Insulin reduction, pancreas working better?

[HelenM]

Three years ago when i was diagnosed I was taking about 40 units TDD.
I gradually reduced it, exercising a bit more. I have never reduced carbs (varies 90-160) a day . By April this year, I was taking 30-32 units (16 lantus), which is about .5u per Kg bodyweight. I was also getting daily hypos (sometimes several a day)(HBA1c 4.9%)
Since April on a pump with Apidra I've continued cutting back now its an average of just under 24 a day. Yesterday I forgot to bolus at lunchtime (45 carbs) but by dinner BS was at 55 mg/dl so yesterday I only took 19u. with BS under 100 all day. I'm doing a lfair amount of exercise at the moment but I did the same last year with a third more insulin.

When I originally had diabetic symtoms (weight loss, drinking
etc) I ignored them and was able to function for 3 years with fluctuating mild symptoms followed by second bout of weight loss ending with hospitlisation with high BS and ketones . Even so my HBA1c on diagnosis was only 7.6% but my C peptide test showed almost no insulin.

I sometimes wonder if my body has some sort of cycle of losing islet cells,followed by regeneration and then the cycle starts again. Is tis reallly possible, could it continue indefinitely?

[lottadata]

Helen,

Typically people with autoimmune Type 1.5 deteriorate over 4 years, you've been going in the opposite direction, so it is quite possible that you might have some other condition which impaired your beta cell function and which is slowly resolving.

There are so many different underlying causes of beta cell failure, and doctors don't do much testing to isolate what is going on. The C-peptide test only tells you that insulin isn't being produced, not why.

You might want to ask if it would be possible to get a new C-peptide test to see if you are getting more insulin production. But it is also possible that your insulin resistance might have decreased, making your body more efficient with what it gets. This can happen when you lower blood sugars as high blood sugars cause insulin resistance. My insulin sensitivity increased dramatically when I lowered my typical post-prandial reading from 180 to 140 and again when I brought it from 140 down to about 110.

Whatever is going on, it's very good news for you!

[HelenM]

Maybe its just that I'm becoming more insulin sensitive who knows? The reason I suggested the cycles is that I remember finding a paper suggesting that people with LADA may have had several autoimmune 'attacks' during their lifetime with subsequent regeneration of beta cells culminating in losing too many and true insulin dependency. I 've been trying in vain to find that paper again.
Whilst searching I found a paper that suggested a) LADA should be renamed autoimmune diabetes in adults with slowly progressive Beta-cell failure
(ADASP)!
b) showed different rates of progression according to differing islet antibodies, Patients with two or three antibodies had severely impaired beta
-cell function (low to unmeasurable plasma C-peptide) after 5 years, whereas this occurred later (up to 12 years) among subjects with only ICAs or GADAs at diagnosis. Patients without islet antibodies or only IA-2As at diagnosis did not show decreases in plasma C-peptide after diagnosis during 12 years of observation.

Interestingly the accompanying graph showed a rise in c peptide at the 5 year mark for those with IA-2As and for GADAs.
Latent Autoimmune Diabetes in Adults: Definition, Prevalence, {beta}-Cell Function, and Treatment -- Stenstrm et al. 54 (Supplement 2): S68 -- Diabetes (http://diabetes.diabetesjournals.org/cgi/content/abstract/54/suppl_2/S68?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=&author1=+&fulltext=lada&searchid=1&FIRSTINDEX=0&sortspec=relevance&resourcetype=HWCIT)

[Scratch]

That's interesting and I suppose it's another piece of evidence that the beta cells continually regenerate throughout our lives. The case of where there are fewer antibodies (as I understand it) perhaps show a situation where the autoimmune attack and beta cell regeneration are nearly in overall stasis, some fluctuation in strength of the immune attack or rate of regeneration of both results in periods where the beta cells can actually gain some ground back.

[Simon]

It is known that the better your control the less insulin you need. That said, to have a HbA1c of 4.9% you would either have to be having hypo's left, right and centre or be honeymooning.

[grace girl]

My own personal theory is that many, many people are actually taking too much insulin, which can cause you to need yet more insulin. Once you actually get the levels set correctly, it's often much lower than where you started.

[lottadata]

You could also get an A1c of 4.9% with very high blood sugars if you had anemia or one of several genetic variants of red blood cell that screw up the A1c test, including sickle cell.

It's depressing that doctors aren't aware that anemia will lower the A1c result and make it completely worthless. I have heard of people who were testing over 200 at every meal who had 4% A1cs and doctors who told them they were doing great.

[lisa821]

Helen, could hormones be a factor here? Are you nearing menopause?
~Lisa

[Del]

Helen, I posted recently about something similar.

I haven't bolussed in months and I go through phases where it really seems that I am producing insulin. I sometimes have lows, even though I eat more or less "normally" (ie no restrictions to what, just to how much) and am on 15 units of basal each morning and each evening, so 30 total per day.

I wonder too. But I'll take it.