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(12) Diabetes

Insulin Dosage

When I was first diagnosed I was put on insulin, but now the dosage has been decreased. The doctor tells me I am in the ‘honeymoon period’ of diabetes. What does this mean?

People often need a reduction in their insulin dose soon after they start taking insulin for diabetes. This is due to partial recovery of the insulin-producing cells of the pancreas. During this period hypos are often a problem but on the whole it is easy to control the blood glucose during this ‘honeymoon’. The honeymoon period usually comes to a sudden end within a few months to a year, often when the person has a bad cold or suffers some other stress to the insulin-producing cells. However, the honeymoon period is a good thing and will improve your chances of successful long-term control of your diabetes.

When I developed diabetes I was started on insulin but kept having hypos, and 3 months ago I came off insulin. Why was I given it in the first place?

Presumably you were given insulin because your doctors thought you needed it. Most people under 40 years old who have ketones in their urine are likely to need insulin and tend to be started on this without any delay. When insulin has been given for a week or so, it is quite common for people to be troubled by hypos, in which case the insulin has to be reduced. Sometimes even tiny doses of insulin cause hypos during this ‘honeymoon period’ and the injections have to be stopped completely. The honeymoon period may occasionally last as long as a year.

I have had diabetes for 9 months and attend the diabetes clinic every month to have my insulin dose adjusted. How long does it usually take before doctors get you balanced?

This is an interesting question as it assumes that it is up to the doctors to balance your diabetes. Of course the doctors and nurses in the clinic must provide you with all the help and information that you need but, in the end, it is your diabetes for you to control. Good control depends not just on the dose of insulin but the site you choose for your injections, the timing and type of food that you eat and the amount of exercise you take. These are things over which your doctor has no direct control. Most people begin to get their blood glucose under control in a few weeks.

Is my insulin requirement likely to vary at different times of the year because of the weather?

Several people have remarked that their dose of insulin needs to be altered in very hot weather – some need to give themselves more insulin and others less. This is probably because people react in different ways to a heat wave. There is a tendency to eat less and take less exercise in tropical conditions. However, because blood flow to the skin is increased in warm temperatures, this could speed up the absorption of the injected insulin and mean that a given dose will not last as long. Everyone is different and you will have to be on the look out for yourself how hot weather affects your own blood glucose.

If my insulin requirements decrease over the years, does this mean that the pancreas has gradually started to produce more natural insulin than when I was younger?

No. It is most unlikely that after many years of diabetes your pancreas will start to produce natural insulin. However, this reduction in dose in older people is well recognized. It could be that you were having more insulin than you really needed in the past. Since the introduction of blood glucose measurement many people are found to be having too much insulin – or sometimes too much at one time of the day and not enough at another. Other possible explanations for older people needing less insulin are that they eat less food, they become thinner, they have a different exercise pattern, and there may be hormonal changes.

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