I don't understand!?!

[robofski]

OK, if you've seen my post last week you'll know that I missed my novo rapid a couple of times last week and yet my BG readings were OK. There were some other things happening like Christmas shopping so exercise was more than usual so maybe that contributed. Today was another lapse at lunch time, here's my day:
7.00 BG 6.3
7.00 16u Levimar
7.30 15u Novo Rapid
7.55 75g CHO
12.00 BG 7.5
12.30 55g CHO
17.00 BG 6.8

So no Novo Rapid with lunch and yet 5 hours later I'm lower than I was before lunch and the breakfast NR would have been well and truly out of my system. What I don't get is if my Pancreas has for some reason kicked in and is producing insulin why am I not on the floor when I take extra?

I've never been convinced about the switch from being type 2 to type 1, I fail to see how that can determine I'm not producing insulin or I'm not using my insulin effectively without some formal test, surely a HbA1C would give the same result regardless of the cause!

Insulin has obviously helped me, it brought my A1c down from 12.0 to 6.6 in 6 months, but several incidents like this are starting to make me doubt it!

Can anyone suggest what's happening?

Dan

 

[Northerner]

It's very interesting Dan - it's not like you are on meagre insulin doses (when you remember to inject! 😉) is it? And if you can get by without it and maintain good levels then you'd surely expect to be hypoing if you had injected

I'm as confused as you! When they decided you were Type 1, not Type 2, what did they base that on? As you say, an HbA1c will make no distinction, you would need a GAD antibody and C-peptide test. Actually, if you were to have a C-peptide test now that would determine how much of your own insulin you are producing. As you know, I'm the opposite as I don't need my basal but can't cope with carbs without injecting. Definitely worth having a chat with the quack! 🙂

 

[trophywench]

Dan

Howsabout you do a basal test by missing lunch and see what happens to your BG?

Cos, is your Levemir covering your lack of QA?

 

[Northerner]

Dan

Howsabout you do a basal test by missing lunch and see what happens to your BG?

Cos, is your Levemir covering your lack of QA?

It crossed my mind too, but since Dan is only occasionally missing his meal insulin then surely he'd be hypoing every day he does if his basal was high enough to cover things?

 

[robofski]

Dan

Howsabout you do a basal test by missing lunch and see what happens to your BG?

Cos, is your Levemir covering your lack of QA?

I'm a bugger for skipping lunch and often don't bother, and my BG remains stable, usually within a mmol of my morning reading, so a good theory but I don't know if I'd buy it 😉

 

[trophywench]

Well I agree it sounds pretty OK in that case BUT what happens in between missed Lunch and pre-dinner?

(I reckon T1.5 anyway FWIW. LOL)

 

[robofski]

Well I agree it sounds pretty OK in that case BUT what happens in between missed Lunch and pre-dinner?

(I reckon T1.5 anyway FWIW. LOL)

I'm stable from morning until evening!

What I don't get is why I'm not having hypo after hypo if I'm producing insulin and injecting it!

 

[Northerner]

I'm stable from morning until evening!

What I don't get is why I'm not having hypo after hypo if I'm producing insulin and injecting it!

Well, maybe it's that you only produce the extra insulin when you need it? That is, your automatic control mechanism where an excess of insulin stimulates an excess of glucagon to balance it, and vice versa? Do you have many hypos, and how low do you get? I do wonder if there is an element of this at work for me as I don't appear to need such pinpoint accuracy with my carb counting to achieve relatively stable levels - as if my pancreas is stepping in to 'smooth out' the edges a bit. I do have lows though, and can have quite low ones in the 2s, but as I said earlier, I seem to have a slightly differently-puzzling situation! 🙂

 

[robofski]

Well, maybe it's that you only produce the extra insulin when you need it? That is, your automatic control mechanism where an excess of insulin stimulates an excess of glucagon to balance it, and vice versa? Do you have many hypos, and how low do you get? I do wonder if there is an element of this at work for me as I don't appear to need such pinpoint accuracy with my carb counting to achieve relatively stable levels - as if my pancreas is stepping in to 'smooth out' the edges a bit. I do have lows though, and can have quite low ones in the 2s, but as I said earlier, I seem to have a slightly differently-puzzling situation! 🙂

Think there must be an element of this kind of thing going on Alan, in 7 months of using insulin I've only recorded two 3.8's and one 3.3, and my idea of carb counting is errr....call it 4 and one for luck!

 

[Northerner]

Think there must be an element of this kind of thing going on Alan, in 7 months of using insulin I've only recorded two 3.8's and one 3.3, and my idea of carb counting is errr....call it 4 and one for luck!

My consultant would be interested to hear this. That's one of the great things about forums actually, it can highlight unusual cases that are not confined to one doctor's knowledge of one person on his books. There are a few people that I have encountered here who seem to have similar situations to me, but who are considered quite different in the approaches taken by their doctors.

 

[Northerner]

Actually, I just looked back at your introductory post and your history is quite interesting - seems to indicate a slowly deteriorating insulin production leading to insulin therapy, which is common to Type 1.5 (LADA) and Type 2, but your doses don't seem to suggest too much in the way of insulin resistance. It may be that your pancreas has recovered to some extent, having been given the extra support of injected insulin, so it can support you itself when presented with some 'challenges'. This seems to have happened to me, as my insulin requirements have dipped significantly since diagnosis (-100% basal, -60% bolus). We've been diagnosed a similar length of time (you 2006, me 2008 - although if I'd gone to the doc's when I first got pronounced symptoms I would probably have been diagnosed T2 in 2006!).

 

[robofski]

Yes you're right, the reason for the insulin was increasing HbA1C's on increasing doses of Gliclazide, with 3 month windows so it had time to have some effect.

When I look back over my test results by July things seemed to have settled down much more than at the beginning and my A1c had reduced to 9.3 by then.

I'm going to try and speak with my DSN and see what she thinks, she did say in the beginning that starting on insulin can kickstart the pancreas to produce it's own and maybe that's what happened but it's just taken a long while to get going (it's my pancreas after all, and it takes me a while to get going every morning!!)

 

[robofski]

Another pretty chart, showing daily average with a 10 and 30 day moving average. Seems to show that my 30 day moving average is pretty stable.

I've spoken to my DSN and she's not really sure what's going on either! Will refer me to the consultant after Christmas, and in the meantime I'm going to try a few days going without any NovoRapid and see what kind of results I get. Watch this space!

 

[robofski]

Well, that experiment didn't last long!

It would appear I can support myself for so long, maybe forgetting the odd injection but certainly not all day.

Only Levimar this morning and here are the BG's

7am 8.4
75g CHO
12pm 7.4
Skipped lunch
5pm 5.9
6.30pm Risotto for dinner (didn't calculate as wasn't injecting but it was a fair portion (maybe 150g of rice))
10pm 10.9
11pm 14.7 😱

(Did have a triangle of toblerone about 9.30 too, Christmas treat!)

So I've taken a couple of units of NR!

Looks like I can't do without the insulin for any length of time (not that I ever thought I could really) but I'm still confused as to why I could have had 15 units of NR with my breakfast this morning and wouldn't have had any hypo but no insulin and I still coped OK, I wonder if I don't produce my own if I'm injecting, I'm just unable to sustain production?

All very odd and quite confusing!

 

[trophywench]

Here's An Idea ....

Elective pancreas removal, then they can count your Beta cells and tell you the answer to that, if you wake up after?

 

[robofski]

Here's An Idea ....

Elective pancreas removal, then they can count your Beta cells and tell you the answer to that, if you wake up after?

I'll keep that option on the back burner

 

[everydayupsanddowns]

I've wondered about this too. In a healthy person the pancreas (iirc) stimulates glucagon and insulin to control BG levels - sometimes in T1s a massive liver dump can seem to follow a fairly minor hypo and other times not - so even in people with few if any islet cells left there seems to be a bit of a balancing act going on. I have also seen posts by people who have reduced high doses and seen a reduction in BG levels - almost as I less low-level counter action was being stimulated when the doses went down.

And if your pancreas still has a bit of 'go' in it, that must surely confuse matters still further when adding variously erroneous insulin injections into the mix...

It's an interesting one that's for sure!