“Sudden onset insulin resistance” …that’s about as descriptive as I can muster up. It hits me occasionally and seems to correlate with a sudden drop off in exercise/steps/activity. I am generally active and had a very active August and September. My pump settings have gradually been reducing my TDD to reduce the lows associated with those busy times. Now in October it’s been up and down.
All it takes is two days in a row of reduced activity (such as sitting at my computer to do something or a long drive) and my post meal spikes are high (250+ three times a day) and long lasting. The treatment that semi-works for me is to correct the high BG with Affrezza.
I use sequel twiist pump which uses Tidepool Loop algorithm. I felt like I had it as dialed in as possible back in August/September. Before I start fiddling (again) with the settings, I wanted to toss this query out…has anybody got some rules of thumb to adjust and prevent these bad days?
Here is a plot of exercise days from Apple health app. I know the best answer is get the workout every day but sometimes that’s not possible.
Ahh, @John58 , it appears you may have Type 1 with insulin resistance, formerly called double diabetes.
Having autoimmune diabetes doesn’t mean one cannot inherit the multiple genetic variants that cause abnormal cellular insulin resistance.
The correlation of physical activity and blood glucose levels is quite marked in Type 2 diabetes. Physical activity increases insulin sensitivity in everyone but much more in T2.
I’m not saying this is true for you. If it is you might benefit from reducing daily carbohydrates and trying to get a 30 minute walk after long drives.
I want to add that it is my opinion that automatic functions on pumps cannot deal with varying insulin resistance. I use a tandem T:Slim with C-IQ.
I’ve had a number of health issues that have increased insulin resistance either chemically (prednisone) or unable to get my regular daily exercise.
When I was on high doses of prednisone, 40mg, I could stack corrections with no effect. I am not suggesting that anyone do this, but the only thing that worked was to use a 100u syringe with a 1/2’” needle and do an intramuscular injection of 10-12u in the deltoid muscle.
Currently I am on the injured reserve list as far as cycling. I have not had to resort to the IM injections but I do override the suggested meal bolus and corrections. It would be nice if a pump could handle insulin resistance, but I don’t see that coming for people like me.
I’m not reluctant to make small changes to my pump settings. If my BG is trending too high after meals I’ll slightly change the I:C ratio to give more meal insulin. If my BG is tending to climb gradually, all by itself for no reason, I slightly increase the basal setting. If Loop’s corrections aren’t actually bringing down the BG I’ll slightly change the insulin sensitivity setting to get more insulin.
Also, I’m pretty willing to taking manual extra doses of insulin when I see a BG rise unfolding faster than I like, rather than waiting for Loop to try to fix it, so this tends to mask any sudden insulin resistance or issues with insulin absorption at the cannula.
Good call - I forget the fact i can adjust my insulin sensitivity - good one to use when dealing with rising progesterone i would imagine will bear that in mind
One thing to watch for is if you change the sensitivity too far, so it becomes too aggressive at dosing, that will cause the algorithm to make the BG oscillate — roller-coaster up down up down up down maybe even with increasing waves instead of decreasing waves. That’s a sign to back off a little.
For me it’s stress and sometimes it feels like insulin AND activity don’t help to get my BG back into a normal range. I guess it’s because the cortisol response takes a long time to fade away. Trying to stay calm and not exacerbate the situation is so hard for me.
Thanks for the ideas…I will keep fiddling/tweaking/adjusting. As I thought this through I remembered I typically used a seasonal basal change (10% more in fall/winter) over the years with Omnipod and MDI before that . I am going to try that first, perhaps it will help.
will bear that in mind