Low Insulin Needs - How long will this honeymoon last?

#1

Hi all - I am 27 years old and was diagnosed with T1D on January 20, 2016. When I was first diagnosed I started on 7 units of Lantus and 14 units of Novolog (3 breakfast, 4 lunch, 7 dinner). For the most part this dosing regimen worked well with occasional lows after dinner because of a lower carb meal.

I started on the TSlim G4 pump in July 2016 with reduced basal and bolus dosing (based on reduced insulin needs with pumps - about 80% dosing). My basal is set at 0.2 units/hr which works out to 4.8 units/day and has not changed since July. And my bolus amounts have decreased from around 11 units per day to 3-4 units/day. Now my TDD is typically less than 8 units (11 months out from diagnosis). My carb ratio is somewhere around 1:30 although I don’t think this is entirely accurate and my correction is between 1:120 and 1:150.

Is there anyone else out there that was diagnosed in their 20s and has experienced such low insulin requirements almost 1 year out from diagnosis? It is difficult not feeling a bit of denial when my insulin doses continue to decrease and I am basically running off basal insulin. How long have your honeymoons lasted and when did you start to see increases in insulin needs. What is your current TDD?

#2

I’m on MDI and diagnosed in April 2016. My insulin has dropped but not too bad and it spends on the time of the month. Before my period I need up to 18u of insulin. During my period…14u. This has been consistent for the last 6 months. Unsure if I’m still in the honeymoon phase since I feel I can control it for now. But I have been about 70 waking up in the last few weeks and on the lower side of where I want to be. It’s weird and never consistent. Do you like the pump?

#3

Ps. Diagnosed at age 33. So not in my twenties but kind of close?

#4

I love my pump - would highly recommend the Tandem tSlim. If you are thinking about this pump, there is a facebook page called “Tandem tSlim pump” which is made up of mostly users, but contains a lot of good information on the pros and cons of the pump. I also have a dexcom which I don’t think I could live without. The dexcom integrates with my pump so I can track my sugars throughout the day.

What are you doing for I:C ratios? Out of the 14-18u, how much of it is basal/long-acting? Do you know if you had a c-peptide test done? Mine was 1.0 (with the lower end of normal being 1.1.

They say that when your honeymooning it is easier to control your bgs because you are still making insulin on your own. Once you stop honeymooning, your insulin requirements generally go up and you can have more erratic bg numbers.

#5

I was dx T1 April 2013 and I don’t think age matters for honeymoon phase (dx @ 43) …In June 2014 I went on pump with similar I:C ratio and Basal Rate 2 weeks later, BAM, my honeymoon phase ended. My insulin needs almost tripled.

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#6

So, I don’t have experience exactly with what you are describing, but I feel it’s related. I was diagnosed as Type 2 in May 2016, put on orals and D&E for control, and succeeded pretty well with that. I was re-diagnosed Type 1 after testing positive for antibodies in August. I’m still only using orals, diet, and exercise to control my BG, even though I’ve been assured that will change in the future (at some point). As mentioned in another LADA thread recently, the scientific literature shows that some adult Type 1s don’t exogenous insulin, or need only very small amounts of exogenous insulin, for many years after diagnosis. The earliest studies of “LADA” or slow onset Type 1 in adults mentioned a common period of reduced insulin treatment needs from 6 months to 6 years post-diagnosis.

Sam and others here have pointed out that in some of the Trialnet data, there is indication that some of us Type 1s (i.e., those diabetics with antibodies to beta cells or insulin itself) never are treated with exogenous insulin, and do OK with other control measures. I suspect that is very, very rare. So what does all that mean about your own case? I don’t think you should feel as if you’re the only one out there. I sometimes feel very lonely out here in “Type 1 living like a Type 2” land, but I know there’s others out there. I’ve even recently met at least one other in this forum. I’m pretty sure you’re in a similar position.

#7

How long a honeymoon lasts is something completely individual. My A1C was 6.2-7.2% for the first year. Then at 15 months it shot up to 8 and three months later is was even higher.

We actually had never discussed what my “Type” was, but at 18 months they had me take the autoantibodies test.

So, my suggestion to you is to “enjoy” the calm before the storm, but keep an eye out for when your treatment is no longer enough to keep your BG under control.

You will go through times when you have to adjust your rates because Diabetes. It’s just the nature of the beast.

#8

I would say my ratio has been consistent at 1:20. But as you know it varies. This week it seems to be 1:30. Sometimes the week before my period it is 1:15.but.for.most of the time it is 1:20 and has been since dx.

My cpeptide was 1.2 in April. My GAD was over 1900 with reference range below 5. Eeek. I know they say cpeptide testing is worthless after dx but I’m curious to know it now.

I feel like i will eventually be on a pump but I’m doing well on MDI. I’m not sure why I have such hesitation with a pump but I do…

I do want the CGM at some point.

#9

Interesting, I feel like a “type 2 living in type 1 land.” Type 2 meds have been pretty ineffective and for six years I’ve been on insulin and currently have a CGM. We are all truly strangers in a strange land.

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#10

What is the unit of measure for your GAD test? My test was performed at Mayo labs and their reference range is < 0.02 nmol/L. My value was 0.16 nmol/L which was high and diagnostic of T1D.

I was hesitant about the pump at first as well - scared that it would somehow give me a lethal dose of insulin. I liked the control with MDI, however I really like how discreet the pump is. I no longer have to pull my shirt up to give injections while at a restaurant!

#11

I’m not surer f the reference range but it was over 1900 units of measurement over. So it wasn’t nice to see mentally. I think I’ll eventually get on a pump but I’m content right now. And a pump is the unknown. I don’t do restaurants often although I really don’t like using the bathroom but not the worst thing. My average was 89 the last few weeks then BAM. Over 200 today randomly. Argh. For no apparent reason. That sucked for me today.