Type 2 on insulin: Much reduced demand for insulin.

[berryr99]

I'm a bit confused and looking for some answers/ comments.

I've been type 2 on Insulin for 25 years now with not very good control. In August I went onto Libre and control has improved from a HBA1C of 70 down to 50.

In August my daily insulin was around 60 units for bolus and 55 for basal. That figure is now down to 40 bolus and 50 basal. There are increasing times when I don't need any insulin as otherwise I would hypo. My weight and exercise levels/food intake have not changed. Evidence from Libre shows a reduction in average in glucose levels. My general health is good. Could I be in some sort of remission ?

Thanks if anyone has any views on this. DNS not very forthcoming.

 

[Proud to be erratic]

I don't have the background understanding to comment on remission, but I am not surprised at all that as your HbA1c has reduced your overall need for insulin has also decreased.

The vast majority of us, regardless of T2 or T1, benefit from lower insulin resistance while at normal to low BG levels - the consequence of your improved control, thanks to Libre providing as much visibility as anyone might want. Those same normal or lower BG levels markedly contribute to the lower HbA1c outcome. Also, while not quite so obviously, I'd bet that your Glycaemic Variability has also improved. I can't remember if LibreView, the Web based collation of your data, provides the GV. It is akin to having a graph resembling a taut washing line over any 24 hr period rather than my wavy squiggle that records my 24 hrs of BG!

Anyway, very well done. Shame your DNS couldn't explain this natural consequence. Is this DNS a Nurse from your GP's Surgery who helps the management of T2s in the Practice or a true Diabetes Specialist Nurse in a Hospital Diabetes Team? I can understand a GP's Practice Nurse not being familiar with this concept, but not so a true DSN.

 

[berryr99]

I don't have the background understanding to comment on remission, but I am not surprised at all that as your HbA1c has reduced your overall need for insulin has also decreased.

The vast majority of us, regardless of T2 or T1, benefit from lower insulin resistance while at normal to low BG levels - the consequence of your improved control, thanks to Libre providing as much visibility as anyone might want. Those same normal or lower BG levels markedly contribute to the lower HbA1c outcome. Also, while not quite so obviously, I'd bet that your Glycaemic Variability has also improved. I can't remember if LibreView, the Web based collation of your data, provides the GV. It is akin to having a graph resembling a taut washing line over any 24 hr period rather than my wavy squiggle that records my 24 hrs of BG!

Anyway, very well done. Shame your DNS couldn't explain this natural consequence. Is this DNS a Nurse from your GP's Surgery who helps the management of T2s in the Practice or a true Diabetes Specialist Nurse in a Hospital Diabetes Team? I can understand a GP's Practice Nurse not being familiar with this concept, but not so a true DSN.

Thanks for this, I knew there would be some sort of explanation: these are factors I just had not thought about as I am so surprised to be in this situation. The DNS was from the hospital (that's how I got Libre) but offered no explanation. Due for another appointment in a couple of months and will mention again.

 

[Lucyr]

That figure is now down to 40 bolus and 50 basal. There are increasing times when I don't need any insulin as otherwise I would hypo.

By “times when I don’t need any insulin” do you just mean there are times you don’t take bolus or are you skipping your basal too?

 

[everydayupsanddowns]

Well done on your improved numbers @berryr99

Glad to hear Libre has been so helpful for you.

 

[berryr99]

By “times when I don’t need any insulin” do you just mean there are times you don’t take bolus or are you skipping your basal too?

Its bolus that I am skipping/reducing and I have reduced basal to 50 units now and will probably drop it a bit further.