Back.. With An Update And Question! (possible Misdiagnosis)

[h4kr]

So, I have taken a little time away from the forum. Was in a bit of a dark place and reading everybody elses woes seemed to compound where I was at.
Anyway.. long story short, I have had a turn around and now am facing T1D. This week I started a low carb, low calorie diet to lose weight for my holiday in a month. This has gone well, except the constant lows and having to pickup my numbers with apple juice/biscuit!
I have cut my lantus by a few units and am not taking any Fiasp before training. This meant that last nights meal of 80+ carbs (pie and mash) took me to 19mmol and an up arrow on my libre scanner after an hour. I went out and did a 25 min 5k run then 30 mins weights and ended up dropping to 3.4. - surely I would need at least .5/1unit to be able to unlock the carbs and burn them? This has been consistent this week; eat, no insulin, train, go low.
I saw the DSN today she has booked me for a anti-body? blood test and mentioned Mody diabetes and Lada, she doesn't seem to think that i am honeymooning 6 mnths in. Perhaps I'm not T1 after all ?
Anyone have here experience the same sort of thing? I am going to experiment for a few days and miss out my Fiasp whilst training and drop my lantus a few more clicks .. see what actual influence this is having on my body.
Chris

 

[Deleted Account]

I am not sure if it explains everything but exercising an hour after injecting means you have a lot of insulin on board during the period when your body is most efficient at using insulin. This will more likely lead to the drop you are seeing.

I find it better if I exercise a couple of hours after injecting so I have less insulin on board.

The logic behind the basal is that it maintains control of the glucose which your liver naturally drips into your blood during the day (and night). When you exercise, you liver releases more glucose than usual to give you the energy for the activity. As a result, you have less glucose supplies for the next 24 - 48 hours. Therefore, I reduce my basal after exercise.

If you want to make sure your basal is set correctly, it may help to do some basal testing (there are links around explaining how this works). As you have a Libre, this will save your fingertips. Given the impact exercise has, you may have to have a day off the gym before starting the test.

 

[h4kr]

I am not sure if it explains everything but exercising an hour after injecting means you have a lot of insulin on board during the period when your body is most efficient at using insulin. This will more likely lead to the drop you are seeing.

This week I haven’t taken any insulin before training and am also 6-7 hours after my lunchtime dose, so expect that is long gone..
I’m dropping low after exercise when fingerprick reads 19mmol starting exercise (and reduced lantus)

 

[h4kr]

So last nights fasting... I have had no insulin for 24 hours now.

 

[Alison54321]

You need to keep an eye for ketones. I don't remember having a honeymoon period myself, but they can last quite a while.

You seem to be trying to prove something, but rather than doing that, it would better just to work out what your body is actually doing.

Are you still taking Lantus, if you stop taking Lantus you need to keep a close eye on ketones, for your own safety.

19mmol after a meal of 80g carbs isn't good, so clearly your pancreas has some issues.

If you can move towards a more investigative mindset, that would be better.

 

[ickihun]

@h4kr I get 19s after a meal of 80 carbs too. I'm highly insulin resistant.
How many units of frasp do you take and lantus?

 

[h4kr]

I guess I am trying to prove something.. this is a bit of an experiment, so is I do have an investigative mindset. Not sure what I’m trying to achieve..

As to numbers before this weeks diet change I was on lantus 19 units and IC ratio of 1:20.

 

[Alison54321]

I guess I am trying to prove something.. this is a bit of an experiment, so is I do have an investigative mindset. Not sure what I’m trying to achieve..

As to numbers before this weeks diet change I was on lantus 19 units and IC ratio of 1:20.

The whole diabetes journey is better served by an investigative mind, as much as we love medical professionals, the day to day experience matters a lot in diabetes.

19 units of Lantus seems quite high, relative to a 1:20 insulin/carb ratio. I tend to follow a trial and error approach to my basal insulin, other people do more scientific things, like basal testing. I'm not sure who to tag @novorapidboi26 is good on this, or he may know someone else.

Just be careful though, as our body have to have a certain amount of insulin daily, to function.

 

[ickihun]

I guess I am trying to prove something.. this is a bit of an experiment, so is I do have an investigative mindset. Not sure what I’m trying to achieve..

As to numbers before this weeks diet change I was on lantus 19 units and IC ratio of 1:20.

Are you obese or overweight, or neither?

 

[ickihun]

The whole diabetes journey is better served by an investigative mind, as much as we love medical professionals, the day to day experience matters a lot in diabetes.

19 units of Lantus seems quite high, relative to a 1:20 insulin/carb ratio. I tend to follow a trial and error approach to my basal insulin, other people do more scientific things, like basal testing. I'm not sure who to tag @novorapidboi26 is good on this, or he may know someone else.

Just be careful though, as our body have to have a certain amount of insulin daily, to function.

@catapillar I find is brilliant in understanding type differences and sound advice for type1s too.

 

[h4kr]

Are you obese or overweight, or neither?

Neither.. 5’8 and 75kg. Just trying to tone up for summer holiday

 

[Fairygodmother]

A basal test might be the best way to see if the Lantus dose you’ve moved to is a good fit. It takes a bit of time but it’s worth it and could give you a better idea of how to control diet and insulin.
Once you’ve got the basal right then you can concentrate on the bolus:carb ratio.
If you’re using novorapid then you can get insulin pens that administer 0.5 units which gives you more flexibility.
These instructions for basal testing include ways to adjust doses on a pump, and are for children, but the basal test itself is the same as for all T1s. https://www.uclh.nhs.uk/PandV/PIL/Patient information leaflets/Basal and bolus testing.pdf
Doing four separate basal tests, one for each quarter of the day, makes the whole thing less taxing. You might find that it’s worth repeating occasionally as you may still be settling in a T1 state.
The half unit pen for novorapid is called NovoPen Echo. I didn’t find a half unit pen for Lantus when I was using it but you can use the Echo for Levemir.
The good news is that according to recent research you’re quite likely, having been diagnosed when older, to still have some semi-functioning beta cells and are less prone to complications

 

[Circuspony]

I don't 'exercise' as in go down the gym, but I have two horses so that makes a normal day for me very active (around 22,000 steps on the fitbit on a standard day) Even just having background insulin - tresiba - in my system can cause me to go low. Mucking out 2 stables and 8,000 steps last week dropped me from 12 to hypo and I didn't have any novorapid on board. I do find Tresiba easier on me than Lantus, because its more predictable. Lantus would drop me suddenly and sometimes an hour after I'd sat down at my desk to crack on with some spreadsheet stuff.

I had a c-peptide test in Feb so I know am still producing some insulin, but I think I just become very insulin sensitive with exercise anyway. If possible I try and avoid having novorapid on board if I'm about to go and do any physical work. That does mean I can run high at times (12 ish), but my most recent hba1c was 49 so I'm obviously not running high for long.

 

[h4kr]

@Circuspony that is very helpful thank you - and makes me feel like I'm not mad!

I am getting the wife to help me with comparative blood tests! We went out to lunch and I didn't do insulin and had a low carb chicken salad. I was 5.6 before eating and wife was same, when we got home an hour and a half later I was 9.9 rising, she was 5.7 (she had breaded chicken and a sticky toffee pudding and custard) - so i know my pancreas isnt doing what it should be doing but an hour later and I have dropped into 4's - this is with no insulin on board (no fiasp in 24 hours and no lantus for 34 odd hours).

Guess i'm not looking to 'not' be diabetic.. more for reassurance that this is kinda normal - if ever diabetes could be normal.

 

[Struma]

A basal test might be the best way to see if the Lantus dose you’ve moved to is a good fit. It takes a bit of time but it’s worth it and could give you a better idea of how to control diet and insulin.
Once you’ve got the basal right then you can concentrate on the bolus:carb ratio.
If you’re using novorapid then you can get insulin pens that administer 0.5 units which gives you more flexibility.
These instructions for basal testing include ways to adjust doses on a pump, and are for children, but the basal test itself is the same as for all T1s. https://www.uclh.nhs.uk/PandV/PIL/Patient information leaflets/Basal and bolus testing.pdf
Doing four separate basal tests, one for each quarter of the day, makes the whole thing less taxing. You might find that it’s worth repeating occasionally as you may still be settling in a T1 state.
The half unit pen for novorapid is called NovoPen Echo. I didn’t find a half unit pen for Lantus when I was using it but you can use the Echo for Levemir.
The good news is that according to recent research you’re quite likely, having been diagnosed when older, to still have some semi-functioning beta cells and are less prone to complications

Reading your link, I think it is for people on insulin pump, and I think the OP is on MDI.
Is there an extrapolation from one to the other please?

 

[db89]

Reading your link, I think it is for people on insulin pump, and I think the OP is on MDI.
Is there an extrapolation from one to the other please?

Although the document details basal testing for pump users the principles can be applied by those on MDI. I prefer MySugr's method for testing personally (although their figures need to be converted to mmol/L as they're in mg/dl).

 

[Fairygodmother]

Reading your link, I think it is for people on insulin pump, and I think the OP is on MDI.
Is there an extrapolation from one to the other please?

The basal test itself is the same for all T1s - stated in my post - the changes each T1 may make to dosing, as I understand it, will vary according to the results of the basal test. As a newly diagnosed T1 the OP might like to make small adjustments and wait 3 or so days to see what effect they have before making any further changes. At least, that’s what I’d do.

 

[h4kr]

So.. I have had no insulin since thurs am. Last lantus was wed night.
Can anyone explain this to help me understand.
Honeymooning?

 

[Alison54321]

My advice would be to try and keep it going as long as you can, so try not to make too many demands on those beta cells,but don't starve yourself either, and keep them happy by feeding your body lots of nice healthy food, think gut health, especially, and try to keep the post meal glucose spikes under control, by whatever means works for you.

But also make sure you keep watching, in case things change. Medical professionals are lovely people, but they base their advice on averages, if this is a honeymoon phase it's later than average, but as I'm sure you know, there's always at least one who hangs around the edges of the bell curve.