Controlling My Diabetes: Bad Insulin or Insulin Resistance

For about a month I have been having serious problems controlling my blood sugars. They go from normal in the morning, but them completely spikes up in the afternoon. I am checking my blood sugars four times a day. I take 30 units Lantus in the morning and then again at night. I take two different sliding scale dosages one for meals and one for corrections of Humalog. They sent me to a nurse practioner at Utah Diabetes Center who isn't doing thing to help me. I want to be with a regular endocrinologist but they are being stubborn and saying that a Nurse Practioner will do. I don't agree with that. I think its because I am on state insurance. I know that they cover endocrinologoist and this Nurse Practitioner isn't even listed in the book of practioners that I have. I'm not sure what to do. I have an appointment with my new primary care physican. My old one moved to Alaska. He recommended this new doctor so hopefully they either send me to an endocrinologist or they can do something. The Nurse Practitioner wondered if it was insulin resistance or if the insulin is bad. I have bulk insulin from when I didn't have insurance and it was stored with ice packs in one those insulin coolers. The styrofoam ones. Could the insulin have went bad from not being stored in the fridge?

What I forgot to ad is I am having to take twice the dossage of Humalog that I normally do. Its went from 2 to 4 units on the sliding scale and 1 to 2 units on the meal scale.

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Comment by Gerri on June 18, 2010 at 11:44pm: The insulin could have gone bad if it wasn't stored properly. Refigerator temp is 34-38 degrees. One way to tell if it's bad is if it looks cloudy. Ask your NP for some free samples.

Dosing insulin according to the carbs in meals is much more accurate than a sliding scale. Have the NP teach you about counting carbs & insulin doses.

To learn your I:C (insulin:carb) ratio, start out with no insulin on board, other than your basal. Eat something that you're very sure of the carb count. Start at something with 15 carbs, not a huge meal. Take a reading. Take your meal insulin 15 minutes before you eat. Test two hours after. If your before & after reading are pretty close (without bad highs or lows), then you've got the right dose. Doctors start patients off on a 1:15 ratio & adjust from there up or down. You need to do this for several days at the same time with the same number of carbs & write it down to see patterns. Raise or lower by 1-1.5 units & keep that dose for three days before making other changes.

Timing of injecting 15 minutes before eating is a general guideline. You need to play around to see what works for you.

People usually have different ratios based on time of day. Most people are most carb sensitive/insulin resistant in the morning. Your ratio for breakfast may be lower than for other meals. Afternoon, when we're more active, usually has a higher ratio. Dinner tends to also be a time when ratio is lower.

Start by testing I:C ratio with one meal & adjusting insulin from there. Then, move on to the other meals.

If you're low or high between meals, it's the basal insulin. Raise or lower by only 1-1.5 units at a time & keep that dose for 3 days to get a good idea of what's happening. Making wild changes won't give you a handle on what to do.

If you've got enough strips, testing should be morning fasting, before meals, 2 hrs after meals & before bed.

These are great books:

Think Like a Pancreas: A Practical Guide to Managing Diabetes with Insulin
By Gary Scheiner

Using Insulin, Everything You Need for Success With Insulin By John Walsh

Comment by Katie on June 19, 2010 at 5:09am: From personal experience my insulin sensitivity decreased significantly when I was having other hormonal problems. Too much estrogen makes your body really insulin resistant. I'm temporarily on a drug that stops estrogen production and had to cut my insulin by 2/3s.
That being said I'm wondering if your insulin is bad. How long was it stored out of a fridge?

Comment by Kelly Rawlings on June 19, 2010 at 8:40am: Great tips, Gerri!

The sliding scale method of MDI is pretty old-fashioned when it comes to type 1. I would expect a diabetes center to teach you how to do the I:C ratios.

Also, do you rotate your injection sites? If not, you may have built up scar tissue and the insulin you take is not absorbing well. I completely overused my lower abdomen for a few years. Once I really started to rotate, I seemed to have better absorption.

Best wishes!