How long without insulin

[nessa1970]

So if someone had type 1 with no beta cell function, I'm guessing this dka thing would come into play and kill you pretty quickly????
How long do you think ,like if you couldn't take insulin for some reason.
I'm type one and in the past I've for silly reasons not taken any insulin for over a few weeks. This did cause hyperglycaemia and you get very weak and feel like logs are your legs. Interestingly tho no ketones atall.
Well 0.9 was highest at week three.
So does this mean that maybe your not a type 1
I ask because everyone on here does say a lot about this dka an even when someone's only missed a dose of insulin like over like four hours.
Seems rather quick isn't it.
Maybe the lada is more suited to myself fo you think?
Should I get a gad test redone and a c-peptide too?
Cheers guys

 

[Dairygrade]

Hi can't really answer this what good reason did you have for not taken your insulin for a number of weeks as a type one or two your risking your health by not taking medication if i accidentally miss a dose my sugar levels go right up and my meter flashes saying i have ketones so i suspect if i didn't take any i would be in hospital or worse hope this helps.

 

[GrantGam]

So if someone had type 1 with no beta cell function, I'm guessing this dka thing would come into play and kill you pretty quickly????
How long do you think ,like if you couldn't take insulin for some reason.
I'm type one and in the past I've for silly reasons not taken any insulin for over a few weeks. This did cause hyperglycaemia and you get very weak and feel like logs are your legs. Interestingly tho no ketones atall.
Well 0.9 was highest at week three.
So does this mean that maybe your not a type 1
I ask because everyone on here does say a lot about this dka an even when someone's only missed a dose of insulin like over like four hours.
Seems rather quick isn't it.
Maybe the lada is more suited to myself fo you think?
Should I get a gad test redone and a c-peptide too?
Cheers guys

How long is a piece of string?

Technically, the onset of DKA is rapid if there is no insulin on-board; within 24 hours in a lot of cases. This is often seen in diabetics who use pumps and have an occlusion which they are unaware of. As pump users don't use basal insulin, DKA can occur in a matter of hours if the elevated BG goes unnoticed for long enough. As with everything though, diabetes is not a "one size fits all" condition - so prerequisites for side effects like DKA vary from person to person.

If you have doubts as to your diagnosis - you should raise this with your Diabetologist.

Just out of interest, what are your insulin requirements and ratios? It would make logical sense that a T1D who could go three weeks without any insulin injections would be producing some of their own. That would imply that their general basal insulin doses are extremely low, along with their I:C ratios too...

 

[azure]

It can be hours or weeks @nessa1970 But I remeber one of your HCPs said you were showing early signs once, I think.

I know you struggle with your diagnosis, but people here, including myself did suggest that you might be Type 1 back when you were labelled Type 2.

GAD tests aren't always accurate for LADA.

 

[catapillar]

I pump so I have no long acting insulin in, I would say my short acting basal has maybe a 4 hour lifetime. My c-peptide is unrecordable so I'm definitely not honeymooning.

In November I went to bed on a Friday night and ripped my pump off at some point in the night in my sleep. By the Saturday morning I must have been pretty hyperglycaemic but the high blood sugar made me too sleepy drained and brain clouded to do anything useful like test my blood sugar. I didn't move all day Saturday and I was pretty out of it and delusional I wasn't seeing things but I was definitely hearing things. I did manage to move late on Sunday afternoon. I put a new pump on, I gave a correction but I still wasn't making much sense. I spoke to my parents on the phone and they couldn't get any sense out of me so they called an ambulance and I was admitted to hospital. I was fully acidotic at that point and had ketones.

So if I had no insulin I'd give it a maximum of a week, probably 5 days would see me off.

But a few years ago when I'd been on holiday in Australia and the time change and the heat had given me nothing but hypos I did give up and hide my insulin for two weeks. I didn't get any ketones then. But I was only about two years into diagnosis so would have been honeymooning. I think I was probably producing some insulin for up to 3 or 3 and half years after diagnosis.

Have you had a gad test? If it was positive once redoing it and getting a negative gad test isn't going to change your diagnosis. One positive gad deat determines you are type 1. The longer you leave it after diagnosis the more likely it is you'll be gad negative. Because once the antibodies have killed off all your beta cells there's nothing for them to do and they'll disappear. So no, there's not a lot of point asking for a repeat gad test if you have had one positive one.

A cpeptide test might well show you are producing insulin. That's not unusual for a honeymooning type 1. LADAis honeymooning type 1. Producing insulin doesn't mean you're not type 1, it just means not all of your beta cells are dead yet. The thing killing them off is your immune system. Your immune system doesn't have a switch to flick that will instantly kill off all of your beta cells, it's a gradual process, killing them off individually one by one and it takes time. So a cpeptide test that shows you are producing some insulin won't change your type 1 diagnosis.

 

[donnellysdogs]

I know I would be dead within 24 hours if I didnt inject and ate.

Without a pre get up injection I am
20-25. All I need to do is get up and put feet to floorand would raise by another 7mmol by midday.
(Without eating)....

I currently have to have tresiba at night, and a bolus and an insulatard injection at 6.30am.. still not making much progress on getting levels better. Cant have pump either.

I know without a doubt that If I ate a nice, hefty, carb, carb, carb lot of meals thru the day with no morninginjections that I would be dead within 24hours...

 

[nessa1970]

Hi can't really answer this what good reason did you have for not taken your insulin for a number of weeks as a type one or two your risking your health by not taking medication if i accidentally miss a dose my sugar levels go right up and my meter flashes saying i have ketones so i suspect if i didn't take any i would be in hospital or worse hope this helps.

No I meant no good reason that I didn't take it. Denile weight issues etc along with depression

 

[nessa1970]

How long is a piece of string?

Technically, the onset of DKA is rapid if there is no insulin on-board; within 24 hours in a lot of cases. This is often seen in diabetics who use pumps and have an occlusion which they are unaware of. As pump users don't use basal insulin, DKA can occur in a matter of hours if the elevated BG goes unnoticed for long enough. As with everything though, diabetes is not a "one size fits all" condition - so prerequisites for side effects like DKA vary from person to person.

If you have doubts as to your diagnosis - you should raise this with your Diabetologist.

Just out of interest, what are your insulin requirements and ratios? It would make logical sense that a T1D who could go three weeks without any insulin injections would be producing some of their own. That would imply that their general basal insulin doses are extremely low, along with their I:C ratios too...

12 lantus morn/nightan novorapid for food

 

[nessa1970]

It can be hours or weeks @nessa1970 But I remeber one of your HCPs said you were showing early signs once, I think.

I know you struggle with your diagnosis, but people here, including myself did suggest that you might be Type 1 back when you were labelled Type 2.

GAD tests aren't always accurate for LADA.

Okay
No I just read something an this person had a positive gad then negitive

 

[nessa1970]

I know I would be dead within 24 hours if I didnt inject and ate.

Without a pre get up injection I am
20-25. All I need to do is get up and put feet to floorand would raise by another 7mmol by midday.
(Without eating)....

I currently have to have tresiba at night, and a bolus and an insulatard injection at 6.30am.. still not making much progress on getting levels better. Cant have pump either.

I know without a doubt that If I ate a nice, hefty, carb, carb, carb lot of meals thru the day with no morninginjections that I would be dead within 24hours...

Whow really
That's very very quick
That's why I was curious because I had carbs coke lookies chocolate mc donalds al through my 3 weeks no insulin an yes I definitely had hypoglycaemia I had no energy, it was difficult to walk infact, not nice at all an enough to snap a silly person back to apriciating there health. The dka thing tho was 0.9 at its highest.
Anyway I understand I think that if you have beta cell function still this can happen.thats quite fortunate I'm guessing

 

[donnellysdogs]

Whow really
That's very very quick
That's why I was curious because I had carbs coke lookies chocolate mc donalds al through my 3 weeks no insulin an yes I definitely had hypoglycaemia I had no energy, it was difficult to walk infact, not nice at all an enough to snap a silly person back to apriciating there health. The dka thing tho was 0.9 at its highest.
Anyway I understand I think that if you have beta cell function still this can happen.thats quite fortunate I'm guessing

Do you mean hyper not hypo..

I know last year I went to 4 ketones within 4 hours...after eating and having real problems with pump cannulas etc etc ...

 

[nessa1970]

Do you mean hyper not hypo..

I know last year I went to 4 ketones within 4 hours...after eating and having real problems with pump cannulas etc etc ...

Sorry yes hyperglycaemia
Really four hours
That's incredible really. So you really have to be hundred percent focused. That must be hard.
So do you no how long beta cells last, I've been diagnosed for two years and four months all up, but but nine months for type one
I do no if I don't take insulin for a day I run hi. But I seem to be able to go for a week with no notice except the dry mouth. I wish they could tell you or test you for how much is left .
I must start being more focused as if I was in your boat I wouldn't last to long with my slack attitude.

 

[nessa1970]

I pump so I have no long acting insulin in, I would say my short acting basal has maybe a 4 hour lifetime. My c-peptide is unrecordable so I'm definitely not honeymooning.

In November I went to bed on a Friday night and ripped my pump off at some point in the night in my sleep. By the Saturday morning I must have been pretty hyperglycaemic but the high blood sugar made me too sleepy drained and brain clouded to do anything useful like test my blood sugar. I didn't move all day Saturday and I was pretty out of it and delusional I wasn't seeing things but I was definitely hearing things. I did manage to move late on Sunday afternoon. I put a new pump on, I gave a correction but I still wasn't making much sense. I spoke to my parents on the phone and they couldn't get any sense out of me so they called an ambulance and I was admitted to hospital. I was fully acidotic at that point and had ketones.

So if I had no insulin I'd give it a maximum of a week, probably 5 days would see me off.

But a few years ago when I'd been on holiday in Australia and the time change and the heat had given me nothing but hypos I did give up and hide my insulin for two weeks. I didn't get any ketones then. But I was only about two years into diagnosis so would have been honeymooning. I think I was probably producing some insulin for up to 3 or 3 and half years after diagnosis.

Have you had a gad test? If it was positive once redoing it and getting a negative gad test isn't going to change your diagnosis. One positive gad deat determines you are type 1. The longer you leave it after diagnosis the more likely it is you'll be gad negative. Because once the antibodies have killed off all your beta cells there's nothing for them to do and they'll disappear. So no, there's not a lot of point asking for a repeat gad test if you have had one positive one.

A cpeptide test might well show you are producing insulin. That's not unusual for a honeymooning type 1. LADAis honeymooning type 1. Producing insulin doesn't mean you're not type 1, it just means not all of your beta cells are dead yet. The thing killing them off is your immune system. Your immune system doesn't have a switch to flick that will instantly kill off all of your beta cells, it's a gradual process, killing them off individually one by one and it takes time. So a cpeptide test that shows you are producing some insulin won't change your type 1 diagnosis.

Thank you very much for all that information it's very interesting. Yes I'm two years four months in from first diagnosis for type two an d I'm nine months in from type one diagnosis.
Whow so I could have another few years of having things s little easier re some beta cell function.

 

[genix]

I think the old rule was you wouldn't get past three days with NO insulin on board. I kicked into full DKA in under 24 hours from a dislodged pump set. I had full body cramps including my face, I was screaming in pain and they gave me morphine. I can say from experience it isn't pretty.

 

[GrantGam]

12 lantus morn/nightan novorapid for food

What is your I:C ratio though?

I wouldn't have said that 24u of basal insulin is a low dose. If you were to have told me that you were taking something like 4-5u of basal insulin then that would suggest you maybe have some pancreatic function left.

The same would be true if your I:C ratio was lower than 1:20 (1:25, 1:30, etc).

Again, it's purely hypothetical - but if in doubt go and see your doctor. I'd imagine they'll need good reason to carry out the tests though, such as frequent hypos, poor control, etc - I think they're quite expensive.

 

[AndBreathe]

What is your I:C ratio though?

I wouldn't have said that 24u of basal insulin is a low dose. If you were to have told me that you were taking something like 4-5u of basal insulin then that would suggest you maybe have some pancreatic function left.

The same would be true if your I:C ratio was lower than 1:20 (1:25, 1:30, etc).

Again, it's purely hypothetical - but if in doubt go and see your doctor. I'd imagine they'll need good reason to carry out the tests though, such as frequent hypos, poor control, etc - I think they're quite expensive.

Grant, I'm not T1, so fee free to shoot me down, but From what I have read, insulin resistance can have a significant impact on insulin doses, person-to-person? Perhaps Nessa has an amount of insulin resistance.

 

[GrantGam]

Grant, I'm not T1, so fee free to shoot me down, but From what I have read, insulin resistance can have a significant impact on insulin doses, person-to-person? Perhaps Nessa has an amount of insulin resistance.

Not at all @AndBreathe As far as I can see, it's a very good point actually.

There is no way to know for sure whether @nessa1970 has elements of insulin resistance until she tells us herself. Certainly sharing her meal time ratios would suggest or dismiss that concept. It's usually easier to asses insulin resistance through meal time does rather than basal requirement. I know a T1 who takes 40+ units of basal insulin (vs my 22u) yet is substantially fitter than I am and uses the same I:C ratio for meals. Yet we are both T1 and both have no insulin resistance.

 

[nessa1970]

I think the old rule was you wouldn't get past three days with NO insulin on board. I kicked into full DKA in under 24 hours from a dislodged pump set. I had full body cramps including my face, I was screaming in pain and they gave me morphine. I can say from experience it isn't pretty.

Mm sounds awful
I guess that's the only thing you have to be careful of re pumping. Otherwise I hear it's fantastic

 

[nessa1970]

What is your I:C ratio though?

I wouldn't have said that 24u of basal insulin is a low dose. If you were to have told me that you were taking something like 4-5u of basal insulin then that would suggest you maybe have some pancreatic function left.

The same would be true if your I:C ratio was lower than 1:20 (1:25, 1:30, etc).

Again, it's purely hypothetical - but if in doubt go and see your doctor. I'd imagine they'll need good reason to carry out the tests though, such as frequent hypos, poor control, etc - I think they're quite expensive.

I. C ratio? Is that my carb thing that's 1 unit to 10 grams of carb an 1. 3 is my correction dose
Is that what you mean
All I no is I take 12 lantus each morning and night as well
Tho I have taken no insulin for two weeks an another time three weeks
I ran HI the whole time but I suspect that was the orange juice an coke drinking all the time because I craved sugar drinks so bad. My symptoms were thirsty toilet heaps weak dry skin
Blurry eyes sometimes s bit drunk seeet smelling urine an mostly no ketones at all cept the last day of the third week it was 0.9 which is fine trace like
So I'm assuming I must have quite good beta cell function right? I mean I'm hearing some say your got ketones early and very sick
I do not get this atall
So I must be still honeymooning as it's called
Yes?

 

[nessa1970]

I think the old rule was you wouldn't get past three days with NO insulin on board. I kicked into full DKA in under 24 hours from a dislodged pump set. I had full body cramps including my face, I was screaming in pain and they gave me morphine. I can say from experience it isn't pretty.

This maybe different for people not pumping tho right?
Say they couldn't have insulin for 24 hours it may take longer
What is full dka mean ? It starts at 0 so what I does it climb too an what is full dka
Would you go to a dr at 3 say or is it 5 maybe