I'm LADA T1 and was VERY slow onset. Should have been identified well over a decade ago, was misdiagnosed T2 nearly 4 years ago, and diagnosed T1 after getting the tests fairly recently (but have been on basal/bolus insulin for about 2 years). I had all the antibody tests done and all showed me positive for T1, and my C-peptide is .26 ng/ml which isn't unusual since a lot of T1s still produce some insulin.
I've been going low carb lately (40-50g) with tighter BG control (have gone above 160 per my Dexcom one time in the past 3-4 days), and my impression is that the impact of my body's insulin production is more apparent now. Those remaining beta cells are actually getting a little rest, and so if I'm around 80-85, eat, and take a bolus to cover the food, I seem to get a phase 1 insulin response (albeit small) as well. This kind of screws up my insulin ratios and such because the ratios are more of a curve. Also, my basal needs seemed to have nose dived after a week or two of reducing my carbs. I eat a lot still BTW.
So does anyone have thoughts on how a little insulin production impacts BG management for a T1? I find that it complicates things about as much as it helps.
Hi Scott A. I've had Type 1 for over 20 years no, dx'd at the age of 63. I make a little insulin during the hours of noon to 4:00--roughly. How does it affect me? I have to take three shots of Levemir rather than two, so that I don't double up on basal Insulin On Board during those hours. I take 3 1/2 at 9:30PM; 1 1/2 at 7:30AM; 2 1/2 at 3:00PM.
While it's a nuisance to remember the 3:00PM shot, I have heard that retaining beta cells/making insulin can somehow reduce the chance of developing neuropathies; goes back to Joslin studies I believe. At any rate, I have minimal neuropathy problems, and what I do have occurred before I was dx'd and did not advance after I started taking insulin.
I had a very good endo at the time. He looked at my pump and meter records and said that that was his conclusion. I've known from the very beginning that I had to have 3 shots of basal--I learned from "eating to my meter" before I'd ever heard that phrase. First I took NPH, then Lantus, now Levemir. Love my Levemir!
You mentioned needing 4-5 alarms. When I first realized all the shots I needed, I actually bought a watch that allowed me to set it to go off a couple of times during the day. The easiest time I've ever had was the years that I used a pump, which you can set to different amounts of basal all throughout the 24 hours. Good luck with all your alarms!
I am LADA was on diet controlled for year and half and insulin now for almost three years. I do not think I am producing insulin anymore but do go through spurts where I need less insulin all of a sudden. Its such a guessing game!
I can't really help with the question since I've been Type 1 for 22 years, since I was 9. Although I've never been tested, I'd be surprised if I produce any meaningful level of insulin. (I read in several places that anything over 0.1 can have a meaningful impact on blood sugar control for Type 1s.) But I do have a question (not so much for the OP, but in general).
I've seen quite a few people post on this forum and others about residual insulin production somehow making control harder or more complicated, and even some people who wish the honeymoon would end. To me this makes no sense. Wouldn't having some residual insulin production help to smooth out small mistakes and help dampen the effect of the millions of factors like stress, hormones (for women), illness, activity, weather that have an impact on blood sugar? Wouldn't this make control easier (tighter with less effort) and less complex (not having to account for every minute deviation in a dozen different factors)? I'm pretty sure all Type 1s experience occasions where their ratios don't work or where they have to adjust their insulin doses up or down. But I would think these changes would be smaller "tweaks" with insulin production instead of sudden giant "shifts" without any residual production.
I woke up yesterday morning at 4.1 mmol/L (74 mg/dl) and had a nearly perfect blood sugar day (only one high reading). I woke up this morning at 17.5 mmol/L (315 mg/dl) with large ketones and have had zero readings in range today (all high except for one low). But I don't attribute this to my pancreas producing insulin one day and not the next—I think my insulin needs shifted suddenly for some reason, which I may never know. I'm pretty sure if I was producing some residual insulin I wouldn't have such giant shifts, although I'm sure there would still be some small ones. Overall, though, I would think it would make control easier rather than harder.
Just my experience, but it was much easier for me to control my BGs when I was in the honeymoon period. I don't really know, but I don't think I had spurts.
I asked Canadian Diabetes Longivity FB page :" My question is related to the research done for the over 50 yrs living with d....Copied and Pasted : is it possible , that pancreas may , just may produce insulin at times ???" Response : Excellent question. The Joslin Diabetes Center has explored this in their 50 year medalist study and the results are explained on their website (http://www.joslin.org/medalist/6268.html)...Here's a snapshot of their discussion: "In addition to the exciting findings regarding diabetic complications, the results from the Medalists have also yielded an unexpected finding regarding pancreatic functions. Surprisingly, over 66% of Medalists appear to still produce some insulin. This finding can be important and exciting since it suggests that some type 1 diabetic patients may still make insulin even after 50 years of diabetes."
Joslin Diabetes Center | 50-Year Medalist Study www.joslin.org
Joslin Diabetes Center is the world’s foremost institution for diabetes research, clinical care and education.
I had numbers last week mid 30 's low 40's ( x 18 ) and a hard time getting them higher :)
Here are my thoughts, and much of it is all theoretical from my impressions of what is going on....
It actually makes control a lot harder in many ways, because the body's insulin response is not predictable. Some days your cells are in burnout, and then in other days, some cells are producing and responding normally. Try setting basal rates when your body is producing 10U one day, 2U the next, and then back up to 7U. Then you bolus for that sandwich, but oops, your beta cells are suddenly kicking in with a nice phase 1 response that would cover half of the insulin that you just gave a full bolus for, and the next day your body gives no response.
Then there are some advantages, but I think they mostly come into play when you are running BG numbers close to normal because otherwise your beta cells are almost always at burnout level (giving all they can give) and possibly mucking things up. Then one's ratios for meals and correction might get fouled up by the body producing some of the insulin.
I think most of advantages for BG management occur when production is a bit higher than mine, or perhaps when taking a very low carb approach. This isn't honeymoon levels. I didn't notice it at all until I went low carb for a week or two, and maybe Super_Sally's post shows some insight on what is going on.
My situation sounds very similar to yours. In my thinking I still have enough natural insulin production to steer my bg levels towards healthy levels, just not enough “horsepower” to keep them where they should be without added insulin. I really think though that having some natural capacity left makes precise insulin dosing and carb counting much more forgiving. Since going to a lower carb diet, and especially by avoiding as much as possible the “bad carbs” such as grains, my levels stay pretty flat all the time. I think this will be much more difficult if the honeymoon ends…
i don't think that's how the body works, that you just spit out insulin from noon to 4pm, that's just a time when most T1's have relatively good (or their best) control. If you read "think like a pancreas" that's the time of day which most of us have the best control, has nothing to do with still producing insulin, it's just the ebbs and flows of a T1's body. I'm glad 3 shots work for you..but that too is adding a lot of peaks, ebbs and flows to your insulin needs - basal doses.
you think it's tough now...i thought that too when I was honeymooning, wait until you're out of beta cells and no longer produce insulin...i used to read stories on here, while I was honeymooning, thinking "wow, at least I don't have it so bad as some folks on here"...then my honeymoon was over and I'm just a full blown type 1 diabetic and have it 'that bad' too; lows are lower, highs are higher, hit harder and management is a constant challenge.
grains aren't bad carbs. i eat low carb, organic whole wheat bread everyday and it never does anything to my blood sugars. many people eat grains and much more.
I am LADA/Type 1. I was misdiagnosed as Type 2 due to my age and managed fine on oral meds for 14 months. My blood sugars were very steady. Then between 14 and 19 months I began a gradual but steady climb until my numbers were consistently very high and at that point I figured out I was Type 1 and began insulin. (I had my c-peptide tested at that point and it was .38)
If I had been correctly diagnosed and started on insulin right away I would have needed very low doses during that first 14 months and probably still had lots of lows. Then for the next 5 months I would have likely had increasing needs which I'm sure would have been very frustrating. My climb did seem steady and in one direction though. I have heard people talk about "spurts" of endogenous insulin which made it even more frustrating determining doses. Frankly once you're running on empty or near empty it seems like things get more stable for many of us.
ha, that hasn't been the case for me, my highs are high and lows lower since honeymoon ended, it's become much more difficult to manage, as there's no longer a safety net and we also burn out our alpha cells too.
Hi Sarah. When I used my MM pump, I set the basal for the lowest setting the pump would allow for about 3 1/2 hours (described above). Still I bolused very little when eating until approx. 4:00PM; now with my Levemir schedule, I still bolus very little for those hours. I don't notice any peaks from Levemir during the daytime. At night the Levemir peak is perfect for when my BG goes up at about 2:00AM to 3:00. When I get up at around 7:30AM, I take one unit of Apidra to cover the dawn phen. (as does Dr. Bernstein). I do believe that I make insulin during those early afternoon hours--just more evidence that we're all different from each other.
