Question for those with zero natural insulin left

I don't think a slice of toast without insulin as a one-off would do too much. Are we assuming that background/basal insulin has still been taken? What about other meals? If you had the toast and no insulin, then your next snack or meal and no insulin then you'd probably be feeling grotty but presumably at some point you'd be having some insulin?
I'm a pump user and a while back I had a dodgy cannula (so no basal insulin for maybe 4-5 hours? and then no bolus, or very little going in) but didn't realise and had eaten lasagne, garlic bread and chips at the pub (photo attached ) and a few hours later my bg was high 20s and ketones were 2.6, so if I hadn't realised or not cared and then eaten something else I probably would've ended up having to take myself to A&E.

Medina27 said:

Just out of curiosity, how little would it take for you to end up in hospital for example would something like a slice of toast skipping insulin be enough to put you in real trouble? I'm curious about what tolerances to expect. I know that I can handle a few cups of tea without worrying too much. But obviously this will change over time

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Well, to be put into hospital for insufficient insulin, it's basically a question of how long it takes you to go into diabetic ketoacidosos. And your blood sugar can be pretty high without ketones if there's enough background insulin in your system to stop DKA. So, I'm on a basal/bolus regime and in 50 years I've never had a DKA, but I've had some spectacularly high levels when I've had too many carbs for my insulin..... (But I've never skipped my insulin, though I've certainly overloaded it with too many carbs).

On the other hand, I believe that folk on pumps can go into DKA quite quickly (less than 24 hours?) if their pump stops providing insulin and they don't realise, because they don't have any background insulin. But it's not so much the carbs, but the lack of insulin that causes issues. You can live with ultra high blood sugars, you just won't feel well and you'll be doing long term damage to eyes, kidneys, heart, nerves etc....

I would have thought the answer is "it depends".
Do you have background basal insulin? What is your diet? How insulin resistant are you? ...

A slice of toast would not put me into DKA but a few hours without basal insulin could.

Five grams of carbs raises my blood sugar by about 2 mmol/l, so a slice of toast without basal insulin would send me into the teens.

Hi, If I wake up with a 4 or 5 reading and I know I will be busy in the morning, I have a yogurt and actively get it down to a good lunchtime number. I don't eat toast, but if I was to eat a slice of gf toast, around 12 carbs and a long walk, then that should bring it down, but inactive it would climb into double figures.

For me it'd be the toast that would get me, my basal rate is quite low anyway, but 5 carbs can raise my BS by 3-5 by itself, so yeah for me the toast would do a lot more damage than no basal (well excluding between 3am and 6am, that wouldn't end well with no basal either)

Think it could also depend on the person if I’m not wrong? Not sure if this goes Person to person or if others have been told to do the same but my DSN told me not to have insulin for anything less than 20g of carbs. So relatively speaking for 1 slice of toast I shouldn’t actually bolus. Now I’m on a pump I bolus for literally everything just down to the fact it’s mega easy. For example today my post workout snack was 3.3G of carbs so I actually took 0.6 units of insulin

Again probably a person to person thing but my pump infusion site failed a few weeks back and I was in the low 20’s. Stayed there for a good few hours before managing to bring it back down but my ketones where only 0.6. As above sleepster was in the 20’s and had ketones of 2.6.

Maco said:

but my DSN told me not to have insulin for anything less than 20g of carbs.

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That's definitely a person to person thing. I'm quite insulin resistant and would need 6 units for 20g..... (Depending a bit on what I'm doing but I'd definitely inject).

EllieM said:

That's definitely a person to person thing. I'm quite insulin resistant and would need 6 units for 20g..... (Depending a bit on what I'm doing but I'd definitely inject).

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Thought as much, even if I was to bolus it would be 2 units.

Maco said:

Not sure if this goes Person to person or if others have been told to do the same but my DSN told me not to have insulin for anything less than 20g of carbs

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I was told this too, but my DSN at the time was useless, although I didn't know it then. It's taken me a long time to get used to bolusing for everything