Youngish Veteran t1d - insulin is not working

[Jabba29]

Hello all, veteran - well 35yrs + t1d. I just joined the forum now as I wanted to see if others had experienced the same issue. I'm always looking for knowledge on diabetes as I'm a nutritional scientist, sports coach and interested in improving health & well being. Forgive me if this post is in wrong area - my first one

Seriously worried - not just the swathe towards obesity and poor actually there seems to be....

no way to test insulin quality.
!

Has anyone felt that the insulin in the last few years has been less effective. The usual response is insulin sensitivity, storage, injection site.... I have covered those and more plus I have tested with glucose rises from varying GI carbs and glyconeogenesis from protein. (fasted) - glycogen and adrenalin released

After the usual checks, site changes, cannula check (I'm pumping ... What if it's the insulin, what if worse still its a new batch. How can I check, I can't!

Nothing online, being a natural cynic I question how can a drug not have quality control checks that are easily checked and truly independent.

I have asked a few diabetics I know and they say I just give more. What if this is lower quality Insulin.

BTW iv asked NICE for their view and if they routinely and individually check insulin for quality.

Views please.

 

[Robin]

Hello, Jabba, and welcome to the forum. I've only had diabetes for 11 years, so a relative newcomer, but no, I haven't noticed any difference with my insulins, I'm on roughly the same doses as I was after I'd settled down after diagnosis ( with tweaking, obviously) and my results have been steady, and always what I've expected. Obviously there have been occasions when I've run high for no apparent reason, but I've usually found an explanation, ( I was developing a lurgy, or using insulin that's been on holiday with me and shoved back in the fridge on return that's seemed a bit less effective) and my levels have always returned to what they were.

 

[Jabba29]

Thanks guys, I'm pretty sure it isn't IR. Iv been doing lchf, intermittent fast and now have 18u basal perday with only protein or small carbs bolus. I'm pretty lean (could always be better of course) but in best shape I can remember.

Keen to investigate all possibilities but the insulin seems to be most likely candidate.

My research doesn't show anyway to check or test insulin quality. We cant tell if it is consistent. Authorities don't hv resources to randomly check

If it is 'weaker' it is more profitable for the manufacturer. I know it's very conspiracy theory ist but without anyway to check we just assume it is one of the many other possibilities.

Im ruling them out. Hope that it is something else, so I can control it.

 

[stephknits]

Cant say I've noticed any difference. However there are so many variables that affect insulin - like hormones, heat, stress, illness, type of exercise, sock colour, which end of the sofa I sit etc that I'm not sure I could isolate any single issue.
Best of luck with your research, though 🙂

 

[Jabba29]

Amen to all of that, the list of effects is endless, especially green socks but why would you wear green socks anyway haha Cheers

 

[Pumper_Sue]

Thanks guys, I'm pretty sure it isn't IR. Iv been doing lchf, intermittent fast and now have 18u basal perday with only protein or small carbs bolus. I'm pretty lean (could always be better of course) but in best shape I can remember.

I suspect your problem is the protein many type 1's have to bolus quite a lot for protein only meals. Your insulin is fine you just have to find how much insulin you need and bolus accordingly with your pump 🙂

 

[Matt Cycle]

Hi Jabba. I've had it almost as long as you and haven't noticed any difference. Yes, occasionally I've thought I seem to be using more and perhaps it's insulin resistance then things have settled down and it's back to normal. You mention you're doing LCHF, the thread below has some interesting points and a word of warning.

https://forum.diabetes.org.uk/boards/threads/high-bg-on-lchf.62794/#post-651593

 

[Jabba29]

The issue I had found was if my bg was high, I would do a correction dose. I usually do 1u to 3mmol. My target is 5.2 but anything 5-7 is ok.

Eg if I was 12 I'd give 2u. After 90mins, no food no adrenalin, light walking, no effect. I'd give another 1. Another hour no effect. 30.more min another 0.5. Still no effect. Pump working, no blockages (I feel it going in) . Maybe after another 2hours glucose slowly drop. But that is 12bg with 3.5u down to 10bg! After 5-6hours it gets down to target, that is just wrong.

Now I'm not fat, exercise is regular not intense when this happens. Low carbs, usually less than 50 pday (usually 20 none impact) . No breakfast 16/8 daily IF. This all points to either insulin resistance or poor insulin quality. IR is improbable. So therefore my insulin quality question

Thoughts?

 

[Jabba29]

During all the above no food at all, so I expect some glyconeogenesis perhaps but the bg remains high or even rises slightly. So giving insulin had no effect or caused bg to rise. This goes against all theory if insulin is working.

Fyi keto WOE and IF is amazing. I have never been in better shape. I do notice the amino acid effects on bg and different ones have greater effects on me. But hey nobody ever said in early days you needed to treat for protein. It was all free food. How info changes with knowledge. Some docs still say you must have some impact carbs to live! It's 120gm written in some medical book they must use in the endo course I think.

 

[Jabba29]

That's interesting @Matt Cycle, i have been reading through those suggested threads. Like Jabba I have been eating a mostly low carb, low protein, high fat diet. I have recently been experimenting with intermittent fasting.
There are definitely issues if too much protein is consumed. Basal is also an issue, but the results on blood glucose are outstanding.
This last 2 weeks my glucose levels have not been above 8. I have had a few lows but that's to be expected this close to the line. (The lows themselves have been sorted out with 3 Dextrose tabs)
If I can keep up the good work until my next Hba1c mid October, I will be expecting a great result.

The energy from keto and IF is incredible, I play ice hockey and have bags of it, oxygen is better I suspect from better production of ATP via ketone bodies. I wish I Knew all this when I played competitively. Stick with it.

FYI I rarely start ice hockey with high bg and it has very Lil effect on my bloods now. Fairly intense exercise with small drops only. That is more likely adrenalin keeping bg stable from Liver, some bg repayment is required after.

 

[Bloden]

Hi Jabba. I've had it almost as long as you and haven't noticed any difference. Yes, occasionally I've thought I seem to be using more and perhaps it's insulin resistance then things have settled down and it's back to normal. You mention you're doing LCHF, the thread below has some interesting points and a word of warning.

https://forum.diabetes.org.uk/boards/threads/high-bg-on-lchf.62794/#post-651593

Yeah, I remember being really surprised when DeusXM admitted his low, low carb approach had left him insulin resistant. He’s so gung-ho about the benefits of low-carbing!

Have you read Vickie de Beer’s “Type 1 and Type 2 Diabetes Cookbook: Low Carb Recipes for the Whole Family”? Her son’s diet is low-carb, high protein and he injects to cover the protein he eats. There’s a section on how to work out the doses.

Could that be your problem, @Jabba?

 

[Matt Cycle]

Now I'm not fat, exercise is regular not intense when this happens. Low carbs, usually less than 50 pday (usually 20 none impact) . No breakfast 16/8 daily IF. This all points to either insulin resistance or poor insulin quality. IR is improbable. So therefore my insulin quality question

If it's insulin quality then everyone would be saying something. There's only 3 or 4 manufacturers so we all get it from the same places. As I mentioned I haven't noticed any difference.

 

[HOBIE]

Welcome Jabba. I have been on all kinds of insulin over my 52yrs plus. It does not work fast enough for me at times but its good stuff . The year England WON the world cup ! ( there's not many people don't no that date )

 

[Jabba29]

Some great info guys and gals. Noone I know locally to test my vials on. Yes basal dropped somewhat and has now been good but noticed a rise during a longer fast, so suspect gng glyconeo...
I'm theorizing that gng isn't as harmful on the body as high dietary bg as the body makes it. Also I don't feel the same if high on gng I do on exogenous carbs that skyrocket my bgs.

It is sort of logical that the body would make better glucose.

I will check out those links.

It seems strangely illogical that IResistance would go up on low carb low insulin. It does on high insulin. High fat. Open minded but dubious.

Some great ideas though. Yes if many haven't had this quality issue it seems to rule out this. I only half fill cart now so it isn't warmed as long. Accu Chek combo, didn't like insight.

 

[Pumper_Sue]

Some great info guys and gals. Noone I know locally to test my vials on. Yes basal dropped somewhat and has now been good but noticed a rise during a longer fast, so suspect gng glyconeo...
I'm theorizing that gng isn't as harmful on the body as high dietary bg as the body makes it. Also I don't feel the same if high on gng I do on exogenous carbs that skyrocket my bgs.

The reason your bloods are rising during a long fast is because your liver is dumping glucose.

There is nothing wrong with your insulin, it's just the way you are using it.

 

[Jabba29]

I guess a synthesized protein based hormone like insulin may not be as effective at bg lowering gng as a normal person. This 'could' be the answer. I have many questions that really have no answers atm, just personal theory. Not many people nowadays that are fully fat adapted.

I'm of course conscious of the phrase the simplest answers are often correct but decades of errors have happened due to that phrase.

 

[Jabba29]

Thanks sue, I understand the liver process and glucagon. It would be logically now to assume it is not the insulin. It then is the effectiveness of my insulin on lowering bg from gng. Plus is this high bg as damaging as normal dietary carbs as I don't feel the same.

High bg is a symptom often misused to treat. My hba1c will be higher I guess, test in a few weeks but I'm carefully looking at everything and not assuming anything.

As an example, treating type 2 with insulin like is common now is definitely not a good strategy long term....drifter off point there sorry.

 

[mikeyB]

Treating type 2 with insulin is perfectly reasonable if other treatments no longer work. It’s a well known phenomenon, T 2 beta cells giving up the ghost after decades of being hammered by T2 drugs. Why is it “definitely” not a good strategy long term? Do you not want T2s to prevent diabetes complications? Do you know anything about T2?

I agree it’s off topic, but an unsupported comment like that could be disturbing to those t2s on the forum who are on insulin.

 

[HOBIE]

It has never been an exact science in my book . Different days different patterns. 🙂

 

[Jabba29]

Sorry it was to demonstrate that treating a symptom not a cause.

I must support that statement :-

T2 is a condition fundamentally different to T1 with similar symptoms High blood glucose (bg) .

T1 is no production of insulin
T2 is too much and ineffective insulin. Usually insulin insensitivity.

Both can have insulin sensitivity issues though but the T1 produces no insulin

Both main symptoms are high bg.

The cause of t2 is considered in most ie non gestational or other factor to be primarily poor diet and nutrition. Metabolic syndrome. The body saying stop feeding me so much processed carbs and sugars. The huge production of insulin to cope and the resultant body fat (not in all cases ) make the insulin less effective.

Over years this results in higher blood sugars/glucose and is detected. The symptom.

The current poor main treatment (in my opinion) is usually drugs to increase insulin sensitivity - metaformin and or more insulin. My reasoning this is poor is logical and explained below.

Treating t2 as an analogy with insulin is like giving Vodka to an alcoholic.

Don't treat the symptom, treat the cause.

Short term this is fine because bg is harmful as raising the glycation of blood it attaches to the haemoglobin and then reduces the cells ability to hold oxygen. High hba1c. Fundamentally starving the body of oxygen long term in absence of increased haemoglobin (from exercise - a protection method) this creates the damage to the body we all know.

Exercise can serve to help but it isn't a good sole method of cure.

The best and most solid method for t2 treatment and cure is giving the body a chance and not eating foods that primarily are insulinogenic (stimulate insulin)

Often a t2 considers it ok to still eat this way as they just administer more insulin to cover the highs of bg (symptom), fundamentally due to lack of understanding of the condition. Tackling the cause is the best strategy

Note in T1 it is the only method using insulin and not administering insulin is lethal usually very quickly.

I have a good understanding of the differences, t2 is in most cases if diagnosed correctly as t2 is very curable. T1 is not.... Currently. 🙂