Type 1, honeymooning, no insulin for a month, had a hypo

[CraigDT]

Hi,

Yesterday I had a late breakfast of cereal(probably at least 70g of carbs), then later a no carb lunch of cheese and meat before going out for a walk.

After walking for a while I felt a bit shaky so checked my blood sugar. It was down at 3.2.

So far so normal, except I haven't taken any insulin for over a month because I am honeymooning.

Has anyone else experienced something similar or had an explanation from a doctor about why that might happen?

Cheers,
Craig

 

[Heathenlass]

During the honeymoon stage, the pancreas still produces some insulin, but erratically . So it's possible that you had an insulin surge that was out of whack with the rest of your metabolism, causing low blood sugar .

It's not often mentioned that this can happen, or that during the honeymoon stage the pancreas is not just producing lower amounts of insulin, but that it is actively malfunctioning in fits and starts too

Signy

 

[Daibell]

Hi. I'm not sure 70gm of carb for breakfast is a good idea when having erratic insulin production? Probably best to keep it down a bit and smooth during the day until things settle.

 

[CraigDT]

Hi,

Why is 70g of carbs a bad idea? At no point has my diabetic nurse, dietician, gp or specialist mentioned that I should keep my carbs down while honeymooning. That doesn't mean they are right of course.

Cheers!

 

[Robinredbreast]

I didn't seem to go through a honeymoon period years ago, so can't help you with that. I was just wondering though if a high carb breakfast was the cause of the sudden hypo, without taking any Insulin for a while and then just a protein lunch, possibly?
Only because if I have what I call a higher carb meal, then it spikes and then my body is fighting for it to stabilise so I then get a big drop, a hypo. But please remember this is just me. Also are you definitely type 1 ? as some members have been misdiagnosed with a given 'type' and then, told they are a different type.
I hope you are feeling better now and take care with careful monitoring as you are just very newly diagnosed and can take a bit of tweaking.

Best wishes RRB

 

[Spiker]

Hi,

Why is 70g of carbs a bad idea? At no point has my diabetic nurse, dietician, gp or specialist mentioned that I should keep my carbs down while honeymooning. That doesn't mean they are right of course.

Cheers!

You should keep your carbs down in general but absolutely while honeymooning without insulin.

I would really recommend that you start or resume using insulin, unless it turns out you are not actually Type 1. Every time you produce insulin from your pancreas you are stimulating renewed autoimmune attacks on your pancreatic beta cells. In my view (following Dr Bernstein) it is wiser to preserve your beta cell function as long as possible as it will make it easier to manage your condition. Let injected insulin do most of the work. Avoid exposing your pancreas to further attack.

But yes you will not find any NHS position on whether to try to extend the honeymoon period or not. They don't seem to have any opinion about it.

Did you get GAD tests and c peptide tests to confirm Type 1? It's possible you have, or had, Reactive Hypoglycaemia instead. Though this can progress to Type 1.

 

[CraigDT]

Interesting. So is the immune response triggered by the production of insulin? Do you have a reference for that one, I haven't looked much into the immune response side of the disease yet.

This hypo event is so far just a one time thing. I was diagnosed last October when I presented with high ketones and blood sugar of about 20. I had weight loss before diagnosis and the usual thirst and drinking. My dad got type 2 when he was in his 70s and I am 36. My antibodies came back negative but the doctors still thought I was type 1 at that point because of my other symptoms. That would appear to be a reasonable assumption given I now appear to be honeymooning which I understand is a type 1 thing, but when I spoke to the nurse on the phone today she seemed less certain. Perhaps more tests at the doctors are incoming.

I had not heard of reactive hypoglycaemia so thanks for that. Gives me something else to google.

 

[Spiker]

It's odd that your GADA antibodies came back negative, as I think that would normally indicate either Type 2, or a Type 1 a long time after complete pancreas burnout. I think more investigation would be a good idea. Maybe you should get more antibody tests done, maybe C peptide.

http://labtestsonline.org/understanding/analytes/diabetes-auto/tab/test/

I don't have a link for an acute relationship between islet cell insulin production and anti-islet antibody activity. I got the idea from Dr Bernstein. Maybe it's not true.

 

[Spiker]

I found this article (2005) on beta cell destruction which has a sort of inverse fact - that the cells destroying the beta cells are also trying to directly inhibit the beta cells insulin production.

http://www.columbia.edu/itc/hs/medical/pathophys/immunology/readings/IsetCellDestructionReview.pdf

Not the same as saying the destruction rate increases with insulin production, I realise.

 

[Spiker]

This article (2004) by authors who propose that beta cell destruction in T2 and T1 should be considered as a continuous spectrum, not as two distinct pathologies, note that many (not all) of the mechanisms of beta cell destruction are also mechanisms of suppressing insulin production, and vice versa.

http://diabetes.diabetesjournals.org/content/54/suppl_2/S108.full

 

[Emmotha]

They would have diagnosed you T1 due to the Ketones. They're not usually present in t2s because T2s usually have insulin production (I believe it's a severe lack of insulin plus high blood sugar that results in high ketones?).

Also I read that not all T1s test positive for antibodies. Seems like you're in one of the small %s.

Would be worth checking for extra tests as spiker recommends

 

[Diamattic]

When you say 'no insulin for a month' do yo mean none, at all, or do you mean no insulin at meals?

Also, how often are you checking your sugars? It is possible you are eating without insulin and spiking 1-2 hours after the meal only to drop back to around normal by the time you eat again.

I just ended my honeymoon phase, it lasted about 9 months, and one morning i woke up, went to work and at lunch ate what i normal ate and injected what i normal inject and felt terrible only to check and see my sugars over 13mmol/L... from that point i had to almost double my injections (but not my basal, that only went up like 2 units)

Make sure you at least keep checking.

The idea behind eating less carbs is because you cannot count on your pancreas working EVERY time you eat something, so it might work great like it has been, for weeks, the day will come when you will eat 70g of carbs and your sugars will go through the roof.

Also, if you eat less carbs you are putting less stress on your pancreas and remaining beta cells, and it may prolong this honeymoon. I would go low carb when possible to stretch out whatever you have left in those cells.

 

[Tylers73]

Just because of honeymoon period you should be still be doing insulin

 

[Markpick]

I'm the same diagnosed January started on 4m of nova rapid before meals and 8 lantus on a night was doing that for about 4 week but with me being a stonemason lifting and moving up and down worktops all day the novorapid was making me hypo morning and afternoon so had to stop using it after talking to my nurse, I'm currently only using 6 lantus now and sometimes using my nova on a night a couple of hours after I've eaten depending on blood sugars with me only chilling on sofa and normally doing nothing strenuous on a evening, all this on instructions from dnurse

 

[tim2000s]

I don't have a link for an acute relationship between islet cell insulin production and anti-islet antibody activity. I got the idea from Dr Bernstein. Maybe it's not true.

Probably this @Spiker : http://www.nhs.uk/news/2013/06June/Pages/Potential-vaccine-for-type-1-diabetes-shows-promise.aspx

"They also measured levels of the so-called proinsulin-reactive CD8+ T cells, which were thought to be responsible for targeting and destroying the insulin-producing beta cells."

"this vaccine seems unlikely to be able to stop all beta cell destruction or restore all function, because the problem occurs through several routes. However, it does show promise at limiting the proinsulin element of the problem."

i.e.The more pro-insulin, the more CD8+ T cells.

 

[CraigDT]

Yeah I really mean no insulin at all. The nurse said they ideally want me taking some, but that with my current numbers I really can't, I ended up having to eat extra every evening to avoid night-time hypos. I test at least 4 times a day, though normally more now I am not taking insulin as I am concerned about the inevitable end of the honeymoon and the post meal spikes.

Anyway, thanks for the input about low carb, it does seem like a sensible approach given I don't know when my pancreas will finally give out and in what manner.

I'm thinking of switching to yoghurt for breakfast, and after that try and tackle my normal bread related lunches. I foresee a lot of meat and cheese in my future.

I have my next specialist appointment in a couple of months so I will see what the deal is with further tests then. Hopefully I get a doctor with some social skills this time.