FUDiabetes

LADA and insulin resistance

Reading comments I have noticed I am using a lot of insulin. I take 66 units of Toujeo at night and use a 1 carb to 1 unit ratio of Novorapid in the morning and one carb to .75 unit insulin later in the day. I was on FIASP but gained a lot of weight and my insulin resistance was getting worse so I switched back to Novorapid a month ago. I was injecting usually in the abdomen, moving injection sites around but have noticed better response when I inject in my arms. I am afraid to inject in my legs because I have a lot of lumps and don’t want to inject into them. My HGA1C is still high, around 8 even with all of the insulin. I don’t take any oral diabetes meds, they are too hard on my digestive system.
So my questions are:
Does anyone else take this much insulin?
Will my insulin resistance in my abdomen decrease if I stop injecting there? And if so how long should I wait?
Any comment or insight is appreciated.

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I don’t take as much as you, but I have some insulin resistance (because I am overweight) and take about 40-45 units of basal insulin in the pump or 55 units if I’m taking long-acting insulin and take 1 unit to cover 10 grams of carbohydrates.

I take metformin, and although I didn’t start it to address insulin resistance, my blood sugar skyrockets and is very hard to get down if I forget a dose. So I’m guessing it does help with that. I take the extended-release version and started at a small dose and worked my way up to 2000 mg/day.

Have you looked into some of the newer oral medications such as the SGLT-2 inhibitors? They don’t have stomach side-effects (to my knowledge, although they can have other side effects, which is why I had to stop using them) and can help a lot with lowering blood sugar.

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Thank you, that is helpful to know. My endo has suggested the SGL2 Inhibitors but I have Painful Bladder Syndrome and sometimes have to urinate every 5 minutes so I can’t take them. Are your HgA1Cs high too? I stopped taking Glumetza cold turkey after taking the max dose for years because of IBS. After 3 days my upper body muscles started twitching really badly for about an hour. My MD doesn’t know why. I won’t go on it again.

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Oh, yeah, those medications would not be good if you have bladder issues. I’m in a similar boat. But those medications seem amazing for those who can use them.

Glumetza is what I take. I haven’t had any issues with it. I have “IBS” as well, but in my case it seems to be linked to another condition I have (eosinophilic esophagitis, related to food allergies). Foods that I react to seem to trigger the horrible stomach issues in addition to the horrible throat symptoms. So by avoiding those foods, I rarely experience stomach issues anymore.

My A1c tends to be around 6.5%, sometimes creeping a little higher or dropping a little lower. It’s only by using a continuous glucose monitor and constantly monitoring and adjusting that I’m able to keep that kind of tight control. Do you use a CGM? I’ve also been at this for more than 28 years, since I was diagnosed as a kid. I think it is sometimes much more difficult to adjust when diagnosed as an adult!

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@Sherba I am on 1000mg of Metformin at night. I am on 4.5u/hr from midnight to 4am, 5.5u/hr from 4am to 10pm and then drop back down to 4.5u/hr til midnight. I still have to bolus for meals and I’m not on a long acting insulin. I’m currently on Fiasp in my pump. I have my first End appointment this coming Tuesday. We’ll see what changes are made then. I’m on the Omnipod Dash system and changing my pod every day right now.

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@Sherba Prior to going on a pump, I took 80-90 units of basal/day and ~120 units of bolus/day. Since going on a pump in the last 2 years my usage has dropped to 59 units/day for both basal and bolus combined. The first 3 months I was on a pump my basal was reduced by 50%. I have/had major problems with high overnight bgs. I am also using Ozempic off-label with great results (the first 2 months were super tough).

I hope you find the magic sauce to get your bgs and A1c in control.

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@Sherba I feel for you. I’m also insulin resistant. I was taking 35u of Toujeo twice a day. Then I switched to Tresiba and am currently on 38u just once a day. It seems to work much better.
My C:I ratio is 3g:1 unit. I have had to take over 100u of novolog to bring down a persistent high of 300.
I take metformin, and that generally keeps me under 250. I had been on Jardiance, and that worked very well, but I developed kidney disease. I tried Victoza, a GLP-1 inhibitor but never got past the nausea.

My doctor finally told me “if you’re blood glucose is to high, just take more insulin” I think that must work because it allows me to keep my A1c around 5.6-5.8.

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I’m a T1 who does not take much insulin at this point (17-18u Tresiba, ~1u:10 carbs (variable though for lots of factors)), but is on metformin ER to manage slight insulin resistance (my doses started to increase, to more like 23u basal, along with weight gain on my belly) that helped bring down my A1c and helped lose that extra weight (still overweight, but back to what feels like my set point). Did you try the ER version of metformin or the regular? ER is much easier on the GI tract for many, though can still be tough to tolerate (though sometimes it seems like people adjust within a couple of weeks or so).

I did also try Invokana a while back. For the first two weeks it was AMAZING. I thought I found a miracle drug—it was like my blood sugars could not break 180. I was so excited. Then it seemed like my body habituated to it, because over the next few months, that effect went away, and I started experiencing high blood sugars again. I was thirsty a lot and did have to increase my hydration (which was tough because I already have to drink a ton because of POTS), so at some point I stopped because it didn’t seem worth it. After stopping, I noticed a slight uptick in morning blood sugars, and I temporarily went up a unit in my Tresiba (but then had to go back down a week later), but that’s about it. So I can’t recommend it based on my experience, but YDMV. Also it’s pretty sad to think you found a miracle drug only to have it stop working… :frowning:

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Wow, that persistent high must have been awful. I haven’t gotten the knack of injecting extra insulin. I often end up injecting too much and crashing. I am just trying to do 5units at a time until I start to come down. Tried Tresiba but it didn’t seem to work. Thanks for posting.

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I tried the ER of Metformin but my IBS was so bad at the time I decided I had to get off of it but have had weight gain since. That sounds frustrating that you thought you had found a miracle drug only to have things change back to how they were. It sounds like you went through a ‘honeymoon phase with it! Thanks for replying.

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My BG would just laugh at 5 units. That 100 units did result in a low hours and hours later. But I just look at a low as another opportunity to eat a donut :yum:.

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Mmmm. Donuts!

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@Sherba I am T2 on a pump and I am very insulin resistant, probably as much or more so than you are. Also I do not take oral meds. One thing that I don’t do is try to limit my insulin amount, I inject what it takes to gain reasonable control. When I first started with insulin I was always asking my doctor how much is to much. The answer is there is no amount that is toxic. Just be careful about lows.

One suggestion I might make is to look at your balance of basal versus bolus. While you have not said how much basal you inject a day with your rates I can imagine it might be a substantial amount. I had this problem, my bolus rate was only 25% of my TTD. I discussed this with my endo, we ended up raising my bolus rate to a higher percentage of my TDD and where possible lowering my basal rate. This helped me to finally reach the target A1c my doctor wished for.

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I often end up injecting too much correction insulin, but I don’t have a problem with crashing. When I see the BG finally start coming down, I watch in case it starts plummeting, in which case I eat some glucose to use up the excess insulin. The CGM makes this relatively straightforward, after some initial practice to get the hang of it. So for me, injecting too much insulin and stacking insulin doses are useful tools to get control of stubbornly rising BG.

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I like the way you think lol

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Hi, I take 66 units of Toujeo for the basal. I am afraid of lows if I take more but I will trying edging it up. My MD has recommended CBD oil for pain so not sure how that will affect by bg. I am sure there are a few threads on this topic here! Thanks for responding.

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Please forgive my ignorance, I’m a Type 1 diagnosed 41 years ago at age 22. I’m not familiar with LADA, could someone please explain it to me? Thanks.

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I believe LADA, Latent autoimmune diabetes in adults, is a just a Type 1, but diagnosed in adulthood of 30+ age, often going through some period of honeymoon where the pancreas still produces some small amount of insulin. To my knowledge, I don’t think the disease is any different than a typical Type 1 diagnosed at a younger age. The LADA still ends up making 0 or practically 0 insulin, and must eventually take insulin. I don’t think insulin resistance is any different in a LADA than any other Type 1.

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It seems like LADA often (but not always) progresses slower than childhood T1 with a more drawn out honeymoon phase, although I don’t know how much of that could be adults catching the early signs of diabetes sooner than kids and their parents. But some researchers have suggested there are differences in the typical nature/course of T1D depending on the age diagnosed. Neither childhood onset or LADA necessarily involves insulin resistance, but in either case, people can have it in addition to T1.

Anecdotally, it often feels like when I’m talking to folks with LADA, that there are differences between how their diabetes functions and mine. I believe some of the other childhood T1Ds here like @Jen have said the same, but that’s just observations, so I don’t want to assume that’s fact.

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My general sense, at least on these online forums, is that folks with adult-onset T1 often seem to achieve much tighter control than those of us diagnosed in childhood. But yeah, it’s all anecdotal, and obviously there are exceptions.

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