Insulin Sensitivity/Resistance

(Krista) #1

I have this weird anxiety that I never really had issues with before. I am pretty good at my diabetes control and recently got a Dexcom G6 which I LOVE. I also work a little bit with some T1D and because of this I’ve started comparing my insulin doses to other people. Which I know and am fully aware is unreasonable and unrealistic. But as I’ve been trying to fine-tune my insulin doses I can’t help but notice that my doses are pretty high (in my opinion). I know I need the amount of insulin my body needs but for some reason it is making me anxious that I feel like I have such high insulin need.

I think maybe it’s because of stress? I’m a graduate student and probably under abnormal amounts of stress. But part of me is fearful that this insulin resistance is bad, not because of the extra insulin I need but because it just seems like I’m abnormal (part of the fear might be the fear of developing more complicated diabetes - like adding extreme insulin resistance into the mix, akin to T2D.) I don’t know if that’s rational or not. Should I be taking measures to combat my insulin resistance? If it is because of stress how the heck can I do that - it’s not like all my responsibilities are going to go away. If you can’t tell I’m also a really anxious person lol.

(joe) #2

@Cereline hi Krista, you sound very convincing, but where’s the disconnect?

insulin resistance isn’t good or bad. it just is. everyone’s a little different here so comparative medicine ends at the discovery we all need insulin. how much depends on a zillion different things.

if your endo is actually concerned, or even if you are concerned, then you can take other meds such as metformin or other T2 medicines (absorbers… not kickers) that help your body make better use of insulin. All medicine comes with complications and adverse reactions, so before you take a new medicine, it had better far outweigh all risks. for T1, since we are already taking insulin, a doctor must weigh when “taking more” insulin is more dangerous than taking another kind of medicine. that’s the only question left to answer.

for me, stress increases my requirement for insulin about 20-50%. exercise and stress reduction, reduces my insulin requirement by up to 60%. I know this by watching it for the last 40 years. I consider myself, on a typical work day, to be slightly insulin resistant… conclusion: So what? =)

by reading your post I can offer 2 bigger things, and please remember I am a mechanic not a doctor. Take Yoga, and get the book “Don’t Sweat the Small Stuff”. and smaller things such as : take walks, ease up on that coffee, make sure you are getting at least 6 SOLID sleep hours. Eliminate people, places, and things in your life that do not actively contribute to your well being.

also (and this is 1000 to 1, against) check in with your endo on that anxiety. There are a few of us that have an endocrine issue with adrenalin, it’s a simple test. If it makes you at ease, I had panic attacks for a year over PTSD and a therapist really helped.

(Krista) #3

Thank you for response. I don’t necessarily think I have any T2 levels of resistance I just have pretty high anxiety based on comparing myself to others. I’m in my 20s and take around 17-18 units in the background and i’m a relatively small person. Pre graduate school it was just a few less. I see other people who “should have” higher resistance taking less and their carb ratios are closer to 15:1, meanwhile I am around 6-8:1 for my meals. Maybe it is lack of exercise for meals…

Ironically, I am in school to be a therapist and have been working with T1 and T2 adolescents for brief therapy interventions at their appoints for reasons like anxiety and depression. So I’m probably just projecting their issues onto myself lol…

I wish I could go to my endo/doc about anxiety but I’m an out of state student and I’m not covered when I’m out of state (mail order pharmacy is how I function lol).

I really appreciate your comment. It probably is just stress and I should work on some stress reduction… I will look into that book! But who the hack can ease up on coffee consumption? lol

(joe) #4

@Cereline hi again Krista, some quick math here (can’t help it, it’s in my genetics) you maybe might not be taking enough basal… this can artificially “increase” your I:C In other words, you are depending on some portion of your meal bolus for background insulin. I have an estimate of your Total at ~40 units per day… by the way this, TDD is so average for adults it’s not worth talking about.

if your bs is good and you don’t see areas for improvement, then follow the First Rule of Medicine: “if what you are doing is working then keep doing it”.

if you skip lunch and your blood sugar rises by dinner… then your basal is off. if you adjust basal upward… you’ll need to adjust mealtime carb ratio number “up” less insulin per gram carb… and your “sensitivity” number will go up as well (less insulin to reduce your bs by xx mg/dl)

if you are really buying books, then please consider “Think like a pancreas” or “Pumping insulin” both explain these numbers and how to test (basal, I:C, sensitivity) and how to adjust. cheers good luck!

(Dennis J. Dacey, PwD) #5

Hi Krista @Cereline, I fully endorse the “words of wisdom” offered by @joe. Most strongly agree with his hypothesis that your basal might need adjusting which can fairly be observed by skipping a meal, or meals, and using your G6 readings to watch for any significant changes. Use your DexCom Clarity to assist you - I’ve found the three different type reports under the “Data Tab” to be extremely helpful.

Clinically defined “Insulin Resistance” is a hybrid condition which spans and complicates at least three of the half dozen medical conditions identified by the common symptom Diabetes Mellites - passing of sweet water - and is neither TypeOne nor Type 2. .

Try not comparing the amount of insulin you use with other PWD - each body is different and each of us have different of the “42 or more other factors” that affect BGL. During my time with diabetes my amounts have ranged between 18 units to 100 units per day [when insulin strengths were U-40 & U-80 [before U-100 became standard] and now sit about 20 units a day while eating 200+ carbs. A few years ago, a survey was conducted among our Medalists Group - 50+ years living with diabetes - to find a consistency in amounts of insulin needed per day. Although we had all used insulin therapy for between 50 and 80 years, the amount of insulin used by each covered a wide range - no particular pattern.

(Krista) #6

I want to say thank you to you both for your kind words and support. I strongly think my anxiety was/is causing me to just latch on to any little thing that I can fret about right now but your efforts of clarification and support really help/helped!

It is funny that you mention that my basal is probably low compared to my I:C ratio because I have definitely have had moments where I thought that same thing - although oddly my anxiety is more around my basal rates being “too much” in comparison to other people of my body size, age, and weight. I’ve heard in the past they are typically close to 50/50.

I never thought about my high “sensitivity” number could be because of a lack of background insulin but that makes sense when I think about it!

I’m hesitant, of course, to adjust my rates to be more balanced between bolus and basal ONLY because, as you mentioned, if it works don’t mess with it. My A1C is good so I don’t want to screw it up lol

In any case, I appreciate all the encouragement. I’m in a hard and stressful time right now and it’s easy to get very, very caught up in my anxiety and emotions and being around SO MUCH diabetes related stuff just brought my personal management even more to my attention than it normally is.

I’m so thankful for the T1D community. : )

(joe) #7

hi @Cereline Krista, - you might be done with this conversation so sorry if I am bothering you but I have just one more thought

basal rates are undeniable. you fast, and if your blood sugar goes down… basal is too high, if it goes up… basal is too low. It’s important to know that all of the other pump setting are incorrect if your basal is off, so I always urge people to get that basal correct before anything else, and to tune it once in a while. this isn’t about a hackneyed 50/50 “rule” it’s about getting that basal to do what you need.

it’s also a perfect use for a cgm.

I have had to fast for several reasons, one of which was surgery… nothing better than when your basal is correct and you can sit all day (albeit hungry) at 90-100 and bs isn’t moving. my longest fast was 3 days, you probably won’t have to do something like this 'till you hit 50 and they want to shove a camera in… oh you’ll find out.

anyway… easy test. all you do is skip a meal and watch. cheers and good luck!