Insulin resistant? Or just slow on the uptake?

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Until recently, I was convinced that I — a type 1 diabetic — was insulin resistant. There were times when I could take 4-unit boluses on no food and not see any effect on my blood sugar for an hour afterwards. Breakfasts of 20 grams of carbs would take more than 5 units to cover.  I began to suspect that I was developing insulin resistance, giving me a double dose of diabetes fun.

But I recently participated in a medical study that involved a hypoglycemia clamp, and it revealed something quite interesting. A hypoglycemia clamp means that a doctor manipulates your blood sugar levels so that you’re clamped in at a low level — in my case, around 60 mg/dl — to see how your body reacts. (In this study, they were looking to see whether or not I still had any ability to make glucagon, a hormone released by the pancreas that helps un-diabetic people avoid low blood sugars.) It means you spend a couple hours in a hospital bed with two IVs in your arm — one with a dextrose solution, and one with insulin. Considering that the insulin and sugar-water are both going directly into your vein, controlled by a computer, you’d think the doctor would be able to manipulate your levels with precision.

However, that wasn’t the case. As my doctor began to slowly increase the insulin drip, my blood sugar began to drop so fast that she had to rapidly up the dextrose drip so that I wouldn’t go too low. And then up it again. And again.

“Did you work out hard yesterday?” she asked me. “Because you’re really sensitive to the insulin.”

“No,” I said. In fact, I’d been in a different medical study the day before, so I had literally spent all day in a hospital bed, about as sedentary as I possibly could have been. “I haven’t worked out for two days.”

This continued for some time — a slight dose of insulin, followed by a recovery dose of dextrose. And then, when the study was over and I was allowed to eat lunch, I had to down three cups of apple juice — plus a dinner roll, pudding, and a slice of cheesecake (I did not pick this menu!) just to bring myself back up to normal.

It was truly bizarre — but also very validating. I now have proof that I am not actually insulin resistant. Far from it! Apparently once it’s actually in my blood, I suck it up like a sponge. The problem, it seems, is absorption: for some reason, it takes a really long time for the insulin from my pump to get into my blood stream. I’ve had this problem through multiple types of Minimed infusion sets (I’ve been on the Silhouette, the QuickSet and, most recently, the Mio). I’ve tried 6mm and 9mm cannulas. Neither is better.  As for where I’m putting the site, my butt is definitely the worst (which is too bad, considering that it is essentially pristine diabetes wilderness, a vast expanse of potential sites) — but my stomach has problems, too. I’ve thought of using my pump for basals and then supplementing that with bolus injections, but that seems like a literal pain.

Instead I’ve been using Symlin, with relative success, in order to match up the curves of my food absorption with the speed of my insulin. I’ve also developed some odd habits, like taking breaks from work to do 100 jumping jacks, standing at the kitchen counter doing leg lifts on the side of my body where the pump is, or occasionally just using my fist to pound the area around the site (not out of anger, though I’m often pissed, but to try to increase circulation). As further proof that this is an absorption issue, I have had many, many afternoons where my blood sugar will stubbornly get stuck in the 180s for three hours, only to plummet (easily 100 points in 20 minutes) if I go to the gym. I guess I had a sense of what the issue is before I went through this study, but  now I feel particularly validated that my original hypothesis was correct: it’s the absorption, stupid.

I’m wondering, does anyone else out there suffer from this syndrome? Any other suggestions of how to handle it? (Another one that works for me is to take a preemptive dose of  Humalog about 15 to 30 minutes before I eat.) And any sense of when there might be a new version of fast-acting insulin available? I’ve heard rumors that there are some in the pipeline, and — as is true with so many aspects of diabetes care — I can’t wait.

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Comments (4)

  1. ferringb at

    While I’m not yet on symlin, I was looking at it for similar reasons- recently switched to the pump and I’ve been finding my absorption rate is a fair bit lower than w/ syringes; in particular if I use the injector for 4-5 days I start getting pretty horrible control as the injector site degrades further.

    While I’ve been on the pump just 3-4 months (out of 12 years of syringes), what I’ve started doing as of late is preloading the insulin- give it a good 15-20m lead time.  Problematic when it manages to hit the blood pretty quickly, but it’s been the only reasonably consistant approach I’ve got to avoid the headache from a glucose high an hour later when the curves don’t match.

    Either way, I’d gone through a phase where the doc’s thought I was resistant, and it turned out I was pretty much the opposite- pump in particular proved that out (varies, but 13-14 g/unit of insulin usually is my ratio).

  2. Laura G. at

    Wow, that’s interesting! Glad you wrote about this. Wonder what types of people absorb insulin slower, and what types faster? I am like this too and have had to choose infusion sets accordingly (no more Silhouettes!) I punch my hip like you, I use exercise and hot showers to help get insulin circulating, and I have to pre-bolus carby meals or use Symlin for them. Also, I carry a syringe and a small insulin cartridge in my meter case, partly for backup, and partly because if I have any serious correcting to do I usually take an IM shot rather than relying on the pump and waiting hours for results. I use about 27 units of insulin a day, too, so I’m not insulin resistant.

    That’s a cool study you were in!

  3. Erin at

    I just pointed to the screen and shouted “YES” to: “…occasionally just using my fist to pound the area around the site (not out of anger, though I’m often pissed, but to try to increase circulation).”  The gym works, too.

    Thanks for the validation, though I don’t have an answer other than, sigh…20-30 minutes of exercise after each meal or “high excursion”.  I second the “faster insulin, please”.

  4. Alice at

    Hello,

    I have had the same problems for about 6 years! Whe I first had diabetes, insulin covered what i ate just fine, but when I turned fourteen I had a low thyroid so had to start taking synthroid. At the same time I would eat y ususall breakfast and would be very high for a long time after wards. It went downhille from there, to the point that I almost never had stable blood sugar and had to take sometimes 8 injections a day. I felt that the insulin kicked in a few hours later and it was very difficult to get back down. Like you, it really helps to wait 30 minutes after injecting humalog and then eating (i feel that the food is digested at the same time at the insulin’s retarded peak). This morning for example I didnt wait after injecting to eat breakfast and I very high and it took 4 hours and10 units to get me back to normal. Like you, it goes back down very easily with excercise. It is hard to work due to that and I am fearful of excercie. My doctor does not believe me, can you answer me I would like to talk to you more

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