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February 16, 2019

Insulin

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Question from :

I found out I was a diabetic when I turn 38 and now that I am 40 I was wondering how long can I go without giving myself insulin before it takes a bad turn. And I was also wondering why my medical physician never found out when I was a child I had diabetes. Not that I have diabetes I also have grave disease and I’m having onset with Addison’s I’m currently getting check for Addison’s. I see an endocrinologist and they gave me insulin pump it’s working fine I also was wondering how long can I live with this insulin pump and if I choose to take it off how much longer will I live with it off. Thank you very much

Answer:

The answer to how long a person with type 1 diabetes can go without insulin is difficult to answer specifically without knowing something about your day to day glucose levels, how much insulin you require, and other clinical keys to suggest how much insulin of your own you are still producing. Since you are an adult-onset and you say you have type 1 diabetes, I assume that is because someone has done something called blood tests for pancreatic antibodies: islet cell antibody (ICA), GAD 65, IA2 (Insulin antibody 2) and ZnT8 (zinc transporter). If you really had type 1 autoimmune diabetes like in most kids, even with an older age of onset, then I would expect one or more of these antibodies to be positive. Your Graves’ Disease is an autoimmune disorder of the adrenal glands making the thyroid hyperactive. You would have thyroid binding immunoglobulins, thyroid stimulating immunoglobulins, thyroid microsomal and/or thyroglobulin antibodies positive. Your Addison’s disease is another autoimmune disorder, this time with positive adrenal antibodies causing inflammation of the adrenal glands and making them no longer able to make cortisone/cortisol because of the inflammatory destruction. So, if you really have all three disorders on an autoimmune basis, it is likely you would have positive pancreatic antibodies causing your type 1 diabetes. This usually causes much more severe deficiency of insulin production and most of the time – but not always – this shows up as a teenager or young adult; occasionally much younger kids and occasionally adults. Associated with specific genetic factors called HLA genes, so often there is also other autoimmune problems in other family members, i.e., celiac disease, hypothyroidism, goiters and many others.

So, with classical type 1 diabetes, even as an adult, very little of your own insulin able to be produced, and you would probably die within 4 to 12 months of stopping insulin. You would experience a slow, miserable drawn out dehydration illness with nausea and vomiting until the dehydration stopped your body functioning. In many parts of the world where there is no access to medical care and no insulin, this still occurs. If you actually had some but not total insulin available, this would be much more prolonged since it wouldn’t be total insulin deficiency then. Some people who cannot afford their insulin, can sometimes get assistance from the manufacturers so visiting their web sites, for NovoNordisk products, for Sanofi products, and for Lilly products, would be worth considering. If your insurance company is not paying for your insulin pump or insulin or any other diabetes supplies, your diabetes doctor should be able to assist with petitioning the insurance company to reconsider. Contacting your two federal senators and also your congress person also can often help gets such assistance. Sometimes changing to a less expensive insulin is worth considering if deductibles are too high. Talking to your pharmacist is also worth thinking about since there are also a group of discount cards (like Good Rx) that may save you money too.

Comment from the editor: Another option for fast acting insulin is Afrezza, an inhaled meal time insulin. Please be sure to discuss this with your doctor as you need a breathing test before using the medication.