Rapid reduction in need for insulin.

[Dogsbody]

Hello,

This is my first post to this forum and I thank you for providing the opportunity , hopefully of getting a bit of advice.

I was diagnosed with Diabetes 2 about 9 years ago, I was prescribed Metformin and then within a very short time ,put onto Insulin( Mixtard).

I have been very successful with my sugar control but there has been a gradual need for increasing the dosage of insulin. Until two weeks ago I had arrived at the situation where I was injecting 85 units A.M and PM.

Inexplicably, a fortnight ago and perhaps 2/3 hours after my am injection, I started to feel quite rough and on checking my blood sugars found that they had dipped to 2.8.

Come the evening on that day and in order to avoid a night time problem I reduced the jab to 40 units . My sugars next morning were very good and so I reduced a little more and did so every day until this morning when I have arrived at just a 10 unit injection; all of this time my sugars have been in the 5's and lower sixes.
Helped a couple of times by a sugar snack.

I do suspect that I could stop my insulin injections completely and need to discuss metformin with my Doc.

My usual doctor is on holiday and the locum has arranged for blood test later this week. I am however quite concerned about why the sudden rapid decrease in my insulin need and what to do if I do continue to get a downward trend and so have to resort to increasing my carb intake.
I am clearly exposed more to the possibility of a hypo in my new situation and that certainly is of concern.

I should say that there had been no change in exercise levels or diet when this rigmarole began.

I would very much welcome experienced advice or comment as this is new territory for me.

Thanks ,
Mike

 

[Steff]

hi there Mike and a warm welcome to the forum , I cant help you on your thread but just wanted to say hello

 

[Northerner]

Hi Mike, and welcome! A few weeks back I experienced a big fall in my insulin requirements, and subsequently have reduced my basal insulin (lantus) by 55%. I have also reduced my bolus insulin (novorapid) by around 35% in the same period. Very confusing! But it does appear to have settled down now at these lower levels. Impossible for me to say why yours have come down so much, but just to reassure you that you are not alone!

Sounds like you are doing the right things and keeping a check on it - keep testing, and see if there are any patterns, and contact your DSN or doctor as soon as you are able. There may have been a change in your metabolism or your cells' insulin resistance that is meaning you are now using insulin more efficiently. I've also been told that seasonal changes can happen, but I guess you'd know about that having been diagnosed 9 years and if it was happenening to you.

 

[runner]

Hi Mike,

Haven't experienced such a drastic dip myself, and am only aware of Northerner's, but you might be interested in these links if you went on to insulin so quickly:

http://www.diabetesexplained.com/lada.html

http://www.locallada.swan.ac.uk/faq.html

There is another thread about this - if you type LADA into the search box (in the pink bar above) you should find it.

Hope it all stabilises and gets sorted for you soon.

 

[Dogsbody]

Thanks for the help and advice (and the welcomes) I do appreciate your replies.

The information about LADA is especially interesting . I was quite unaware of such a thing.
I recall that it was only a week or so between being diagnosed with diabetes 2, being prescribed metformin and then onto insulin, so from what I have just read it would seem likely that LADA is my problem. It would appear though that treatment is the same.

What is of interest to me is that I have Sjogrens Syndrome, Myositis ( auto immune malfunctions) and an unidentified metabolic muscle disorder.
I think I need to ask questions about the connection between these problems.

As for my most recent BG count it was perfect this evening at 5.5 and that with only 8 units of insulin --two weeks ago it would have taken 85 units plus to get close to that.

Depending on my morning readings I intend to miss my usual morning injection of insulin tomorrow and observe my sugars closely throughout the day. If that turns out OK I intend to reduce to zero. This is a little weird to say the least.

Thanks again for your replies

Mike.

 

[runner]

Thanks for the help and advice (and the welcomes) I do appreciate your replies.


Depending on my morning readings I intend to miss my usual morning injection of insulin tomorrow and observe my sugars closely throughout the day. If that turns out OK I intend to reduce to zero. This is a little weird to say the least.

Thanks again for your replies

Mike.

Hi Mike,

Sounds like you did the right thing in a gradual reduction, but I would strongly advise you to seek medical advice - could you contact a DSN at your hospital or phone Diabetes UK, before deciding to come off insulin. You blood test should reveal how your body is using insulin mre accruatrly too. If you are actually a type 1 or LADA, it's likely you will always need some insulin. Maybe you could ask about different systems of management. A lot of us here are on multiple injections - the basal /bolus regime where we inject long acting insulin once ot twice a day and faster acting with each or most meals, according to BS. I often only need 1 or 2 units to cope with each meal - maximum so far is 4. I currently use 13 units of long-acting. This can vary by a couple of units. It means you have to inject and test quite a lot, but it gives you much more control. Some people are moving on to pumps.

 

[Northerner]

I'm not sure if LADA can extend over 9 years, or if it would exhibit these kinds of patterns. From what little I know, LADA is a gradual decline in pancreas function - less and less insulin and gradually climbing BS, until finally giving out. This almost sounds like the reverse! Still, this condition can manifest itself in so many different ways -who knows? As runner says, do speak to someone before stopping the insulin altogether - I would have thought under the circumstances you could be fast-tracked to seeing a DSN or consultant rather than waiting for the blood test. I'd urge you to call now - I wouldn't want to wait if it was me. My case was different in that I reduced gradually but progressively over about a month and I was only on a total of 60 units a day.

Call today, please Mike!

 

[insulinaddict09]

Hi Mike and Welcome , Please make an appointment to see your doctor or

DSN , never feel tempted to stop medication without medical supervision,

especially not something as important as Insulin . It is better to speak to

the professionals rather than taking unnecessary risks with your long term

health. Let us know how you get on 🙂

 

[Heike]

Hi Mike and welcome. I'm having the same problem as you. After 2 years on insulin my bg's kept dropping. I used to inject 58 unit of insulartard twice a day and humalog with every meal. I did see my DSN as I was worried about it. I now have stop taking insulartard altogether and reduced the humalog as well. Why this happened I don't now, neither does the DSN, she just find this an interesting situation. What I find interesting is that I also have sj?grens syndrome, but I don't think it got anything to do with this.

 

[Dogsbody]

Hello,
Thanks again for the sensible replies, they are much appreciated.

I actually chickened out of reducing the insulin dose to zero yesterday morning and instead visited the support nurse at the local clinic.

On her advice . last night I reduced insulin to zero and also stopped my metformin. My bloods have remained very stable for 18 hours now without any medication whatsoever. The only thing I have noticed is a slight dull headache and a feeling of mild hunger but they is more than likely just one of those things and totally unconnected .
The nurse is recommending that I get referal to a Prof of Endocrinology at the local teaching hospital and I hope that will be underway next week.

I strongly suspect that what has been happening to the diabetes is directly related to my muscle problem ,although in the past my docs(neurologists) have dismissed this link. I would love to prove them wrong.

Secifically in reply to 'Northener'. It is quite likely that LADA is a possibilty.

My diabetes seemed to develop over a three week period 9 yrs ago /thirst /fatigue/etc I recall my bg were 30 ish and I was put onto metformin. My bloods remained high and within a week of diagnosis I was placed on insulin.
Over the nine years my demand for insulin had steadily increase and it had become more difficult to keep the BG low. But that all changed within the space of one morning. There seems to have been a spontanious return to the natural prodution of insulin and /or the renewed ability of muscle cell to use what is available. I have as yet not noticed any improvement in my muscle ( I have extreme exercise intollerance with rapid recovery - suspected of being an as yet unknowns or un researched glycogen storage disease ). Being greedy I am hoping that the changes reported regarding insulin will soon show in my muscle endurance for that has beem my most severe problem for nearly thirty years.

Thanks again everyone for your interest.--
Mike

 

[Northerner]

Fascinating stuff Mike, thank you for posting it. Hopefully, as you say, your muscle problems will improve in time too! You must be quite a challenge to the endocrinologists!🙂

 

[insulinaddict09]

Thanks Mike , can I echo Northerner , fascinating , thanks for posting that information .