Insulin Not Working? Other Available Options for Regulating Blood Sugar Levels

If you’re using insulin to manage your diabetes and still experience adverse changes in your blood sugar levels then it could be a sign that it may not be working. If your blood sugar levels remain high despite taking insulin, this could lead to a serious health concern.

Fortunately, there are other ways to help manage your condition such as following practical steps to control your diabetes, healthy lifestyle habits, and alternative diabetes medicines.

Why is my blood sugar not going down with insulin?

There are a number of factors that could prevent insulin from working effectively. The most obvious of these is not taking enough insulin, or perhaps taking it in a way that stops it from bringing blood sugar levels down to the desired level, for example you could be taking it at the wrong time.

Another reason could be that you are not following your recommended diet and exercise plan to manage your weight accordingly. There may also be an underlying medical issue that is stopping any reduction in blood sugar levels.

All these possible reasons should be considered before opting for alternative medication.

Insulin resistance

If your insulin has stopped working, you may have developed insulin resistance over time. A condition that causes the body’s cells to build up a tolerance to insulin, making it less effective so that it can no longer regulate blood sugar levels sufficiently.

To combat this condition, your doctor or healthcare professional may advise you to make changes to your insulin routine, or they may prescribe additional medication to reduce the resistance.

How to make sure you're getting enough insulin

If your insulin is not working as expected you should check that you are taking the correct dose before considering any adjustments. Not taking enough insulin is a common and concerning issue.

Check your blood sugar levels regularly

Checking your blood sugar levels on a regular basis is essential to understanding how your body reacts to insulin doses, medication, food choices, and any changes to your general lifestyle.

Sometimes, if an individual feels ok and is content that their diabetes is being managed then this can lead to them becoming complacent in terms of checking their blood sugar levels. This can possibly result in issues if their body builds up resistance or they make sudden lifestyle changes. This is why, even if you feel fine, you should continue checking if your blood sugar levels are within a normal range.

You could devise a routine for blood sugar testing. A good strategy to go about this is choosing a glucose meter that suits your needs, ensuring it is always on hand, and setting notifications to remind you every day.

Set alarms so you don’t miss a dose

Anyone with type 2 diabetes should not run the risk of missing their dose of basal or bolus insulin, as this could result in a sudden rise in your blood sugar levels. However, sometimes life can get in the way, whether it is a busy day at work or getting stuck in traffic. As well as setting reminders on your phone, you could also leave notes around the house, e.g. on the refrigerator, or ask a family member to remind you when possible.

Alternate the injection site

If you regularly inject insulin into the same site on your body then this can result in the formation of fatty lumps of tissue on the skin’s surface. This can not only affect the visual appearance of the injection site, but it can also impact how much insulin can be absorbed into the same spot.

Injecting into this fatty area means your body is not receiving a consistent amount of insulin as the absorption rate may differ each time. This can impact the regulation of your blood sugar levels, with a lack of absorption resulting in an increase in blood sugar levels, and a faster rate of absorption leading to low blood sugar levels.

You should make sure to alternate the injection site regularly, choosing parts of the body where there is a layer of fat, such as the stomach, upper arm, thigh, or buttocks.

Check your injection technique

Your injection technique can also affect how much insulin is absorbed, with a surprising amount of people getting this vital task wrong.

Some of the common mistakes include:

• Using a needle that is too long: If you use a needle that exceeds 4mm in length then it is possible that the insulin will be injected into the muscle rather than the subcutaneous layer (the fatty layer beneath the skin). This can result in the insulin being absorbed too quickly.
• Not pinching/folding the skin: Children and people who are particularly slim generally need to inject the insulin into a pinched piece of skin. This ensures the skin is folded and the insulin is injected into the fatty layer and not the muscle.
• Withdrawing the needle too fast: Withdrawing the needle too quickly could risk only part of the insulin dose being injected, meaning you will not benefit from its effects. Always ensure to hold the needle in the skin for at least ten seconds after the dose has been administered.
• The insulin has not been mixed correctly: Some insulins like Neutral Protamine Hagedorn (NPH) or pre-mixed combinations (like Insulin Aspart Mix 70/30) are supposed to appear cloudy. To make sure the insulin is sufficiently mixed, you should gently roll the vial back and forth before injecting it.
• Test the pen needle: Always check that the pen needle is working correctly by dialing two units on the dose button while holding the pen needle in an upright position. Then, press the dose button and check if you can see that insulin has been secreted from the needle tip.
• Reusing syringes/pen needles: A syringe or pen needle should only be used once. This is because the needle will likely be damaged after a single use and will not be able to effectively deliver insulin if used again. Reused needles can also contribute to the buildup of fatty lumps under the skin, known as lipohypertrophy.

Check for issues with insulin pumps

Always check to make sure your insulin pump is working as it should, three issues that could stop the pump from working effectively are:

• A blockage/occlusion: An occlusion or blockage prevents your pump from delivering insulin. This can occur if the cannula (needle) is bent when inserted, or if there is a kink or buildup of pressure in the pump’s internal tubing. The formation of crystals within the solution can also cause a blockage. Most pumps will sound an alarm if there is a blockage.
  
• Air bubbles in the insulin pump: Air bubbles can form if there is a loose connection in the pump’s internal tubing or if the pump has not been primed correctly. To avoid air bubbles you should remove any air from the pump’s reservoir and tubing when refilling it or inserting a new cartridge/infusion set. You should also try to use insulin that is fresh out of the fridge as air bubbles can form when the solution reaches room temperature.
  
• Loose infusion sites: Another common issue is the infusion site becoming loose, usually happening when sweat is present which can make it difficult to insert the cannula/needle. This means the site is too loose and the needle cannot get enough purchase. If this happens, you should try a different infusion site.

Ensure there are no issues with your insulin

There are other insulin-related issues that may have been overlooked, such as the insulin exceeding its expiry date which will make it ineffective.

Insulin can also be affected by temperature and shouldn’t be stored in a refrigerator that is too cold or be left in direct sunlight. When on the move in hotter weather, you should keep insulin in a cool bag or a specially-made cooling wallet. Do not use insulin that has changed from its original appearance (like discoloration or clumping).

Talk to your doctor about other medications you are taking

In some cases, additional medications that you may be taking could impact the efficacy of your insulin. Therefore, if you are taking multiple medications you should speak with your doctor about their effects, and whether this could be stopping your insulin from working. Some common over-the-counter drugs, such as cough and cold medicine could cause an issue.

Medications that could impact your blood sugar levels include:

• Steroids/Corticosteroids: These are used to treat inflammatory diseases and conditions (e.g. arthritis).
• Birth Control Pills: e.g. ethinylestradiol and norethindrone.
• Decongestant Medicine: Such as flu and cold medicines or cough syrups.
• Anxiety and Depression Medications: Used to reduce anxiety, depression, ADHD, and other mental health conditions. (e.g. clozapine and olanzapine).
• Medication for high blood pressure: These drugs help to regulate blood pressure (e.g. beta-blockers and diuretics).
• Statins: Used to reduce cholesterol levels (e.g atorvastatin (Lipitor) and fluvastatin (Lescol).
• Adrenaline: Used to treat severe allergic reactions.
• Anti-acne medication: e.g. isotretinoin (Accutane).
• Anti-rejection drugs: Reduce reactions by weakening the immune system (e.g tacrolimus)
• HIV/Hepatitis C medication
• Niacin: Vitamin B3

Speak to a medical professional about your insulin dose-to-carb ratio

Insulin allows a person with diabetes to process the glucose produced from the carbohydrates in food, thus providing the person with energy. As insulin regulates the levels of glucose in the blood, it is essential to match the amount of insulin you take with the amount of carbohydrates you eat.

To ensure you are maintaining the correct balance, you should speak with your doctor or care provider to devise a personal plan to work out your ideal insulin-to-carb ratio.

What could happen if your blood sugar won't go down with insulin

When your blood sugar levels are consistently higher than expected and your body is not responding to insulin, it could lead to some serious complications and put your overall health at risk. Below are some of the potential issues that may develop if your blood sugar is not regulated.

Long-term complications

Continued high blood pressure could result in long-term conditions such as heart disease, kidney disease, nerve damage, vision impairment, foot ulcers, or it could even result in a stroke.

Complications associated with these conditions can include:

• An inability to heal properly: Continued high blood pressure could result in the poor healing of wounds, including an inability to fight off infections. This means it can take much longer to heal from cuts and sores or heal from the incisions made during an operation. This also increases the chances of infection and gangrene.
  
• Eye problems: Having high blood sugar for a long period of time can also cause damage to the blood vessels in the eyes. One consequence of this is diabetic retinopathy, and in some severe cases, it could lead to a loss of vision or blindness.
  
• Infections: High blood sugar levels can weaken the immune system, making you more susceptible to infections, particularly urinary tract infections and skin infections.
  
• Kidney damage: Diabetes that’s not regulated could lead to developing kidney disease (diabetic nephropathy) which, in turn, could cause kidney failure if left untreated.
  
• Nerve damage: Unregulated diabetes can lead to diabetic neuropathy (nerve damage) which can have symptoms such as pain, numbness, and a tingling sensation in the hands, feet, arms, and legs. Nerve damage can also impact coordination and sensory function.

Life-threatening complications

Long-term complications can sometimes turn into life-threatening situations if they are not medically treated.

These could include:

• Heart and vascular problems: If left uncontrolled, diabetes can increase the risk of heart disease and other vascular issues. It can also lead to high blood pressure and the narrowing of the arteries (atherosclerosis) which can eventually lead to a heart attack or stroke.
  
• Diabetic Ketoacidosis (DKA): DKA is the result of high blood sugar levels and low insulin levels. It is more common among people who have type 1 diabetes, but can also affect people with type 2 diabetes. This life-threatening condition can result in the buildup of ketones and can make your blood become acidic.
  
• Hyperosmolar Hyperglycemic State (HHS): HHS is more prevalent among people with type 2 diabetes and leads to severe dehydration and changes to a person’s mental condition.

Oral medicines that can manage diabetes

Should your insulin stop working the way it should, the most common solution would be to visit your doctor who can then prescribe oral medication to help manage your diabetes.

Oral medications could include the following:

• Metformin: Metformin is recommended by the American Diabetes Association for people with type 2 diabetes. However, metformin may not be effective for everyone, and in such cases, alternative treatment options should be considered.
  
• Glucagon-Like Peptide 1 (GLP-1) Receptor Agonists: Oral Semaglutide (Rybelsus) stimulates GLP-1 receptors in a person’s pancreas, increasing the amount of insulin they produce, while also inhibiting the production of glucagon.
  
• Sodium-Glucose Cotransporter 2 (SGLT2) Inhibitors: A medication that increases the urinary excretion of glucose and reduces the concentration of plasma glucose.
  
• Dipeptidyl Peptidase-4 (DPP-4) Inhibitors: Prolongs the presence of endogenous GLP-1 and glucose insulinotropic polypeptide by stopping them from breaking down. This inhibits the release of glucagon, increases the secretion of insulin, delays the emptying of gastric contents, and decreases levels of blood glucose.
  
• Pramlintide: A synthetic version of amylin which is the neuroendocrine hormone that is produced alongside insulin by the pancreatic β-cells.
  
• Thiazolidinediones (TZDs): Increases insulin-dependent glucose disposal and inhibits hepatic glucose production to better regulate a person’s insulin sensitivity.

Consider participating in a clinical trial

Another avenue you could go down if insulin is no longer working is to participate in a diabetes clinical trial. Modern clinical trials and studies offer access to brand new treatments and medication, while also developing a personalized care strategy for each participant. This means a person may have access to a much higher level of medical care than the general public.

As well as having access to new treatments and therapies that may better manage your diabetes, you will also play a significant role in advancing scientific research, potentially helping to improve the lives of millions of people around the world.

Clinical trials are highly regulated to ensure that they are safe for all individuals, with each phase meticulously designed to determine how effective and safe each treatment is.

How to find a clinical trial to suit your needs

The best way to find a clinical trial that you may be eligible for is to discuss the possibility with your doctor or healthcare provider. Alternatively, you could search online at various clinical trial databases, like ClinicalTrials.gov, or dedicated clinical study websites.

Clinical trials are completely voluntary and it is possible to withdraw at any stage. This gives participants a level of flexibility to try new treatments and medication to better manage their diabetes, without any unwanted pressure.

Lifestyle changes that can regulate your diabetes

There are a number of lifestyle changes that you can make to try and improve the efficacy of insulin and control your blood sugar levels.

Improve your diet

Anyone who has diabetes needs to focus on having a balanced diet that is represented by all the major food groups. This means that every meal should have an adequate mixture of carbohydrates, proteins, and healthy fats. For example, you can get carbohydrates from grains, vegetables, and fruit, proteins from lean meat, and healthy fats from nuts and seeds.

Anyone with diabetes should limit or avoid food that contains a lot of sugar like soda, candy, chocolate, and fruit juice that is not sugar-free.

Many insulins need to be balanced with a consistent amount of carbohydrates. Therefore, it is recommended to limit processed carbs like fries and bread, and eat more fresh, unprocessed vegetables to better manage your diet and carbohydrate intake.

You should also try to avoid eating too much, as eating excessively large portions can increase blood sugar levels. It could be a good idea to purchase weighing scales to accurately measure your portion sizes.

Eat regular meals

It is good practice to try to eat meals at the same time each day to more effectively manage blood sugar levels and work alongside your routine for taking insulin. If you feel hungry during the day and feel the urge to snack then try to stick to healthy options like nuts, fruit, or yogurt.

Stay hydrated

Always drink lots of water throughout the day to stay healthy and better manage your blood sugar. If you are in the mood for something a little more exciting than water then consider a low-calorie, low-sugar fruit juice or herbal tea instead of a soda.

Monitor the weather

If your body temperature changes suddenly, it can impact how well your insulin works. This is why you should always pay attention to the weather forecast to make sure you are properly prepared, as both extremely cold weather and hot weather can affect insulin’s effectiveness.

Have consistent exercise levels

Regular exercise is highly recommended to manage your diabetes and improve overall health, however, it is important to follow a routine. Furthermore, if you exercise frequently, you may also need to eat more carbohydrates so it is crucial that your insulin doses correspond.

It should also be noted that competitive sports and high-intensity exercise can also affect your blood sugar levels due to the way these activities have an effect on other hormones in the body.

Manage your stress

Stress hormones (such as adrenaline and cortisol) impact the body in many ways, triggering the body’s ‘fight or flight’ responses. If your stress levels are left unmanaged then this could keep your blood sugar levels abnormally high, increasing the chances of diabetes-related complications.

Effective stress management strategies throughout the day include pilates, yoga, meditation, and breathing exercises. Simple measures such as relaxing with a book or socializing with friends are also proven to bring down stress levels. You should also ensure that you are getting a good amount of uninterrupted rest each night.

If you are experiencing issues with stress and are finding it difficult to manage then you should speak to a medical professional at the earliest opportunity.

Try alternative therapies

Exploring alternative therapies like acupuncture, herbal remedies, or mindfulness techniques can be beneficial for some people who have diabetes. However, you should always speak with your care provider before considering new treatments as they may have an impact on your existing treatment.

Quit smoking

Smoking increases the risk of developing type 2 diabetes and can also make the condition harder to manage, especially when it comes to determining the correct dose of insulin. Anyone with diabetes should seriously consider stopping smoking, not only to better manage their diabetes but to also improve their overall health and avoid serious diseases.

Lose weight

Weight management is important for anyone who has diabetes, especially if their insulin is not working as expected. This is even more important for people who have type 2 diabetes as maintaining a healthy weight can improve insulin sensitivity, reduce blood sugar levels, and avoid long-term complications that could be linked to diabetes.

If you are considered to be overweight, then setting a target to lose between 10-15 pounds is a realistic goal that can make a big difference.

Allow yourself to recover from short-term illness

When you are ill, your body may release hormones that increase your blood sugar (and in turn, increase the amount of insulin needed). Therefore, you should test your blood sugar (and maybe even ketone levels) regularly to make sure the insulin is taking effect. You should also refer to medical guidelines to check the best practices for a person with type 1 and type 2 diabetes who is feeling unwell.

Summary

If your insulin is not working then you should not take any significant action without consulting with your doctor or healthcare provider first.

A simple adjustment to your existing medical treatment may suffice to help manage your blood sugar levels. This could be a change to your normal routine when injecting insulin, getting prescribed a different type of insulin or other types of medication, or simple lifestyle changes you could make.

By working with your healthcare provider and making healthy lifestyle changes you will be able to better manage your diabetes. From maintaining a more balanced diet, attempting to lose excess weight, and taking action to reduce stress levels. It is possible that by making these changes you could avoid more serious medical intervention if your insulin suddenly stops working.