[akornak]

All,

I've been a Type 1 Diabetic since I was 17 years old and I'm now 36. Most of my life I've been on Humulin Lente and Humulin Regular on one to two shots a day. Now that Lente is discontinued I'm going t switch to Lantus likely.

Anyway, a couple of times during all these years (and is happening now), I have bout of not being able to get my blood sugar up. Basically what happens is I start the day off normal and by lunch time yesterday my blood sugar starts to slowly drop. Normally, I just take some jiuce and I'm good. Yesterday however, it took be 4-5 glasses of soda and a meal just to get it to normal. I start getting into a panic mode becuase I'm not sure what to do and feel a little boxed in. The rest of yesterday I had a problem getting the blood sugar back to normal (during the insulin peaks). When I woke up in the morning today, my blood sugar was 348 and I was actually happy! I decided to NOT take my Lente and only take one shot of Humalog of about 25 units. It's two hours later and after a meal and I'm down to 80 and getting nervous again.

My questions to the group are:
- Have you ever heard of this problem? Any ideas?
- Is my body making more insulin again?

As I said, this has happened before but then a few days later I'm back to normal. Any help would be appreciated.

[DeusXM]

For a start, your somewhat erratic insulin regime isn't helping. 25u of Humalog in place of your Lente really isn't a good idea. No doubt you'll be going low very soon (and you'll have to really fight to get it back up again if you've taken that much), and then tomorrow morning you are going to wake up feeling abysmal because you'll have no insulin left in your system and you'll be starting DKA.

Overall, reduce the amount of both basal and bolus insulins you're taking (it sounds like your requirements have changed from what they used to be - maybe the weather?). And I'd seriously recommend getting off Lente and regular ASAP and moving onto Lantus/Levemir and Novorapid/Humalog.

[seacomp]

Hello and welcome to the forum. I hope we can help.

Originally Posted by akornak

My questions to the group are:
- Have you ever heard of this problem? Any ideas?
- Is my body making more insulin again?

The only time I've had something similar is when I've made a mistake; taking more insulin than I thought, taking the wrong insulin, etc.
You pretty experienced at taking insulin so this is not likely, however. I wouldn't put too much hope in a positive change in your pancreas; be great if it did happen!
Again, Welcome.
P.S. Tell us a little more about yourself. We like all the details.

[akornak]

DeusXM,

I think the reason I skiped the Lente today is becuase of my panic feeling that I couldn't get the sugar up (which I couldn't) and not wanting to end up in the ER. I only have once and that was when I had the stomach flu. To be honest, I'm not too woried about the Ketones or all the rest as my body has always made a small amount of insulin. Oddly enough, I've been diagnosed as a inbetween Type 1 and Type 2. I AM planning to either switch to a pump or go to Lantus. But I've even more paranoid of Lantus for the following reason. What if this happens again? I know there are no peaks to Lantus but how it God's name to I get my sugar up with a contstant acting insulin? I've used this method of taking Humalog alone after a day like yesterday and the day after I'm perfect. Thanks for all your help btw.

[DeusXM]

With the Lantus, it's a lot easier to treat a hypo than it is with a peaked insulin. Here's why:



Bear in mind that this compares Lantus with Insulatard so it's not an exact correlation with Lente, but the science is still the same.

See that great big peak with NPH (Insulatard)? That's when you're having hypos. Note how the overall action of Lantus is lower. Lantus isn't burning up as much glucose in one go as other basal insulins, so as a result you have fewer hypos but you get better control. The trick is to match your Lantus dose with your natural glucose output from your liver. The way modern MDI works is that Lantus deals purely with your background glucose production, keeping it stable, and then you clear the spikes with your bolus dose.

Your Lente has a peak - and a lot of money says that when it's peaking is when you're having hypos.

[akornak]

seacomp,

Thanks for the reply as well. I ALWAYS worry that I'm going to take too much or worse accidentaly take the wrong insulin combo. I've read crazy stories about that and have friends that have done it. I watch closer than ever on that one. So I know it wasn't that. Also, since this has happened to me before around this time of year, I do wonder about DeusXM's comment on the weather. Very weird it it is. I'll let you know what I hear from my Dr's.

As far as info about myself - as I wrote I'm 36 married with one beautiful baby boy (11 months). I work in the mobility area (PDA's and such) primarily in business strategy for Financial Services companies. This is the best job in the world. I get to try all the latest and greatest mobile toys and work for a great company.

Anyway, I'm born and raised in the midwest but travel quite extensively. Which is also why I need to get this issue resolved.

thx

[akornak]

Thanks Deus - excellent information. I also saw that graph from my Dr. I've never heard of the term Insulatard. Does that just mean it peaks?

My problem is with the mind. I know it's the best thing to go with, but paranoid about changing insulins after 19 years. My glyco's have been ~7 or below most of those years. I know that's not always an accurate measurement since the ups and downs are the bad parts. I can tell you that I probbaly have to many of those in the last few years only due to my job. College was great since I walked and excercised eveywhere! Anyway, thx for the support.

[DeusXM]

Insulatard is a specific brand name for the isophane insulin made by Novo Nordisk. Insulins can get a bit confusing because everyone seems to have a different name for them. Basically, 'NPH' and 'isophane' refer to a synthetic insulin that's cloudy and is used as a basal insulin. 'NPH' is how it's refered to in the US and Canada. In the UK, 'isophane' is more commonly used. 'Insulatard' is the specific version of it made by Novo Nordisk. Eli Lilly make a range of similar insulins under the brand name Humalin.

There's nothing 'wrong' with these older insulins and in some cases they're actually preferable to the newer ones. Many people though find that they hit a wall with basal insulins that peak - eventually it gets to the point where you simply can't take enough basal insulin without eating a lot at first to deal with the peak. That's why a lot of people with T1 used to put on weight - with Insulatard and Humalin you do tend to feed the insulin, rather than the other way around. You can get reasonable A1Cs with them but you can't really get a good A1C on peaking basals without having a lot of hypos.

Lantus and Levemir can be a bit daunting at first, and there's usually a lot of trial and error in the first few days because your bolus doses usually need a bit of re-evaluation - because you're not peaking and troughing on your basal anymore, some boluses need to go up, some go down, and some stay the same. However, you can get some fantastic results with Lantus and Levemir. With a bit of work, you can get as good control as you would on an insulin pump - it's possible to get an A1C of under 5.5 on Lantus. In any case, it's certainly easier to get your A1C under 6.4, which is where it should be.