What to do with falling Insulin Requirements

W

Wendal

Well-Known Member
Relationship to Diabetes
Type 3c
Morning I wanted to open a separate thread and basically asking for others thoughts,comments,advice and experiences.
I have been diagnosed with Type 3c diabetes for just over a year and currently on NR typically 4-6u per meal and 6u of Lantus as basal.That regime worked really well for first 12 months and have achieved very decent control and happy with my management and level of knowledge.
The last few weeks I have noticed my insulin requirements seem to have noticeably fallen and I am trying to readjust my regime to better manage my BG levels.
Gradually I have reduced my daily bolus to nothing and my basal to 4u of Lantus and although I do spike to 11/12 after say a 50-60g carb meal it comes back down to 7 within 2 hours ( no insulin) and even quicker iffI go for a short walk.
I can of course reduce my basal more or eat more and am happy enough to do this and I do not get “ hypo anxiety” but last night I did take a 2u correction as I had a Pizza and my levels were heading North just before bed( no other bolus all day).
So my question is has anyone else been through this and yes I am likely to still be in honeymoon period but is there a type of final hurrah before the Beta cells give up or can the R &R by being given exogenous insulin recover at all to produce more/ improve insulin sensitivity like some medications can.
I have not had a C Peptide test at all but wonder if that is worthwhile.
Any thoughts or comments welcome and thanks in advance.
 
@Wendal,

I am tempted to surmise that with your potentially ill quantified pancreatic damage a fair degree of irregular panc'y behaviour might be routinely expected; also the period recently spent with regular extraneous insulin could have created a period of "rest" for your formerly overworked panc'y which might now be "helpfully" bringing some refreshed homegrown insulin to your party. Also, as you continue to settle into improved BG management you almost certainly will have decreased Glycaemic Variability and that results in a reduced use of insulin

So one, two, or all of these things might be contributing. I recall my insulin use reduced as I finally settled into a routine, mainly thanks to CGM bringing some sanity to my world. And looking back at my prescription requests for insulin they are definitely less this year than from 3+ years ago. Needles are much the same but test strips are less.

Finally, although you make it sound as though your former work routine has just continued, have you perhaps actually eased back a bit on your daily / weekly activity levels?
 
Thanks Roland and some things to think about but the falling BG levels seem quite significant and yes my endocrine cells may be producing some and I have not finished all my experimentation.
Tonight I had a big chippy tea so 100-120g of carbs and I know pretty much exactly how my BG responded when I had the same meal about a month ago.
So yes I did go for a walk which is another variable but at least I could continue with no insulin.So 90 minutes after the meal I am 6.9 and flat but I know it will spike up a lot later but will probably refrain from any corrective insulin so I can get a better idea of my body’s response.
I am tempted to make a GP appointment not that I am concerned about anything in particular but just to have the conversation that I seem to have fallen out of the NHS system re regular pancreatic reviews so just want to prompt them as I am still on blood thinners and Omeprazole for instance for last 2 years and think I need a review of whether I still need to be on them but will need a CT scan.
When I had my AP attack one of the Consultants looked at my CT results and said How sorry he was so I thought the prognosis was not great and I know the pancreatic cells do not regenerate like hepatic cells can.
However I feel in myself I have recovered back to normal and I suppose I would like to clarify exactly what function my pancreas currently has.
As for work I am probably doing exactly the same and feel very energised so am probably doing more if anything.
I suppose I am also conscious that I am caught between the gastroenterologist and the endocrinologist dilemma like many of us and just trying to plot the best pathway I can.
Anyway thanks for your input and gave a nice rest of the w/ end.
My wife is back from Menorca tomorrow so my last hours of peace and quiet lol
 
You mention blood thinners in the same sentence as Omneprazole. I had a TIA in April and am now taking Clopidogrel daily. My Omneprazole was changed to Lansoprazole, because the Omneprazole has a compatibility issue with Clopidogrel and, I thought, blood thinners in general. I'm away from home until 20 Sep and have no P-i-Ls with me, but I know this Pharmaceutical business is routinely your world. I was curious about why my script was changed? Or at least what had I not fully understood.

I know that you are diligent in keeping close tabs on your experiments, as you exploit the trial and learning process. Have you come across the 42 factors that can affect our BG? [https://www.google.com/search?q=42 ...od sugar&ie=utf-8&oe=utf-8&client=firefox-b-m]
You might find that you are the beneficiary of your own relaxed approach to your BG management and as you get more confident and secure in your daily routines you just are now even less stressed about your D in general - hence better GV and hence less insulin. Just a thought. I know that I try to avoid getting stressed - but I know that I too frequently fail with that concious effort and then worsen matters by chiding myself for succumbing to getting stressed in the first place! Vicious circle!

I've just spent a week in Inverness and stayed alive but with pretty poor TIR; I just couldn't seem to get the carb guessing (sorry, diligent counting) at all right. We are now in Jersey and again I'm just naturally running way too high, thanks to poor carb estimating. Anyway, a nice 'rest of weekend' is assured already, but thanks for the thought. The weather is delightful, no car (just us and 7 day bus passes) and no responsibilities for another 7 days.
 
Hi Roland,
Following your TIA it makes sense to be given Clopidogrel which is an anti platelet medication ( so helps prevent clots) and there is a difference between how it acts than a blood thinner like Apixaban which is an anti coagulant.
The use of Proton Pump Inhibitors like Omeprazole and Lansoprazole ( faster acting) is often recommended to be used with blood thinners etc where risk of GI/ reflux issues are a possible concern.
It may be the fact with your TIA affects a different part of the body so my blood thinners are acting to prevent the risk of a clot forming in the minute myriad of blood vessels etc in my upper GI tract that we are on different medications plus Consultant preferences.
I am just generally surmising Roland as obviously I am not medically qualified to give specific advice or comment.Not sure if I have helped or not.
I will need another CT scan to assess the state of my blood vessels in my upper GI tract to decide whether I need to continue on my Apixaban but my GP thought that I at least needed a review and that was 6 months ago but as I seem to have been “ discharged” from the local NHS system then I need to seek further advice.
Anyway hope you had a great time in the Highlands and sometimes relaxing our diabetes control a little helps us in the longer battle and if course life is for living
I do appreciate the multi factorial nature of diabetes but in the absence of say an infection I am trying just to moderate the 3 main ones ie Diet/ exercise/ medication to try and chart the best way forward.
Quick update I did actually end up with a 4u correction after last nights very high carb tea and managed to limit the spike to 13 and although it settled down to mid 8s overnight it was delicious and a real treat.
Enjoy Jersey.
 
What a conundrum for you @Wendal

I think you are doing a good job, taking things carefully, and experimenting to try to keep on top of your changing situation.

Our previous admin @Northerner had a fairly classic adult-onset T1 story, but gradually over the years his need for basal gradually reduced until he stopped taking it!

My insulin needs ebb and flow over the year, but only really up and down a few units of TDD.

I’m not sure with Type 3c whether some form of pancreas self-repair is possible (given you won’t have ongoing autoimmune attack destroying your beta cells) but it’s an intriguing possibility.

Have you asked your consultant or DSN about your fluctuating doses?
 
PS Roland found this which may help.

Clopidogrel is a pro-drug activated by the enzyme CYP2C19. Omeprazole and esomeprazole are inhibitors of this enzyme meaning concurrent use can reduce plasma levels of activated clopidogrel. Although other PPIs can inhibit CYP2C19 to a lesser extent, clinically significant interactions have not been observed.

Plus As clopidogrel can increase the risk of bleeding, proton pump inhibitors (PPIs) are commonly prescribed with clopidogrel to reduce the risk of serious GI issues.

So I can see the dilemma so Lansoprazole ( which is a PPI) is not contraindicated to use with Clopidogrel whereas Omeprazole ( another PPI) is contraindicated hence your change of medication. My non qualified opinion only.
 
everydayupsanddowns said:
What a conundrum for you @Wendal

I think you are doing a good job, taking things carefully, and experimenting to try to keep on top of your changing situation.

Our previous admin @Northerner had a fairly classic adult-onset T1 story, but gradually over the years his need for basal gradually reduced until he stopped taking it!

My insulin needs ebb and flow over the year, but only really up and down a few units of TDD.

I’m not sure with Type 3c whether some form of pancreas self-repair is possible (given you won’t have ongoing autoimmune attack destroying your beta cells) but it’s an intriguing possibility.

Have you asked your consultant or DSN about your fluctuating doses?
Click to expand...
Hi Mike thanks for you input and I was aware that some folk manage to get by with just basal alone and I suppose part of me is wondering can I get by with such a regime with a regular habit such as a walk after a meal etc and not going into heaven on the carbs.
Then just make the odd adjustment if I want to have a higher carb meal like last night.
My understanding is that the pancreas cannot self repair unlike say the liver but what I never had fully explained is the extent of the damage ( was just told it was significant) and a few “ it does not look good” but as I say I am back to normal and essentially fully recovered ( only the medication). So it may be worthwhile just pushing to have an informed conversation with someone but as I said we sometimes fall between the Upper GI gastroenterology and endocrinology Consultants.
At least I am opening up the issue in my own mind so am empowered to do something about it and really appreciate everyone’s input.
PS Mike as am sure you are aware Type 3c affects the Alpha cells so Glucagon regulation and also there are links between the exocrine and endocrine cells so Pancreas damage and Diabetes in both a direct and an indirect way( don’t think fully understood by certainly likes of myself)
Have a good rest of w/ end
 
Hope you find a system that works for you :star:
 
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