Lantus - what's protocol here?

[mirror]

Quick update
Really odd
Yeah - no problem today
no insulin given still no ketones (blood ketone test on a meter)
Daughter lively (Apart from morning - she'd been up loads of the night like us!)
In night 2.30, 4.30 bm 2.8 and 2.9 - lucozade x 200ml plus around 40 g carbs of flapjack. Both times.
All other bms fine
6.30 5.6
8.30 4.6
10.30 5.3 ( milkshake 50g)
11.50 7
1 pm 50g (scone jam hot choc)
2.30 12.8
4pm 12(140g mcdonalds Inc full sugar coke)
6 pm 9.5 ketone low

 

[Spiker]

So literally no insulin, no Novorapid, no Lantus (since - when?) despite loads of carby food?
Has this off label drug pushed her T1 into remission???

 

[mirror]

No insulin at all since the one unit novorapid and one lantus midday Saturday

 

[Spiker]

Before you @mirror or anyone gets their hopes up there is approximately one recorded case, ever, of T1 going into remission. That's out of millions.

Did you ever get any liver tests to see if she is still dumping glycogen from her liver like T1s normally do?

 

[mirror]

Will be on the case tomorrow
Assuming it's liver problems to be fair

 

[Spiker]

No insulin at all since the one unit novorapid and one lantus midday Saturday

Wow. When you get the consultant on line tomorrow I would really press for a C-peptide test (as well as liver tests) to see if her insulin production has resumed/increased. Did she ever have a C-peptide test? Most people don't get one. But if she did it should be in her notes or medical records somewhere.

 

[mirror]

Never heard of it
No idea
( one question - I thought as a diabetic (t1)- (since 20 years, so no honeymoons here) that even if you have glucose in the blood ( by pumping food into her) you somehow NEED insulin to be able to utilise it?(silly hope)

 

[mirror]

Just quickly googled
C peptide test needs no food / drink for 8-12 hours ( she'd be hypo)

 

[mirror]

Ps don't know what you mean by liver dumping glycogen?

 

[Spiker]

Never heard of it
No idea
( one question - I thought as a diabetic (t1)- (since 20 years, so no honeymoons here) that even if you have glucose in the blood ( by pumping food into her) you somehow NEED insulin to be able to utilise it?(silly hope)

Correct. Without insulin the glucose just hangs around in the bloodstream until it is excreted by the kidneys. Some cells can use some of it but most can't.

She's been diabetic 20 years? This is just, I don't know, unbelievable.
Are you absolutely sure there's no way she is injecting without you knowing? Sounds like she is ambulatory, reasonably functional, just has a kind of brain fog around numbers etc?

 

[Spiker]

Ps don't know what you mean by liver dumping glycogen?

In a T1 diabetic the liver constantly spills glycogen into the bloodstream unless this is corrected by injected insulin. Insulin suppresses the release of glycogen (sugar), but in the absence of insulin it just spills out all the time. This is the main reason why we need basal insulin rather than just needing bolus insulin with food.

If, hypothetically, her liver stopped spilling glycogen then her basal insulin needs, and total insulin needs, would drop dramatically. It still wouldn't explain why her BG is correcting down, after a carb rich meal, without any bolus insulin supplied, without even any basal insulin on board. This is X Files territory!

 

[mirror]

100 % not injecting
She's complicated in terms of functioning
Understands mostly everything (but can't 'do ' noise or complex conversation)
Expressive communication poor
Short term memory poor

 

[Spiker]

Just quickly googled
C peptide test needs no food / drink for 8-12 hours ( she'd be hypo)

Alternatively then do a blood test for the insulin concentration in her blood. If she didn't inject it, she's making it. Somehow.

 

[Spiker]

100 % not injecting
She's complicated in terms of functioning
Understands mostly everything (but can't 'do ' noise or complex conversation)
Expressive communication poor
Short term memory poor

After 20 years of T1 I could almost inject Lantus in my sleep - it's almost completely automatic.
But OK, just checking. It seems the most logical explanation, wanted to rule it out.

 

[ConradJ]

How often and when does she take the 'off licence' med?

...I wonder if it's suppressing the metabolism system in another way and preventing the absorption of glucose into the blood stream?

This situation is utterly perplexing, more so because the BG results are low overnight and until early pm, whence they rise until night-time again.

 

[mirror]

She's had ONE dose (iv in hospital)
Would have been due for another on 7 Sept (4 weekly)

 

[Spiker]

10.30 5.3 ( milkshake 50g)
11.50 7
1 pm 50g (scone jam hot choc)
2.30 12.8
4pm 12(140g mcdonalds Inc full sugar coke)
6 pm 9.5 ketone low

I would still be wary of giving her carby food without bolus when her BG is high (over 7-8) before a meal. While she is showing a drop after these meals, any time she goes to 10 or so there will be a BG drop caused by renal dumping (sugar being excreted). This is not ideal. Not a huge acute problem compared to what she's been facing but not ideal as long term (ie years) it will cause kidney damage. In the short term the problem it causes is just a diagnostic problem - we can't tell why those BGs are dropping. Is it because there is some insulin-like action or is it just renal dumping. Drops from well below 10 mmol/L are more conclusive as insulin-like action.

Is she still on the steroids by the way?

 

[mirror]

Conrad - happy to tell you via pm the med if you are interested

 

[Spiker]

She's had ONE dose (iv in hospital)
Would have been due for another on 7 Sept (4 weekly)

Right but each dose is supposedly active for 4 weeks.
And it's relevant that this is her first dose. Any adverse (or just plain weird) reactions would occur with the first dose.
A very, very far fetched theory would be, as the off label drug is supposed to block autoimmune action, is that it has somehow allowed her pancreatic beta cells to recover. If so, it is literally the breakthrough of the century. I am sure there are a dozen more boring explanations that we just haven't thought of.

 

[mirror]

Yeah still on steroids
We're dropping by 5mg a week, so on 35 g a day this week