Really low doses of insulin

#1

As a newly diagnosed T1 my low doses of insulin keep me well-seated in denial. I’m taking 7u of Lantus in the morning and my carb:bolus insulin ratio is about 30g:1u. When I’m reading about intensive insulin regimes these figures seem ridiculous!

One endocrinologist has told me these are totally normal for ‘honeymooning’ and another endocrinologist told me they point more to LADA or MODY being likely for me. A diabetes nurse educator told me that it could be an strong sensitivity to insulin and that I could have these low doses for a while and outside of the honeymoon.

Not trying to 'brag' about low insulin requirements, but wondering if there are others out there who started out that low and am interested to know what time frames they had with regards to honeymoon and so on...

#2

hello a, welcome to the club, so sorry you had to join.

i am also honeymooning, have been since nov 2011. i am also on an I:C ratio of 1:30 and on 4 units of levemir. i also look at the "real" diabetics and think their dosages are crazy high and very scary. i have a real live diabetic friend that i see once a year and this summer was the first time i saw her with both of us having the D. i asked her how much she would have to bolus for my (carb free) salad and she eyed it up (shes a pro 3 years in)and replied, like three units. floored that she would have to bolus for chicken and greens. i just never want to go there but i know im on my way...

one thing i didnt realize at the beginning about peoples dosing was that t2s are usually the ones who have the really high doses since they are insulin resistant.

i live in spain and they just said im t1, no mention of lada or anything so dont know. doesnt really make a difference to me tho, as i know i have to insulinate every day whichever it is!

enjoy the honeymoon!!
m

#3

All I can recall 29 years plus back ( 1983 ) , that I started out in hospital on 45 u ( I did suffer from a low BG incident ; thank goodness I was in hospital !) Soon back to work , normal activities , a vacation followed in summer of 1983 ..we were cycling a lot ..and my daily requirement was 2 u ( no talk about ratios then ) .I am still sensitive to insulin ( TDD just under 20 ) and not a low carber .Part of a unit less and I end up with higher than I like my meter readings to be ; part of a unit more and I may end up with a low BG ...the challenges of living with diabetes !...and for everyone it will be different.Some require more , some will need less
I see you are from BC ...and welcome to TuD.org from the Shuswap !

#4

Sounds normal to me. Diagnosed LADA 2.5 years ago, insulin since March. Only needing 2u basal daily; bolus ratios range from 1:12 at breakfast to 1:30 at lunch. And like Shawnmarie, I don't correct yet, as my highs seem to always self-correct to 75-100 within a couple of hours.
I assume this is still honeymooning. But the endo said that it's likely a bit of insulin sensitivity also.

#5

Pretty much the same thing I went through 27 years ago. I think there is more information about why newly diagnosed T1s might be going through a honeymoon period which may have ramifications down the road, but I'm not sure how the information actually affects your treatment options in the short term.

My "honeymoon" lasted a few years, well past the two years that my endocrinologist predicted it would last. There are a lot of lifestyle factors that will affect your insulin dosing, so things like increased activity level, increased lean body mass, decreased carb intake, so on, can work together to keep your insulin requirements at a minimum as you start to see a decrease in beta cell function. Some diabetics find that, even though they see an increase in insuin requirements, their insulin dosing becomes more predictable as they become more reliant on their exogenous source.

Really, the important thing is to stay on top of your insulin requirements at all times, whether they change slowly, quickly, or barely. It's nice to have extremely low requirements. I remember having to make very few lifestyle changes, but my extended honeymoon also started me off on years of bad habits based on unrealistic expectations about how much work it would take to manage my condition.

#6

No matter what kind of diabetic you are, it's still hard. No you're not faking it at all. Hope everything stays easy for as long as possible.

1 Like
#7

Everyone's diabetes is different. I don't think there is much in the way of "typical" insulin requirements, whether you're honeymooning or not. You need the insulin that you need. So many things affect exactly how much insulin your body absorbs. Remember that in non T1s, the insulin is dumped directly into the bloodstream. But when you take insulin via injection or through a pump, you're injecting it subcutaneously, and this then has to be absorbed via the fat cells.

We are all different, and most of us have variations in terms of how well/fast we absorb insulin, which in turn impacts insulin requirements. In addition, factors such as weather (in heat you need less insulin), sleep patterns, the secretion of other hormones, physical activity, diet, and many other things impact how much insulin you need relative to the next person.

I always say to just focus on what your body needs to achieve normal BGs. That's the right amount of insulin.

#8

I wish I could remember if I had a honeymoon phase or not. Diagnosed in 1986 and I was put on quite a lot of insulin straight away. I ended up being hungry all the time. So a good many years of this I figured things out myself. I discovered I don't need that much insuliin at all. Compared to you it may seem like a lot. Usually take 1unit of Novo for bfast, 2-3 for lunch, then 4 Novo at teatime. 10 Lantus at bedtime. Before this I was on between 10-16 for each meal, ridiculous. There is a lot more info out there now and hopefully you will be able to prolong the honeymoon phase. Good luck, oh yeah, whenever I decide to excerise, which isn't often, I become more sensitive to insulin.

#9

Thanks for all the info here - it really helps me legitimize the sense I have of my insulin requirements to know that there are others out there, honeymooning or not, who also take low doses..

#10

Thanks for all this info about your experience.. I'm wondering when in your timeline with diabetes you became pregnant? It's hard to believe my endo when she suggests there is no evidence to suggest that pregnancy, despite it's inherent increase in insulin needs, would halt the honeymooning process I'm currently 'enjoying'. Sounds like you experienced just that, though. That's great.

#11

How much insulin you use depends on many factors - including "honeymooning",
how much you weigh (smaller people need less than larger people), insulin sensitivity, and , of course, how much carb you eat.

The average T1 who produces no native insulin uses about 0.7 units/kg/day total daily dose of basal and bolus insulin. This is *average* and there is a large variation. So a 175 lb ( 80 kg) person would average about 56 units a day total dose, while a 100 lb (45 kg) person might use 31-32 units. Some people are more insulin sensitive and some are more insulin resistant, and would use more or less than these numbers.

I am about 1.5 years since diagnosis and I know from C-Peptide tests that I am still prducing some insulin, though it has been dropping rapidly. I started out at diagnosis using about 20 units a day (10 basal, 10 bolus) and am now up to about 65 units a day. It slowly increased over time as the native insulin production fell off.

You see it happening as your fasting and post-meal BG numbers start going up and you increasingly have to make adjustments to compensate.

Other factors can bring the total daily dose down : losing weight, exercising, insulin sensitizing agents (metformin and others).

Like everything with diabetes, it's highly individual.

#12

P.S. studies have shown that starting on insulin therapy soon, while you are still producing some insulin, prolongs the time that you continue to produce insulin, which helps you with control.

#13

sounds like good news to me - my A1C was at 9.5% at dx and I'm thankful as I know it could have been a lot worse before diabetes was figured out..

#14

I use approx 4u basal and 7-10u bolus every day. I am on a pump and extremely insulin sensitive. Just depends who you are, everyone is different

#15

I was diagnosed at 19 years old with type 1 (LADA) and hypo-unawarness,started at 5 units lantus and 3 times novorapid.now im up 15 units lantus in just 4 years.
I think when diagnosed very early in autoimmune type diabetes(specially the LADA type)it tends to destroy the beta cells in the pancrease more slowly(due to multiple factors not yet understood),so when i was diagnosed i still had 50% pancreatic beta cell reserves and each year that % is depleted,in which you might notice you need a little bit more of insuline.
My dad was diagnosed at 19 years old too with LADA but had a much slower progression of destruction than i did.
well hope this help.

#16

My A1c was 14 at diagnosis. Started 15 units of Lantus, then endo adjusted down, down, down to 10. Now 3 years later I'm back up to 15. My ratio used to be 30:1, then 20:1 , now it's anywhere from 10:1 and 15:1 depending on the time of day. I used to think I wasn't really diabetic (lol) when I was honeymooning. You are T1 and don't let the "experts" tell you otherwise.

#17

Hi A: When I was first diagnosed, my I:C ratio was also 1:30. My honeymoon lasted about 1 year; if I were diagnosed today I would choose to immediately go on an insulin pump to preserve remnant beta cells as long as possible (plus insulin pumps allow for precise low doses). Endo Bruce Buckingham at Stanford has had enormous success in preserving beta cell function by putting Type 1s on insulin pumps and intensive therapy immediately after diagnosis (no time on MDI).

#18

Hi Shawnmarie: The basal rate on an insulin pump can be set incredibly low, which would work for someone with little exogenous insulin requirement and allow "resting" of the remnant beta cells. I am just expressing what I would do now, if diagnosed today and had the benefit of 20/20 hindsight (in this current age of insulin pumps and insulin analogs--seems like yesterday I was diagnosed but in fact it was the Dark Ages of R and NPH and an insulin pump was a rare thing indeed). Nonetheless, despite some early missteps due to my misdiagnosis, I have been doing intensive insulin therapy since about month 2. All the studies that I have read that look to prolong the honeymoon do it by intensive insulin therapy preferably via pump from as close to Day 1 as possible. And there is enormous benefit to prolonging the honeymoon--diabetes is so much easier to manage and the possibility of complications is greatly reduced. Now, would an insurance company pay for a pump in your situation is another question.

#19

While I agree with Melitta that early aggressive insulin management is important, I don't feel that the moving to the pump immediately is necessarily good. I think the primary reason that your pancreas burns out is glucotoxicity and that occurs when blood sugars are over 140 mg/dl. If you can maintain tight control with meds and MDI, then you should do fine. I'm in no hurry for a pump. It is more complicated, more expensive and it builds up scar tissue faster. But if your blood sugar is well controlled (< 140 mg/dl all the time) then I don't think there is a compelling reason to move quickly to a pump. Just my opinion.

ps. And a pump despite it's precision and accuracy, still cannot compensate when your own insulin production surges and wanes.

#20

Hi Brian and Shawnmarie: In people with autoimmune diabetes, the primary reason for beta cell loss is the immune-mediated destruction of the beta cells. A lot of people talk about the glucotoxicity that occurs when blood glucose is over 140 mg/dl, but I believe that all of the studies that look at that phenomenon were done on people with Type 2 diabetes (i.e., no immune-mediated beta cell destruction). I agree with Brian that insulin pumps are complicated, cause scar tissue (and really attractive fat pods, too!), and expensive, but again, the researchers who have achieved the best results in prolonging the honeymoon have done it via intensive insulin therapy using a pump.