May 11, 2003
Daily Care
Question from :
About four months ago, I had a virus and was diagnosed with what they said was type 1 diabetes. My glucose was 250 mg/dl [13.9 mmol/L], and I had severe ketones in my urine after a virus. I was travelling and did not get that much information. Three days later, my glucose was controlled (I was told I was in the honeymoon phase), and my hemoglobin A1c after three weeks was 4.6%.
I still kept taking 10 units of NPH for three months but was sometimes going low without the symptoms so I quit insulin and started eating less carbohydrate. I lowered so much my carb intake, and I could see the pattern between carb intake and glucose. However, it is getting kind of impossible to control it these last three weeks. My glucose goes up and down all the time for no apparent reason. (The same 15 grams of carb may increase my blood sugar by 100 mg/dl [5.6 mmol/L], decrease it 40 mg/dl [2.2 mmol/L], and or it might stay the same).
The problem is that I never know when my pancreas will release insulin or not so I can do the right thing. I was negative for islet cells antibodies, and I am feeling really tired because of these swings. Does it sound like my honeymoon phase is almost over? Why do people gain weight when they start insulin? Can it be minimized? Would Glucophage be a good medicine for this phase since it does not lower the blood sugar?
Answer:
Are you still taking no insulin? If so (and perhaps even if you are taking small amounts only) your honeymoon is probably near an end. It would be helpful to know which pancreatic antibodies “were negative.” I would recommend that you have the GAD 65, ICA 512, and even insulin antibodies remeasured.
People can gain weight with insulin because it is a hormone involved in energy storage and utilization. If you eat more calories than you need, your body will store those calories for later use. When we store calories, we gain weight.
Glucophage [metformin] may help, but I think you first need a careful visit with your diabetes team to review insulin needs, a meal plan, and exercise patterns.
DS