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



Melissa
It might be worth factoring in that the crudeness of two injections a day. I
always thought here was a chicken and egg factor that the knock on effect of
the day before meant that the next day still carried fallout. The team would
only allow us increase by a unit a day so MDI might have responded very
differently.
I have learnt more about insulin resistance than I knew existed!
Many thanks
Mir
----- Original Message -----
From: "Melissa P. Ford" <email @ redacted>
To: <email @ redacted>
Sent: 05 January 2005 15:29
Subject: 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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