Puzzled/confused/irritated - the normal diabetic

Sorry, this is long.

Some background:
Dx 06/01/2003
Type 1 diabetic - positive GAD test
Severely insulin resistant - usual daily dose about 400u
Medication - insulin, no other diabetic drugs

I have Recurrent Vomiting Syndrome, and had an attack this weekend. (Basically rvs makes you spend 6-8 hrs continuously crawling into the bathroom to throw up, then back to try and rest. Fluid intake of any kind triggers more puking, producing dehydration). Anyway, early on I puked on the pump, so removed it and handed it over to poor husband for cleaning.

So Monday morning, I wake up with a hypo. I have had ZERO insulin for over 24 hrs, OK, also no food but... Have not yet put pump back on. After serious thought I assumed this is my liver restocking its sugar after a liver dump I was unaware of.

Monday evening. Hypo. Still not put pump on, but am eating small amounts (2x toast, pot yoghurt). Beginning of confusion.

Monday/Tuesday midnight. Ditto. That's right, hypo with no insulin. This time I checked with the Libre and two other devices. Beginning to think What's going on?

Tuesday morning. Reinstalled pump, fortunately had the idea to reduce basal rates, and since I hate hypos, I went to 50% of previous. Had lunch, bolusing about half what I normally would. Another hypo. Decided against dinner. Another hypo in night.

Wednesday. I'm just about keeping it under control, down to about 30-40% of previous doses (which have been steady for over a year). All Libre bg graphs just show a continuous steady downwards trend, only spiking when I eat at hypos.

What the heck just happened to me?

Any ideas, anyone please. Can 48 hrs of no food/energy intake 'reset' insulin resistance? I don't mind if my insulin dose goes back up, but if it crashes again I'm in danger. It's only because my husband was scanning my arm that two of these hypos were picked up.

Edited by Mod

Sorry for the language mod. And I even thought I was keeping it down! Will do better, I promise.

Brunneria said:

@Seacrow

Firstly, your vomiting sounds horrendous. What an ordeal. Do you get it happening often? What a cruel situation.

Regarding your insulin needs, how about this as a theory (but that is all it is...)

The more insulin we use or produce, then the more insulin resistant we may get. IR varies from person to person, and there are many factors involved. As I am sure you know, T2 is a condition of IR, but T1s can and do experience it too if any of those many factors get involved. Sometimes T1s find that their insulin resistance grows in proportion to the amount they have to use.

What if your illness, and not eating, and therefore reducing your insulin usage, caused your IR to drop? Therefore your body is suddenly making more and better use of insulin and not needing as much?

If that theory is correct, your IR (and therefore your insulin needs) may rise again as you return to your normal way of eating.

Click to expand...

So, no food AND no insulin drops the IR. Explains why previous vomiting attacks, where I kept basal insulin going, didn't have the same effect.

Sounds plausible. It can't be quite that simple though, otherwise thousands of type two diabetics would be fasting for 48 hrs and reaping the rewards. Maybe you need to actually 'run out' of insulin, and a lot of type two's still produce some.

I'm now down to 20% of my 'standard' doses and still going hypo. I just ate an entire bar of chocolate, and an hour later my bg has gone up by a whole 5 mmol/l. I've suspended my basal again. It sounds like a dream to suddenly not need insulin and wave bye to the diabetes, but it's actually just causing more stress.

Yep, RVS is absolutely horrible. At diagnosis I was spending 18 hrs throwing up every fortnight, and another day and a half recovering enough to keep down food. I told my GP I was losing the will to live. It's a funny condition, only appears in people with a history of migraines. One of the current theories is that its an abdominal migraine, as opposed to a head-based migraine. With medication I'm down to 8 hrs a month.