My 16 yr old son was diagnosed with Type 1 diabetes about 6 months ago. After a couple of weeks of both basal and bolus insulin use, he no longer needed basal or bolus with very low carb ( 70-80 gram a day). But about 3 months ago, I started him on bolus (novolin R) and increased his carb intake gradually to the current level of 170-180 grams per day with a total daily 17-18 units of Novolin R spread evenly among the 3 meals. His average glucose is about 90-100 mg/dl and A1C is about 5.0%.
He has not needed basal for about 5 months and now he is waking up with 70mg/dl average. His dinner bolus is usually done around 6pm. I am wondering if it is solely the bolus Novolin R that is keeping his fasting glucose low or it is a sign that he is still making his own insulin at night?
That sounds like he’s still making some insulin, which is normal in the “honeymoon period” of a new case of type 1 diabetes. If you want a definitive answer, the C-peptide blood test measures this: The beta cells of the pancreas manufacture a molecule called proto-insulin, which then gets split into two parts. One part is insulin. The other “left-over” portion is C-peptide, and the amount of that hanging around in the bloodstream tells how much insulin the body is producing.
But you don’t actually need a C-peptide test to know what to do. The simple thing to keep in mind is “if your BG is too high, you need more insulin.” So watch his blood glucose over time, and when it starts drifting upwards, gradually add a long-acting basal insulin. And he probably will want to move from fixed doses of Novolin R to customized doses of a faster insulin such as Novolog or Humalog, using the “carb counting” technique to decide a specific dose depending on what he is eating. Your medical team should be giving him and you proper advice and instruction in these matters, but if you see that the BG is starting to get out of hand, don’t hesitate to seek out assistance. If they are unable to help to your satisfaction, look elsewhere among medical professionals and experienced type 1s. Because fundamentally, type 1 is self-managed every day, not professionally-managed a few times per year.
Thank you Sam and bhk for your replies. I think it makes a lot of sense and I sure hope to keep him in this honeymoon as long as possible. I am trying to use anti-inflammatory diet and supplement since it is due to autoimmunity.
I am so glad to have stumbled upon this forum and find a lot of discussion very informative and there is so much to learn about this disease. Thanks for providing this platform for exchanging ideas.
As to Novolin R vs Novolog, I find R is much suitable for my son’s diet which is mostly slow digesting carb and proteins. Novolin R covers longer by at least 1 to 2 hrs. That’s the reason why I switched to R. Otherwise too much hypo for him.
I’m glad to hear this! I will caution you though that you’ll encounter some pushback on using older insulin formulations in online groups because the universal assumption is “if I can’t afford it out of pocket is must be way better.” Pay that no heed. If it works better for you then that’s absolutely great! I personally use afrezza which is lightening fast for fast carbs and more and more have been using regular for slow carbs… and more and more have been considering novolog/humalog to be basically just an awkward compromise in many cases…
Your explanation makes it clear that you are giving excellent care. My message is just to watch for a change. Since your son is making some insulin, that helps control the BG rise early in a meal, before the R has come to peak action. As his honeymoon period passes, you may see an early spike in BG during meals, and this spike may grow to such an extent that you may wish to use a faster insulin to control that. As you correctly point out, taking fast insulin for a slow-digesting meal can cause a low BG early, followed by a high BG later. One way to manage that is to use a technique such as split bolus, or dual-wave, or square wave to spread the action of the fast insulin over time. Sam’s technique is a good alternative: his afrezza controls the early meal spike, and the R lasts long enough that a split bolus or dual-wave bolus becomes unnecessary. So there are many reasonable ways to get a good result.
My only message is to watch for a change, and be prepared to adjust the treatment as needed. “It used to work perfectly and now it doesn’t work right anymore” is a routine experience when treating diabetes, so we’re always tinkering with our treatment to get the BG results we want.
I also think people have bad memories of using R because they were using it in combination with NPH and as a bolus insulin for fast-acting carbs, which it isn’t well-suited for. It’s fantastic for protein/fat digestion as well as inducing the equivalent of a temp basal increase for a few hours.
I’m just over 2 years post (a very early) diagnosis, and still no basal outside of during pregnancy last year. I do use Novolog and Afrezza, though, since I tend to eat more carbs than most and spike very quickly.
Thanks so much for the heads up. I totally agree with you that his sugar management may change one day to a point that the faster acting type of bolus insulin would be required. I will definitely keep your advice in mind when that day comes. I also like Sam’s technique of using afrezza and R combo. Never thought of that. That’s why I love this forum!!! You guys are all so helpful!
Maybe! When I was diagnosed I started on just 10 units of Levemir once daily and it worked great. I actually thought Levemir was a once-a-day 24-hour basal, but it was likely because I was honeymooning. It’s possible with a very low-carb diet and R that a person could get by on just a larger evening shot of Levemir, but I’m not sure it would work for most type 1s past the honeymoon stage once more carbs are introduced.
Welcome @Catalyst5, glad to see you found us. You may want to introduce yourself here:
I am really glad you are testing and found a solution for your son, that is exactly what this community is about. It is also interesting that you have found a good use for a rather uncommon insulin (Novolin R) which adds some interest, since so few of us currently use that insulin.
I would take a very small exception to your very low carb description. There are many that are indeed very low carb (i.e. Bernstein) and they eat less than 30 carbs a day. Many of us define 70-120 as “low carb” and above 200 as high carb. But the carb ingestion is of course a very personal thing, as is the definition. The most important thing is that you have found a combination that is working really well (A1c of 5.0% is a beautiful thing).
Oh, a good reminder of how everything is so relative… To me, I would call Bernstein’s 30 g a day very very low carb. I never tried that on my son. He already felt weak with 70-90 carb a day, so I figured to go down to 30 g is simply unrealistic. Now with 160-180 gram a day he is doing fine energy-wise. (he is not atheletic at all, more on the sedentary side).
Plus I do prefer a more balanced diet rather than favoring either protein or fat heavily for the sake of calories. But that is a personal opinion of course. My common sense tells me too much of any one particular type of nutrient is no good. People may not see bad consequence in a year or 5 years, but long term consequence of too much protein or fat is not exactly known.
So I guess my son’s intake shall be called moderate carb-in between low and high…
We also currently eat 80-120 carbs a day, because that is where my son feels the control is best and he can still function athletically. He runs cross country (eats more carbs during this season) and plays baseball. I also happen to agree with you i.e. very low carb.
I mentioned it because in many of the forums I am in, Very Low Carb is almost always defined as <30. High carb is usually defined as >200, and there are no consistent labels for what lies in between, where many (including us) find a happy medium.
From most sources I have read, “low carb” generally refers to anything below 100 grams a day, and “very low carb” to anything below 20-30 grams per day. I think a lot of people call 100-150 grams per day “moderate carb”, and I’m not sure there’s a term for higher than that, as generally eating more than 150 grams per day doesn’t require any restriction beyond just healthy eating.