Wil Dubois

Got questions about life with diabetes? So do we! That's why we offer our weekly diabetes advice column, Ask D'Mine, hosted by veteran type 1, diabetes author and community educator Wil Dubois.

This week, Wil answers questions about those "without reason" blood sugar changes and insulin pump infusion sites that get wonky and don't seem to work. Wil has some thoughts, of course, so read on to hear what he has to say.Ask-DMine_button

{Got your own questions? Email us at AskDMine@diabetesmine.com}



Ruchika, type 1 (married to a type 2) writes from India: My husband, Arvind, is type 2. He was following a multiple shot regimen along with Reclimet for a long time. However, suddenly his blood sugar levels started increasing for no apparent reason. The doctor changed his drugs. Now he’s experimenting with Janumet and Glipizide. Still the levels are high. He’s frustrated because despite proper diet and some degree of exercise, nothing seems to be working. We are simply clueless. I’m type 1 for the last 35 years. Kindly share something regarding this.

Wil@Ask D’Mine answers: I appreciate the fact that between the two of you, you feel you should have three times the knowledge of diabetes that anyone else does. 2 + 1 = 3, right? No wonder you are feeling frustrated! But here’s the thing that most type 1s never quite grasp about type 2 diabetes: It’s dynamic.

Our type 1 diabetes is only briefly dynamic, and that’s during the honeymoon phase. Once the immune system slaughters all of our beta cells, the diabetes itself is stable. Sure, if we put on some weight, our insulin resistance goes up. If we are under stress, our livers will dump extra sugar into our bloodstreams. If we go to the never-ending pasta bowl at the Olive Garden, we might have to visit the ER. But all of that aside, our diabetes is actually pretty stable. Or more correctly I should say that given stable lives, our diabetes would be stable.

Not true of type 2.

Type 2 is an ever-evolving process. It’s a disease that gets steadily “worse.” And like the march of Roman boots across the ancient world, there’s no stopping it. We throw drugs at it, and the armies of type 2 diabetes eventually overwhelm them—or the body adapts to the meds and they become less effective. Treating type 2 is shooting at a moving target. The only thing you can count on is that the therapy that works today won’t work tomorrow.


Two parallel processes drive the progression. Type 2 is a disease of insulin resistance, and that resistance grows stronger over time. At the same time, the resistance erodes the body’s ability to fight the advance. For the first decade or so, while the diabetes is lurking under the surface, the pancreas over-produces insulin to compensate for the resistance. But at some point pancreatic burnout happens and the blood sugar rises. In medical parlance this is referred to as a pooped-pancreas. (OK, I totally made that last bit up.)

In some people the progression of these parallel processes is linear, steadily advancing with the march of time. In others it goes in bursts and fits. With some folks the advance is leisurely. In others, breathtakingly fast. But the fact that type 2 diabetes gets “worse” is universal. That’s why it’s called a progressive disease. We’re not talking about its politics. We’re talking about its unstoppable growth over time.

Your hubby's diabetes just had a growth spurt.

And his doc did the right thing. When faced with such a growth spurt in type 2, advancing the therapy is the right thing to do. In fact, it’s the only thing you can do. And while at first glance it sounds like his doc threw the baby out with the bathwater and started over, all he really he did was add one new drug.

The old Reclimet (unique to your part of the world) is a metformin and a sulfonylurea polypill. In the new plan he still gets both medications, the met from half of the Janumet, and the sulfonylurea from the new Glipizide pill that was added. What’s new to the therapy mix is the Jan in the Janumet, which is Januvia. This med is a DDP-4 Inhibitor. (If you want to understand how those work, check out my column Baseball bats, Charles Atlas, and Drunken Rodeo Clowns.) But all you really need to know today is that Januvia is a lot like my wife first thing in the morning: It takes her a while to get up out of bed and get to work. In fact, Januvia can take a full six weeks to show full effect. So it could be that your husband’s sugar is no better simply because the new med hasn’t taken effect yet.

It’s very frustrating; I get that, but give it time. High blood sugar is dangerous, sure, but since type 2s are rarely at risk of a high sugar coma, it’s OK to give the med some time to spool up and see if it’s the right choice for his new, bigger, badder, stronger diabetes.


Elaine, type 1 from South Carolina writes: I am a 53-year-old female. I’ve been type 1 since I was 19, pumping for about 8 years, and use 6mm quick sets. I’m overweight and looking at me you would think that I would use the 9mm, but 6mm seems to work better. Here is my problem: Last night I went through five infusion sets before I got one to work. I tried inserting in my lower abdomen, left and right, love handles and upper abdomen. I finally found a small indent on the front of my thigh and that worked. I rotate as much as I can, and usually use my arms as they are most reliable. Some of these are sites that by all reckoning should work but don’t. This is a frequent and annoying problem. I don’t get bent cannulas or occlusion warnings. What would keep so many areas from working and what happens to all the insulin I bolus for corrections as I wait for a site to work? Thinking of giving up on pumping. Any ideas?

Wil@Ask D’Mine answers: Research shows that shallower is better when it comes to infusion sites. In fact, there’s development going on to try to figure out just how to place infusion sets jusssssssst under the skin, in much more shallow regions than we use today. And it’s not just infusion sets. New pen needle research shows that shorter needles are better regardless of how heavy the poke-ee using them is. So it doesn’t surprise me that you get better results with shorter sets. At least, once you get the damn things in place.

As to why you are having so much trouble, we need to talk about Jell-O. 

Not to be rude, but picture your “love handles” like a bowl of Jell-O. If you stick your finger into the center of the bowl, what happens? You create a little depression, right? You can even make a pretty deep crater before your finger breaks the surface, right? The same thing can happen with the guide needle of an infusion set. In chubby folks, the needle can push the skin down before it penetrates, creating a depression. If the edge of the set hits the higher terrain around the rim of this crater before the needle penetrates the skin, it can lead to the cannula not being inserted at all, or not being placed deep enough. Of course, this is all under the hood, so you can’t see what’s happened.

There’s no occlusion alarm because there’s no occlusion. And the site doesn’t work because the cannula didn’t go into the tissue, although you might still feel the insertion, as the needle is longer than the cannula. I suspect the missing insulin is dribbling around on your skin and evaporating.

The solution? Pinch or spread. You need to do everything possible to keep the target site flat. That’s probably why your arms work better because you, uh, have less Jell-O there. Try sucking in your stomach, stretching the skin as flat as possible between two fingers, and pushing the inserter very firmly against your skin before you trigger it.

So don’t throw in the towel. Just beat the Jell-O flat.


Disclaimer: This is not a medical advice column. We are PWDs freely and openly sharing the wisdom of our collected experiences — our been-there-done-that knowledge from the trenches. But we are not MDs, RNs, NPs, PAs, CDEs, or partridges in pear trees. Bottom line: we are only a small part of your total prescription. You still need the professional advice, treatment, and care of a licensed medical professional.

Disclaimer: Content created by the Diabetes Mine team. For more details click here.


This content is created for Diabetes Mine, a consumer health blog focused on the diabetes community. The content is not medically reviewed and doesn't adhere to Healthline's editorial guidelines. For more information about Healthline's partnership with Diabetes Mine, please click here.