July 4, 1999
Question from Coral Springs, Florida, USA:
I have been diabetic for 23 years. The last few years I have noticed the insulin doesn’t work as good as it used to. How do you find out if you are insulin intolerant? I basically eat the same foods, and exercise, but sometimes the insulin works, and sometimes it doesn’t.
Insulin action is dependent upon so many variables that can vary indeed from time to time. Very frequently, simple factors such as different injection sites, the integrity of subcutaneous tissue to correctly adsorb insulin shots after many years of diabetes, the blood sugar at the time of injection, time waited before eating, glycemic index of the different foods we eat, hormonal changes over time and so on, can and do play a major role than ‘intolerance’ to insulin action. Moreover, after 23 years of diabetes, the residual secretion of the endocrine pancreas is generally over and this could be one of the main reasons for what you noticed.
A new insulin regimen might help towards better metabolic control. I’d suggest you ask your diabetes team to review your insulin regimen with you.