Reducing my insulin amounts

[David Colegate]

Hello. I was wondering if somebody could help me with some advice. I am supposedly type 1 at 41 triggered by my son's chicken box a month ago on metformin x1 and humulin pen injections twice a day.

I have lost a Couple of stone and been reducing my Insulin as my glucose bottoms out around 5.
I am now holding 5 to 7 at 3 units twice a day of insulin and one metformin. I normally have to reduce my insulin every 3 or 4 days by 1 unit. (I started at 18 four weeks ago)

I was prescribed x2 metformin to start today,which I have done, but it is dropping me down hovering around 5 with no excercise. Being a bank holiday I am not doing much when I am normally very active in my job that keeps my glucose levels in the green.

It feels that I either need just one metformin and a little insulin or two metformin and no insulin.

I understand that I could be on my insulin honeymoon being newely diagnosed but wondered is it better to be on metformin with no injections or not. Oh keytones are 0.2

Can anyone relate to this or advise me a little. Cheers David

 

[Resurgam]

If you are type one then injecting insulin is essential for life.
Metformin will not sustain you, it is prescribed a lot but I'm not sure that it is useful to all diabetics.
Please do not stop using insulin, even if it is only a small amount, but going to see your doctor to discus your situation would be a good idea - I think there are half unit pens which could be something useful for you in the future - but that is for your healthcare professionals, I can only answer as a biologist, without even a Masters.

 

[azure]

@David Colegate There are many Type 1s here diagnosed at a similar age to you - you're not alone Let me tag @Juicyj and @urbanracer for you.

Can I ask a few questions? Is your weight loss deliberate or unexpected? What insulin do you take and when (ie the name of the insulin)?
Were you prescribed the Metformin due to insulin resistance or were you initially thought to be Type 2?

 

[catapillar]

So who has diagnosed you as supposedly type 1? Was it an endocrinologist, or your GP? You don't sound convinced by the diagnosis. Have you had a cpeptide test and GAd test?

Are you in the uk? It's fairly unusual for a newly diagnosed type 1 in the uk to be commenced on a mixed insulin regime (which is what I'm assuming your twice daily humalin is, a humalin 70/30?), the preferred insulin regime for type 1s, according to the NICE guidelines, is a basal/bolus regime. It's also fairly unusual for a type 1 diabetic to be prescribed oral medication for diabetes, like metformin, unless they were struggling with insulin resistance. Who has prescribed you metformin? And for what reason? On low doses of insulin it doesn't seem like you have insulin resistance.

If you're blood sugar levels are holding at 5-7, can we assume the ketones are coming from a low carb diet and not related to hyperglycaemia?

 

[urbanracer]

Hello. I was wondering if somebody could help me with some advice. I am supposedly type 1 at 41 triggered by my son's chicken box a month ago on metformin x1 and humulin pen injections twice a day.

I have lost a Couple of stone and been reducing my Insulin as my glucose bottoms out around 5.
I am now holding 5 to 7 at 3 units twice a day of insulin and one metformin. I normally have to reduce my insulin every 3 or 4 days by 1 unit. (I started at 18 four weeks ago)

I was prescribed x2 metformin to start today,which I have done, but it is dropping me down hovering around 5 with no excercise. Being a bank holiday I am not doing much when I am normally very active in my job that keeps my glucose levels in the green.

It feels that I either need just one metformin and a little insulin or two metformin and no insulin.

I understand that I could be on my insulin honeymoon being newely diagnosed but wondered is it better to be on metformin with no injections or not. Oh keytones are 0.2

Can anyone relate to this or advise me a little. Cheers David

H i @David Colegate , I was diagnosed at the age of 54 and have been using mixed insulin (humalog Mix25) with an additional rapid acting insulin for almost 3 years now.

Would like to see your answers to the questions posed by @azure and @catapillar before trying to provide advice though.

 

[David Colegate]

Hi Resurgam. Thanks for responding. As suggested I will be calling my gp in the morning and not planning to take a second metformin tomorrow unroll further notice.

I am awaiting the big blood sample results for the three month test. Since this takes six weeks to get the results the hospitals diagnosis was treat for type 1 but unclear results could be type 2. They kept me in overnight and sent me on my way with the insulin and training the following day. The metformin was prescribed by my diabetic gp.

I suppose I am hoping it's type 2 not 1 and I can drop the insulin. Oh my insulin is humulin isophane.

 

[David Colegate]

@David Colegate There are many Type 1s here diagnosed at a similar age to you - you're not alone Let me tag @Juicyj and @urbanracer for you.

Can I ask a few questions? Is your weight loss deliberate or unexpected? What insulin do you take and when (ie the name of the insulin)?
Were you prescribed the Metformin due to insulin resistance or were you initially thought to be Type 2?

Hi and thanks for your response. I am on isophane insulin and the diagnosis was unclear so I am being treated as type 1 awaiting full blood results. The metformin was prescribed as my gp said it helps type 1 and is good for my heart in comparison to insulin. It certainly levels out my glucose reading spikes as I can tell. It also has really impacted me today as I have taken two 500g tablets. One for a month then two thereafter.

My readings have been just over 5 all day at rest.

're my weight and insulin sensitivity.

After original weight loss / unquenchable thirst and peeing 15 times a day. Overnight stay at hospitol etc.

I have stopped sugar, diet change etc cutting back on carbs. 2 stone loss since this started. As I lost weight and my BMI dropped 2.0 points the insulin became more effective and I needed less to stay around 5 to 7 glucose reading.

I hope that I may be type 2. My keytones have been around 0.2 - 0.4 max.

What do you think.

 

[azure]

Thanks for the answer @David Colegate

I couldn't say what type of diabetes you have but I will say that it's very good that your doctor is considering Type 1. A surprising number of adults are assumed to be Type 2 when they're actually Type 1 and so don't always get the most appropriate care.

Early on in Type 1 diagnosis, a few people can stop insulin injections temporarily. These people are usually adults as adult-onset Type 1 comes on more slowly.

You may also want to look at the LADA section here. LADA is a form of Type 1 that has a particularly slow onset and some people with LADA can treat it with tablets and/or diet initially.

Whatever your type, the most important thing is to keep your blood sugars controlled and it sounds like you're doing this

Do you know what tests your doctor is doing to,determine your type?

 

[David Colegate]

Hi. Thanks for your message. I am waiting on the main 3 monthly blood test result. A1C. My gp seems sure its type 1 and my son's chicken pox seems to have been the trigger. It can on suddenly with the 33 glucose blood count .

 

[catapillar]

Hi and thanks for your response. I am on isophane insulin and the diagnosis was unclear so I am being treated as type 1 awaiting full blood results.

You're being treated for your diabetes with humalin isophane and metformin? This is not being treated as a type 1. It's quite a strange and outdated insulin to be on really. Are you in the uk?

As above, the preferred insulin regime for type 1 diabetics according to NICE is a basal/bolus insulin regiem, and no oral diabetic medication, metformin should only be considered for type 1s if they have a BMI of 25+ and they want to improve glucose but minimise insulin. The nice guidelines on the diagnosis and treatment of type 1 diabetes quite clearly state do not offer adults newly diagnosed with type 1 diabetes non basal bolus regimens (that is twice daily mixed, basal only or bolus only). You're being treated with isophane insulin (which is an intermediate acting insulin) only.

A hba1c result doesn't go anywhere to determine type of diabetes. It just tells you what your blood sugar control has been like for the last 3 months. A hba1c result should be available within a week. Tests to assist in determining what type of diabetes are a cpeptide test and antibody testing, there is normally a bit of a wraith for results from antibody testing. Have you had a cpeptide or a a GAD test?

 

[azure]

Hi. Thanks for your message. I am waiting on the main 3 monthly blood test result. A1C. My gp seems sure its type 1 and my son's chicken pox seems to have been the trigger. It can on suddenly with the 33 glucose blood count .

There are additional tests that can help with diabetes type: a GAD test to look for antibodies and/or a C Peptide test to check your insulin production.

If there's any doubt about your type or your treatment, ask for a referral to a specialist. Very few GPs have the knowledge necessary to determine diabetes type, especially if you're Type 1.

 

[azure]

Just as an aside, chicken pox is unlikely to be a trigger. Type 1 comes on over time. The auto immune attack is ongoing and its only when aapproximately 80% of your islet cells have been destroyed that the remaining cells can't cope and your blood sugar goes out of control.

Often Type 1s have an event that 'pushes them over the line' eg a virus, pregnancy, illness, etc but the auto immune Attack has been happening, unknown to them, for some time prior to this.

 

[David Colegate]

Hi All.

I think to round this off. I plan to take x1 metformin tomorrow instead of x2 and discuss this with my GP in the morning about my dosage. Then discuss half dose insulin pens / Which insulin is more suitable moving forward / is metformin right for me / await A1C results etc As answered by Resugam, insulin injections must continue, however small, and cannot be replaced by metformin tablets.

Thankyou all for your comments and taking the time to respond. Wishing you all the best. David.

 

[David Colegate]

Hi yes. I live in Bristol. I don't know exactly what I have been tested for as it is still all a bit new to me. I can tell you that I have checked my hospitol report and it says what I have said. Treating as type 1 untill clarification. Mixed indicators.

I must hope I am being treated with the correct insulin and tablets. Otherwise I will be a bit annoyed. .....

Just checked again. The hospitol prescribed the humulin 1 isophane plus metformin following kidney function blood results.

 

[David Colegate]

Just as an aside, chicken pox is unlikely to be a trigger. Type 1 comes on over time. The auto immune attack is ongoing and its only when aapproximately 80% of your islet cells have been destroyed that the remaining cells can't cope and your blood sugar goes out of control.

Often Type 1s have an event that 'pushes them over the line' eg a virus, pregnancy, illness, etc but the auto immune Attack has been happening, unknown to them, for some time prior to this.

Wow. That's interesting. I have read that 5% of New type 1s have it triggered by a virus and chicken pox is pressumed a trigger.

God there is too much information on the internet when you look. Your comment does make some sense 're the onset

 

[azure]

Wow. That's interesting. I have read that 5% of New type 1s have it triggered by a virus and chicken pox is pressumed a trigger.

God there is too much information on the internet when you look. Your comment does make some sense 're the onset

That may be so (I'm no doctor or scientist) but the trigger happens some time earlier.

When a person is diagnosed with Type 1, they tend to think of things that happened shortly before their diagnosis and blame them, but usually the trigger happened unnoticed and unknown by them some time earlier.

Yes, there's loads of information out there - some good, some bad. If you are shown to be Type 1, then the book Think Like A Pancreas is very good and very popular with Type 1s here

 

[urbanracer]

Wow. That's interesting. I have read that 5% of New type 1s have it triggered by a virus and chicken pox is pressumed a trigger.

God there is too much information on the internet when you look. Your comment does make some sense 're the onset

Have a look at this (if you're interested). A bit heavy going in some places and I don't pretend to understand all the words myself but it's an interesting read nonetheless...............
http://diabetes.diabetesjournals.org/content/54/suppl_2/S125

 

[David Colegate]

Hi urbanracer. Thanks for the link. That was a dull read but interesting about the final trigger being a virus and the up to ten years journey / battle to that point of emergence. Thankyou.

Nice to know the journey.

 

[CJOtter]

I am an adult onset type 1 and had a really long pre diabetic phase where I felt tired all the time and then a slow onset of frank symptoms and then finally a long honeymoon period. I was told by my consultant at the time that the theory is that there is a viral insult in childhood which leads to the autoimmune response. If you are adult onset then your immune system is just slow on the destructive process.