For the last 11 days I haven't taken any basel or rapid acting insulin. For the first week I ate what I wanted - carb overload - and for the last few days I've eaten very little and practically no carbs. I only tested about 3 times during the first week and got readings of 10.2, 11.6 and 4.6. The last few days I've tested every few hours and I've gently moved between 4.9 and 6.0. What's going on? Why are my levels not sky high? Am I not really diabetic (and there was some confusion as to which type I was at diagnosis)? I'm worried about whether it's bad news not to have any basel insulin in you as, apparently, is used for other functions in the body aside from dealing with carbohydrate.
Could you explain what insulin regimine you were using before stopping treatment? How much basal/bolus? What were your reaadings like? I think a little background would help us give better answers.
11.6 is sky-high enough to suggest something's not right. I think that many theorists (e.g. Dr. Bernstein) and many members agree that having reasonably normal BG is the goal. I know quite a few folks who work to avoid taking insulin through a number of strategies (diet, exercise...) but I don't think that 10.2 and 11.6 mean you're clear. It may indicate some "home grown" insulin still being put out by your body but it may not last forever so it probably would be a good idea to stay on top of it? 3 tests is also a very small sample size for a week of "carb overload", were those pre-meal, 2 hour post-meal, fasting, a mix?
Just because you have type 1 doesn't mean all your natural insulin production is totally zero. In fact, most T1s, even after 50 years still have some residual insulin production. My bet is that after you dropped to "no carbs," your natural insulin production was kinda able to keep you "ok." In fact, before the discovery of insulin, patients were put on a starvation diet which had almost no carbs. Children with T1 could live for as long as 4 years, albeit in misery. You can read about the personal experience of Elizabeth Hughs in the book "Breakthrough." If I remember, she lived for three years on the diet before finally being saved by insulin.
I have to tell you, even though you might find that you can go without insulin and at times seem fine, your blood sugar is still running high. And it is not uncommon to find your natural insulin production surges and wane, so please don't be lulled into a sense that things are fine. You could wake up tomorrow having lost your insulin production and find yourself with a dangerously high blood sugar and in DKA. Please consider testing on a regular schedule, at least 4 times a day and it would be prudent and safe to continue your insulin regime. Please think about it.
Not uncommon for a pancreas to produce some insulin, as the others have said. Many see this with lows for which there isn't an explanation. Of course, the highs burn out remaining beta cells. Please, please don't risk not taking insulin.
Thanks for replies so far. Here's the deal with me:
Dx 2 years ago, age 40. (39 yr old brother dx same weekend.) Started a basal bolus regime at about 4 months in. I'm a researcher by trade, so researched. Decided on very low carb approach. Very successful - lost weight, A1C around 5, felt better than for a long time. 4 units Levemir in the am, 4 in the pm, Novorapid for food but no more than 3 units a day (30g carbs). Testing about 7 times a day. Got fed up. Ate carbs, got carried away, stopped testing, had a week off. Got cross. Fasted for 2 days. Now eating the way I want to in terms of what I believe to be best long-term (low carb, low doses, rule of small numbers etc) but levels seem good without any insulin at all. Though it's only been 2 days! If I take insulin surely I'll go low. What to do?
I'd do what you're doing to avoid a crashing low. As long as you're testing frequently to catch & correct any highs & to see a pattern if BG starts creeping up. How are your fasting readings?
I agree with the others. Because your age at diagnosis it is likely you are slow onset Type 1 which means that your beta cells are destroyed more slowly and you might still have significant insulin production left. If you are curious about this a c-peptide test will tell you how much insulin you still make. But studies show that early use of insulin can slow down beta cell death so since you are scientifically oriented you might want to research this and consider whether using a small amount of insulin is in your best interest.
So the average T1 uses a total daily dose of 0.7 units/kg (some more, some less, depending on insulin resistance, exercise, etc). Since you said your TDD is around 11 units/day (you said 8 units basal and 3 units bolus) and my guess is you probably weigh more than 15 kg (34 lbs), you are likely producing some native insulin.
If you were producing none, what you would see is a fairly rapid increase in BG over a period of a few hours, even without eating. The symptoms of diabetes would return (peeing , thirstiness, weight loss, vision changes) as your blood sugar rises and soon ketoacidosis would start. untreated, that leads to coma and death.
I would not fool around with the experiment you are trying for several reasons (a) you will burn out your remaining beta cells faster as they are overstressed trying to keep your blood sugar under control. This will make control harder in the future. and (b) you risk DKA if for some reason things start to spin out of control suddenly as native production falters.
(c) Extended periods of high blood sugar will cause microvascular damage to your organs (retina, kidneys, limbs, etc).
At a minimum, have some basal insulin in your system to prevent DKA.
numbers in the 10 range (180 mg/dl ) are NOT GOOD.
What happens at first is that the basal insulin has a tail and some is still there for a few days. What happens next is that the beta cells try to respond to the incoming glucose. They overwork. The point at which they wear out will be seen when you have high blood glucose.
Then you will need much more insulin than you have been taking. The theory is that we save our beta cells somewhat by starting insulin early on.
An 11 mmol/l is 200 mg/dl, pretty high to me. At this rate you will start feeling some lousy beginning neuropathies.
Yes its bad news not to have insulin in you to allow the cells to function, pass signals and keep healthy. Your 4.6, 4.9, and 6 are great readings. And obviously, your beta cells were doing their thing for those readings. But when you eat carbs, what happens?
If you weren't "really diabetic", your blood glucose wouldn't even give a blip on eating a normal carb meal.
Your goal should be to preserve what you've got. Try not to test it too long! :)
Thanks again, for the replies. Today my b/s readings have been 4.4, 5.1, 4.3, 4.6. These are great readings. But I still haven't taken any insulin, basal or bolus. It's not that I'm avoiding insulin for some reason, but my levels don't really warrant any, or am I missing something? Surely if I take a basal dose I will have a hypo. I don't need bolus doses as eating very low carb. Can you see my dilemma? I'm fully expecting my b/s levels to go up, but they haven't yet and so I don't know what to do.
I don't pretend to be a doctor, but it sounds to me like you are T2 or are a recent-onset LADA with a significant number of surviving beta cells. There are T2's who are able to avoid BG medication (insulin and other) simply by losing weight and eating a very low carb diet. Some of them post here and will probably chime in. It could be, I suppose, possible for a recent onset LADA with lots of surviving beta cells to accomplish the same thing.
Besides seeking your doctor for real medical advice, I think you need to consider two things.
1. Is there a benefit to taking basal insulin in order to prolong the survival of your beta cells? If so adding back basal insulin might be a good idea regardless of whether you continue with your current diet or not. Adding basal won't make you hypo (you know that becuase you were doing it just a couple weeks ago) - it will simply reduce the constant load on your pancreas.
2. Are you willing and able to stick with the diet you are currently eating? Do you think you want to do it for the long term? If not, you might need to add back your bolus insulin as well - both to prolong beta cell survival and to match the food you are eating. The fact that you were hitting 10 and 11 when eating more carb indicates you will need bolus insulin if you go back to that way of eating.
(And to fully answer your question - I've had T1 for 37 years. If I stopped taking all insulin for two weeks I would be in the hospital or worse).
Whether you are T2 or slow onset LADA T1 with some beta cell function left I agree with Jag about adding some basal back in. As long as your not adding more than your body needs and causing lows then your onboard insulin production should scale back naturally thus helping to prolong beta cell function. The trick is to find the right balance.
I would be doing what I could to find out what my correct type is. If your doctor hasn't already done so T1 autoimmune antibody testing is in order. Knowing for sure what type you are will help determine where you go from here. If you are T2 you might just be able to control with diet and exercise alone
In the UK they use a different scale it's called 'mmol' not sure what it stands for. To convert mmol to mgdl multiply it by 18, I think. Someone correct me if I'm wrong.
