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The use of Metformin in conjunction with insulin is becoming more common in the treatment of T1. It inhibits glucagon secretion, which releases liver glucose and increases blood glucose. Most T1s make too much glucagon, and apparently it gets worse with age and duration of T1. Metformin didn't...

You need to insist on a proper diagnosis. The antibody panel of tests being negative would pretty much rule out T1 diabetes. From the low blood glucose symptoms, it could be reactive hypoglycemia. Do these hypos occur after carby meals, like crumpets? In any case, rest assured that blood...

That these episodes are so sudden is striking. Has she been checked out for an insulinoma?

The body is complex and we have no control over most of what happens in it. All we can do is focus on things we can control. What we eat, exercise getting enough sleep and hopefully reducing stress. In this case, changing eating patterns could make a big difference, simply because it reduces the...

Sounds like a really difficult situation. Bear in mind the main noise factor complicating treatment decisions is carbohydrate consumption. Matching insulin action with glucose load is difficult at the best of times. Removing that noise factor would simplify the process for her. Moving to a...

The short answer is just do the best you can. Insulin required will increase and the numbers will stabilise as the honeymoon wears off. I wouldn't get too worried about high numbers at this stage. Low numbers need urgent attention.

It could be reactive hypoglycemia. Blood glucose drops after consuming carbs. It can be a precursor to T2 diabetes. I would get a blood glucose monitor and test when not feeling well after eating carbs. If blood glucose falls below 4, it could be causing those feelings and you need to get it...

Getting type 1 at 23 is not unusual. Nor is getting type 2 at this age. My diabetes nurse's youngest T2 patient is 9 years old (in NZ). Having a definite diagnosis of the type will be useful, so insist that the antibody tests get done. Results should be available in a few days. At this stage you...

Yes, coffee is a stimulant and it can increase blood glucose. Liver glycogen, mobilised by stress hormones. But most people don't see a difference. I would look for a pattern before dosing for it. Removing the carbohydrate noise factor and doing a test should do it. Before lunchtime, well after...

That 28 day period is after opening. Unused vials, cartridges or pens last for years if refrigerated. I haven't had problems with unrefrigerated insulin either, but then I haven't allowed it to get too hot.

If the basal insulin dose is right, blood glucose shouldn't drop overnight. Unless if there has been unusual exercise during the day, in which case eating chocolate before bed helps. It has a low glycemic index, so the blood glucose supporting effect lasts all night.

Declining insulin sensitivity as endogenous insulin production fades is normal. Using 70 units of insulin for a 54 kg body sounds like a lot, but until blood glucose is stabilised and corrections are no longer required, the actual insulin requirement is uncertain. My suggestion is to do the...

That sounds like inadequate basal insulin action. Do basal testing again. Volatile blood glucose and having to do lots of corrections could explain the weight gain. Closing the basal action gaps makes bolusing much easier and more predictable.

I have only used reusable pens, since they became available in the '80s. Novo make the best reusable pens as they show how long ago the last shot was taken. Couldn't do without that. The latest Lantus pen is a big improvement on the previous one, but still no time recording. The next reusable...

If the metabolism has been conditioned to rely on glucose for energy, yes, 150-180 grams of carb a day may be required to feel good and perform well. But if the metabolism is retrained to use mostly fat for energy, this is no longer the case. Living without carbohydrate becomes the norm. It...

I would want the type of diabetes confirmed. The main effect of Byetta is to increase insulin production after meals, which only happens with T2. It also slows stomach emptying and lowers glucagon, which works for T1s. Like all drugs it has side effects. This is from drugwatch : It seems you...

Reconnecting with the medical team is a good starting point. Insulin requirements have probably increased over the last two years, so basal and bolus dosages need to be reviewed. You will have to establish an insulin:carb ratio that you can use for meal bolusing, and it is different for...

I am confused. What are are you trying to say here?

The low carb dinner could also have something to do with it. Fat in a meal reduces insulin sensitivity for hours after eating. If you eat low carb and high fat every night, you may want to increase basal action in the following hours.

They use the ADA recommendation range for comparison purposes. The ADA recommends keeping HBA1c below 7% and TIR over 70%. With closed-loop it is over 90%, so clearly better control. Even for an anecdotal report.