10-06-2011 05:58 PM
Okay so from everything that I've been reading Fasting Insulin Levels or (FILs) are supposed to be:
<10 good. little to no insulin resistance
10-13 is mild insulin resistance
>13 is moderate to severe insulin resistance
I just got my blood work back... *DUN DUN DUUUNNNN*
According to my lab results anything <17 is ok. Although the article I read off the PCOS website that I frequent says that anything above 8.8 is BAD. Even a reading of 9.3 increases cardio vascular problems eight-fold! So okay... a third source says that anything <30 is workable.
My FILs came back at 83!!!!!!!!
WHAT DOES THIS MEAN!?!?!?!?
It can't be that I am giving myself too much insulin or I'd be constantly going low. I can barely get my sugars down to the lower 200s on a GOOD day!
My other question..... I did my blood work fasting. They said I only needed to be fasting for 8 hours minimum. I was fasting at least 11 hours for certain because I went to bed at 9:00pm and my appointment wasn't until 9:30am and they didn't do the blood work until 10:00am.
Can taking my Levemir at dinner have really made that much of a difference? Can it make any difference? Would it have been enough to make my FILs go that high? My FBG was sitting at 213 that morning so I wasn't low and I sure as hell had insulin in my body.
I take my Levemir 2x a day and I usually take my night time dose between 6:00-7:00pm. That's when I eat dinner and take my Humalog and then I may even snack after dinner (most days).
WHAT IS GOING ON!?!?!?
10-06-2011 09:59 PM - edited 10-06-2011 10:00 PM
Phew, you've got some tough issues, but hopefully, we can give you some ideas to talk to your doctor about.
The first thing you should know is that, according to labtestsonline.org, the insulin test ought to be understood in conjunction with a fasting blood glucose test. The entry on insulin: the test reads as follows:
Insulin levels must be evaluated in context.
|Disorder||fasting insulin level||fasting glucose level|
|Insulin resistance||↑↑||normal or ↑|
|Not enough insulin produced by the beta cells (as seen in diabetes, pancreatitis, for example)||↓↓||↑↑|
|Hypoglycemia due to excess insulin (may be seen in insulinomas, Cushings, excess administration of exogenous insulin, etc.)||normal or ↑↑||↓↓|
|↑ = somewhat increased; ↑↑ = greatly increased; ↓↓ = greatly decreased|
Elevated insulin levels are seen with:
Decreased insulin levels are seen with:
So, the first thing you ought to know is that having elevated FIS is not enough to say there is a problem. Talk with your doctor about what s/he thinks the conjunction of your high FIS level and the fasting bg that was measured at the same time means. If you've been taking corticosteroids, levodopa, or oral contraceptives, let him/her know so that can also be taken into consideration. Perhaps something you took for another problem has interfered with the test result.
Can insulin interfere with the insulin fasting levels test? Well, from what I read on labtestsonline.org, the answer isn't entirely clear. The passage reads:
Insulin assays are designed to measure endogenous human insulin. However, different assays react variably with exogenous (animal or synthetic) insulin. If someone is receiving insulin, these effects should be clarified with the testing laboratory. If several or periodic insulin assays will be performed, they should be analyzed by the same laboratory to ensure consistency.
Essentially, what that means is that while the test is meant to measure the insulin you produce, different ways different labs run the test can cause the results show the impact of your injected insulin and the lab needs to clarify what technique(s) were used and whether or not the technique took into account your use of injected insulin. Also, they need to be specific about the type of technique used so other labs which may do the same test can conduct the test in the same way, so results can be accurately compared.
Is there a specific reason for you having the fasting insulin test? It's not exactly a common test to be run, even for people with diabetes. If it was run to help determine the type of diabetes you have, it might be better if you had a GAD test or insulin antibody tests run, since high levels of insulin antibodies and/or a high GAD level is more closely associated with type 1 diabetes. If your doctor wants to know how much insulin you're producing to see if there are any viable alternative treatments, a c-peptide test is an alternative (and indirect) test of your internally produced insulin that is not affected by your injected insulin.
If, after talking with your doctor, you and s/he find yourselves without the answers to your questions with the results you currently have, you may want to discuss some other alternatives. I hope you find the answers you're looking for!
10-06-2011 11:47 PM
Ditto On what Anglea Said..
As for this is more of a Immediate concern to me at least..? > I can barely get my sugars down to the lower 200s on a GOOD day
That I would be focusing on That Immediately .. Could care less if I was Insulin Resistant or Not or much anything else for that matter
Just Want to (a) Get those BG's Down under ave 140's 1st , 120's 2nd and 100 3rd priorities..And if it take s100 U's TDD day? So be It..
Starting out with
#1- Get the Bible> Think Like a Pancrease to establish the basics
#2- For my LLI ( Long Lasting Insulin) , of using Levimire? I take it to First Keep my BG's Down Over Nite..Strive to Go to Bed with btwn 90-120 and get up in the Same range..
Take enough to get that Job Done 1st..
If I am above 120 by Bedtime? I then have to Pay the Price for Not Taking the right Dose for My Dinner....And I don't eat any snacks 2 hrs before Bedtime..Unless I have too ..For a hypo or whatever other Reason..
A. Take a CB ( Correction Bolus )
B. And Unless I am Certain that will get the job done? Set my Alarm, test in 3 hrs later ..and be ready to take another CB. Takes all of about 2 Min. after waking up..roll over to the nitt table, test, and I have a Small Index Card printed out for what my CB is and how many u's to take per That Chart..
Eg: If 150-90 Treat the bal = 60 pts..
That is, if you know what your SF/CBF is.. If it's a factor of 1-20? Then if 60 pts over = take 3 units..
Overnite is 1/3rd of your 25 hr day for your BG's and Its really Important to get up Being " In Range" , otherwise you can spend the next several Hours or even until Lunch getting things back under control..
That is what I would focus On 1st.. Getting those Overnite and AM Readings In Range..( 80-120)
The rest of the Day sounds like your I:CR ( Insulin-to-carb Ratio) is Not Right..
That is Assuming your Testing Enough> Like A Minimum of 3 hrs after eating..Seeing as Novalog Normally Peaks out In 2.5-3.5 hrs and I think we should be "In Range" after 2 hrs..and surely with -in 3 hrs..
Max 150's at 1 hr after eating, 120's after 2 hrs and 80-90's after 3 hrs..and until Next Feeding Time ..
Then you can Focus on Doing your Basal Testing For Covering things InBtwn Meals during the day thru till bedtime..
By taking your LLI at Bedtime ? You can Fast an easy 12 hrs and test to see if it's "Still Working" effectively..
-You go to bed with a 120, get up with a 120-150 max and by the 12th hour your still 120? It's Still working.. If it's +150? Red Flag time..
-Eat Some "0" Carb Stuff and Diet Drink and go for 16 hrs and see where it's at by then..
-Odds are? It isn't lasting more than 12 hrs effectively..and surly Not 16 hrs..
Some days? I wont take a 2nd Shot of Levemire at Lunch .. I'd just Test Every 2 & 3 hrs , take a CB and stay in the 90-110's the rest of the day..
I even Did a Test Not Taking Levemire at Bedtime, just Novalog, every 3 hrs. and had Great BG's Overnite and when I got up..!
So when that Levemire Isn't Getting the Job Done in the AM's? The Heck with it, and it will happen.. about every 3-6 wks it goes haywire.. I just use Novalog..
Probably has something to do with My Liver or some other thing going on..
How much Testing? I ave 10x a day if things are going well
More if they aren't..
It's the only way I've figured out How to Keep my Bg's Under Some kind of Decent Control and get those 6% A1c's
I know, if I could Get a Pump? I would get better BG's..
These LLI's are not called the Poor Mans Pump for nothing.. They are Not As Consistant and Dependable as they claim
B ut then again, Imagine if they admitted this and Required Every T1 to Be on a $8,000 Pump? and Another $couple of Hundred a Month for Infusion Sets? as they should be?
and having to Replace them every 2-4 yrs with another , then another, etc..
Then Add a $3,000 CGM and their Supplies? Every couple of Yrs?
Sorry, I just got back from meeting another New Endo , thru Medicare and Said the same thing.. " You Don't Need a Pump, Your Doing Fine & Pumps Are for those having alot of Problems..."
Yeah right , Like Being a Human Pin Cushion, injecting 8-10x a Day is alot of fun..
I'd rather be a Junkie and at least feel good from it..
I told Her , Thanks , but you best Stick to Treating Your T2's With Pills and Diets..and Not T1's and go save $ for Medicare with Someone else, thank you..
and I walked out of her office..
I Clarified That was the reason I was Seeing this Endo.. To Get On a Insulin Pump.. when I made the app't and Asked her Receptionist to verify that..Otherwise Lets not wasit The Dr.'s and My Time ..
Sounds like your Endo Is just as Incompetent..
10-08-2011 04:45 PM
I'm not sure why he gave me the Fasting Insulin test. I have been a T1 since 2008, so there's really no going back to figure out what's wrong there.
I had the GAD test back in 2007. It came back "Strongly Positive." The range for my labs was 0.0-1.45. My result was 49.02. It only took a year from then for my beta cells to call it quits and I was put on insulin 100% of the time then.
My doctors keep getting angry telling me I'm not doing something right. I've been trying to tell them for years that it didn't seem like the insulin was working properly. I've tracked everything for them. My eating habits and everything. I have a very bad appetite and it goes beyond my body telling me to eat something. I will literally be in physical pain and continue eating for no reason. I'll sit there and cry while stuffing more food down my throat. I get so depressed because I never feel full.
I want to get on the pump, but because of my IR and my insulin needs, I can't. It can't provide enough insulin to get my numbers in a good range. I asked both my Endo and Reproductive Endo to put me on Metformin. My regular Endo is a jerk and I'm looking for someone new. My Repro Endo is running a few more tests and then said they may try me on Metformin. They are still trying to figure out if I have PCOS for sure. Nobody I've found really deals with T1's with PCOS or IR so it's really frustrating.
10-08-2011 09:23 PM
I have to be honest. If your FBG is still 250-300 mg/dl and your doctors are not working with you directly, talking with you every week at least, then you need to fire their *ss.
The fasting insulin levels can be used to determine insulin resistance "if" you have high fasting blood sugar. if this is your case, metformin is a quite reasonable option.
But in either case, I think it is irresponsible that any doctor would not work directly with you to normalize your blood sugar. You should be aggressively correcting to bring your blood sugars down and adjusting your basal insulin as needed. If you are actually severely insulin resistant, then 20 units/2x/day may be woefully inadequate. And being at such high blood sugars makes you even more insulin resistant.
You need to be your biggest advocate. If your doctors won't treat your properly you need to speak up.
10-09-2011 11:00 AM
So I just went through some of your previous posts and it does seem clear to me that you are struggling with making the right decisions about your own care. Your head is not in the right place, you are depressed and frustrated and you a really struggling.
Doctors help us, but ultimately the vast majority of decisions about our diabetes care, we make ourselves. We decide what to eat, we decide what our insulin doses should be and we decide our exercise. After that, doctors are simply our advisors and gatekeepers. Might metformin help you? Perhaps, but it won't suddenly make you strictly adhere to your diet. It won't make sure you take insulin at the right doses. And metformin is not going to fix this.
You need to work on your whole attitude towards your care. You cannot skip insulin or take wrong doses. You need to be mindful about eating. I think it would really help you to work directly with someone. There is someone local to me (in the DC area) that works with people in these things, (DiabetesTherapy). You can ask her for referral to someone in your area.
Taking care of our diabetes is hard, we all know that. Getting control involves walking a narrow path. You have been knowingly making decisions that take you off the path of proper blood sugar control and health care. You know this in your heart. We want you to be around for many years and we really want to help you to make changes. In the end, getting your head on straight is going to be at the center of these changes. Please work on that.
10-09-2011 02:35 PM - edited 10-09-2011 02:40 PM
I have to agree with what BSC wrote.
Also, as I've mentioned to other folks new to the forum and or Type 1 DM, it is very helpful to keep everything in one thread - when each thread is about the same thing, and or is a very recent update. That way, we get to see the whole entire picture. It is also helpful for other folks chiming in, that may not have seen your other threads. It is far too confusing to those, that do not read the forums each and every day, and to those that don't read each thread.
Do see about getting some outside help for this. BSC has provided a link, that will help you find someone in your area. If I recall correctly, in one of your other threads, I put the link to the ADA page that can also be of help - by just typing in your zip code. Angela provided information from labtestsonline.org, just above in her post to you. You may want to copy that off, and hand it to your physician(s).
Please don't be upset, and do see that we all are trying to help you. That help, also includes that which you may or may not, want to hear or read.
Trisha - edited while proofing, to add one additional sentence.
10-10-2011 12:32 AM
I have a very bad appetite and it goes beyond my body telling me to eat something. I will literally be in physical pain and continue eating for no reason. I'll sit there and cry while stuffing more food down my throat. I get so depressed because I never feel full.
I am sorry to hear you are having such difficulties. I read through your posts in other threads to get to know you a bit better. i understand you're seeing multiple doctors, that you're having a hard time getting your doctors to believe you, that you are trying very hard to eat in a way should lower your blood glucose and reduce the insulin resistance you appear to be experiencing. I hope the information we're providing to you is helping you.
I want to make one thing clear: Depression, Eating Disorders, and diabetes go hand-in-hand. That you are having these problems is not your fault! People with diabetes are at least 4 times more likely to experience depression than people without diabetes. People with type 2 diabetes are more likely to have experienced compulsive overeating than people without diabetes. When your diabetes is not well-managed, you are more likely to experience depression. The diabetes, eating disorder, and depression can feed off of one another and as a result, make one another worse. I encourage you to ask your doctor for a referral to see a psychologist, ideally one who specializes in depression and/or eating disorders and who has had experience with people with diabetes. That way, you can get the treatment you need for these problems, which will also help your diabetes health.
I know you've heard about Symlin; Symlin can help blunt your appetite, possibly help you lose weight, and perhaps reduce your insulin resistance. If I were you, I'd talk to my doctor about Symlin, as well as metformin. I'd want to know as many possible options as was feasible and then evaluate them before starting one or more of them. You can work with your health care team and you can start managing this condition. It will get better!
10-10-2011 08:10 AM
I was already refered to a psychiatrist. It's taken me a while to get in to see her. My appt. is October 18th. Before that though, I was seeing a psychiatrist for over 3 years for my depression and eating problems. He was the only one who ever really tried to help me. I used to be on Celexa. We tried 4 other drugs before that and nothing worked. I was on Celexa for almost 2 years. I just recently switch to Cymbalta to help with my neuropathy during the day. It was horrible. It made me more depressed and suicidal. So I went back to Celexa about a week ago. I've noticed a small change but the depression is still there.
I have talked to my Endo about Symlin. He outright said he wouldn't consider giving it to me right now. Just like he said he wouldn't put me on a pump for a while. I get that we need to keep adjusting before I can go on a pump, but the OmniPod rep I've been talking to said my body requires way more daily insulin than the pump can provide.
When I brought my test results from my Reproductive Endo to him, he shrugged it off. He said my number would be high because I take insulin. I'm not an idiot. A number that high, highly indicates insulin resistance. It's not like I injected myself with tons of insulin before the blood was taken. And even if I had, I would've crashed big time with that much insulin in my body.
I saw my Reproductive Endo also on Friday and he is considering putting me on Metformin. They ran a few more blood tests and I go back for the results on October 17th. They want to see if they can give me an official PCOS diagnosis so that they can say that is what is causing my IR.
10-11-2011 08:34 AM - edited 10-11-2011 08:35 AM
There are lots of good psychiatrists, but these days most of them have given up on psychotherapy and just prescribe drugs. You don't want someone to just give you another pill. And unfortunately., that may be all you get from a psyciatrist. That is not going to help you. You really need to see a therapist who can talk with you and lead you through dealing with these issues. You want a psychologist or someone trained in psychology (MA or MS in the field, LCSW, MSC, etc). I might even suggest a particular type of therapy that would be helpful, "cognitive therapy." Cognitive therapy "seeks to help the patient overcome difficulties by identifying and changing dysfunctional thinking, behavior, and emotional responses." Many therapists actually will advertise that the provide cognitive therapy.
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