Insulin Rejection

[Renata]

Hello there....i have had type A diabetes for 10 years now, and i have never thought of entering or looking up forums until now, since i am desparate for an answer for a couple of questions.
it seems that my body starts rejecting insulin after a while of use
a couple of years ago i started using lantus once every 24 hours and it worked great,after a year or so my BGL somehow started to have high results in the morning when i wake up. i tried changing my diet , i tried rotating the shots' areas so finaly i split the lantus into two shots one every 12 hours and it works for now.this is typical when i used mixtard, levemir and every other type this is what happends then i would change into another type and so on ..is this normal? i really dont like having to take as many shots i am running out of places to inject myself!

[Subby]

Hi Renata, welcome to the forum.

i tried rotating the shots' areas so finaly i split the lantus into two shots one every 12 hours and it works for now.this is typical when i used mixtard, levemir and every other type this is what happends then i would change into another type and so on ..is this normal? i really dont like having to take as many shots i am running out of places to inject myself!

Could you explain what's been going on with specific different insulins a bit more? What does "change into another type" mean? I had some ideas come to mind as I read your post, but I'd like to hear more first...

[Tattoo azz]

hi Renata. It does sound like you may be experiencing some resistance, have a long talk with your Dr about it. You may want to mention that some T1's (me included) have been put on Metformin as this sometimes can reduce resistance. Talk with your Dr tho first, also what size needles do you use? If they are too long or too short that can have an effect as well.

[CarrieScott]

i used lantus for years before switching to a pump. i had an endocrinologist once tell me that i was showing "signs of insulin rejection". i never understood what this meant and unfortunately did not ask for clarification. i have always wondered what he meant by this and often worried that there is something wrong with me. so far though, my BS stays relatively steady and am keeping good A1C levels.

i'll be watching this thread to get more insight to the rejection phenomenon.

[Renata]

i started off with mixtard twice a day, i made some experiments and found the right system for me where i would create balance between dosage,diet,workout,stress..etc two years later i needed to higher the dosage which worked for a while but then i needed to higher it again.
At that point my dr. suggested that i would change the insulin to levemir and novorapid then actrapid which i did.i was caught in the same cycle...it is perfect for a while then the doses seem to elevate and i would split the long term shots to a certain point where the dr. simply suggests to change to another insulin type.
now i am on lantus and apidra.i used to need 16 units of lantus every 24 hours which worked great then after a while it kept rising to 26 and still no results so i split them up to 18 am 8 pm it is fine now but i am wondering will i need to change to another insulin type in a couple of months?
i understand that it is not uncommon for levemir not to work for the whole 24 hours..and i was convinced that this is the case until i needed to split the lantus shot as well...
i appreciate your help :)

[Renata]

Tattoo azz
i am using micro fine 0.3x8mm for lantus solostar now...
how do i know if it's the right size for me?
Thanks for the tip i will set an appointment with my Dr asap :)

[AngelKitty]

Hi Renata and welcome to the forum :)

Needle size = what you are comfortable using, what hurts less and bruises less and gives you best absorption.

I don't use a pump myself, but have you considered this as an option for tighter control on your insulin requirements?

[Subby]

Hi Renata, as far as I know, it is possible for insulin to become less effective. However, what I am wondering is whether partly the issue is your body changing (both obviously and just as it goes through growth stages) over the years and your insulin requirements have simply gone up.

I'm not so much "pushing" this possibility, as raising it to be a candidate to make sense of at least some of your escalating needs.

Many diabetics here (including myself) have seemed to find that changes in dosage requirements do occur from time to time, such as, jumping up another 5 - 10 units. I myself started at age 17 on about 50 - 70 total daily units. a couple of times through my 20s I went through a period where I needed to adjust my insulin up. For about the last 2 years I've been on 90 - 100, given a similar diet to the one I had back then.

A couple of reasons for the sorts of reasons for your insulin requirements changing can be -
- changes in the timing and amounts of hormones released internally through normal operations and through the day (such as dawn phenomenon, see below)
- increase in weight, or ??? factors, leading to insulin resistance
- other, less known changes to the body, many probably natural as we age
(Others, which I don't mention because you are obviously knowledgable, such as eating more carbs, stress, lifestyle, etc)

So much of what makes up our insulin requirements may be hidden, so little they seem to understand about insuln resistance for example. I have a lot of IR and they cannot tell me why. It has to be a possibility to think about - of insulin "losing it's effectiveness" whenever we need more. Yet, if I was to blame my insulin type myself, I would be wrong: recently going from Lantus (4 years)/Novorapid to Novorapid/Novorapid (on the pump) my insulin requirements stayed identical. That's just an example, worth mentioning, where I suspected Lantus strongly of losing effectiveness over the years, but it was proven to be the same dose I needed on Novorapid...

The dawn phenomenon is probably what you came up against when you started being high in the morning and is an example of the body changing it's ways, and releasing hormones and internal energy that (it thinks) are useful to help activate the body. From what I can gather this may occur at growth stages of our life, yet are not just the "obvious" growth stages such as puberty.The hormones and glucogen have an impact on the BG, leading to our dose suddenly being innefective in the morning, and something like DP often has to be tackled with higher doses and tricks to get around lows at other times. Your split dose sollution is an example of a way that might get around it.

Anyway, the point of this is to broaden the possibilities of answers here for what has been going on for you. Perhaps you did lose sensitivity with some insulins (i'm sure that happened with NPH for me, although it was more a very strong _feeling_, and while I do go with feelings a lot, perhaps an illusion at the time...) and perhaps at other stages it's a changing body (such as Dawn phenomenon, and again its been know to happen for the body just to develop reasons for a higher dose to be required). While your dosage has increased, in comparison to other diabetics it doesn't seem excessive. You can use a Total Daily Dose calculator such as on this page Free Insulin and Nutrition Tools (http://www.diabetesnet.com/diabetes_tools/) to get an idea of what would normally be "expected" of your situation (very rough). Mind you I've always been about twice what I should be without being overweight or other typical reasons, so it really is just a very rough guide.

I'm not really trying to answer your question that much, what I see you might do is look into some of these issues like dawn phenomenon, insulin resistance (as opposed to an insulin losing effectiveless), learning about your basal needs and fluctuations through the day with a tool you can use called "basal testing"... there are also lots of blank spots in understanding insulin requirements and changes to insulin requirements, but still there's a bit to learn and think about. You might also find or think up ways to "test" if this occurs again, if it's the insulin losing it's effect, or you needing more insulin. (Such as means testing with a certain other insulin... as an off the cuff idea)