, but 20mg is still a fairly low dose (it was what I was started on) so I’m not sure how much if any impact another 10mg a day would have.

How low carb is your menu? And have you been reducing carbohydrate intake to try to reduce doses? Below a certain carb intake, some people see a rise in insulin resistance, which resolves when they add more carbs back in. It’s a bit counterintuitive, but we have members here who have resolved their insulin resistance by adding more carbs back in.

Another possibility may simply be age? As we get older our BGs tend to rise, along with HbA1c? So perhaps a small part of the changes you are observing are just a natural part of the aging process?

Hope you are able to find a fix.

Would you experiment with a different rapid insulin in case your body has ‘gone off’ NR? Either Humalog, Apidra, or one of the newer ultra-fast insulins like Lyumjev or Fiasp?

 

[rebrascora]

Oh yes, good point about low carb. If that is a new strategy, you will most likely need to inject for protein release. If you don't eat enough carbs, the body breaks down protein to produce the glucose it needs. Protein ghenerally starts to release 2 hours after a meal and provides a slow steady rise for about 4-6 hours afterwards. I follow a low carb way of eating and I need to inject up front for the carbs I eat including carbs from tomatoes and onions but then inject a correction about 2 hours after the meal to cope with the protein release and sometimes a further correction an hour or two later as it continues to release. I get good results doing this and Libre allows me to see when I need it and experience and Libre tell me how much I need, but it definitely can increase the amount of insulin you need for a meal, compared to if you eat more carbs and of course more injections.

 

[helli]

There are two things to consider with low carb which can affect insulin needs
- as mentioned, if you body is not able to get enough glucose from the carbs you eat, it will break down protein so you need to dose for protein as well as carbs.
- some people experience insulin resistance with a low carb diet and insulin sensitivity returns when they eat more carbs

I too was on 20mg statins per day and this did not affect my insulin resistance.
I have recently reduced this to 10mg (the opposite direction to you) , and my insulin sensitivity did not change.

My only other thought is how you are generally feeling and whether you have some other new medical condition which your body is fighting by dumping extra glucose. If you are feeling under the weather in any way, it may be a good idea to get it checked out.

 

[Liz Gale]

Welcome to the forum @Liz Gale

Sorry to hear your well-established diabetes management system isn’t working as you expect at the moment.

Sounds like you are being methodical, and doing all the right things. If those haven’t worked, and if this has been going on for long enough that it seems unlikely to be illness / increased stress etc then I can see that it would be very frustrating.

Do you have any leftover needles at the previous length? What did you use previously? On injections I never wen’t shorter than 8mm (I’m also fairly slim), but I know many these days get on perfectly well with 6’s or 4’s. If that’s a change in insulin delivery… perhaps your body absorbs differently from that depth? (I have no evidence for this, it’s jyst a hunch, and in your shoes I’d fancy going back to the previous length to rule that physical factor out.

Statins have been known to raise BG in some people, but 20mg is still a fairly low dose (it was what I was started on) so I’m not sure how much if any impact another 10mg a day would have.

How low carb is your menu? And have you been reducing carbohydrate intake to try to reduce doses? Below a certain carb intake, some people see a rise in insulin resistance, which resolves when they add more carbs back in. It’s a bit counterintuitive, but we have members here who have resolved their insulin resistance by adding more carbs back in.

Another possibility may simply be age? As we get older our BGs tend to rise, along with HbA1c? So perhaps a small part of the changes you are observing are just a natural part of the aging process?

Hope you are able to find a fix.

Would you experiment with a different rapid insulin in case your body has ‘gone off’ NR? Either Humalog, Apidra, or one of the newer ultra-fast insulins like Lyumjev or Fiasp?

Thank you so much for your input. I think the needles might be an issue for sure! I am going to try the 6mm needles again. I think your hunch might be correct. I do try to change injection sites regularly as I know I get lumpy, hardened areas.
I know age can affect insulin absorption but this seemed to happen almost overnight and not gradually. I have also tried increasing carbs as I also heard that too low a carb diet can affect things, but alas no difference. I use novo rapid as my bolus and Toujeo 16 units as my basal. That does seem to keep my overnight levels stable, what ever my levels are, so afraid to up that in case of overnight hypos. Although hypos are not an issue lately. Hypers are much more of a problem lately.
I’m delighted I joined this forum thank you very much for your advice and taking the time to respond. I will let you know if changing back to bigger needle size helps

 

[trophywench]

I had this at the end of last year. I've ben using Novorapid since 1998 and my carb ratio like yours was always 1u to 10g CHO. But, as you say, often like I hadn't bothered bolusing for meals. Always used 6mm cannulas and pen needles. Then right at the end of this January I swapped my elderly insulin pump cos it was past it's 'Use By' date for a brand new closed loop Ypso pump. Hence, different cannulas and these are 4mm, metal, ones. OMG - suddenly - I'm as mega sensitive to the insulin again, as I was 20+ years ago !

Yes, this is batty - same as yours, which just happens to be the dead opposite of what's happened to me. Simple demo (and we see hundreds of examples) of every person being different!

 

[Liz Gale]

I had this at the end of last year. I've ben using Novorapid since 1998 and my carb ratio like yours was always 1u to 10g CHO. But, as you say, often like I hadn't bothered bolusing for meals. Always used 6mm cannulas and pen needles. Then right at the end of this January I swapped my elderly insulin pump cos it was past it's 'Use By' date for a brand new closed loop Ypso pump. Hence, different cannulas and these are 4mm, metal, ones. OMG - suddenly - I'm as mega sensitive to the insulin again, as I was 20+ years ago !

Yes, this is batty - same as yours, which just happens to be the dead opposite of what's happened to me. Simple demo (and we see hundreds of examples) of every person being different!

Really interesting. I am on a waiting list for a pump so hoping that will make me more insulin sensitive again. I got 6m needles today and am using these now, not much difference so far but I’m hoping it will soon. It’s as if the NR is having no impact whatsoever. Might try other suggestion and experiment with increasing basal by a couple of units. It’s just so frustrating! But thank you for all the advice. Good to know I’m not alone!

 

[rebrascora]

If you decide to increase your basal dose, it might be useful to raise your low alarm to maybe 5.0 for a few days until you see how it pans out, particularly overnight, just to give you advance warning of levels dropping whilst you sleep.

 

[nonethewiser]

Really interesting. I am on a waiting list for a pump so hoping that will make me more insulin sensitive again.

Very unlikely a pump alone will make you more insulin sensitive again, my basal needs slightly decreased when switching to a pump which I believe is quite common amoung pumpers, but bolus requirements for meals generally don't change that much, well they didn't for myself.

What a pump could do for you is deliver your bolus doses over hours to suit your very low carb diet, found when I went LC bg would rise slowly over many hours which at time needed multiple bolus injections, with a pump those sort of meals would be more doable & less troublesome on a pump IMHO.

As a previous novorapid user can definitely say that switching to fiasp has made a difference to my own bg management, might be worth asking about a switch to another bolus insulin to see if that makes any difference.

 

[DaveB]

Hi. I have occasions where my Novorapid has virtually no effect for a few hours after I inject but on other days it will start working after 30 minutes. I rotate sites etc but have never been able to find any pattern. I have a lowish carb diet and have low weight.

 

[Liz Gale]

Hi. I have occasions where my Novorapid has virtually no effect for a few hours after I inject but on other days it will start working after 30 minutes. I rotate sites etc but have never been able to find any pattern. I have a lowish carb diet and have low weight.

Thanks for response. Have you ever found out why your NR is not taking effect for a few hours?? It’s so worrying and frustrating when you’re trying to do all the correct things and it’s just not working. There MUST be a reason especially when all of the suspected causes have been eliminated. My changing back to 6mm needles hasn’t worked. I am now, from this evening going to stop taking the statin as the very slow insulin response appears to have coincided with starting on & increasing statins. I will experiment for a week and gauge response and hope for the best will advise on any progress.

 

[SB2015]

Thanks for response. Have you ever found out why your NR is not taking effect for a few hours?? It’s so worrying and frustrating when you’re trying to do all the correct things and it’s just not working. There MUST be a reason especially when all of the suspected causes have been eliminated. My changing back to 6mm needles hasn’t worked. I am now, from this evening going to stop taking the statin as the very slow insulin response appears to have coincided with starting on & increasing statins. I will experiment for a week and gauge response and hope for the best will advise on any progress.

Hi Liz the action of Novorapid for a meal will vary according to the fat content of the meal and also the size of the meal. Is there any link there? I have been on increasing doses of statin and not noticed any impact on the action of my NR.

D certainly keeps us on our toes. I hope that you can find a solution.

 

[Proud to be erratic]

Hello Liz, are you using refillable pens? If so could your bolus pen be suspect? Or the cartridge? Have you tried NR from a fresh (different) batch with a different pen?

I'm a retired Civil/Structural Engineer and my brain always searches for a reason when things change. Sometimes that reason is just not obvious or simple and I've had to accept that contradiction. You say this underperformance by NR has been going on for "some months" which introduces the extra complication that perhaps you introduced some subtle variation "some months" ago and that is now much harder to identify today.

For what it's worth (and you've been managing this D malarkey for far longer than I have) my BG management is heavily influenced by getting my basal right. My Tresiba is very stable and adjustments are infrequent. But when my basal requirement has drifted it does make bolus management really tricky and much more demanding of my time. Again, all so difficult to identify from some months ago and of course thus so frustrating. But because this NR sensitivity change has become more long-standing, perhaps a back to basics review is appropriate. That subtle, hidden, variation has introduced a basic change.

Have you asked your GP for any blood tests recently to compare with older results? Could this be something else that is triggering BG changes, from which basal adjustment is needed?

In Gary Scheiner's book 'Think Like a Pancreas', Scheiner tells his reader early on that "Diabetes is Complicated, Confusing and Contradictory". It is so true!