How long without insulin

[GrantGam]

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?

Yes that's correct I:C is your insulin to carb ratio. If you're applying this ratio to your meals (accurately) and landing back into your target range within the 3-5 hour DIA of your bolus insulin, then that would tell me that you are not insulin resistant and that you certainly need all that bolus insulin to cover the carbohydrates from your meals. The same can be said for your Lantus dose; if you carry out a basal rate test and find that your BG is steady (or even rising); then you definitely need the basal insulin which you inject every day.

'HI' on a BG meter is somewhere over 30mmol/l; which is chronically high. Remember that DKA doesn't present in all T1's with elevated BG, but a lack of insulin is directly proportional to high BG readings. If you don't have enough insulin on-board, your BG rockets. This is what happened with you - so I'd doubt you have 'quite good beta cell function'. As to why you never developed DKA over 3 weeks I have no idea, if it was shortly after diagnosis then you may have been honeymooning and had just enough self produced insulin to keep you alive...

As I said before, if you have concerns regarding your diagnosis then you should express this with your GP or Diabetologist - they can run tests for you, providing the supporting evidence you give for your uncertainty as to what type you are has any weight to it.

 

[nessa1970]

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.

What is insulin resistance? Does that mean beta cell function?

 

[nessa1970]

Yes that's correct I:C is your insulin to carb ratio. If you're applying this ratio to your meals (accurately) and landing back into your target range within the 3-5 hour DIA of your Novorapid insulin, then that would tell me that you are not insulin resistant and that you certainly need all that bolus insulin to cover the carbohydrates.

'HI' on a BG meter is somewhere over 30mmol/l which is chronically high. Remember that DKA doesn't present in all T1's with elevated BG, but a lack of insulin is directly proportional to high BG readings. If you don't have enough insulin on-board, your BG rockets. This is what happened with you - so I'd doubt you have 'quite good beta cell function'.

As I said before, if you have concerns regarding your diagnosis then you should express this with your GP or Diabetologist - they can run tests for you if the supporting evidence you give for your uncertainty as to what type you are has any weight to it.

Um sorry I'm confused
How can a type 1 diabetic not get dka
If they do not take insulin
I don't understand
I'm sure that's all I've read throughout the forum is these poor people that have gone thru that
So your saying I have no beta cell function cause I run HI
I can run HI for a long time
Is it because I drink the orange juice then maybe drinking carb drinks helps keep ketones away

 

[nessa1970]

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.

I'm confused
What does insulin resistance mean ?
I don't understand the food thing when I take my insulin properly carb counting etc my numbers are 4.5 - 8.0 for the most part
Is that mean I have beta cells still?
I don't no that this matters to most people but I'm curious to know
And I have spoken to my dn an all she keeps saying is I'm type 1
Well I no that
I'm wanting to no how much I have left
An I'm assuming you have some left because I was in a bad space took no insulin atall for 3 weeks an I did not get extra sick like others
So I'm assuming I have beta cells still
Is this not an option ?
I mean I took insulin again after 3 weeks because I could hardly walk my legs were like concrete my balance went off I felt bit goga in my head an all I could do was pee all day an drink about four to six litres of coke a day
But no ketones really I'd hardly count 0.9 high.so I was very ill but hyperglycaemic I'll
Oh I'm not making sense
No matter

 

[AndBreathe]

What is insulin resistance? Does that mean beta cell function?

Insulin resistance is whereby an individual's body doesn't deal with insulin (whether naturally produced or injected) quite as efficiently as it might, in an ideal world. It doesn't really have anything to do with beta cell functionality. There's lots out there on Google and the like, and there have been a few threads on here by T1s with insulin resistance.

I don't believe any of us can tell if you how much, if any beta cell function you may have remaining. Only a blood test would ascertain how much, if any, natural insulin you might be producing.

To be honest, I think your biggest goal should be to try to get your head space into a place whereby you're regularly taking your insulin, matched to what you eat, to try to give your body a rest from the bloods roller coaster, and get on with recovering for you.

Did you mention you were being considered for a pump at some point?

 

[GrantGam]

I don't understand the food thing when I take my insulin properly carb counting etc my numbers are 4.5 - 8.0 for the most part
Is that mean I have beta cells still?

If you take your insulin after accurately carb counting your meal and your BG is 4.5mmol/l - 8mmol/l then that implies that you needed the insulin that you took. If you didn't need the insulin (had a functioning pancreas), it's more than likely that you'd be having hypos regularly after taking bolus insulin.

Only blood tests can confirm your degree (if any) of pancreatic functionality - and whether you do, or do not have working beta cells.

I was in a bad space took no insulin atall for 3 weeks an I did not get extra sick like others

I could hardly walk my legs were like concrete my balance went off I felt bit goga in my head an all I could do was pee all day an drink about four to six litres of coke a day

I'd say that those symptoms qualified you for being a LOT more than sick @nessa1970; you were clearly violently ill. As much as I appreciate your query, and it is interesting, the important thing that we can all agree on is that you clearly need your insulin to function like a normal human being. Why didn't you get DKA? I have absolutely no idea, I - nor none of us here for that matter - are doctors, so maybe a Diabetologist would be able to enlighten you if you asked them.

Even if you do have LADA, which I think is what you're getting at here, you'd still ultimately be a type 1 diabetic. The autoimmune response is the same, it's just the onset which is slower. Bear in mind that a lot of clinics and doctors to not recognise T1.5 or LADA. To them there is just T1 and T2, which I must admit I quite support the idea of.

 

[catapillar]

Um sorry I'm confused
How can a type 1 diabetic not get dka
If they do not take insulin
I don't understand
I'm sure that's all I've read throughout the forum is these poor people that have gone thru that
So your saying I have no beta cell function cause I run HI
I can run HI for a long time
Is it because I drink the orange juice then maybe drinking carb drinks helps keep ketones away

Having ketones is one thing. Being in diabetic ketoacidosis (DKA) is a different thing.

Ketones in someone who is type 1 and not taking their insulin are clearly a signal that their blood sugar is too high. The next stage is DKA, DKA is when the ketones poison the blood and turn it acidotic. This is what kills.

Insulin resistance is when your body isn't processing insulin properly. A very high insulin to carb ratio might suggest some insulin resistance. Insulin resistance, or not, doesn't have anything to do with beta cell function in a type 1.

Yes, you might have some residual beta cell function. That's not unusual in a recently diagnosed type 1. A cpeptide test can tell you whether your producing any insulin. But the answer won't really mean anything of any significance to your type 1 diagnosis and management.

Quite frankly your questions seem nonsensical. Obviously you were very unwell with dangerously high blood sugar when you weren't taking insulin, so just take your insulin to stay healthy. Whatever function your beta cells might be clinging onto it obviously not enough to keep you alive and kicking without exogenous insulin. The only difference having some beta cell function is having to you now is that at some point in the future you may find you need slightly more insulin. Really in terms of day to day management it doesn't make any difference.

Drinking orange juice or full sugar coke with no insulin and a blood sugar of high is only going to further increase blood sugar and increase the risk of DKA and make you sicker.

What answer is it your hoping for? What option is it you're asking about? You have type 1 diabetes, the options are: take your insulin or; die. It's that simple, it's that binary. Running your blood sugar at unrecordably high levels for weeks on end increases your risk of significant diabetic complication whether or not you get ketones during that time.

 

[nessa1970]

Insulin resistance is whereby an individual's body doesn't deal with insulin (whether naturally produced or injected) quite as efficiently as it might, in an ideal world. It doesn't really have anything to do with beta cell functionality. There's lots out there on Google and the like, and there have been a few threads on here by T1s with insulin resistance.

I don't believe any of us can tell if you how much, if any beta cell function you may have remaining. Only a blood test would ascertain how much, if any, natural insulin you might be producing.

To be honest, I think your biggest goal should be to try to get your head space into a place whereby you're regularly taking your insulin, matched to what you eat, to try to give your body a rest from the bloods roller coaster, and get on with recovering for you.

Did you mention you were being considered for a pump at some point?

Yes I did that appointment is in June as they wanted me to be more reliable with taking the insulin
I'm actually perfect when I'm really going hard an I seem to burn out at six week mark an get upset by weight but even more of the effort involved and I just need a break so I just stop all of it an be me before diabetes
I'm a smart woman so it doesn't make any sense atall I no
I had some today tho so that's good I suppose
Have job interview this week so I can't go in looking all white like I am so I took insulin eight unit not much I no but something

 

[db89]

The next stage is DKA, DKA is when the ketones poison the blood and turn it acidotic. This is what kills.

Is it the continued presence of ketones which causes this or simply the level they reach in the blood which causes the acidosis (or both even)? Sorry to butt in just curious and wanting to learn.

 

[nessa1970]

Having ketones is one thing. Being in diabetic ketoacidosis (DKA) is a different thing.

Ketones in someone who is type 1 and not taking their insulin are clearly a signal that their blood sugar is too high. The next stage is DKA, DKA is when the ketones poison the blood and turn it acidotic. This is what kills.

Insulin resistance is when your body isn't processing insulin properly. A very high insulin to carb ratio might suggest some insulin resistance. Insulin resistance, or not, doesn't have anything to do with beta cell function in a type 1.

Yes, you might have some residual beta cell function. That's not unusual in a recently diagnosed type 1. A cpeptide test can tell you whether your producing any insulin. But the answer won't really mean anything of any significance to your type 1 diagnosis and management.

Quite frankly your questions seem nonsensical. Obviously you were very unwell with dangerously high blood sugar when you weren't taking insulin, so just take your insulin to stay healthy. Whatever function your beta cells might be clinging onto it obviously not enough to keep you alive and kicking without exogenous insulin. The only difference having some beta cell function is having to you now is that at some point in the future you may find you need slightly more insulin. Really in terms of day to day management it doesn't make any difference.

Drinking orange juice or full sugar coke with no insulin and a blood sugar of high is only going to further increase blood sugar and increase the risk of DKA and make you sicker.

What answer is it your hoping for? What option is it you're asking about? You have type 1 diabetes, the options are: take your insulin or; die. It's that simple, it's that binary. Running your blood sugar at unrecordably high levels for weeks on end increases your risk of significant diabetic complication whether or not you get ketones during that time.

I guess if I'm completely honest if I can get away with not doing anything for a week here in there an be normal I'll take it
As in having some bet cells gives me some sort of break
Because after doing it perfect runs my dry after six to eight weeks
I'm drained
So yeah
I find all this extremely hard to maintain so I guess until I can sort this burnout I get too i we'll be undone trouble

 

[azure]

I guess if I'm complaining honest if I can get away with not doing anything for a week here in there an be normal I'll take it
As in having some bet cells gives me some sort of break
Because after doing it perfect runs my dry after six to eight weeks
I'm drained
So yeah
I find all this extremely hard to maintain so I guess until I can sort this burnout I get too i we'll be undone trouble

@nessa1970 If you do have some remaining beta cells, then the fastest way to kill them is to have prolonged very high blood sugars....

When you don't take your insulin, even if you don't get DKA, that doesn't mean all is well. If your BS is unreadably high without insulin, then that's very bad. Such high blood sugar is toxic to your body. It will damage your kidneys, your eyes, your blood vessels - whether you have DKA or not.

I know you're finding the strain of managing Type 1 hard, but not taking insulin isn't the way to deal with that. It'll backfire big time.

If you're worried about your weight, then maybe ask to see a dietician or a counsellor if you feel you're prone to emotional eating. Not taking insulin to lose weight is very dangerous. It's not worth it.

 

[nessa1970]

@nessa1970 If you do have some remaining beta cells, then the fastest way to kill them is to have prolonged very high blood sugars....

When you don't take your insulin, even if you don't get DKA, that doesn't mean all is well. If your BS is unreadably high without insulin, then that's very bad. Such high blood sugar is toxic to your body. It will damage your kidneys, your eyes, your blood vessels - whether you have DKA or not.

I know you're finding the strain of managing Type 1 hard, but not taking insulin isn't the way to deal with that. It'll backfire big time.

If you're worried about your weight, then maybe ask to see a dietician or a counsellor if you feel you're prone to emotional eating. Not taking insulin to lose weight is very dangerous. It's not worth it.

It's not really the weight so much anymore @azure. I think it's not having control or I don't know actually. I no it's very unhealthy not to take the medicine
But it's not just that is it it's food, counting and weighing ,writing down blimmin blood sugars what I ate how blimmin much and all that **** then having hypos which I hate hate hate
I'd rather run high
So I just burn out
Honestly I just go...
Stuff this I'm having a break
That's it really
An although week two it gets bit worse it's not as bad as all that other stuff
I'm trying to imagine fitting it into my working life
We're not all strong you know, as in we have our different levels of coping
I have had great support from you an juicyj ( that's probably wrong) the spelling, and others but I find I'm in this circle and I'm stuck
I have great family good life nice loving supportive fiancé six grandkids
Yet here I am
Sorry
It must get annoying or frustrating seeing my posts after all this time
Here she goes again
I actually even will admit that when I'm running hi I don't hate it
Though im very ill I get a point where I just don't care
This time I have s job interview weds so I took eight units basal today real happy I did that
It's something

 

[nessa1970]

Having ketones is one thing. Being in diabetic ketoacidosis (DKA) is a different thing.

Ketones in someone who is type 1 and not taking their insulin are clearly a signal that their blood sugar is too high. The next stage is DKA, DKA is when the ketones poison the blood and turn it acidotic. This is what kills.

Insulin resistance is when your body isn't processing insulin properly. A very high insulin to carb ratio might suggest some insulin resistance. Insulin resistance, or not, doesn't have anything to do with beta cell function in a type 1.

Yes, you might have some residual beta cell function. That's not unusual in a recently diagnosed type 1. A cpeptide test can tell you whether your producing any insulin. But the answer won't really mean anything of any significance to your type 1 diagnosis and management.

Quite frankly your questions seem nonsensical. Obviously you were very unwell with dangerously high blood sugar when you weren't taking insulin, so just take your insulin to stay healthy. Whatever function your beta cells might be clinging onto it obviously not enough to keep you alive and kicking without exogenous insulin. The only difference having some beta cell function is having to you now is that at some point in the future you may find you need slightly more insulin. Really in terms of day to day management it doesn't make any difference.

Drinking orange juice or full sugar coke with no insulin and a blood sugar of high is only going to further increase blood sugar and increase the risk of DKA and make you sicker.

What answer is it your hoping for? What option is it you're asking about? You have type 1 diabetes, the options are: take your insulin or; die. It's that simple, it's that binary. Running your blood sugar at unrecordably high levels for weeks on end increases your risk of significant diabetic complication whether or not you get ketones during that time.

I don't know
Self destructive I guess
I can't manage to last being a wonderful diabetic for long
And I no I won't get complications I mean I've only had it a short time
I think you have to be pretty much really bad for ages years
So I'm not to concerned re that side it's to far off
I'm tunnel vision
I will try again tho to jump on the do it perfecto diabetes boat but if history is anything to by I just burn out cause too me there's no reward really
You still have it an have to do it till your dead
It's bloody hard
We're not all made the same
I struggle
Thank you very much for replying I totally understand all you said and I will try again
Hopefully I can try to go for longer maybe challenge myself for a two month mark
Hands in air

 

[GrantGam]

Is it the continued presence of ketones which causes this or simply the level they reach in the blood which causes the acidosis (or both even)? Sorry to butt in just curious and wanting to learn.

It's more down to a lack of insulin than anything else.

It's the levels that the ketones reach which causes the blood to turn acidic resulting in DKA.

Dehydration plays a large part too. As the body tries to rid itself of the extra glucose (through the urine) it takes with it a LOT of fluid. With the loss of fluid the blood becomes acidic quicker due to their being a less overall volume to concentrate.

Imagine it a bit like putting the same amount of orange squash into a dram glass and a pint glass and then having a taste. The dram glass is a lot sweeter because there's less water. So a bit like DKA really, where the ketones can build up to dangerous levels quickly in a dehydrated body. Sorry for the terrible analogy, but that's my take on it...

 

[tim2000s]

Hi @nessa1970 there's a young woman called Laura, who was also known as Ninjabetic. She was diagnosed at around 16, and took no care of herself for the best part of 10 years. You can read her story about getting diagnosed with Gastroparesis here, which hit her after about 10 years. She took such bad care of herself in those first ten years that she was diagnosed with stage 4 retinopathy after 9 years and told she would be most likely to go blind. Complications don't take forever to arrive if you are constantly running with your glucose levels at "Hi". They more often take less than ten.

I know you're struggling with your T1 diagnosis and wish it would go away and wasn't there, but sadly, with the levels you're running at, you are putting yourself at high risk of all of these things in a very short period of time. Please ask your clinic for help and go back and speak to a counsellor.

 

[nessa1970]

Hi @nessa1970 there's a young woman called Laura, who was also known as Ninjabetic. She was diagnosed at around 16, and took no care of herself for the best part of 10 years. You can read her story about getting diagnosed with Gastroparesis here, which hit her after about 10 years. She took such bad care of herself in those first ten years that she was diagnosed with stage 4 retinopathy after 9 years and told she would be most likely to go blind. Complications don't take forever to arrive if you are constantly running with your glucose levels at "Hi". They more often take less than ten.

I know you're struggling with your T1 diagnosis and wish it would go away and wasn't there, but sadly, with the levels you're running at, you are putting yourself at high risk of all of these things in a very short period of time. Please ask your clinic for help and go back and speak to a counsellor.

I will read that link thank you very much
Yes I do need to talk to my dn team an my therapist also
I need to sort this out
I need help getting over the burn out part
I'll do some arrangements tomorrow
Thank you

 

[catapillar]

I don't know
Self destructive I guess
I can't manage to last being a wonderful diabetic for long
And I no I won't get complications I mean I've only had it a short time
I think you have to be pretty much really bad for ages years
So I'm not to concerned re that side it's to far off
I'm tunnel vision
I will try again tho to jump on the do it perfecto diabetes boat but if history is anything to by I just burn out cause too me there's no reward really
You still have it an have to do it till your dead
It's bloody hard
We're not all made the same
I struggle
Thank you very much for replying I totally understand all you said and I will try again
Hopefully I can try to go for longer maybe challenge myself for a two month mark
Hands in air

I would suggest that the pressure you are putting on yourself to be a "perfect diabetic" is unrealistic and probably contributing to the burn out. There are no perfect diabetics.

The idea that you can avoid complications for ages even if you are running at unrecordably high levels is also unrealistic.

You say you're a smart lady, but you're certainly not taking a smart approach to your diabetes management. Do seek further help from your DSN and counsellor/psychologist. Make sure to tell them about theses periods when you stop taking insulin.

Have a read of think like a pancreas to learn more about what type 1 is and how to manage it. Don't pile so much pressure on yourself to be perfect, you don't have to test dozens of times a day, or weigh and note everything you eat. Those are just things that can improve management. If you need to do the bare minimum, do the bare minimum - but that does include actually taking your insulin.

 

[azure]

@nessa1970 Please don't think we're all strong - we're not. Type 1 is **** and I'm sure there's not a Type 1 here who doesn't know that.

But let your hatred of Type 1 drive you to beating it. You don't have to be a "wonderful diabetic" like you said. You just have to keep it controlled and in its cage. You won't be successful 100% of the time because we're all only human, but that doesn't mean you should give up.

When you think you're treating yourself to a break by not taking your insulin for two or three weeks, you're not. You're handing control of your life to the Type 1, and you're hurting yourself. So kind of a double kicking. The damage high sugars causes is insidious and invisible to start with, so don't think its not happening. As Tim says, it can happen quite quickly.

No one here is fed up of you or thinks you're stupid or any of those things. We understand and the responses you're getting are because people care about you and want to help. X

 

[nessa1970]

@nessa1970 Please don't think we're all strong - we're not. Type 1 is **** and I'm sure there's not a Type 1 here who doesn't know that.

But let your hatred of Type 1 drive you to beating it. You don't have to be a "wonderful diabetic" like you said. You just have to keep it controlled and in its cage. You won't be successful 100% of the time because we're all only human, but that doesn't mean you should give up.

When you think you're treating yourself to a break by not taking your insulin for two or three weeks, you're not. You're handing control of your life to the Type 1, and you're hurting yourself. So kind of a double kicking. The damage high sugars causes is insidious and invisible to start with, so don't think its not happening. As Tim says, it can happen quite quickly.

No one here is fed up of you or thinks you're stupid or any of those things. We understand and the responses you're getting are because people care about you and want to help. X

Thank you very much for that @azure
I will try to keep taking insulin and I will do bs testing for lunch an do a morning an afternoon test too.
Think that's a good start.
I'll try not to put too much in to fast also
Otherwise I'll get overload
I have drunk a lot of water today so I am trying replace the coke and the juice
I drink up to six litres a day when running HI
So Iv only had a bottle today so I'll try get that back to nothing but water
Thank you again for listening
X

 

[nessa1970]

I would suggest that the pressure you are putting on yourself to be a "perfect diabetic" is unrealistic and probably contributing to the burn out. There are no perfect diabetics.

The idea that you can avoid complications for ages even if you are running at unrecordably high levels is also unrealistic.

You say you're a smart lady, but you're certainly not taking a smart approach to your diabetes management. Do seek further help from your DSN and counsellor/psychologist. Make sure to tell them about theses periods when you stop taking insulin.

Have a read of think like a pancreas to learn more about what type 1 is and how to manage it. Don't pile so much pressure on yourself to be perfect, you don't have to test dozens of times a day, or weigh and note everything you eat. Those are just things that can improve management. If you need to do the bare minimum, do the bare minimum - but that does include actually taking your insulin.

I have that book and I will go thru it again over Easter
I'm going to do the bare minimum an climb from there . Try baby steps
Thank you