Confused at my current situation after illness

[rickykemp]

I've recently suffered a spell of norovirus which hit me particularly hard. I'm a T1 coming up to 3-4 years with good control (average HBA1C around 40) and to make sure I didn't crash blood sugar wise (I almost went into hypo coma last time I had food poisoining) I decided not to take either insulin as I wasnt able to eat anything, and for the last 4 days, including the time I was ill, my blood sugar has remained steadfast in the 5-8 range even when I have been able to eat/drink.

Obviously, people with T1D don't get better. There isn't a cure. I know that.

I've always suspected I've been able to produce some insulin (hence my low HBA1C) which helps my control, but surely if I wasn't eating/drinking anything, my blood sugar would have dropped, and when I do eat, it should have risen without insulin.

Could it be something related to my immune system being 'distracted' from attacking the islet cells by the norovirus? Has anyone else had something like this?

 

[alhubb]

If you're not taking either basal or bolus insulin you won't be having hypos. But if you're not eating either, your blood sugar wouldn't necessarily go up.

But if you did eat stuff, it is more likely that you're body is burning through the sugar who have in your body to use to fight the viral infection. Much like what happens when you eat and do exercise.

 

[rickykemp]

If you're not taking either basal or bolus insulin you won't be having hypos. But if you're not eating either, you're bloody sugar wouldn't go up.

But if you did eat stuff, it is more likely that you're body is burning through the sugar who have in your body to use to fight the viral infection. Much like what happens when you eat and do exercise.

Isn't it insulin that allows the body to burn up the sugar though?

 

[GrantGam]

If you're not taking either basal or bolus insulin you won't be having hypos. But if you're not eating either, you're bloody sugar wouldn't go up.

But if you did eat stuff, it is more likely that you're body is burning through the sugar who have in your body to use to fight the viral infection. Much like what happens when you eat and do exercise.

BG does normally increase when basal insulin is not taken. This is because the liver gradually releases it's stores of glycogen over the course of the day. That's the only purpose of basal insulin.

There has been a few posts on this forum over the last few months with reckless T1's who have stopped taking their insulin. @rickykemp, no offence, but not taking your insulin is stupid and reckless, all you're doing is inviting a whole load of problems. With death being a possible problem I'm afraid.

Did you test for ketones at all when you were unwell?

As to why your BG's remained in range is a question you should be asking your doctor. I'd be very surprised if you were actually a T1, given the fact you went 4 days without either basal/bolus insulin and remained in range the entire time. Periods of illness are notorious for pushing BG's up in T1D.

There is slow onset T1 (often referred to as LADA) which is pretty much identical to T1, but with the difference that the beta cell attack is somewhat drawn out. This 'may' be a possible reason why you managed to stop taking your insulin.

Go and see your doctor and please keep taking your insulin.

 

[alhubb]

BG does normally increase when basal insulin is not taken. This is because the liver gradually releases it's stores of glycogen over the course of the day. That's the only purpose of basal insulin.

There has been a few posts on this forum over the last few months with reckless T1's who have stopped taking their insulin. @rickykemp, no offence, but not taking your insulin is stupid and reckless, all you're doing is inviting a whole load of problems. With death being a possible problem I'm afraid.

Did you test for ketones at all when you were unwell?

As to why your BG's remained in range is a question you should be asking your doctor. I'd be very surprised if you were actually a T1, given the fact you went 4 days without either basal/bolus insulin and remained in range the entire time. Periods of illness are notorious for pushing BG's up in T1D.

There is slow onset T1 (often referred to as LADA) which is pretty much identical to T1, but with the difference that the beta cell attack is somewhat drawn out. This 'may' be a possible reason why you managed to stop taking your insulin.

Go and see your doctor and please keep taking your insulin.

Not if, as I said before, you are using the glucose in your body to fight an infection for example

 

[alhubb]

Isn't it insulin that allows the body to burn up the sugar though?

No, Insulin is used to store glucose as glycogen

 

[GrantGam]

Not if, as I said before, you are using the glucose in your body to fight an infection for example

Wrong.

In the absence of insulin, which is commonplace when a T1 with zero insulin production does not take exogenous insulin, glucose cannot be used. This is why hyperglycemia and DKA commonly present in newly diagnosed T1's. They simply cannot utilise any of the glucose in their blood stream.

Even when fasting and not taking insulin, BG will increase to dangerous levels in a typical T1. The OP's situation is entirely atypical though, which is why a visit to the doctor would be recommended.

EDIT to correct - *This is why hyperglycemia and DKA commonly present in newly diagnosed T1's. They simply cannot utilise the majority of the glucose in their blood stream.* - Assuming that the majority of newly diagnosed T1 have a remaining element of insulin production.

 

[catapillar]

Sick day rules for type 1 diabetics are pretty clear, don't stop taking your basal insulin - http://www.leicestershirediabetes.org.uk/uploads//documents/Type1_Sickdays_LDC_JAN2015.pdf

If you've decided to stop taking all insulin with no medical advice that does seem somewhat... reckless? Are you familiar enough with sick day rules? Perhaps you could as your DSN for some advice on insulin management when unwell - the hypo you experienced with food poisoning obviously sounds a bit of an unpleasant experience.

It's very likely you could be honeymooning, that is type 1 with residual insulin production. A long, strong honeymoon is not uncommon in people diagnosed with type 1 later in life. You can have a cpeptide test to see what your insulin production is looking like.

Some illnesses can make you much more sensitive to insulin, just depends on the processes going on in the body while its fighting an infection or virus, so if you still had some basal in you system from last dose increased sensitivity from illness might be helping out a little when you haven't been taking insulin. Sometimes illness can just push blood sugar down, most commonly they send it up but it likes to do unexpected things to make sure your paying attention.

If there's a query over type of diabetes you can have tests to see if you have the antibodies associated with type 1.

I would suggest having a chat with your DSN to make sure you safely recommence insulin and understand the sick day rules.

 

[alhubb]

Wrong.

In the absence of insulin, which is commonplace when a T1 with zero insulin production does not take exogenous insulin, glucose cannot be used. This is why hyperglycemia and DKA commonly present in newly diagnosed T1's. They simply cannot utilise any of the glucose in their blood stream.

Even when fasting and not taking insulin, BG will increase to dangerous levels in a typical T1. The OP's situation is entirely atypical though, which is why a visit to the doctor would be recommended.

Wrong, as you so politely put it.

Yes, they can. Insulin PROMOTES the uptake of insulin into the cells to be used for glycogen stores or glycogenesis. During exercise, the glucose in the blood stream is used up first and then replaced by the glycogen stores in the liver, which are then used up. The reason why you go low after exercise is that you cannot regulate the amount of insulin in the body and therefore glucose in the bloody stream is continually taken up and stored or used.

Like you said, DKA is common in the newly diagnosed, this is because they are NOT exercising all the time or fighting an infection before diagnosis, therefore BG rises. They can utlise the glucose in their blood stream, but just not at the rate that is being produced or released (i.e regulate) or the high enough absorption of glucose. It is NOT the complete absence of glucose utilisation.

 

[GrantGam]

Wrong, as you so politely put it.

Yes, they can. Insulin PROMOTES the uptake of insulin into the cells to be used for glycogen stores or glycogenesis. During exercise, the glucose in the blood stream is used up first and then replaced by the glycogen stores in the liver, which are then used up.

"Insulin PROMOTES the uptake of glucose into the cells". But, only in the instance where there is sufficient insulin on-board. Regardless of where the glucose is coming from; insulin MUST be present in order to move the glucose from the blood into the muscles, liver and fat cells. No quantity of exercise or state of illness will move the glucose from the blood into the aforementioned areas and allow the host to survive...

The fact that the OP has managed to keep BG within range for 4 days without insulin injections of any sort, suggests that there may still be an element of insulin production sufficient enough to allow him to tick over without exogenous insulin when fasting. Again, this is a completely atypical situation and not one that would fit the majority of T1D's.

DKA is common in the newly diagnosed, this is because they are NOT exercising all the time or fighting an infection before diagnosis, therefore BG rises.

So you are saying that T1D can be managed by exercise or illness? Do you take insulin @alhubb?

I would recommend that you have a read through your posts and have evidence to back up your claims. They are, on the whole, bold as brass and fictional.

 

[alhubb]

"Insulin PROMOTES the uptake of glucose into the cells". But, only in the instance where there is sufficient insulin on-board. Regardless of where the glucose is coming from; insulin MUST be present in order to move the glucose from the blood into the muscles, liver and fat cells. No quantity of exercise or state of illness will move the glucose from the blood into the aforementioned areas in decent enough amounts to support life...

The fact that the OP has managed to stay within range for 4 days without insulin injections of any sort, suggests that there may still be an element of insulin production sufficient enough to allow him to tick over without exogenous insulin when fasting.


So you are saying that T1D can be treated solely by exercise?

Yes, thank you for highlighting and correcting a typo.

No, insulin promotes the uptake of glucose, but glucose can still move in small amounts into cells without insulin. Plus also, although insulin is the main hormone involved in this process, there are other hormones that can do the same job but less effectively. This just shows your lack of biological knowledge of how glucose uptake works.

At no point have I said anything of the sort that T1D can be treated solely by exercise, any suggestion that I did is idiotic.

 

[alhubb]

"So you are saying that T1D can be managed by exercise or illness? Do you take insulin @alhubb?

I would recommend that you have a read through your posts and have evidence to back up your claims. They are, on the whole, bold as brass and fictional.

Yes, I do take insulin. At no point did I say that T1D is caused by not exercising, I was countering your point that DKA and BG rise before diagnosis is proof that the body can't use the glucose in the blood stream.

On what basis are you suggesting my "claims" are bold and fictional? Are you a doctor or scientist specialising in diabetes?

 

[alhubb]

I've recently suffered a spell of norovirus which hit me particularly hard. I'm a T1 coming up to 3-4 years with good control (average HBA1C around 40) and to make sure I didn't crash blood sugar wise (I almost went into hypo coma last time I had food poisoining) I decided not to take either insulin as I wasnt able to eat anything, and for the last 4 days, including the time I was ill, my blood sugar has remained steadfast in the 5-8 range even when I have been able to eat/drink.

Obviously, people with T1D don't get better. There isn't a cure. I know that.

I've always suspected I've been able to produce some insulin (hence my low HBA1C) which helps my control, but surely if I wasn't eating/drinking anything, my blood sugar would have dropped, and when I do eat, it should have risen without insulin.

Could it be something related to my immune system being 'distracted' from attacking the islet cells by the norovirus? Has anyone else had something like this?

Please ignore the disagreement between myself and other person posting. I do think it is not sensible to stop taking insulin when you're ill. It might be worth discussing with your DSN and consultant your insulin requirements during illness, as they would be better at advising you. You could even see if you could CRP test to see if you are still producing insulin. Good luck and hope you feel better soon

 

[GrantGam]

@alhubb, I really don't know what to say - I am literally at a loss as to what your angle is here? I corrected your inaccuracies (which are based on my experience and also the experience of the vast majority of T1D's worldwide).

If you're not taking either basal or bolus insulin you won't be having hypos. But if you're not eating either, you're bloody sugar wouldn't go up.

Not taking basal insulin is likely to cause a T1D's BG to increase. Regardless if they are fasting, ill or both. Just because there is no food being consumed, or bolus insulin administered - does not mean that the BG will remain stable. This was the initial inaccuracy of yours that I corrected and you've taken it to heart.

The second inaccuracy of yours that I corrected was regarding illness and it's ability to keep BG down, without the background presence of a basal insulin. Again, highly unlikely.

I will leave it at this though, because I simply don't have the time to waste.

And no, I'm no doctor. But you did imply that DKA commonly presents in the newly diagnosed because they are not exercising all the time or fighting illness... The fact of the matter is that DKA presents because of a lack of insulin and the inability to utilise glucose for energy. It has nothing to do with the quantity, frequency or intensity of exercise. Likewise, it has nothing to do with being well or unwell. Equally, no amount of exercise or severity of illness will ward off DKA or hyperglycemia - only insulin will.

I would say warding of hyperglycemia and the possible resultant DKA would fall under the category of "managing T1D". This is why I asked, whether you thought exercising or illness could manage type 1 diabetes. Because according to your statements: no insulin + a period of illness = BG's not rising...

Anyway, enough of this as the thread is becoming derailed.

 

[alhubb]

@alhubb, I really don't know what to say - I am literally at a loss as to what your angle is here? I corrected your inaccuracies (which are based on my experience and also the experience of the vast majority of T1D's worldwide).

Not taking basal insulin is extremely unlikely to prevent a T1D's BG from increasing. Regardless if they are fasting, ill or both. This was the initial inaccuracy of yours that I corrected and you've taken it to heart.

The second inaccuracy of yours that I corrected was regarding illness and it's ability to keep BG down, without the background presence of a basal insulin. Again, highly unlikely.

I will leave it at this though, because I simply don't have the time to waste.

And no, I'm no doctor. But you did imply that DKA commonly presents in the newly diagnosed because they are not exercising all the time or fighting illness... The fact of the matter is that DKA presents because of a lack of insulin. Nothing to do with the quantity, frequency or intensity of exercise. Likewise, nothing to do with being well or unwell.

Anyway, enough of this as the thread is becoming derailed.

Firstly, you are "correcting my inaccuracies" based on being a T1D and not science and empirical evidence. That is my angle here.

OK, I agree in everyday scenarios if you didn't take your basal, yes your BG would increase. I was talking about when you're ill, but I wasn't clear enough in my first post and that is my fault.

No, it is not extremely unlikely. We all react differently to illness/fasting/stress etc, and BG is no difference to that, one thing that may happen to you might not happen to others. Some find BG goes up, some go down. Some people die from 'flu, some people just feel a bit ill. One rule does not fit all. I for one find exercise will keep my BG and insulin requirements down, and that I have to split my basal unevenly as during the day I am more active, which keeps my BG low. So clearly not "unlikely" at all.

I did NOT imply that DKA is due to not exercising. That is a huge inaccuracy and massively misquoted. DKA presents itself due to a lack of insulin regulating the amount of glucose in your blood. At times of stress, eg illness or exercise, you BG can drop lower. This obviously would not stay lower if you eat etc nor did I say that exercise alone would keep your BG within a normal range. Clearly exercising every minute of the day is not physically possible and in no way did I suggest that. I only said that exercise would lower BG in pre-diagnosed, not that it would be within range or cure for T1D. My point, as I clearly made, was to counter your point about the use of glucose during exercise and illness as you well know.

 

[ickihun]

Yes, thank you for highlighting and correcting a typo.

No, insulin promotes the uptake of glucose, but glucose can still move in small amounts into cells without insulin. Plus also, although insulin is the main hormone involved in this process, there are other hormones that can do the same job but less effectively. This just shows your lack of biological knowledge of how glucose uptake works.

At no point have I said anything of the sort that T1D can be treated solely by exercise, any suggestion that I did is idiotic.

I agree thou with the liver, especially, it can store for a very very long time. I have fatty liver so maybe longer than most.
As we all know fat slows things down.
I always thought it has to have insulin thou to do the conversion from carbs and proteins to glucose (energy). Allexperts say the same. Who has told you otherwise?

 

[GrantGam]

No, it is not extremely unlikely. We all react differently to illness/fasting/stress etc, and BG is no difference to that, one thing that may happen to you might not happen to others. Some find BG goes up, some go down. Some people die from 'flu, some people just feel a bit ill. One rule does not fit all. I for one find exercise will keep my BG and insulin requirements down, and that I have to split my basal unevenly as during the day I am more active, which keeps my BG low. So clearly not "unlikely" at all.

I also find that exercise keeps my insulin requirements down, but it does not eradicate my need for insulin - specifically basal. That is why we (you're included here too by the way) require a basal insulin.

Goodbye @alhubb. Enjoy the rest of your day!

 

[alhubb]

I agree thou with the liver, especially, it can store for a very very long time. I have fatty liver so maybe longer than most.
As we all know fat slows things down.
I always thought it has to have insulin thou to do the conversion from carbs and proteins to glucose (energy). Allexperts say the same. Who has told you otherwise?

It is the other way round. Insulin promotes the uptake of glucose into cells, storage of glucose, synthesis of fatty acids and proteins and supresses the breakdown of proteins and fatty acids.

 

[alhubb]

I also find that exercise keeps my insulin requirements down, but it does not eradicate my need for insulin - specifically basal. That is why we (you're included here too by the way) require a basal insulin.

Goodbye @alhubb. Enjoy the rest of your day!

That is entirely true and I haven't disputed that. When you're ill your body is working over time to fight the illness (even though you are physically laying on the sofa) therefore it has a similar effect to exercising constantly.

Goodbye to you too. Hopefully this conversation will inspire you to investigate what happens in your body more.

 

[rickykemp]

sorry to cause any arguments here. Regarding taking my insulin, I am now that I am able to eat, but at a reduced dose (1:1 rather than 1:1.5). I am pretty much back at my normal diet, but again, my blood readings are extremely stable and havent budged from 6.0 to 7.0 all day, even after a bottle of locozade (the sport one with the electrolytes as i'm still recovering) and some digestives. I had a sandwich at lunch, and with my normal novarapid dose I would go to 9, then a gradual decrease to 4-5 but my blood hasnt budged and has stayed within the 6.0 to 7.0 range.

I've even tested my meter, and that is working fine according to the control solution instructions.