“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.
@John58 Thanks for asking about this. I suffer the same thing and have strived for a while to dial in an override or temp target without success. Example: I just got back from a “vacation river (bus) cruise” during which I usually walked significantly further each day due to excursions and ran a “vacation setting reducing my insulin intake/dosing including basal. It worked for the most part except my meals which were as well higher carb sorts though I was pretty good about deserts. I also accepted higher variances in BG because of the environs, more wine with dinner, etc. I’ll be interested in any comments from others!
BTW, I use Omnipod Dash, G7, and DIY Trio as an AID.
Same thing I did on a trip during August-September and it worked reasonably well, probably because I was either on my feet or on a bike for most daylight hours every day.
The other thing I did in August was quit taking Metformin (did not want to deal with the gastric side effects while travelling). I had been on a 500mg extended release Metformin since starting on the twiist pump which seemed to help mitigate insulin resistance back in July. I don’t relish the idea of restarting the Metformin but alas I might need to, time will tell.
So far to attempt a fix I have increased my total daily basal by about 7%, with the increased basal rates running from 8 am to midnight. Not satisfied with this fix based on this morning’s after breakfast spike, probably will wait until next week to adjust other settings.
Thanks for mentioning this, I have been wondering about this too. (My initial diagnosis 12 yrs ago as T1/LADA was based on the antibodies test but I had been roaming around with high BG an hbA1c of 14+ and all its symptoms for many months prior and possibly years prior). Is there an antibody test or other to explore this possibility? Or is it diagnosed by detailed review of BG swings, insulin doses and activity levels? Or is a clinical diagnosis unnecessary, would anything be gained from a clinical diagnosis?.
The tests for those with out Type 1 fasting insulin levels and Homeostatic Model Assessment of Insulin Resistance don’t work for Type 1s.
There is a formula that sounds wrong to me having to do with total daily insulin dose TDD of higher than 1u TDD per kilogram of body weight. That would put me at 77u TDD when I at 55u TDD.
The other things are gaining abdominal weight, high levels of triglycerides, and fatty liver.
There is a test that is very expensive and reserved for research called hyperinsulinemic-euglycemic clamp.
I based my opinion on the possibility you may be insulin resistant on t sudden rise of blood glucose levels when physical activity is curtailed. This is what I experience.
People with T1 and non diabetics will experience varying insulin resistance from physical and emotional stress, physical activity and corticosteroids. We with the gene variants the IR is stronger abnormally so.
The 2 things that aid us in increasing insulin sensitivity are a carbohydrate restricted diet and regular daily exercise of at least 30 continuous minutes daily. Metformin and maybe GLP1 Agonist can increase insulin sensitivity a bit. The gold standard with or without drugs is diet and exercise.
I’m about 175 lbs and lately average about 55 units daily, plus or minus a few. So about 0.7u/kg.
That TDD was higher back in spring and last winter when I was carrying about 10 extra pounds and using (or should I say attempting to use) Omnipod 5. I started Metformin and twiist pump at about the same time and attribute the weight loss in May-June-July to Metformin and the keeping it off to the twiist pump and a lot of activity in August-September. Now lately I’ve had to take correction bolus (Affrezza) 2-3 times daily to knock down post meal highs. Fortunately I have not put the 10 pounds back on.
Yes. About one day is when a change in exercise hits me. It cuts both ways; if I increase exercise significantly I start going low after 1-2 days unless I reduce my “IC” ratio (so, because it is back-arsewards I have to increase the number).
I don’t know what “insulin resistance” is other than pejorative. It’s my insulin sensitivity that changes. The seasons are changing, I’m getting less active, my insulin sensitivity is going down.
It can help to adjust diet. My insulin sensitivity goes up if I eat less. However the problem is that at this time of year my exercise levels decrease to the point where I barely need to eat anything. I like to eat.
So I must decrease my insulin sensitivity by changing my IC from my 100IC profile (which is in fact set to 9.5g/IU) not to “JBowler 120 sensitive” (12g/IU) to, hum, I just created it; “JBowler 80 insensitive” and modified all the mysterious but certainly related numbers (“sensitivity”, “basal”) to match. I think I got it right…
Thanks for the reminder, and don’t take no shyte; it’s insulin sensitivity, not resistance, and it is 100% part of being a T1.
Activity can make such a big difference too! Hopefully others using Loop have some tips for those less active days. It’s frustrating when your settings work so well and then suddenly everything changes!
will bear that in mind