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RE: [IPk] Re: Insulin resistance ? and my new Cozmo pump!!



Hi Nanette,

YEA, glad your new pump is making you smile :) !

I understand high bgs contributing to insulin resistance _in the short-term_ 
--if my bg goes up to something like 15, which does not happen often, I 
might need more insulin per 2 mmol/L to take it down to 5 than I would need 
to reduce it from 10 to 5. One unit per 2 mmol/L is my usual correction 
factor but if I'm quite high I might need more than that. More often, 
though, I find that the insulin resistance caused by a quite high bg makes 
it take up to 90 minutes for my bg to start shifting at all, but eventually 
the dose takes me down to where I should be; it just takes longer.

My hazy recollection of why this happens is that insulin works to suppress 
glycogen output from the liver and if you haven't got enough insulin both to 
cover carbs/acute hormone releases [stress] _and_ suppress the liver (that's 
what basal insulin is for), extra glycogen gets dumped from the liver. Then 
it takes time for the correction dose to do the dual job of speeding blood 
glucose into cells where it should be _and_ to reach the liver and tell it 
to stop pouring out glycogen already. Once everything settles down, Lesley 
shouldn't see a big gap between giving a bolus and her bg changing as her 
Dia-Port is putting the insulin very near to where it goes in a non-diabetic 
individual, but the rest of us are getting it rather backward by giving 
insulin through the skin so it has to work through lots of tissue to get 
where it wants to go. It's the best we can do, but it's not physiological.

I'm not quite grasping why the high-bg insulin-resistance effect would 
continue for up to 48 hours as Mir said she's seeing with Grace. I have only 
heard of insulin-resistance at high bgs as a short-term/sorted within 5 
hours or correction bolus kind of thing. But I am willing to believe it 
happens on a longer-term basis and to ask a diabetologist about it!!! Will 
report back if/when I get a good answer :> .

Thanks,

Melissa
Type 1 11+ years; MiniMed pumper 7.5 years; Animas pumper 1 year; flipping 
through my mental Rolodex of diabetologists.... ;->


----Original Message Follows----
From: Nanette Chana Freedman <email @ redacted>
Reply-To: email @ redacted
To: email @ redacted
Subject: [IPk] Re: Insulin resistance ? and my new Cozmo pump!!
Date: Wed, 5 Jan 2005 14:37:37 +0000 (GMT)
Melissa,

It is my experience, and something that I am also sure that I have read
somewhere, that type 1 diabetics commonly become more insulin resistant
at higher BG. In my case, the greater insulin sensitivity at lower BG's
is very striking, and quite sensitive to exact BG level. But many many
people find that they need more insulin to reduce BG from say 20 to 15
than from 12 to 7. One of the reasons, which has been discussed
previously on this list, is that at high BG, a lot of glucose is being
spilled out into the urine, and the insulin has to be sufficient to
take care of whatever is causing all that additional glucose that is
not measured in the blood. However a second reason is increased insulin
resistance at high BG. I wish I knew the mechanism, but can't remember
it - if you find out, please let me know.

Nanette (happy to have received my new Cozmo pump today - it has so
many menus and options it feels like a wonderful new toy, with lots of
flexibility - mush more than my old, and much beloved Disetronic
H-plus, which has reached the end of its days - I never thought I would
be so happy about a new insulin pump.)

 >I would have thought that becoming insulin resistant (whether from
 >growth/stress/sex hormones, or weight gain) would lead to higher bgs
rather
 >than higher bgs leading to insulin resistance. Can someone describe a
 >mechanism for high bgs causing insulin resistance in type 1 rather
than
 >insulin resistance or insufficiency causing high bgs in type 1?

 >I learn something new every day!

Melissa





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