How long without insulin

AndBreathe said:

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.

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GrantGam said:

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.

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GrantGam said:

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.

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AndBreathe said:

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?

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catapillar said:

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.

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azure said:

@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.

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catapillar said:

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.

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tim2000s said:

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.

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azure said:

@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

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catapillar said:

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.

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