[StAnderStv]

Hi gang. The short version of my question is whether anyone has experienced transient insulin resistance.

Here's the long version (and it is long, sorry about that): I've been on a pump for about 10 years, pretty good control (A1c < 7.0 usually). I've always noticed that if I'm sedentary, like on a long drive or airplane flight, my insulin stops working: I can give myself a ton of insulin and my bg stays high. Until, that is, I unpack the car or do something moderately active, then boom: I'm diving into the fridge for juice because I'm crashing.

My problem is that now this seems to be happening more regularly. When I'm in this mode, if I eat a crouton my bg spikes to 200 (OK, I exaggerate slightly ) and it doesn't matter how much insulin I bolus. It only comes down very gradually over the next 8 hours or so.

I've been managing this by going for a quick run--5-10 minutes of jogging seems to activate all that insulin and reduces my bg by 50-100 mg/dl. While this works, it's often not convenient or possible.

My questions are a) whether any of you have experienced this? b) does anyone have any idea what's going on? Is it resistance at a cellular level or is it an absorption problem? Can insulin itself cause insulin resistance?

More details than you may want to read: it feels like my body is in one of two modes. When in the "bad mode," I have to stay away from carbs almost altogether for a day or so and keep my total insulin intake low. Then it goes back into the "good mode" in which my ratios are all normal for me. I don't know what triggers the bad mode yet, but I suspect it's a combination of not exercising enough and eating too many carbs (and therefore having to bolus with more insulin). I'm 47, I do cardio 3-4 times a week and weights once a week. I love food and wine and long walks on the beach. Oh wait, wrong forum. I have also been working with my endo on this, but he doesn't really have any ideas yet. I've tried switching insulin manufacturers, I've tried injecting in different sites and changing my infusion sets. Nada.

Thanks in advance,

-Steve

[Mich]

Hi Steve,

Well, you about summed it up. We all experience this. It comes and goes. For some folks, it is predictible, a daily pattern. For other's it's a complete mysterty as to how and why it happens. Some constants: stress (illness, mental stress, pain) and time of day (the dawn effect). The mystery part is how much our bodies will react to those condidions. We are all different. When I was yoounger, I had a more stable reaction, but as I get older, not so much.

You do very well as a person with diabetes, you pay close attention to your body and its reaction to various condidtions, then try to find patterns so you can deal with it. I feel this is the secret to a long and happy life with our charming and ever-present condition.

Have a good day,

Mich

[poodlebone]

If I'm off my routine and am less active than on a typical day I do find that my BG goes up and it can take more insulin that usually to get it down. Long car rides are bad, if I end up sitting at my desk for several hours without getting up my BG will go up. At work I try to get up every half hour or so and just move around for a minute. If I'm somewhere and can't just get up and move around, like in a car, I just raise my basal or do a correction as soon as I see my BG rising.

[Gordonm]

Yes I run into the same problem. With my job I spend quite a bit of thime in the car. I may ride for 2+ hours and my BG slowly rises as soon as I get out and start moving it drops. Same on an airplane only worse. I try not to eat a lot if I know I'm going to be sedintary for a prolonged period of time and just be ready for the drop when I start moving again.

[rak1978]

Yep, I'm right there with you. Good mode and bad mode.
Lately, mostly bad mode. I think when I'm in "good mode", I relax a little on the carbs which triggers the "bad mode". Then when I'm in "bad mode" I greatly decrease the carbs which triggers the "good mode". Ahhh, so confusing. The solution for me is probably to be consistent (a huge weakness of mine). If you're anything like me, this may be something to work on. Consistent activity, consistent diet, etc... how boring . Plus, being a 1.5, I think there's a level of inconsistency on how much your pancreas can assist.

Good luck! Let me know if you solve the puzzle.

[StAnderStv]

Originally Posted by Mich

We all experience this. It comes and goes. Mich

Thanks, Mich. I'm surprized to hear you say this. My endo looked at me kind of funny when I told him what was going on, like he doesn't see this a lot. Does your response curve stretch way out? My BG overnight goes down linearly over about 8 hours if I can't get out and run (which, by the way, is a bummer for my wife: "Hey hon, it's 2:00 AM, just going for a quick run...") It feels like it's redefining "fast acting" insulin.

-Steve

[StAnderStv]

Originally Posted by rak1978

Yep, I'm right there with you. Good mode and bad mode.
Lately, mostly bad mode. I think when I'm in "good mode", I relax a little on the carbs which triggers the "bad mode". Then when I'm in "bad mode" I greatly decrease the carbs which triggers the "good mode"....

Good luck! Let me know if you solve the puzzle.

Thanks, Rachel. Yeah, that sounds like me. I'm considering going full-on Atkins or something. Do you think it's just carbs or does it feel like there's a non-linearity with your insulin response: that is, do you think high BG itself causes insulin insensitivity or too much insulin that causes it? I haven't been able to back this up, but to me it feels like the latter. It feels like the insulin is there but just not active (since going for a 5-minute run can literally drop my BG 100 mg/dl).

I'll definitely post back if I figure something out. Thanks again.

-Steve

[Subby]

I get a lot of issue in this area. Not to discount your take on it as a very random thing, I went from thinking it was random to realising it is very much tied up with my 24 hour biological rhythms. I have periods I am more insulin resistant,m when I need more basal insulin and when carbs and stress can catapult well out of control with little "push" - and other times when my insulin reacts a lot more consistently and I am less likely to be "reactive".

The complicating factor for years for me, was a) a lack of basal control without a pump, therefore huge systemic problems controlling basal needs even before the other issues might kick in and b) that if I ran into trouble during one of those periods, it can of course leave me high for a long time, blurring my sight as to when is more problematic and when is not. I had an additional complication that taking via needle means very poor absorption, again the pump helped to remove some of the control obstacles to start to see the terrain.

Again, I'm not discounting that there is/can be a big random nature to having these issues, and I don't know if we do or don't share similar dynamics going on. One thing I do not have is the ability to get insulin reaction so quickly, though exercise does help a lot. But thought I'd just jot down a couple of point forms of the trail I've taken to see more sense out of my own BG madness.

- on getting pump, through a form of basal testing (skipping meals, minimal meals etc) separated basal from bolus issues and discovered huge basal control issues with relatively flat basal rates. Also with a rudimentary form of basal testing, discovered exactly how much events and stress like work or driving can cause sharp BG climbs.

- Through experimenting with basal rates, and later moving onto structured basal testing, discovered that I have a very "curvy" basal profile through the day that on the whole repeats near the same time - which tells me that my body has periods of insulin resistance/liver/hormone release that ebb and flow. Find that only 10+ basal rates "ramping up" and "ramping down" help to maintain basal control through the day. Less than that and I'll be either going high or low at one end or other of a basal rate.

- During times of high basal needs, I am more resistant and more prone to reactivity. I react strongly to heat - a shower can raise me 3 mmol/l 60 mg/dl within 30 min during those times, for example. So having located these times, I can at least minimise problematic foods and try and avoid stressful situations as much as possible during them.

- CGMS testing reinforced these basic issues. It pretty much mirrored the basal rates you see below, they were not enough to actually deal with the issues - and if I pushed them further, high insulin during resistant times would pool and crash in at the next non resistant time. I think of resistant times like "hydrophobic" times - build the insulin up, it will still just tend to sit of the surface to eventually break through at a later time. I think my profile of increasing resistance through the day, followed by a sharp dip around 5pm, then another wave, may indicate partly I may have a reoccurring liver release issue, both daily and perhaps in conjunction with stress. I got a prescription for metformin, and I have found that with strategic taking of metformin, my basal highs are very much "capped" and that stress is perhaps half as likely to cause a spiral upwards of BG. Metformin has also seemed to add in a measure more of "give and take", BG control is less like tightrope walking, more like walking a plank.

Just to indicate the kind of picture that emerged for me of my high basal needs/high resistance vs low needs/low resistance through the day, here's a somewhat old graph of my basal rates. The metformin has reduced these peaks and troughs substantially, or softened the degree I need them.

[StAnderStv]

Subby, this is helpful. I'm going to give basal retesting a try. It's also interesting that you're on metformin as well: I haven't heard of that before.

Thanks,

-Steve