# New hope from the 'seven year switch' in Type 1 diabetes



## Northerner (Jun 9, 2018)

New research has shown that the rapid decline in insulin production that causes type 1 diabetes continues to fall over seven years and then stabilises.

A team at the University of Exeter Medical School found evidence that the amount of insulin produced declines by almost 50% each year for seven years. At that point, the insulin levels stabilise.

The finding is a major step forward in understanding Type 1 diabetes and contradicts previous beliefs that the insulin produced by people with the condition drops relentlessly with time. It offers the hope that by understanding what changes after seven years, new strategies could be developed to preserve insulin secreting beta-cells in patients.

https://www.sciencedaily.com/releases/2018/06/180608200105.htm

Interesting - my insulin loss appears to have stopped around 4 years after diagnosis.


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## Matt Cycle (Jun 9, 2018)

University of Exeter are involved in a lot of T1 research a lot funded by JDRF.  We never hear owt of any outcomes regarding DUK and T1 research.


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## Radders (Jun 9, 2018)

I heard this yesterday morning on radio 4. They had a woman on who they said was still producing 50% of her insulin requirements after 40 years. They did say she was the top end of the spectrum but it made me wonder what difference it would make to symptoms and why it is easier to control: unless the 50% is very predictable, that is.


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## Northerner (Jun 9, 2018)

Radders said:


> I heard this yesterday morning on radio 4. They had a woman on who they said was still producing 50% of her insulin requirements after 40 years. They did say she was the top end of the spectrum but it made me wonder what difference it would make to symptoms and why it is easier to control: unless the 50% is very predictable, that is.


Since April 2012 I have been producing sufficient insulin to cover my basal requirements (although there's some likelihood that I am covering this partly with the bolus insulin during the day). Not sure how much that equates to percentage-wise, but given the usual 'starting' ratio is 60% bolus/40% basal for newly-diagnosed T1s, it must put me up in that sort of region. I'm pretty sure it has helped me obtain good control over the years, although it doesn't appear to have helped me with the maculopathy, which is probably just bad luck. On the Libre I show a perfect flatfish in the 4-5 mmol/l region most of the time   

There have been a few members here over the years who have had similar experiences, so I know it's not just me! I wonder if being diagnosed in childhood leads to greater loss of production, given the more rapid changes in a child's body than an adult?


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## Radders (Jun 9, 2018)

Very interesting. I was diagnosed aged 29 and my insulin requirements are quite low but I definitely need some basal. However the amount I need is heavily influenced by my carb intake on previous days. I wonder whether I’m still making some too.


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## Matt Cycle (Jun 9, 2018)

I was diagnosed at 18 and my insulin requirements haven't changed a great deal in most of that time.  They have reduced since going on the pump but that's expected.  Basal's around 18u a day with (obviously depending on what carbs I eat) a roughly 50:50 split basal/bolus.  The only way of measuring whether you're producing any insulin is the c-peptide.  This would also give you your type classification.  I had one last year as a requirement for getting the pump and it came back not detectable.  I presume that means I'm not producing any.  Whether I produced any in the first 7 years I'll never know now but from what I can remember no one at the clinic said anything.  Did they even measure it then?

As far as I'm concerned basal is one of the most difficult things to control.  Count your carbs and as long as your ratios are correct you're not going to be far off.  But you haven't got a cat in hells chance of knowing what your liver is doing.  Yes you can do basal testing but this can change daily - exercise, illness, stress all affect it.  I know you can't compare exogenous and endogenous insulin but I still haven't found out even a rough comparison of what a non-diabetic on average would produce in terms of basal units.


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## Northerner (Jun 9, 2018)

Matt Cycle said:


> I was diagnosed at 18 and my insulin requirements haven't changed a great deal in most of that time.  They have reduced since going on the pump but that's expected.  Basal's around 18u a day with (obviously depending on what carbs I eat) a roughly 50:50 split basal/bolus.  The only way of measuring whether you're producing any insulin is the c-peptide.  This would also give you your type classification.  I had one last year as a requirement for getting the pump and it came back not detectable.  I presume that means I'm not producing any.  Whether I produced any in the first 7 years I'll never know now but from what I can remember no one at the clinic said anything.  Did they even measure it then?
> 
> As far as I'm concerned basal is one of the most difficult things to control.  Count your carbs and as long as your ratios are correct you're not going to be far off.  But you haven't got a cat in hells chance of knowing what your liver is doing.  Yes you can do basal testing but this can change daily - exercise, illness, stress all affect it.  I know you can't compare exogenous and endogenous insulin but I still haven't found out even a rough comparison of what a non-diabetic on average would produce in terms of basal units.


My consultant once told me that a non-diabetic person produces, on average, about 20 units of insulin a day, although I daresay there's quite a variation in people and I'm not sure how much of that would be regarded as basal. I was on 20 units of lantus after diagnosis and it was still about 16 units after 2 years, then it started to fall.


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## everydayupsanddowns (Jun 9, 2018)

I think there are rough estimates based on units per kilo (some centres use these to try to work out a starting TDD, or a complete reset where people are struggling)

Can’t remember the numbers, but mine worked out pretty much spot on at 68-70 kilos and around 30 units per day. 

You would expect basal:bolus split to fall roughly in the range of 40:60 to 60:40 in non-Ds I think.


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## Northerner (Jun 9, 2018)

Benny G said:


> I have always been curious @Northerner, about your low insulin dosage. With such a low amount of basal have you tried living the low carb life. I suspect your bolus would reduce to the point of occasional correction doses only.


Yes, I've tried it @Benny G - I found that even going very low carb my levels would climb to between 8-10 mmol/l through the day, with the occasional post-meal level going up to around 12 mmol/l. It seems I need some bolus/supplementary insulin during the day to deal with fat/protein/increased liver activity during the day. I currently eat around 100-130g carbs a day but my bolus requirements can vary from 12-35 units of novorapid (not on a daily basis, of course, but changes according to seasons, year of the goat, stage in Milankovitch Cycle etc.   I'm happy enough managing it on insulin and eating my preferred diet, seems more controllable for me.


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## Radders (Jun 9, 2018)

My total daily dose is around 20 units, slightly less than half of which is basal. I weigh 63 kg and eat about 90g carbs a day but I do seem able to convert protein very easily. I’m veggie as well but eat a lot of nuts and cheese so my protein intake is probably comparable to that of a meat eater.
When I was on MDI I was a lot heavier and taking 4 times as much insulin on a diet high in carbs. My levels fluctuated wildly and I had some shocking hypos but my HbA1c was typically just over 7%. Nowadays it hovers around 6. I wonder if the unpredictability was down to my own insulin production or as I thought at the time, the variable absorption of such large doses of insulin. Interestingly although I didn’t make the connection until recently, I also suffered high blood pressure, for which i took medication for nearly 3 years. Proper carb counting and the pump brought that into normal range.


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## mikeyB (Jun 10, 2018)

All this shows is that everybody is different. I’m sure it infuriates consultants, because they would like everyone to be the same. They should have big signs in the clinics to that effect.


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## FM001 (Jun 10, 2018)

Interesting article and discussion.

Wonder if we also use less insulin as we get older, as a example in my twenty's  was injecting 60 units compared to now where its around 30 units, basal is currently sitting at around14 to 15 units.


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## FM001 (Jun 10, 2018)

Benny G said:


> That is interesting. Were you using a different kind of insulin in your twenties? Some of the older insulin types are not as potent as humalog or novorapid and required higher dosage.
> Your basal dose is the same as mine, small world.



It was 30 years ago so it was the older style insulin, but even on analogue insulin my doses have steadily reduced over time.


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