I guess It's the Honeymoon Stage

I am still learning all about this disease on my own, through reading books, doing online research and asking questions to other folks with diabetes. Luckily, I will finally have my first appointment with an endocrinologist tomorrow, after going nearly three weeks since diagnoses. Lord knows I have a bucket load of questions.

The first 2 weeks or so, I was slowly etching away at my blood sugars. I started on 15 units of Lantus at night, and about 2-6 units of Novolog during the day. Eventually, I had to up my Lantus to 20 units in order to get my levels down. I was averaging between 180-300 during that time. After Christmas, I became very ill with a stomach virus and was eating barely anything. I took sips of coconut water, sprite, juice and nibbles of Popsicles to keep my blood sugar at a healthy level. During this time, I was only taking 20 units of Lantus a night, and averaging levels of 66-110. Interestingly, after I started getting better, even though I was more or less resuming my same eating habits, I began to suffer from about 2 lows a day. I was continuing to take 20 units of Lantus and 1-3 units of Novolog per meal. I even downed my nightly dose of Lantus to 15, instead of 20. I was still experiencing the lows, so yesterday I started only taking 1 unit of Novolog before eating, regardless of the carb count. This was out of fear of blood sugar drops. My blood sugar has continued on this steady pace, and I am really surprised.

I did a bit of research and it sounds like I could be experiencing the “honeymoon stage”, though I haven’t personally spoken to anyone about their own experiences with it. Of course, as a newly diagnosed diabetic, there is a secret ferocity inside of me that yearns to believe that my body has decided to simply not have diabetes anymore. Deep down inside, I know this isn’t true. Regardless, it will be such a relief to see the specialist tomorrow!

defintely write you questions for you endo. I always seem to forget one and remember it in the parking lot. are you tracking your insulin/food intake? might help you and your endo understand the lows you get better. Great job! and good luck tomorrow.

Wow, you’ve learned a lot already!

There’s a large number of factors that can be why insulin needs change. You name at least a couple:

1: At diagnosis your insulin needs were higher because you had been running high bg’s (maybe even some DKA?) for a long time. This diminishes insulin sensitivity. After your bg’s normalized then your true (not messed up) insulin sensitivity came back.

  1. A stomach virus can really up my insulin needs even though I’m not eating anything.

Many websites and books push the “linearized” model of insulin sensitivity (i.e. that one unit will bring your bg down by 40) but it isn’t that simple (sensitivity varies depending on time of day, your bg when you take it, etc.). And for me, prolonged moderate exercise (e.g. painting the house) can substantially reduce my insulin needs. So don’t buy completely in to the simple models where there is a “single” correct basal dose - that’s a good starting point but you have to know that it really isn’t a perfect model.

My gut feeling is that you might want to drop your basal (lantus) a little more. When you’re still making much of your own insulin (and I’m pretty sure you are) the usual rule of thumb that about half of daily dose is basal and half is bolus isn’t necessarily true.

Yeah, I went through the honeymoon phase, for a few days about a year after diagnosis I didn’t need any insulin at all. And I’ve had “fool’s honeymoon” where I have a string of hypos but really what I just needed was a lower basal dose.

My daughter (14) was diagnosed Nov 29 & her numbers are bouncing all over the place. She has even had a few days where she didn’t take insulin for her meals, just the Lantus at night. And the Lantus started at 15 or so & is now at 5, back with some insulin shots for meals. The doctor’s office says it’s the honeymoon phase. Plus, she’s a teenager. I am also hoping to enroll her in a clinical trial of a drug for newly-diagnosed diabetics that may extend the honeymoon phase, may preserve some of her beta cells that are producing insulin & may avoid some of the later side effects of diabetes. We are thinking about the Defend 2 trial in Indianapolis. You may want to check some of these clinical trials at JDRF.

Interestingly, the endocrinologist told me that they suspect me of having type 1.5 diabetes (ok, fine) and that I should continue to lower my daily insulin dosage until I am ingesting none at all. While it is true that I have been having many more lows (including two this morning within 2 1/2 hours) and have been lowering my insulin as a result, after opting to not take any today with my meals, my blood sugar has now jumped up to 232! So thanks doc! I feel just as confused as before!

what was the meal that cause the big spike?

I had a salad with tuna, avocado, tomato, dressing, one serving of natural cheetos, 3 pieces of dark chocolate. Nothing too extreme, but normally I would have supplemented that meal with 1-2 units of insulin. Not a lot compared to most people, I know, but something. Crazy enough, as it went down later on its own, I continued to eat foods I wouldn’t even normally eat (1/2 grilled cheese, popcorn, nachos, a glass of whiskey and half a small chocolate milkshake, over the course of 3 1/2 hours) and when I went to bed my blood sugar was 165! I couldn’t believe it. I must REALLY be honeymooning.

try this again tomorrow w/o the chocolate and see what happens. we’re all an experiment of one of what works and what doesnt’. yesterday actually I f’ed up bad and have a piece of key lime pie at dinner when I got home I drank 2 glasses of red wine to combat my high sugars (not a great idea but I didn’t want to take any more meds or go for a run so I hit the bottle which usually brings my sugars down - the whisky may have done somethign similar for you - just a guess) either way - cheers!

Low blood sugars going strong! But, my c-peptide and some other test that I don’t remember did come in, and I am definitely Type 1.

how was the docs visit otherwise?