Needing less and less insulin!

[johnny368]

Hi folks,
Has anyone experienced having to take less and less insulin to the point of none at all depending on their activities?
I've been T1 for 2 years and 6 months now and take Lantus for background and Humalog for carbs etc. I've never needed a high dose (14 units of background and a ratio of three quarters to 1 unit of humalog for every 10g of carbs or thereabouts) however over the last few months in general i've needed to cut down on my dosage. I have a physical job painting & decorating so when working have always compensated for this by dropping my humalog to around half a unit per 10g of carbs but during the last 6 months i've had to take no insulin at all during the day on a couple of jobs where i've had to be on the road before 6am for a couple of hours, then work 8 - 10 hours followed by the same drive home. Breakfast is usually 60 - 80g of carbs then around the same for lunch with the odd snack in between due to my BG dropping into hypo mode even with no insulin. I've now lowered my Lantus to 12 units and this has slightly helped. I don't rush around like a lunatic but am constantly on the go and this doesn't happen all the time but just wondered if anyone else has experienced this. I saw my DAFNE doctor a couple of weeks ago and he said that it's perplexing but not sinister, he didn't have any answers as to why this would be. On the other side of the coin over last Christmas I struggled to keep my BS under 10mml thinking the honeymoon was over but as soon as I got back to work I had to drop my insulin again. I now take a ratio of half a unit to 10g of carbs but that can still fluctuate.....but not all the time so there is no pattern to it.
Does anyone have any ideas? It would be much appreciated.

Many thanks,

John.

 

[Emmotha]

Hello,
How strange! I know when I am inactive my blood sugars shoot up, so maybe u r very sensitive to that.
Could your basal still be too high? If you are hypo'ing without Bolus then it could be

 

[johnny368]

Hi,
95% of the time my BS's are within range, obviously I get the odd spike but I if I have to get up at silly o'clock and work then sometimes I need no insulin and other times I just need to drop it slightly. I thought that it was maybe a honeymoon thing whereas my pancreas has kicked back in a bit or that maybe i'm the only person ever to recover from T1 and be a medical anomaly thus making becoming a millionaire in the process but that's just wishful thinking. Being now that it's Easter and I havn't worked for a few days i've had to up my humalog and the DAFNE rules are working with adjustments etc so I reckon the basal is about right.

 

[himtoo]

Hi johnny368
welcome to the forum
from reading your post it definitely sounds like honeymoon !-- there are no exact rules on how long it lasts and how variable it can be in terms of insulin requirements.
just take it 1 day at a time and keep on living your busy life ( best way to be ) .
**** ! -- always hoped i was going to be that millionaire in the early days

 

[smidge]

Hi Johnny.

Is it possible you have LADA rather than full Type 1? It's an adult onset form of autoimmune diabetes and is usually simply lumped together as Type 1 by the medics. However, with LADA you still produce your own insulin for a long time - not the shortish honeymoon that full Type 1s get, but many years and the amount you produce fluctuates. After more than 5 years, I still produce some insulin and it catches me out sometimes and I have to rapidly reduce my doses.

Having said that, exercise certainly has a drastic effect on my insulin needs - when I swim, I have to reduce both my basal and mealtime by about a third for several days after - and believe me, my swimming is not Olympic standard - more of a saunter up and down the pool. The other things that real drop my levels are shopping and hoovering bizarrely as neither seem particularly energetic. So maybe the painting and decorating really do sensitise you to insulin in some way or make your pancreas kick back into life for a bit.

Smidge

 

[jaywak]

I know Johnny it dosn't make sense does it? I have been injecting for 40 years and have experienced this on several occasions to the point were i'me thinking THANK GOD I'ME CURED ! but it always changes back again.

 

[johnny368]

Hi Smidge,
That's very interesting. My DAFNE specialist did make the comment that when I was 'found' two and a half years ago they're were pretty **** sure (which is not 100%) that I was T1 due to the antibodies in my blood reading 76 rather than around 5 but to keep my eye on it. My father was T1 but he died back in 1977 so maybe he wasn't as nowhere near as much was known about diabetes then. As I explained mine seems to play up when I work very long days. Thanks for your insight, i'll read up on that one.

 

[johnny368]

Well at least i'm not on my own Jaywak but thought the specialist would have heard of this.

 

[noblehead]

Possible LADA or an extended honeymoon period, but physical exercise/activities can make us extremely sensitive to insulin so perhaps your background insulin is enough to keep your bg levels steady at the moment, if your consultant isn't concerned then I wouldn't worry about it and just make the most of this time

 

[jaywak]

Johnny I think the the specialists don't always listen to us and would tell me not to be so daft as it's not possible for this to happen [i'me still a novice after 40 years]. We are all different and our bodies all react differently, No one size fits all!

 

[johnny368]

Yes I did think that I'm still honeymooning as i've read that it can last from weeks to years but it's only recently that it's had a bigger effect on my BS. When my BS went sky high over Christmas a different specialist said that the honeymoon was most probably over but I did have my doubts.
Thanks for the comments, i'll keep on investigating.

 

[jaywak]

I have dropped my Novorapid a couple of units and got the same bg then dropped it again and got the same result but it always creeps back up again. Sometimes you will find what you did 36-48 hours ago regarding exercise work etc will lower your blood suger.

 

[Marina Kurkov]

This is 2023 --- Johnny may have found the real cause by now ---- hope his endocrinologist caught up with the times., I have the same problem and have found out that I have Addison's disease. The adrenal glands have been assaulted by the immune system, the same one that caused my diabetes---- more than half the people with Addisons have also diabetes 1.... my treatment is about to begin --- drugs that need to be adjusted and taken forever after, just like insulin.... still, glad that some of the symptoms will be gone... the constant exhaustion, the dizziness, the unearned tan on my legs (that comes and goes...

 

[oldgreymare]

This is 2023 --- Johnny may have found the real cause by now ---- hope his endocrinologist caught up with the times., I have the same problem and have found out that I have Addison's disease. The adrenal glands have been assaulted by the immune system, the same one that caused my diabetes---- more than half the people with Addisons have also diabetes 1.... my treatment is about to begin --- drugs that need to be adjusted and taken forever after, just like insulin.... still, glad that some of the symptoms will be gone... the constant exhaustion, the dizziness, the unearned tan on my legs (that comes and goes...

Wow, that is interesting - my endocrinologist at my last appointment noted my blood sodium was borderline low and told me to keep an eye out for Addison's symptoms. My insulin needs do vary day to day but I've put it down to my highly variable diet, exercise, stress lifestyle...

 

[jaywak]

Wow, that is interesting - my endocrinologist at my last appointment noted my blood sodium was borderline low and told me to keep an eye out for Addison's symptoms. My insulin needs do vary day to day but I've put it down to my highly variable diet, exercise, stress lifestyle...

That is how life is for a type 1 , that is if you want to live a reasonably normal life !

 

[Simon Grey]

One thing that the diabetes educators don't do well is explain how exercise - or more accurately energy-burning activity - does to BG and how this works with insulin. I am an engineer so look at energy balance in a different way. So all energy expended through activity or heat-loss must be paid for by a balancing input of energy.
Basically, any ingested carbs end up as glucose in the blood and there are two routes for glucose to get out. One is being metabolised by insulin to produce glucagon (stored energy) and the other is to be directly 'burned' by exercise. Hence if the energy in is less than that burned, plus that converted by insulin, then you have a problem. So a job where you are active all day, and probably losing body heat too is continuously taking fuel out of the tank. Long-acting insulin does the same thing so there is a constant drain that has to be topped up. So it is not unreasonable to be able to run on zero insulin when active. I do this when out on in the hills walking and climbing.
It doesn't explain however why you would progressively need less insulin, but I have found that I get phases of being super-sensitive to insulin and phases of needing lots (or just being super un-stable). Usually a good day out on the hill sorts that!
Another thing to bear in mind is that fat also gives energy, and the route to storage is via BG, albeit that the conversion process is more involved and takes longer. My belief (although I can't find written evidence for this) is that long-acting insulin does more for the slow release of energy by fats than it does for carbs, which tend to be short-acting.
Sorry for the burbling! Perhaps its all nonsense!

 

[SimonP78]

One thing that the diabetes educators don't do well is explain how exercise - or more accurately energy-burning activity - does to BG and how this works with insulin. I am an engineer so look at energy balance in a different way. So all energy expended through activity or heat-loss must be paid for by a balancing input of energy.

The EXTOD conference does a good job of introducing people to the subject, I'd recommend it for that, and for those who already know their way around exercise for the opportunity to chat with other T1 diabetics who exercise to see what they strategies are: https://abcd.care/events/extod-conference-adults-type-1-diabetes

So it is not unreasonable to be able to run on zero insulin when active.

Are you Type 1? If so, how long have you been diagnosed. I certainly agree with your points about energy in/out (I'm also an engineer) and that exercise reduces insulin needs, however, I'd be very surprised if someone could live without any insulin (i.e. if someone is not producing any insulin at all).

Perhaps there is an edge case (ketogenic adaptations, lots of exercise, no carb intake), I'm not so sure though....

My belief (although I can't find written evidence for this) is that long-acting insulin does more for the slow release of energy by fats than it does for carbs, which tend to be short-acting.

It's not so much the basal as the lack of bolus afaiu - there is a concentration effect: high insulin concentrations prevent lipolysis (i.e. breakdown of fat) and increase the storage of triglycerides, so lower levels of (or no) insulin allow fat to be used by the body as energy.

However, a low level of background insulin is required to prevent hepatic glucose production, and depending on how insulin sensitive the muscles are (due to exercise) may also be sufficient to allow glucose transport into the muscles (i.e. to allow carbs to be eaten and used). But typically no bolus == no carbs, which would therefore mean that fat conversion is the only thing going on.

 

[jonathan183]

One thing that the diabetes educators don't do well is explain how exercise - or more accurately energy-burning activity - does to BG and how this works with insulin. I am an engineer so look at energy balance in a different way. So all energy expended through activity or heat-loss must be paid for by a balancing input of energy.
Basically, any ingested carbs end up as glucose in the blood and there are two routes for glucose to get out. One is being metabolised by insulin to produce glucagon (stored energy) and the other is to be directly 'burned' by exercise. Hence if the energy in is less than that burned, plus that converted by insulin, then you have a problem. So a job where you are active all day, and probably losing body heat too is continuously taking fuel out of the tank. Long-acting insulin does the same thing so there is a constant drain that has to be topped up. So it is not unreasonable to be able to run on zero insulin when active. I do this when out on in the hills walking and climbing.
It doesn't explain however why you would progressively need less insulin, but I have found that I get phases of being super-sensitive to insulin and phases of needing lots (or just being super un-stable). Usually a good day out on the hill sorts that!
Another thing to bear in mind is that fat also gives energy, and the route to storage is via BG, albeit that the conversion process is more involved and takes longer. My belief (although I can't find written evidence for this) is that long-acting insulin does more for the slow release of energy by fats than it does for carbs, which tend to be short-acting.
Sorry for the burbling! Perhaps its all nonsense!

Insulin does things other than controlling blood glucose levels - surviving without it is not practical. We use the chemical bond energy rather than converting mass to energy - atoms in and atoms out (actually molecules in and molecules out) we don't convert atoms (mass) into heat. A simple energy balance model is not accurate - we are not bomb calorimeters

Glucagon is produced by alpha cells in the pancreas and gets the liver to produce glucose rather than store it as glycogen. Insulin produced by beta cells in the pancreas suppresses the production of glucagon (by the alpha cells), and triggers 'energy storage' rather than 'energy use' (effects include liver converting glucose to glycogen for storage).

Physical activity increases insulin sensitivity. Some people find short term exercise reduces blood glucose others find it increases blood glucose concentrations - simple models I have encountered do not fully explain these effects.

Things are much more complicated and still only partly understood - think of trying to diagnose all potential issues with a car with the bonnet welded shut and only being able to analyse liquid you can catch in a drip tray ... it's a difficult issue

 

[SimonP78]

Physical activity increases insulin sensitivity. Some people find short term exercise reduces blood glucose others find it increases blood glucose concentrations - simple models I have encountered do not fully explain these effects.

There's a whole section about this in the EXTOD talks and handbook.

High intensity (i.e. anaerobic) exercise produces more stress hormones than lower intensity (aerobic) exercise. More stress hormones mean a larger response from the liver converting glycogen to glucose (to help with fight or flight.)

One of the suggestions for those who find their BG dropping during aerobic exercise is to do some anaerobic exercise to get a liver dump (running on the spot, etc). Obviously there are some caveats here, but it's apparently quite effective for those who only do low intensity exercise (e.g., walking). I do see the effect of harder efforts while riding, but I don't tend to have much left in the liver (or the legs for that matter!) by the time I'm running low.

There are other effects at play, which are also related to the stress hormones effects on the liver, e.g. competition/event stress can cause extra BG rises and on the opposite side habituation to a given activity can reduce the rise that is seen (in my experience at least).

 

[Tony337]

Hi
My neighbour and i have almost 100 years of type 1 diabetes between us.....

He takes 7 units of Lantus a day low carbs keeps fit and uses very little novorapid.

I take 24 units of levimir don't low carb and take 1 to 10g of novorapid as per meal.

Both of us have good control.

Both completely different but achieve similar results at the end.

I wish you well

Tony