End of honeymoon?

[AmyGreen]

Right i'll try and keep this short but need some advice.

Diagnosed in pregnancy 3 yrs ago (said I was probably diabetic before because my HBA1C was stupidly high), had my daughter and then 4 months later was pregnant with my second daughter who is now 1.5 yrs old. It was between pregnancies I was diagnosed as Type 1 and since the first pregnancy I've been on insulin. Now I've always been told I will have a bit of a honeymoon period where I won't need a lot of insulin etc. I needed a fair bit in pregnancy both times but still small amounts. Last year I did a DAFNE course but my HBA1C has always been ok (last one done a few weeks ago 52.

Anyway fast forward the last 6 months or so...... i've been on a health kick, bought a fitbug, been walking 6-7 miles a day, limiting calories (not having loads of carbs, I'm still not the best eater) and lost 2.5 stones. Now with my walking I've found that I've needed approx 3-5 units of novorapid a day and thats it. A year ago it was probably 30 (DAFNE did make me realise i was taking far too much), but I was doing the general 1-10g of carbs and thats been cut to about a third. I could generally have a breakfast of 30g/40g and no insulin as the walking I did afterwards helped. I have been having 1 unit of background in a morning and I did have 1 unit of background at night but cut that a few weeks ago but i have just started it again.

Anyway (again), the last 2 days or so my blood sugars have been higher. My walking hasn't differed, neither has my food.
Yesterday for example

Morning was around 7, had 30g carbs for breakfast, so did 0.5 quick (before could have been no units), was still 7 before lunch. Had 55g for lunch and 2.5 units. Before dinner I was 8 something and had approx 40g dinner and 2 units with it. Had a snack (was 5.2 before snack) which was 17g so had 1 and about 3 hours later I was 12. Now I know these aren't huge numbers and considering i'm not taking a lot of insulin with food either, but they are higher for me. I think I'm dehydrated (didn't drink much yesterday) and had a migraine. Obviously I will see how the next few days go, but could my honeymoon period literally change overnight?

I know in general if I went back to 1 unit to 10g carbs even then it wouldn't be big numbers of insulin, but I've got used to not a lot of insulin at the moment it seems a big jump to me. My questions, could this be the end of my honeymoon period? Could it just be a one off being dehydrated or having a migraine (a side note I generally do tend to have a low level of ketones, generally 0.6 or below but yesterday I'll admit I had none but this morning I've got a level of 0.6) or could it just be something else? I end up rambling and this probably doesn't make to much sense, but if someone reads this and has had a honeymoon period and can tell how their's went then it might help. I was told probably about 2 years ago that my honeymoon period might last a year (originally diagnosed as Type 1 as I had a very very high number of ANTI-GAD? antibodies). Lately i've been questioning my type 1 diagnosis and thinking i'm more type 2, seeing as i'm eating better, losing weight and not needing that much insulin. I just don't know

 

[himtoo]

Hi Amy
In the really short term it sounds as though you are doing EXACTLY the right thing -- you are testing and eating to your meter and getting exercise.
The so called honeymoon period can fluctuate as your pancreas sort of gives up the ghost.

The interesting point you make about potentially being T2 and not T1 is that from your description you have not been seing any insulin resistance , which is more common in T2.

for the next few months it sounds as though you should carry on as you are but obviously keep in touch with your DSN if the changes worry you .

 

[smidge]

Hi Amy,

I'm not a big fan of the phrase 'honeymoon' for LADA/Type 1.5 - I guess that suits full Type1 - and I believe it really can end overnight. That's not what you're seeing though. You are seeing a gradual increasing need for insulin - which is very typical of LADA - it is a progressive condition so that's not surprising.

Your increasing requirement might be temporary e.g. an infection, menstrual cycle, pregnancy (hormone changes play havoc with BG. ) I might just be that you've now progressed to needing more background insulin to get the base level lower. What are your post-meal readings like? I guess if you're following DAFNE you won't be taking any, but only by knowing whether your BG is higher constantly or higher because of your food will you get a full enough picture to work out what's happening.

Smidge

 

[cz_dave]

I'm not a big fan of the phrase 'honeymoon' for LADA/Type 1.5 - I guess that suits full Type1 - and I believe it really can end overnight. That's not what you're seeing though. You are seeing a gradual increasing need for insulin - which is very typical of LADA....

Smidge

I think I am experiencing this. Specifically, I find my insulin to carb ratio has decreased, from 1:20 to 1:15. My basal insulin needs, on the other hand, seem to be quite stable. I only take 4 units Levemir per day.

I suspect I will soon be at 1:10 for my fast-acting insulin. Should I expect my basal needs to go up too @smidge?

 

[ElyDave]

change in weather recently as well. Some people get significantly affected by high/low temperatures.

Don't know about T1.5 to much but honeymoon period can last a long time. I'd say I'm still there as I'm on about 4 U/day basal novorapid and similar bolus, with carbs around 100g/day and a 25:1 ratio. I'm just under 2.5 years since diagnosis.

 

[cz_dave]

Interesting. Could you share more on the post-prandial BG levels you typically achieve?

 

[ElyDave]

who, me?

 

[cz_dave]

who, me?

Yes.

 

[ElyDave]

right

As an example,

Tuesday
pre breakfast 6.2, no carbs (coffee with cream and a handful of nuts), no bolus, +2hrs 6.2
pre lunch 4.8, 20g carbs, 0.75U bolus, +2hrs 7.4
TBR of 30% three hours ahead of exercise
pre gym (hour on the turbo) 5.5 15g carbs taken, 30m in 5.4 no carbs, 60 mins 4.7 no carbs
dinner pre 4.8, 15g carbs main meal 0.55U, 20g carbs dessert 0.8U, +2hrs 6.7
Pre bed 8.2 (odd for me) correction 0.15U
Total 70g carbs

Yesterday
pre breakfast 5.5, no carbs, coffee, nuts, +2hrs 6.3
pre lunch 6.2, 20g carbs, 0.8U, +2hrs 8.0 - no correction for the 6.2 as I was running later
TBR of 30% three hours ahead of exercise
pre run 5.9, 15g carbs, mid run 5.8, post run 3.7, no more carbs
pre dinner 5.4, 35g carbs total, 1.45U bolus, +2hrs 5.1
pre bed 4.2, 5g carbs
Total 75g carbs

Today so far
pre breakfast 5.4, no carbs again, post breakfast 5.4
Pre lunch 5.9, 20g carbs, 0.85U, post lunch 7.4
Yoga this evening, no adjustments to basal rates, BG should be steady or see a slight rise.
pre yoga (about 5:30) 4.4, 10g carbs, post yoga 6.8
pre dinner (30mins later) 7.2, 25g carbs, 1.15U.

That's fairly typical for me

 

[tim2000s]

Had an interesting chat with Jonathan Valabhji tonight, who did the research in the nineties that lead to the discovery some long term T1s still had some functioning beta cells. He mentioned that those who somehow retained them found that they had a substantially easier time than those who had none. I suspect that's happening with you @ElyDave.

 

[cz_dave]

right

As an example,

Tuesday
pre breakfast 6.2, no carbs (coffee with cream and a handful of nuts), no bolus, +2hrs 6.2
pre lunch 4.8, 20g carbs, 0.75U bolus, +2hrs 7.4
TBR of 30% three hours ahead of exercise
pre gym (hour on the turbo) 5.5 15g carbs taken, 30m in 5.4 no carbs, 60 mins 4.7 no carbs
dinner pre 4.8, 15g carbs main meal 0.55U, 20g carbs dessert 0.8U, +2hrs 6.7
Pre bed 8.2 (odd for me) correction 0.15U
Total 70g carbs

Yesterday
pre breakfast 5.5, no carbs, coffee, nuts, +2hrs 6.3
pre lunch 6.2, 20g carbs, 0.8U, +2hrs 8.0 - no correction for the 6.2 as I was running later
TBR of 30% three hours ahead of exercise
pre run 5.9, 15g carbs, mid run 5.8, post run 3.7, no more carbs
pre dinner 5.4, 35g carbs total, 1.45U bolus, +2hrs 5.1
pre bed 4.2, 5g carbs
Total 75g carbs

Today so far
pre breakfast 5.4, no carbs again, post breakfast 5.4
Pre lunch 5.9, 20g carbs, 0.85U, post lunch 7.4
Yoga this evening, no adjustments to basal rates, BG should be steady or see a slight rise.
pre yoga (about 5:30) 4.4, 10g carbs, post yoga 6.8
pre dinner (30mins later) 7.2, 25g carbs, 1.15U.

That's fairly typical for me

Wow, thanks so much. I am still trying to figure out the right path for me in terms of carbs/post-prandial levels and also how agressive I should be on the low-carb front. This helps a lot.

It looks like you have some pretty good control there.

 

[ElyDave]

Had an interesting chat with Jonathan Valabhji tonight, who did the research in the nineties that lead to the discovery some long term T1s still had some functioning beta cells. He mentioned that those who somehow retained them found that they had a substantially easier time than those who had none. I suspect that's happening with you @ElyDave.

I suspect the same @tim2000s, but not sure how I could prove/disprove. I do occaisionally wonder whether I've been misdiagnosed, but then go and have a run of results I can't explain for a few days.

Is there a paper on the subject that I can get hold of?

 

[cz_dave]

I suspect the same @tim2000s, but not sure how I could prove/disprove.

Wouldn't the C-peptide test reveal if you still have some endogenous insulin production?

 

[tim2000s]

Yes, but research that Jonathan Valabhji did showed that many T1s still produce Insulin.

 

[ElyDave]

Yes, but research that Jonathan Valabhji did showed that many T1s still produce Insulin.

Tim, any papers associated with that?

 

[cz_dave]

Yes, but research that Jonathan Valabhji did showed that many T1s still produce Insulin.

My endo had me re-do the c-peptide test after 6 months to see how the auto-immune attack is progressing. He also had me re-tested for GAD.

 

[tim2000s]

Tim, any papers associated with that?

They seem to have been publicly shed pre-Internet. I've not found them yet.

 

[Ian DP]

All T1s in the honeymoon period still produce insulin. Dr Bernstein states that many T1s diagnosed in the honeymoon period can stay in the honeymoon period for many, many years, even for the rest of their life.... Thus continuing to produce some insulin. I have been a T1 in the honeymoon period for over two years now and not on yet on insulin.

 

[Kristin251]

I have found weather change makes a difference as well as exercising. I have to take 1/2 unit for every 5g of protein so not just for carbs. Protein effects me just as much. I am taking very little insulin as well. 1-1.5 units per meal and 2 or 3 background before bed. Seems diabetes is just like a baby. As soon as you have a routine it all changes. I do best keeping protein on the low side and also better with some plant protein. Small meals help as well.

I was diagnosed LADA 1.5 years ago at age 51 with a GAD over 250. I don't think there is any honeymoon phase for me as BS and insulin are too consistent. Some foods make me IR so I stay away. I feel funny when I have to correct, roller coastery