Comment by Lila on February 2, 2011 at 2:40pm

Hi Jean,

I feel your pain! Insulin resistance is evil. Made worse by the fact that medical science hasn't quite figured out what causes it and how to fight it.

I have to say if I was at 361 though, I'd have done exactly the same as you and injected 14 units. Ignore what your doctor said - what does s/he know anyway?! But, is your morning FBG usually that high? Could it be that your basal dose isn't properly set? I was lucky enough to go on a carb-counting seminar for insulin users and had my basal tested there so I know my dose is good for me.

The other issue is that Novolog (which is called Novorapid here in the UK) is not as rapid as advertised for some people. I found out after a few days of testing every 45 minutes (ouch! I was testing so much I even had to change lancet hahahaha) that it does diddly-squat in the first 2 hours after injection. During this time, it was entirely possible for my BG to rise despite zero food or liquid intake. Possibly the same thing is happening for you? My endo said this was a sign of insulin resistance - though this didn't actually make sense to me because the insulin does work, it just takes an awfully long time.

Comment by Brunetta on February 2, 2011 at 3:02pm

How long have you been on insuin, Jean? I am type one and not insulin resistant unless I have had meds, such as steroids, to make me that way for a period. I have found that the apidra I use is quick acting, but not as quick for high high blood usgars ( over 300). It sometimes will take my blood sugars up to 2 21/2 hours to drop back to normal. I never eat when I am that high though,
After a correction bolus ( I generally inject if the high is due to a bad infusion set), I thendiligently watch the CGMS (if I am wearing it,) or test every 30 minutes. I really do not like to eat if my blood sugar is over 200, unless I have to. I drink a lot of water and test a lot. When I get under 150, I might take a meal/ snack and the pump will tell me how much insulin I have on board so I know how to correct/bolus. I try to avoid 'stacking' but it is not quite that easy at all times.The books 'think Like a Pancreas" and " Using insulin both have chapters about insulin usage for those who are resistant( type 2).

God Bless,
Brunetta

Comment by Trudy on February 2, 2011 at 3:12pm

Hi Jean. I am very insulin sensitive. This morning my blood sugar quickly went to 350 for no reason. I have had this happen before and found in those cases that one of my insulins--Levemir or Apidra--had stopped working. I assumed this to be the case and opened new containers, injected, and some hours later I began to function again. This usually happens mid-winter or mid-summer, so I figure it has to do with the way my insulin is treated before I buy it. I am v-e-r-y careful with it from the second I buy it. Well, good luck with the drawing board...

Comment by Mimi on February 2, 2011 at 4:36pm

Hi Jean - I have been type I for almost 22 years and also insulin resistant. In Dec. 2010 my doc started me on Symlin - WOW has my world changed. My also difficult morning numbers are 80-135! I'm on a pump and this additional shot per meal takes a bit getting use to. I have found lots of good info on this site regarding Symlin - Jason's blog.

Good luck and sure do understand.
Sue/Mimi

Comment by Gus Pearson on February 2, 2011 at 6:27pm

Hi Jean, my Endo has told me that when i hit 150 for each 50 over that i should add 1 unit of insulin to what I'm to take at the time prior to each meal. I take 55 units at breakfast and if i'm 155 i take 56 units and so on. I don't know how your doc would think about it but it really helps me out figuring how to treat insulin depentants.

Comment by LaGuitariste on February 2, 2011 at 8:10pm

Thanks everyone for your replies! I got "Using Insulin" and "How to Think Like a Pancreas" and "Blood Sugar 101" last Friday and I'm working my way through them. In the meantime, I'm so angry at my doctor that I could scream. Every thing I read, I think "She never told me that! We didn't do that! I had no idea about that!"

She gave me some bone-headed, useless sliding scale and I have no idea what my Insulin:Carb ratio is or my Correction Factor or what my correct basal rate should be. Or how to handle a high over 250 or a low under 70 except what I'm reading in books and on-line. I got NOTHING about any of this from my doctors or my HMO.

I'm really starting to hate my HMO with a purple passion. They do NOTHING to help diabetics. Nothing. No CDE's. No classes. You can't get an appointment with an endo to save your life. No CGM's. No Levemir. They are EVIL. Truly, truly, truly evil to diabetics.

I go hypo, my doctor shrugs. I skyrocket, my doctor shrugs. When my A1C came back 10.7 she smiled and told me how "great" I was doing. I wanted to smack the smarmy smug smile right off her idiotic face.

I. AM. NOT. DOING. GREAT.

Sheesh.

Comment by Gerri on February 2, 2011 at 9:13pm

Arrrgh, the frustration! Morning highs are the most stubborn to bring down. Hate it, hate it. What was BG before bed?

14 units should have made a signficiant dent, but bear in mind a couple of things. BG could have been on a continuing upward trend, so that the 14 units kept it from going higher. No difference between 361 & 363, so it didn't go up though it sure didn't decrease. When you take large doses, take them in separate injections in different sites. Large doses don't absorb predictably. People have varying success with different brands, so worth trying another if you can convince your doctor. When I can't get numbers to budge, I open a new vial & return the old one to the pharmacy for an exchange. Done this several times with no problem.

Doctors rarely tell us how to use insulin effectively.

Comment by Natalie ._c- on February 3, 2011 at 1:16am

Insulin resistance itself varies according to time of day, exercise on previous day, and what you've eaten on the previous day. So what might work perfectly one day is a bust the next.
361 and 363 are not actually different; they fall within the meter's range of error. But one thing to remember is that when your BG is very high, you become MORE insulin-resistant, and it takes more insulin to bring you down. The only thing I can think of to do is to experiment by increasing your insulin dose slowly to see what will bring down a high BG like that. Also, drink a LOT of water -- it helps flush the glucose out of your urine.
I'm really sorry you didn't get any diabetes education (I did, but it was all for Type 2, and mostly wasn't relevant to me). So you have to be smart, as you are doing, and educate yourself. Experiment as much as you need to, as long as you are slow and cautious about it. Also, you might consider Byetta or Victoza if you aren't already on them -- they restrain the liver from going on a glucose-spurting holiday.
Good luck!

Comment by LaGuitariste on February 3, 2011 at 3:26pm

Hey y'all,

My bg's are up in general and my eating has deteriorated as my job comes to an end (only one more day and I'm done with my long hours and evil commute...at least for a while).

Starting Saturday I'm going to have a lot more time to clean up my act, read my books and bug my doctor.

Thanks for your kind and helpful words.

The one thing I am the WORST at is being "regular" at anything: sleeping, testing, cooking, shopping, eating, exercising... schedule? what's a schedule?

I know I need to work on this, and I'm trying.

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