August 30, 2004
Other
Question from Georgetown, Texas, USA:
I was diagnosed as a type 1 diabetic just over five years ago, confirmed by antibody testing. I went through an extended honeymoon period. I was never completely off insulin at any point, but my blood sugar levels were easily controlled for about a year and a half on relatively “low” doses of insulin, about 15 units a day.
Following that, I started on a roller coaster ride of blood sugar levels. I assumed I was “done” with the honeymoon period. I needed more insulin and I started pumping as a solution to the wild numbers, which greatly improved things. However, I still don’t take a total daily dose of insulin that is what my doctor would expect someone my size to take. I’m 5 feet 7 inches and about 130 pounds. I’m not particularly athletic, and, unless I overeat by quite a large margin, i.e. when it’s someone’s birthday or a holiday like Christmas, my total daily dose is only around 22 to 25 units a day.
Much like the body still produces some insulin in the “honeymoon” period, is it possible that the autoimmune damage could be somewhat “incomplete” long term, leaving the body to produce “some” insulin, but not necessarily enough to be considered anything close to non-diabetic? Occasionally, a few times a month, I do have unexplained lows, mainly after meals, even when I’m 100 percent sure I counted carbs correctly. I’m not particularly prone to DKA like some type 1’s seem to be. I’ve only been in DKA once, when I got severely dehydrated while sick with strep throat and literally couldn’t stand to swallow any fluids, but other than that I’d consider myself a “normal” type 1.
My A1cs have been under 7 since I was diagnosed, so I do think I’m getting “as much” insulin as I need to keep my numbers normal. Is it worth figuring out what’s going on? Or, should I just be thankful that I don’t seem to be prone to DKA, and just treat the random lows as they occur?
Answer:
You still sound like you have type 1 diabetes. Many of the interventions that have been looked at for type 1 diabetes are still trying to quantify whether some insulin secretion persists. It is thought that some insulin secretion, although not enough to make the blood sugars normal, has important long-term benefits. For instance, some insulin secretion would be more likely to respond to rising blood sugars and temper any rise with the hope of some long-lasting effect. Efforts to look at whether some people maintain some insulin secretion has shown that some do. However, the longer you have type 1 diabetes, the less likely it is to have insulin secretion. The autoimmune process is persistent. It may go a different rates in different people. Your situation is not unique. I would say treat you sugars as best you can as this has the best chance of prolonging any beta cell function into the future.
JTL