Honeymoon stage


(phiney) #1

Hi I am 53 I was misdiagnosed November 2016 as a type 2. I finally went to an Endocrinologist and he suspected I may have type 1, because my brother had it, and My 2 sisters and I also have auto immune diseases. I was diagnosed as type 1 on May05, 2017. My blood sugar is well maintained. I try really hard to watch what I am eating and and test all the time. Here is my question. I was told I am in the honeymoon stage, was anyone else in the honeymoon stage when they were diagnosed? Can you tell me about how long you were in it and what happened when it was over. The nurse made it sound like one minute I’m going to be fine then the next minute I’ll have to be rushed to the hospital. She gave me an insulin pen just in case and I take only 1 unit in the am and 1 unit in the pm, I also take 2 metformin still. I have no idea what to do with this insulin pen if my blood sugar goes high and it is the weekend and the Dr.'s office is closed. Also, am I in la la land thinking that I can control this with my diet and insulin. Thanks for any help anyone can give me.


(Linda) #2

Hi I too am recently diagnosed and I don’t know what the honeymoon phase is either. I was diagnosed April 2016 and was on a long acting insulin pen with 6units once a day. Also used a short acting pen to bonus with meals. Usually 1-2 units depending on carbs. I just started on a pump and it is so much easier. Carb counting is key and on my opinion a low carb diet works the best. I eat ~10 carbs or less per meal. Then I need less insulin and avoid compounding things by potentially adding type 2 to the mix (high carbs plus high insulin equals insulin resistance). I also find that if I have more carbs I have less control. Sorry I didn’t answer your question, but yes I do believe that diet and exercise can certainly help! Unfortunately there is no cure for type 1.


(Munirnara) #3

Hi Friends,
Good morning from Lahore, Pakistan.
I read your cases carefully & honeymoon period concept compels me to make few comments here.
I myself have been diabetic since the year 2002.
It was T2 initially. First 3 years only on diet control & metformin.
Next 7 years on pills. Since last 5 years on insulin.
I believe that there is no such thing like honeymoon period. If it is diagnosed at early stage then it is really lucky for someone.
But in most of the cases, (specifically the region from where I am, it is generally diagnosed several years after its existence & after that people take too long to accept & believe it & start medication, and then for next few years hard to take proper measure to control it, so honeymoon period never come in their way), it diagnosed lately so literally honeymoon period ,if there might be, had already gone in unawareness. However,somehow if it is diagnosed during the pre-diabetic transition (as IGT, impaired Glucose tolerance) then there is a genuine chance to enjoy next few years without too much medication which may be referred as honeymoon period to a larger extent, During that period it is still possible to defer & prolong the progression for next few more years by adopting strict control on diet & doing regular work outs. For example if it might take 3 years to finally convert into confirm diabetic then by taking above measure it may be delayed by next couple of years more or so.

Further I have been observing that treatment theories have been undergoing a drastic changes. For example now it has been generally advised to start taking the insulin during T2 phase instead of surviving on pills for next few years & then finally come to insulin.
Actually this aspect sometime create confusion to a particular person whether he is T2 or T1. Because some years before, generally it was widely understood belief that when someone on insulin then he is type1 for sure because in most of cases insulin was never prescribed to a newly diabetic. But things have been changed now.
So, still I am not sure after reading your case whether you are diagnosed as confirmed T1 or not?
Because from your comments it appears that your BG level remain maintained only for a couple of units of insulin.
Generally type1 DM person needs more insulin than that & at the same time very limited diet in terms of carbs as to go well with BG levels most of the time.

Further you have said that during Nov 2016, you were diagnosed at T2. So, it is correct then still it is possible that you might be t2 to some extent. Doctors opinions are however prevail & authentic in this regard please.

As regards, your questions, you can enjoy this period relatively for a longer period of time in terms of years by keeping a vigilant eye on
your intake specially carbs intake. Try to build & develop habits of avoiding taking juices, anything having natural sweeteners like ice cream, fruit cocktails with lot of added sugars & off course items having huge content of fast acting carbs like breakfast cereals, white bread, french fries, junk food.
For more better results you may choose to take advice from a dietitian, who may give a tailored made meal plan according to your needs & requirements which may also fits your biology & body chemistry as well.
Further you need to take more & more awareness about the different events & situations which generally happened to a diabetic person like if anytime BG goes down (HYPO episode) then what to do exactly without being getting panic?

So, by following certain known & well established rules of diabetic life, you can still enjoy happy life without any complications for many years to come.

Another thing may help you is to keep asking, posting, sharing & following doctors & support team advises religiously.
Hoping for a healthier life.
Good Luck & stay healthy.

Kind Regards,
Munir Nara.
(Lahore 32C, 1055 Hours)


(joe) #4

hi @phiney, hi @Momoftwins,

honeymoon is a term used to describe what often happens when you first start taking insulin after a t1 diagnosis. IMO it is a very irresponsible thing to call it, and the medical community can do a very bad job in both explaining it and helping patients deal with it: some patients run around thinking their t1 went away because the don’t need insulin anymore, many just think t1 is easy to control.

Honeymoon is a description of when your blood sugar first starts to come down as a result of taking insulin and many people find that they start making insulin naturally again. during honeymoon it can be much easier to control blood sugar because you are making insulin and therefore don’t have to inject much, if any. if you are making any insulin the possibility of DKA is greatly diminished.

honeymoon can last 2 weeks to a year or more. mine lasted 6 months

autoimmune type 1 diabetes will eventually kill off all insulin making cells and so, the honeymoon will eventually end. since you need insulin to survive, if you have t1, no amount of diet and exercise will control blood sugar alone, your body eventually starves.

when it ends, may people have more difficulty maintaining blood sugar. if you have t1, you can probably consider dropping the metformin eventually unless you are also very resistant to insulin (have to take huge amounts of insulin). please consult your doctor. good luck!


(Crisann9) #5

Hello. I am sorry to hear that you are going through some unresolved/unexplained issues with Honeymoon Phase. My son is 10 and was diagnosed type 1 four months ago. Your post about not knowing or being educated on Honeymoon phase is concerning. It makes me feel fortunate that his endocrine team at Children’s Hospital of Philadelphia are providing very good medical and educational care.
He is in the Honeymoon phase which means he requires less insulin as his Beta Cells that produce insulin in the pancreas have not yet been fully knocked out. Eventually they will cease to secrete any insulin. He has check ups every three months and gets his A1C done - his appointments for the entire year were given to us once he was discharged from the hospital. So far we have gone to different carb to insulin ratios but he really is taking only small amounts of insulin with meals/food depending on grams of carbs consumed. He also takes long-acting insulin (Lantas) at bedtime and that too has increased just a bit. He is a growing boy, still has yet to hit puberty. I am told these scales and amounts will change many times as he goes into manhood.
Your post makes me realize that adults go through this as well. I knew that some people have been diagnosed over 30, but I guess I thought they didn’t have a Honeymoon Phase. I knew that a lot of people have been misdiagnosed as type 2 just based on age of onset.
Again, I am sorry to hear of your frustration/concern. You are educating people though and this diabetic journey needs the support of others.
Of note: There is a TrialNet study I was offered for myself and other children to be tested for marker antibodies - my blood screen didn’t reveal any and so I was told I would never have type 1 diabetes, but that didn’t mean I couldn’t get type 2.

I recommend the Trial Net study or blood analysis for any type 1 with children or maybe a sibling/parent of a type 1.


(skiz22) #6

Hey @phiney.

My experience is the same as @joe. The honeymoon is just a period when your pancrease can still produce some levels of insulin. At times it will, at times it wont. I know when I was in this stage that I had trouble keeping my blood sugars up, as you cannot predict when you will produce natural insulin, but you are still taking your injections at least to some degree.

My honeymoon stage lasted about 4-6 months, it is different for everyone. When I came out of this stage it was not a sudden thing, it was progressive and I had to increase my insulin along with it. Typically like @joe said, you will have alot more difficulty controlling your numbers when you come out of this stage.


(lsmchugh0306) #7

Hi Phiney,
My experience is also similar to Joe and Skiz22. I was diagnosed in Sept 2013 at 51 years old, with Type 1. My Dr. immediately started me on Lantus (long lasting insulin) and I was taking very little each day, just 1 unit if I recall. After about 2 months, my numbers started spiking after meals, and they started me on fast acting, Bolus with each meal. After that, I could still snack lightly without insulin between meals. As time went on, my insulin needs for long lasting and mealtime insulin gradually increased, and no longer could I snack at all without bolusing. I’m probably out of the ‘honeymoon’ period by now, after almost 4 years, but I still have to adjust my mealtime ratio upward occasionally (and my long lasting insulin as well), and as recently as this week. I started on a pump last June, and it has been a very good experience for me. Like the others stated, it’s a slow progression, and numbers become more difficult to control as the disease progresses. I have been very lucky to have a fabulous Endocrinologist, who had warned me of what would happen as time went on. It takes a bit of getting used to, but as you gain knowledge, you will also gain confidence in what to do in different situations.


(tedquick) #8

Hey @phiney.
My experience doesn’t include any Honeymoon Phase, since I was diagnosed in 1956, just 4 years after doctors started being told that there WAS such a thing as Juvenile Diabetes, now called Type 1. I went into DKA coma and was on insulin full time after that.
Anyway, as I understand it, the Honeymoon Phase happens when the diabetes is just developing, but only if it is diagnosed early enough. This happens because the pancreas’s Beta cells can only cover demand until roughly 20% of them are still alive and active. When you reach the turnover stage of 20% then bg starts going up, and if you’re lucky enough a doctor will realize what’s going on and start you on insulin.
When the insulin shots begin it relieves the over stressed Beta cells, possibly giving them enough of a break that they can repair themselves a bit so that they can start making roughly enough insulin to keep you healthy. Taking a small dose at that time may be sufficient if done correctly under a knowledgeable endocrinologists close supervision.
It generally takes about 6 months for the immune system too kill off enough of the remaining Beta cells to require full blown insulin doses which will usually remain fairly constant from then on, except for growth changes and other miscellaneous variables that happen at times.
As for what Honeymoon amounts too when the diabetes develops at a later age (more correctly known as LADA, Latent Autoimmune Diabetes in Adults) the honeymoon often lasts 2 years or so, but is unnoticed for most of it.
I know this not from personal experience, but because I have been helping all kinds of diabetes online since 1986, so I’ve seen much of the available information on the subject.


(phiney) #9

I want to thank everyone who answered me. I am very appreciative that I have found this site with people who are willing to share their experiences and help out. Yes I was very worried that I would go from being able to produce insulin and the next day nothing. I already made an appt with the endo so I can learn what to do when my numbers get higher. They didn’t give me any instructions about changing the amount of insulin I take if I need to. It’s pretty much like they tried to scare me by making it sound like doom and gloom is pending. I am going for a follow up and if I can’t get any answers or be treated like an adult I will find another Endocrinologist. Thank You all for your help.


(str021) #10

I was originally diagnosed as T2 because my C-Pep level was still above .8 after gall bladder surgery. I was taking Invokamet, but starting having high glucose issues after 8 months. I switched to Lantus (once daily) and Novolog (before each meal). My A1c stayed the same. In December 2015, I switched to a Dexcom CGM with the OmniPod insulin pump. This combination has reduced my A1c to 6.4. The CGM notifies me of any low events and high events so that I can take insulin or walk to bring down my level or eat to bring it up.


(mglass) #11

I was diagnosed type 1 feb 2017. no fam history. followed at Joslin diabetes in Boston, the leading researchers. I asked my endo there about the honeymoon phase and she said it can last for months or years. No way to predict. I was prob diabetic for quite a few months but because I exercise and eat little carbs I had no symptoms until some weight loss and at that point A1C was over 10. On daily Lantus. I do have Humalog at home in the event sugars go over 200 and I would think all type ! diabetics should have this available. there are great resources on the Joslin website regarding LADA (latent autoimmunde diabetes in adults). Just ordered continuous glucose monitor.


(karenchq) #12

I was diagnosed T1 March 2016 at 50 years old. I think that it was a very long slide in the honeymoon period before being diagnosed with symptoms for 10 years prior. 8 years ago I went to my general doctor complaining of extreme weak spells during exercise (which do still puzzle me), high intake of water, frequent urination, confusion etc and told at that time I was boarderline diabetic. Did I have T1 then? I think so and just progressed very slowly were there was/is some insulin still being made. I started insulin March 2016 with blood sugar 650 and A1c 13.7. I started with 2-3 units Novorapid for meals and 6 units Lantus. In that time, I have increased the Lantus to 7 and the bolus has stayed the same, so probably still in the honeymoon phase. Thank you for posing the question as I am also interested in what others are going through in their journey.


(Munirnara) #13

Hi Friends here!!!

Good morning!!

The topic “Honeymoon phase” is highly interesting.
Hey KarenCHQ, your above case & comments made it more interesting.
You had symptoms 10 years ago, Right?. It appears that most probably you had not TID at that specific instant rather may be pre-diabetic (IGT state, impaired Glucose tolerance) or T2D atmost. From the awareness taken from several confirmed diabetic now, revealed that at the beginning (generally several years ago), BG sometime remains normal & at times out of range & gradually started remain high most of the time, untill few corrective actions like diet control, exercise & metformin not taken. Then few years later, still either need to add sulphonylyurea to go well or add little bit insulin to keep going well. Ultimately,last resort becomes insulin to survive, no matter for how many years after the initial stage.

So, in terms of above scenario specifically, may we say that so called “honeymoon phase” exists till then & eventually insulin becomes the last resort as pancreas fails to produce even a small drop of insulin?
OR so called “Honeymoon phase” refers to only T1d persons? as T2D person’s pancreas still having the ability to generate small amount of insulin for few years after detection.

From various discussions it possibly reflects that when someone diagnosed with T1D newly & started insulin immediately then it may be resulted in taking Off the huge pressure from pancreas & in turn it may still produce little bit insulin for sometime depending upon the fact that how much pancreas was working at the time of detection? besides other factors like rate of its deterioration, diet control after detection, lifestyle and stress level.

Other possibility to interpret for “Honeymoon phase” may be the healthcare professionals decisions on the basis of the results seen from a detection case. May be, in the opinion of the healthcare professional, if a person’s detection results are in such a way that insulin therapy deems fits for him then healthcare professional may recommend insulin therapy straightaway despite his pancreas is still working somewhat. In that scenario, that specific person may be able to control his BG in the best way by taking too little insulin without facing too much problems & BG perform well most of the time nicely as internal insulin is also there as a back up support till it completely wear out with the passage of time.

Specifically speaking about the region from where I am, here generally people get scary & become too much worried & sick as soon as they hear about using the insulin.Because it was a well established fact here that insulin is the last stage & this concept had taken by storm & a person put to insulin started thinking that his life is about to over. Anyhow, things have been changed to a little extent as the awareness increases but still more than 90% diagnosed DM prefers to avoid insulin & wants to survive on pills for few years.On the contrary, this tendency has been wearing out in advance & developed countries where insulin has been considered as a first line of defense straightaway. May be this could be the possible cause for several persons as not to differentiate clearly whether diagnosed as T1D or T2D?

Hey KarrenCHQ, your case seemed to be more T2D detected 8-10 years back rather T1D.

Keep asking, sharing & posting.
Good Luck & stay healthy!!

Kind regards,
Munir Nara.
(Lahore 33C, 1229 Hours)


(joe) #14

hi @KarenCHQ,

the weak spells are explainable. your entire body needs insulin for energy, insulin . only the brain can process blood glucose without insulin… or most t1’s would not survive.

without insulin, blood glucose builds up, but muscles STARVE. your workouts, with insufficient insulin, caused fat and muscle to be digested and used for fuel. The metabolism of fats (and muscle) can be detected by ketones in your blood. this is why they tell us to check ketones. the confusing thing is they tell diabetics ketones are bad, but if you need to lose weight, ketones will be present and it means your diet is working.

hi @Munirnara, Honeymoon is most used as a description of the body making insulin after a catastrophic total failure, or “onset” of T1. the phenomena describes that, after you get sick and start taking insulin, many people find they start making a moderate amount of insulin again. it is generally not used to describe a LADA very slow onset where very slow attack of islet cells slowly diminish insulin production. it is also generally not used to describe t2, where many t2’s continue to make insulin long after diagnosis. t2 is a complex illness with both significant hereditary and environmental factors.

I don’t think calling it something is what matters.

if you make a lot of insulin and are significantly resistant to it, “type 2” medications are often worthwhile when used with diet and exercise to control blood sugar.

if you don’t make enough insulin and are also resistant to it, “type 2” medications, and insulin are often worthwhile when used with diet and exercise to control blood sugar.

if you don’t make ANY insulin, then insulin is required to survive. Injecting insulin is necessary and used with diet and exercise to control blood sugar

if you don’t make ANY insulin, and are also coincidentally resistant to insulin, insulin is required to survive. Injecting insulin is necessary and used with diet and exercise to control blood sugar, and “type 2” medications are often worthwhile when used with diet and exercise to control blood sugar.

call these permutations anything you would like to! the goal in every case it to control blood sugar.


(karenchq) #15

Joe,

Thanks for responding to my question as well. I Exercise a lot and strenuously (marathons, hiking and moutain climbing etc). Do you think that is part of the reason I could have gone so long by burning off some excess sugar while still having some insulin production then progressing to the point years later were the remaining beta cells could not provide enough insulin? I was not super thin either so not burning a lot of fat as I was hungary all the time and ate a lot. Not that it really matters now, but I am curious to know how long I had been running around with high blood sugars. As I said my insulin dose is quite low so must still be some function.


(joe) #16

@KarenCHQ, I don’t make any insulin. Haven’t for decades. exercise can reduce my insulin requirement by over 50% so yea, regular exercise means I can make balance with about half the insulin of if I am sitting around.

first: I am a mechanic not a doctor. Here’s what I think: If you were trained to run a mile in 5.5 minutes, and you did it every day. If you steadily started making less and less insulin, you would be okay for a while (high level of exercise) then your blood sugar would rise when you weren’t running and then it would be high all the time. as the point tipped, you’d be tired all the time but completely exhausted if you were exercising. that 5.5 minute mile wilt begin to decay to 6, 7, 8, etc. no matter how hard you try. working harder at this point makes it worse.

without adequate insulin, you can’t convert blood sugar to usable energy for muscle. since your heart (for example) needs energy to beat, your body converts fat and muscle to a form of sugar that can be absorbed by muscle tissue for metabolism. the high sugar levels would pull water out of your cells as well. you would be tired and dehydrated. if you worked out in this condition you accelerate the metabolism of fats and muscle. the buildup of sugar will be “vented” by your kidneys and take a lot of water with it, your cellular dehydration can become overwhelming. as the insulin levels drop, you can lose up to 5 lb of water per day. you will lose fat stores, you will start to lose muscle mass, your body is starving and dehydrated the buildup of ketones alone could kill you, if it doesn’t, the starvation will, eventually.


(karenchq) #17

Joe,

Thanks for taking your time and give us newcomers the benefit of your wisdom, it is appreciated.

Karen


(Munirnara) #18

Hey Joe & Friends here
Good morning from Lahore, Pakistan!!!

Thanks a lot Joe for your highly informative response. It really cleared few confusions exist in my mind.
Though u r not a healthcare professional but still you are quite knowledgeable & it is wonderful that u r really doing well by helping others like me.

I request you if u can please comments in some details about few confusions as below:

I had been pre-diabetic from 1996 - 2002.
Finally diagnosed as T2D in july 2002.
First 3 years on diet control & little workouts & taking metformin.
Then next 7 years on sulphonyl urea & metformin.
Since March 2012, surviving on humulin 30/70. Untill 6 weeks back, mostly dependent on two shots.
It was very good in the beginning as BG level remain within ranges much better than on pills.
It was so friendly that soon after (probably after 6 months) I quit to monitor BG levels & rely that it would be OK. No need to worry too much. All went well. During these 5 years, I tested the HbA1C rarely (less than 5 times) & found it less than 7%. Eye check couple of times & found OK.
It was 6 weeks back, suddenly I started feeling unusual tiredness & problem with the vision. I started again checking BG level & surprised to see the high swings ( from 300 to more than 400), I was shocked.
I decided to follow the healthcare professional advise, given 5 years back to adjust the doses in case of BG irregularities.
Unfortunately, here in our region, going to healthcare professionals frequently is of little use, as I had been tried during the initial stage & had several bitter experiences. Though healthcare professionals are respected but here situation is too much different. It is quite an uphill task to find a genuine specialist here. Lots of them claims that they are expert in treating DM but they are not in actual. Therefore, i decided to take awareness from sites and in the process found this wonderful site.

So, what I did to adjust doses. After little hit & trial & awareness taken from sites, I concluded that most probably insulin doses in the morning and then in the late evening are wearing out too quickly now, leaving a huge gap in between to cover. SO, I decided to inject 3 times. In morning, mid day & then in late evening by trying to adjust timing properly if not all equal exactly. Results beginning to appear good as BG level started remaining to lower side, sometime hit a HYPO condition after 5-6 hour of limited meal (restricting carbs to 50-60 gram per meal with slight variations). Now I get used to HYPO in these 6 weeks which I do correct by taking 30-40 ml of juice containing rapid acting carb and it does well in 15-20 minutes time. Apparently all is looking well as last A1c a month back was 6.8%.
But still feeling awkward like:

  1. whether I am taking correct steps?
  2. whether it is OK to take insulin (humulin 30/70) thrice a day?
  3. whether doses (20 units per injection) which I have done at my own are really OK?
  4. whether injecting insulin again say after 6 - 7 hours, while previous insulin may be there & may still be working there is OK & not harmful?
  5. is it OK to go with higher dose even not required really & only as to avoid high BG and if it is followed by HYPO then correct it by taking fast acting carb as to neutralize the effect of excess units of insulin?

Could you please help me ?

Kind Regards,
Munir Nara.
(Lahore 35C 1100 Hours)


(joe) #19

@Munirnara,

hi this is really a new topic, I might split this one to start a new one - for now we should leave it here.

No one should give medical advice, and by no means should anyone take advice read here or elsewhere online and implement without understanding that insulin is a dangerous medicine and careful adjustments have to be made because consequences can be very bad. I try to give the best practical information I have with my 30+ years of experience, but you should know that everything I say is an opinion and not medical advice. Diabetics must learn to be their own doctors at some point.

  1. regardless of “correct” you are taking steps which shows your seriousness and your self care. which is great. hypos are more immediately dangerous than highs, you must always have fast acting carbs around and if you change things, take good notes and test more.

  2. you are “stacking” the “70” which can lead to lows, because your mix has long acting insulin, and that long acting can stay in your body from 12-24 hours, overlapping, potentially 3x overlapping at some point of the day (I would think at supper) the long acting can lead to hypos at various times of the day. any change you make to long acting insulin can take 3 days to a week to show up as a “trend”. there are too many strategies to discuss here so I strongly recommend you purchase and read the book “Think Like a Pancreas” by Gary Scheiner.

  3. I take 50 units per day, total. This is not wrong or right, this is what I typically need. There are days when I need less that 25 units (total) and days I need 100+. With insulin resistance, it is possible to need 300 units per day. The amount of injection to meet needs is right, not the number of units. Once I decided to eat a full-on (US based) Chinese dinner with all the gravy and sauces, rice, salt, etc. I needed over 40 units. I choose to not do that a lot! Pizza can be over 100g carbohydrates but the carbs absorb over 8 hours for me… needs a special dose and requires me to test every hour for the first 4, then every other for the next 4 hours, if I have any hope to control my blood sugar.

  4. stacking insulin can be very dangerous, see 2), I would be most afraid of the dangerous overlap of your mid day shot of 70-30 and the “double long acting” in your system at 2 AM. There are other insulin formulations. There is straight fast acting (no long acting mix) there are different long acting insulin as well. I use a pump but technically I “inject” 6x a day. When I was on shots I was injecting at least 5 times a day.

  5. you are describing the “roller-coaster” and I personally HATE the roller-coaster. it is not incorrect. I say it that way because it is a very personal decision. You can make almost anything work, but for me, it depends on how I feel and if I can “keep it up forever”. hbA1c of 6.8% is in target range for T1 diabetes, so in the world of “right and wrong”, your control is “right” it is the effort to get there that needs evaluation. the best way is the way that keeps you alive. even better if you can be both alive and happy, better still if you can be alive, happy, and learn or grow everyday. If you tolerate the roller-coaster then that’s ok, if you want control but no highs and no lows, you will need other insulin formulations (not 70/30) available to you and you need to learn how to use them. by overdosing insulin and having to add carbs, your calorie intake and total insulin is higher than “just enough”. Controlling your weight may become a factor.

The “poor man’s pump” (sorry I didn’t make it up) is a shot (or 2 shots) of pure long acting, such as “insulin glargine”. then every time you want to eat and anytime your blood sugar is a little bit high, you inject separately fast acting “Regular” or very fast acting “Insulin Lispro”. The fast acting is active for only 4 hours and does not affect the long acting. multiple short acting shots is ok for blood sugar “corrections” or eating. You can eat whenever you want. You can test to see how much 1 unit of fast acting lowers your blood sugar and use that as a reference: example for me, 1 unit reduces blood sugar by 30 mg/dl. if I have a blood sugar of 180 mg/dl I can inject 3 units to “correct” (actually in the pump I can deliver 2.66 units). there are tests you can use to find out how many carbs for 1 unit of fast acting and use that as a reference for eating: example for me 1 unit for each 12 grams of carbs. if I eat a small apple (~15g carbs) I inject 1 unit of fast acting (actually with a pump, I can deliver 1.25 units). this method is called carb counting and is explained fully, along with testing long acting, in the book “Think Like a Pancreas”. Best of luck to you always.

Joe


(Munirnara) #20

Hello Joe,

Good morning from Lahore, Pakistan.
At the first place I am surprised to find your great response which is far rather very far away from my own expectations.
I really have no words to praise your great & superlative remarks & comments. I am surprise in terms of the fact that can a person be so generous, kind and sincere like you to help out someone like me in such a brilliant way?
Though, I am more than 100% agree with your comments regarding healthcare advises which are too valid in a realistic world but believe me from your above response, if it doesn’t look like that you are more than that but, atleast, & based on the above marvelous response you are not too far behind from any regular healthcare professional. I am highly impressed & highly obliged.
The beauty of your response is that you have covered almost all the requested information brilliantly and also in concise way by giving some outstanding practically observed example from real daily diabetic life.

Your guesswork findings are almost true. For example, you have anticipated HYPO during & around 2AM, it is highly true as I have faced atleast 3- 4 HYPO episodes during the time 3AM & 4AM in the last 6 week. Suddenly, I woke up from sleep and feeling uncomfortable like weakness in legs, cold sweating, heart rate feeling like sinking & strange anxiety. I took at once chilled juice (about 50ml) every time and in all cases got better within 20 minutes.

From your highly informative content which is a blend of deep practical experience & knowledge, I understand, fixation of insulin daily doses as fixed units have no importance rather it may be changing everyday accordingly the situation on that specific day & time. For example, If i m taking 20 units routinely then I may adjust it as many times as needed. Right?

2nd thing I understand is, instead of premix insulin (like humulin 30/70), rapid acting insulin in combination with long acting give us more flexibility in terms of meal schedule & control on BG. Right?
It also provides freedom to eat to a certain level. Right?

I will try to find your recommended book from local market & will update you accordingly please.
If not get from local market then I will try to use few contacts to get one from UK.

Now few more questions please, if u don’t mind please:

1- From few crude testing (not too much accurate), I have seen that during morning & breakfast same amount of insulin ( 20 units of humulin 30/70) produce less good results in comparsion to the same amount as stated above in the afternoon & lunch. Let me put it in this way, If I consume 50g of carb in morning during breakfast then BG first went skyhigh (around 300 or 350) in about 75 minutes while premeal (breakfast) reading was 110 or 95, then after 3-4 hours it came down to 170 - 190 & after 6-7 hours of breakfast it came inside 100. Then before lunch I took another dose of 20 units & consume same 50g of carbs but this time found different result from morning, though BG went high enough but didn’t stay there too much and came down inside 170 in less than 3 hours. Can u help me please?

2 - Is it possible or there is some possibility exist to use rapid & long acting combination & go on to fast?
This would be your extra ordinary help as fasting month has been expected to start here in next 8 days. Fasting duration will be around 3: 15Am to 7:03 PM (almost 16 hours). I have been unable to keep fast since the year 2011 or 2012. I tried in the past but resulted in high BG after taking pre dawn meal, and after that too much urination resulted in severe dehyration within 4- 6 hours after pre-meal so I couldn’t go on. Then I tried different things like adjusting doses in terms of units but everytime ended up either too low or too high followed by too much urination within 5-6 hours. Then I decided to give up since then.
But after reading above specially rapid + long acting formula, I am thinking, may be there exist some hope? I mean, there may be a way there to apply to keep fast while keeping BG level nicely during entire fasting period?
May be there a possibility exist to take & adjust rapid in such a way that it may cover pre-dawn meal perfectly without too high BG spike for too long and then long acting keep the routine BG under check through out the day till sunset?

GOD BLESS you & stay healthy,

Kind regards,
Munir Nara.
(Lahore 36C, 1150 Hours)