Type 1.5's: Start with Basal-only, or Bolus?

[foxl]

Okay this may sound like a dumb question on the face of it, but I have read that some docs start you on bolus-only, others on a basal-only regimen.

I probably do not have huge needs for insulin at this time, since I am well controlled with low-carbing and oral meds. I am just beginning to think on these ideas.

So ... those of you who began with basal-only or bolus-only regimens, did you try the opposite, and please share experiences with starting on whichever, in general?

[rak1978]

I was put on a basal and bolus immediately upon diagnosis.
That's an interesting question though. I've never heard of giving one without the other. I learn something new every day here. :)

[foxl]

I was put on a basal and bolus immediately upon diagnosis.
That's an interesting question though. I've never heard of giving one without the other. I learn something new every day here. :)


I was surprised to hear of anyone recommending basal-only, and letting your pancreas do the bolus, but apparently some do.

[Grunch]

I think bolus only makes sense cause the pancreas could be able to take care of basal. But if it can't even do that how can you expect the pancreas to bolus? Seems like a bad idea to me.

[foxl]

I think bolus only makes sense cause the pancreas could be able to take care of basal. But if it can't even do that how can you expect the pancreas to bolus? Seems like a bad idea to me.


My thinking, too, but apparently if you do not require basal out of it, it gets some rest ... !?

[rak1978]

Maybe and only if you ate ZERO carbs this would work?
I need a higher basal and not as much bolus when I cut the carbs.

[foxl]

Maybe and only if you ate ZERO carbs this would work?
I need a higher basal and not as much bolus when I cut the carbs.

hmmm ... might depend on just how much IR you have -- ie, your liver spewing glucose would lead to higher basal needs?

Any guesses on the physiology of that?

[Subby]

I'm thinking the basal only approach, may well be an idealogical hangover from basal-only approaches of type 2. After all, type 1.5s may be coming from an incorrect type 2 diagnosis, and the doc may not quite be wrapping their head around it, and may be thinking along type 2 approaches.

Just pure conjecture.

In the end, being someone as involved as you are, Linda, it's all good, it's about having choices. You can try one or try the other if it's on the books, if it doesn't work you can switch or go full intensive.

I must admit that your problems with variable fasting, suggests basal in the mix no matter what, to me. Then again you could try bolus and see if this resting concept, helps with your basal abilities...

[foxl]

I'm thinking the basal only approach, may well be an idealogical hangover from basal-only approaches of type 2. After all, type 1.5s may be coming from an incorrect type 2 diagnosis, and the doc may not quite be wrapping their head around it, and may be thinking along type 2 approaches.

Just pure conjecture.

In the end, being someone as involved as you are, Linda, it's all good, it's about having choices. You can try one or try the other if it's on the books, if it doesn't work you can switch or go full intensive.

I must admit that your problems with variable fasting, suggests basal in the mix no matter what, to me. Then again you could try bolus and see if this resting concept, helps with your basal abilities...

:D knew you'd have some ideas to contribute! And I will hang onto them ... thanks!

[rak1978]

hmmm ... might depend on just how much IR you have -- ie, your liver spewing glucose would lead to higher basal needs?

Any guesses on the physiology of that?

Well, my theory is that it has to do with the dawn phenomenon.
When I bolus at breakfast time, that probably covers carbs as well as the DP. When I eat no carbs, I don't bolus and then the dp is a problem. I probably should just bolus regardless of carbs with breakfast to cover that....maybe then my basal settings would be fine? Seems like I have some experimenting to do.
Just thinking out loud...didn't mean to hijack the thread with my personal experiences.

[soso]

I started on bolus only..as that is the only time my bg was high at first. I do believe the pancreas getting a break helps to spin the honeymoon out and even though it is only anecdotal evidence that has been the case with me...

I also know of a lot of cases where Drs start the patient on Lantus only as a way of keeping the sugars a bit more in line.. though this is usually with T2 I think... it def would not work with me. I think one of the reasons for the Lantus only approach or maybe mixed insulins is that one shot a day is not so scary for the patient who dreads going on it. Easing them in gently perhaps?

Anyway, IMO it was the way to go and has worked very well for me.

Linda, just curious, but at what numbers/level would you consider adding insulin?

[foxl]

I started on bolus only..as that is the only time my bg was high at first. I do believe the pancreas getting a break helps to spin the honeymoon out and even though it is only anecdotal evidence that has been the case with me...

I also know of a lot of cases where Drs start the patient on Lantus only as a way of keeping the sugars a bit more in line.. though this is usually with T2 I think... it def would not work with me. I think one of the reasons for the Lantus only approach or maybe mixed insulins is that one shot a day is not so scary for the patient who dreads going on it. Easing them in gently perhaps?

Anyway, IMO it was the way to go and has worked very well for me.

Linda, just curious, but at what numbers/level would you consider adding insulin?

Soso, I do not KNOW! I have an Endo appt. end of Aug and am looking to her recommendations. I may be adding it now, but frankly I do not know ... my numbers are really quite good right now, I hate to mess with a good thing, but if there is an advantage to using low-dose insulin, for preserving beta cell mass, I think I should, And then, I do not have much flexibility in my diet. But then I debate about unnecessary insulin and feeding it, and weight gain ... URGH.

[Subby]

But then I debate about unnecessary insulin and feeding it, and weight gain ... URGH.

Don't forget insulin doses vary wildly. The typical type one is in the realms of 20 - 40 units TDD. I say typical extremely loosely. The Walsh book you have will have a table of expected insulin use. It's interesting to look at, then you can go and throw it out the window when it comes to the real world and anything but vanilla type 1s with little resistance. (Ok, so there might be a consideration for type 2s, can't remember)

These are extremely rough illustrations, no accuracy intended. More a sense of scale.

A highly resistant type 2 might take 200 or 300. A pretty resistant type 1 (me) I take about 80 on a relatively low carb diet. Or, really heavily resistant type 1, back up towards 200.

Some LADAs I've seen wanting a boost to their natural abilities, have started on doses like 5 or 10units long acting. Maybe a few units for dinner bolus. That kind of thing. Maybe a TDD of 15 or 20.

I'm just thinking, the weight gain argument might be a bit of a blind, if you find you benefit nicely from doses on the lower scale like that and are not feeding the insulin (which I would take for granted, being firmly low carb that you are). Feeding occurs from things like sticking to set doses, not adapting or modifying.

[foxl]

Thanks Subby ... hope you are right, in my case! I'd hate to gain back those 30 lb ...

[zoelula]

I was worried about weight gain as well, Linda. (It's in my nature to worry about it!). It made sense that I was losing protein in my urine when I was high and that when I was down to normal I would be absorbing all those calories. But I am on a fairly low dose of insulin, and even when my TSH crept over 5 at one point my weight has stayed the same.

[zoelula]

Oh and to answer your original question, my doctor thinking I was Type 2 started me out on Lantus only, way too high a dose for me (25). I was too low in the mornings, too low before meals and still had post prandial peaks.

[foxl]

Oh and to answer your original question, my doctor thinking I was Type 2 started me out on Lantus only, way too high a dose for me (25). I was too low in the mornings, too low before meals and still had post prandial peaks.

Well now, that would be telling! Great description!

[Funnygrl]

I started with bolus only, but in, like, two weeks I saw an endo and he was very surprised I was just on bolus and said it was obvious I needed basal too and I was started on Lantus also, then moved to the pump fairly quickly. I was later told I was more typical of plain type 1 then 1.5.

Bolus only seems like a fair starting point as that's when bgs will be highest- post prandially.

Basal only also has it's advantages if you just need a bit of support- it helps around the clock and is generally only 1 shot/day.

[foxl]

I just read in Joslin's 2005 edition, that they recommend basal instead of bolus, for early LADA. Hmmm ...

[Ohana]

I am on bolus only, and sometimes I take as little as 2 units of Humalog a day. (I don't need to bolus for every meal on some days)

Most I have ever taken in a day is 8 units. I adjust so I am not feeding the insulin, yet consistent doses of insulin does seem to give my pancreas enough of a rest to allow for some buildup. (If I take insulin regularly for several days I can get away with more uncovered carb leway for a few meals than if I only take it occasionally for strictly carb covering... I can always take 2-3 units with any meal and not go low... so if I do this consistently then I can see the rested effects, on the other hand, if I only take it as needed for extra carbs, then I see little to no leway in how my pancreas can handle the occasional extra carbs) Wow, there has to be an easier way to say what I am trying to say....:o

Also, I wanted to say on this bolus approach, My morning numbers (I am assuming this is representative of my basal needs) haven't budged at all. they do their own swinging routine, but I didn't notice a huge shift when I started insulin.

but, as always YMMV.

I personally preferred to start insulin early. I think it is a more natural way then using meds to force more insulin production, or combat cell resistance (of which I am told I have very little) it just seemed to be more logical, even if slightly more annoying and invasive (and really not that big of a deal!)

But it has to come down to your own decision of when. Then when you make that decision, you will "own" and feel comfortable with you decision and that will make it a more positive experience.

[soso]

Soso, I do not KNOW! I have an Endo appt. end of Aug and am looking to her recommendations. I may be adding it now, but frankly I do not know ... my numbers are really quite good right now, I hate to mess with a good thing, but if there is an advantage to using low-dose insulin, for preserving beta cell mass, I think I should, And then, I do not have much flexibility in my diet. But then I debate about unnecessary insulin and feeding it, and weight gain ... URGH.

Exactly the same thought process I went through at the time!

One deciding factor for me was to preserve my own insulin production as long as possible, having read accounts of the protective qualities of c-peptide. There is no doubt I am having an easier ride so far than people who have no endogenous insulin..

yes, it has it's downside in the upsy downsy of it and I am often troubled by slight lows and YES I have gained a bit of weight but the lows are often caused by me being sloppy with my carb counting and exercise situations and realistically if I am being honest my bloody mindedness about not wanting spikes over 7. The weight is a combo of feeding those lows...and honesty again, cos I am trying to address my issues about it, I would do better with the glucose tabs than choosing chocolate...and the simple fact that I am able to eat more carbs,so have, but have not been cutting down on the fat .. that said, I feel I could lose this weight in a month if I applied myself..
On the plus side, I am not as depressed about my situation as I have been. I feel my acceptance and integration of the regime into my life without crying jags has started to really happen and I no longer look at other peoples food with envy. Insulin gives me a lot of options.... I can eat what I want and bolus for it, therefore I don't feel trapped.. it is my choice to eat well and care about my body, so not completely fear motivated.I don't ned to eat the pie...I can if I want. So I don't want (welcome to my convoluted little world..tee hee)
I look way way better than I did without the insulin.. yes my a$$ is bigger, but I have more muscle and don't look pale and frail the way I used to..people have stopped looking serious when we chat and they say I look well.

Just in case it is of interest to you, my A1c was 5.2 when I started bolus insulin..my thing was that I could not keep my pp spike below 7 even on <25g of carb per day and often I ate less than that. Couldn't see myself keeping that up forever anyway.

my first A1c after 3 months on insulin was 4.9 then over the next year it climbed to 5.2 and it has stayed there since... Lower A1c's have been associated with still having c-peptide, at least so I have read.

I agree with what Ohana has said.. when you are ready you will know.

I also had the thought, well, I am not all that bad.. if I hate the insulin I can always just stop taking it and go on as before..

Sorry for manuscript..edited to say
my tdd at the mo is 3u Lantus and 6-10u Novorapid (3yrs of insulin use)

[foxl]

Ohana, and Soso, thank you both SO much for your thoughtful responses!

I am wondering if my endo is gonna think I am a lunatic for even ASKING about insulin, yet, A1c 5.8 and minimal peaks ... morning FBG of 100 -120 max ...

But then I MISS some carby foods! Like the accursed bean soup ... how much fake meat must I eat? LOL. So maybe I would be more apt to get a prescription for bolus than basal at this point ...

I got Using Insulin in the mail and the author does address LADA more heavily than most which I like, but suggests not starting insulin until A1cs are stuck above 7. What does everyone think of that? Is it necessary, to avoid lows, or is it arbitrary and catering to the "EW, no shots!" folks?

[Subby]

John Walsh is very conservative with certain things. Like, following/defending mainstream high carb diet. And mainstream A1c targets.

I think it's probably just older standards, personally. If there was a good reason, it will be in there.

[soso]

Ohana, and Soso, thank you both SO much for your thoughtful responses!

I am wondering if my endo is gonna think I am a lunatic for even ASKING about insulin, yet, A1c 5.8 and minimal peaks ... morning FBG of 100 -120 max ...

But then I MISS some carby foods! Like the accursed bean soup ... how much fake meat must I eat? LOL. So maybe I would be more apt to get a prescription for bolus than basal at this point ...

I got Using Insulin in the mail and the author does address LADA more heavily than most which I like, but suggests not starting insulin until A1cs are stuck above 7. What does everyone think of that? Is it necessary, to avoid lows, or is it arbitrary and catering to the "EW, no shots!" folks?

so that is to have an average bg of 8.6 or 155.. before adding the insulin..eek... it's not an unfair desire to want a bit of bean soup... also, something I tried was eating a half cup of cooked oatmeal to see what happened.. 13.7 is what happened. I realized I had done all I reasonably could to fix my 'lifestyle'

Go with your own gut, not mine not your Dr's, we've all got our bias.
Good luck Linda, though don't think ya really need luck..lol..

[foxl]

Thanks, both ... Subby, glad to hear that POV since I have not really looked at Walsh enough to have a sense of his approach (though his comments on carbs in the diet ... meh!).

Soso, Oatmeal I can actually do a bit of, like say, 1/2 c. cooked, with CREAM. But I WILL be showing my postprandial tests of carbier foods to the Endo!!! I am thinking of building a portfolio, in fact ... because presenting with that A1c, I don't want to get summarily rejected for insulin therapy!

[soso]

eyebrows were raised at my A1c at the time, but it was really more about what I had to do to keep those pp's down that was the deciding factor for me.. I am lucky that though I am sure she would never have suggested it my GP has been super supportive about my decisions—though I think she has been amazed at what it is possible to do if you have the mindset... OTOH we can never really know if it has been a lot of luck helping me out so far. Only thing I know is for the 6 mths prior to dx I was in a world of hurt and now I'm back to being me(ish!)

[dbc]

I got Using Insulin in the mail and the author does address LADA more heavily than most which I like, but suggests not starting insulin until A1cs are stuck above 7. What does everyone think of that? Is it necessary, to avoid lows, or is it arbitrary and catering to the "EW, no shots!" folks?

I think most doctors assume the patient is not really committed to managing their own diabetes (unlike pretty much everybody on this forum :) !)

So the treatment plan errs on the side of highish BG numbers, because that approach is 'safer' in the short term than a plan which attempts to get the numbers down to the non-diabetic range - which WILL result in potentially fatal hypos in a patient who has not "got with the program".

My endo was reluctant to start me on insulin until I had consecutive 3-monthly A1c's over 6.6%. Now he realises I am committed to doing the best I can (and am reasonably successful), he pretty much stands aside and lets me get on with it.

I've heard a number number of horror stories from healthcare professionals recently which indicate that people who are really serious about managing their diabetes seem to be in the minority. . . .

[Ategeler]

I was put on basal once a day at first. Now I need to bolus for only heavier carb meals. Basal will preserve beta cell function.

[foxl]

I was put on basal once a day at first. Now I need to bolus for only heavier carb meals. Basal will preserve beta cell function.


Yup -- Joslin's states that they recommend basal-only, initially.

[Rich G]

Okay this may sound like a dumb question on the face of it, but I have read that some docs start you on bolus-only, others on a basal-only regimen.

I probably do not have huge needs for insulin at this time, since I am well controlled with low-carbing and oral meds. I am just beginning to think on these ideas.

So ... those of you who began with basal-only or bolus-only regimens, did you try the opposite, and please share experiences with starting on whichever, in general?

For as many years as I've had T2 I've never heard of T 1.5. What is it?

[foxl]

For as many years as I've had T2 I've never heard of T 1.5. What is it?


Type 1.5 is slow-onset autoimmune d. Also known as LADA, or latent autoimmune d of adulthood ... often mistaken for type 2

[dbaratta]

Don't forget insulin doses vary wildly. The typical type one is in the realms of 20 - 40 units TDD. I say typical extremely loosely. The Walsh book you have will have a table of expected insulin use. It's interesting to look at, then you can go and throw it out the window when it comes to the real world and anything but vanilla type 1s with little resistance. (Ok, so there might be a consideration for type 2s, can't remember)

These are extremely rough illustrations, no accuracy intended. More a sense of scale.

A highly resistant type 2 might take 200 or 300. A pretty resistant type 1 (me) I take about 80 on a relatively low carb diet. Or, really heavily resistant type 1, back up towards 200.

Some LADAs I've seen wanting a boost to their natural abilities, have started on doses like 5 or 10units long acting. Maybe a few units for dinner bolus. That kind of thing. Maybe a TDD of 15 or 20.

I'm just thinking, the weight gain argument might be a bit of a blind, if you find you benefit nicely from doses on the lower scale like that and are not feeding the insulin (which I would take for granted, being firmly low carb that you are). Feeding occurs from things like sticking to set doses, not adapting or modifying.
OK, what is type 1.5? I have only heard of type 1 and type 2. I guess I am clueless. As for insulin I guess I am a very low dose compared to type 1's. I only take 22 units Lantus at night and upt to 50 units depending what I am eating over the course of the rest of the day. That is why I am going to try to get back on the orals and see if maybe a small dose of lantus and the orals will help me keep things on a more even note. I am still up and down and really have no clue why most of the time. :oP

[foxl]

Poppy read the post above yours :D

[e||ement]

Linda
I'm T1 but honeymooning...my I:C ratio is 1:30. So far dairy carbs and veggie carbs have little to no effect on me.

That said, I have had days where I haven't bolused at all, if I'm eating low carb. This weekend, I bolused once on Saturday morning and not again until Sunday night when I had a carby snack. No corrections needed either. (However, I did drink a bottle of wine on Saturday night, so of course that is a factor...but I did reduce my basal by 25% on Saturday night.) Anyway, my numbers were great without bolus or correction with watching what I was eating.

So from my experience, I think that if you can manage spikes with a low-carbish diet, basal-only is the way to go over bolus-only. I think it would be easier to manage and more predictable.

[foxl]

Linda
I'm T1 but honeymooning...my I:C ratio is 1:30. So far dairy carbs and veggie carbs have little to no effect on me.

That said, I have had days where I haven't bolused at all, if I'm eating low carb. This weekend, I bolused once on Saturday morning and not again until Sunday night when I had a carby snack. No corrections needed either. (However, I did drink a bottle of wine on Saturday night, so of course that is a factor...but I did reduce my basal by 25% on Saturday night.) Anyway, my numbers were great without bolus or correction with watching what I was eating.

So from my experience, I think that if you can manage spikes with a low-carbish diet, basal-only is the way to go over bolus-only. I think it would be easier to manage and more predictable.


Hmmm... maybe why Joslin's recommends basal-only, too! I have yet to see a rationale for it, but that makes sense!

thanks!

[sofaraway]

When I started using insulin just over 3 years ago I started on basal only. They did want me to start on mixed insulin but I refused and said I wanted to go onto basal bolus because of the flexibility I needed. They then decided to try basal only once a day lantus, I did see some improvement in my numbers, from constrantly being 15-HI I came down to most numbers readable. but after around 2 weeks or so it was obvious despite increasing the basal dose that I was not going to be able to get control on basal only so I requested some bolus insulin, my DSN was reluctant as it was a friday afternoon that I got hold of her, but she did sort it out for me. Ever since then I've been on basal bolus and it's worker wonders for me.

[nikki75]

That is awesome that you were able to get your A1C down so quicly. What meds are you taking and how low is low carbing to you?

[foxl]

That is awesome that you were able to get your A1C down so quicly. What meds are you taking and how low is low carbing to you?

What, who? Me?

[SB_Krista]

I too have my Endo appt at the end of Aug, and am facing the decision to start on basal insulin too. I think adding some basal insulin would help get my morning and in-between meal blood glucose levels down some, so that I have a bit more room to move up with a meal. Currently, I'm living live between 120 and 150 and eating a rather limited low-carb diet. Plus, having some basal insulin on board might shut my liver down some with less glucose dumping. I think I can manage the post meal sugars with my diet, and the Januvia that I'm on as I appear to still have some native insulin production. I've lost about 23 lbs and am currently at my ideal weight for my height, so weight gain would definitely be a drag. But, I don't think basal insulin would affect that much....I hope!

[foxl]

Yes ... Krista, you seem to be farther advanced than I -- my
A1c and fastings are much lower, my C-peptide is higher
(1.3), and my GADs were > 30.

But then I was only diagnosed in Feb. I am curious if I can even handle a low dose of basal insulin, without crashing. It will be interesting to learn this, together.

[lorilei]

i am so sorry Linda...i am cruising in at the last minute and honestly have not scanned above...I bolussed first because my post meals were the first to spike....but it was only a short stint that way.. within three weeks i basaled as well ...i was chasing the rhythm of my pancreas with a bolus only and that caused some funky spikes etc..the basal made me rock steady and easier to finalize the bolus..but you probably know this already..:)

[foxl]

i am so sorry Linda...i am cruising in at the last minute and honestly have not scanned above...I bolussed first because my post meals were the first to spike....but it was only a short stint that way.. within three weeks i basaled as well ...i was chasing the rhythm of my pancreas with a bolus only and that caused some funky spikes etc..the basal made me rock steady and easier to finalize the bolus..but you probably know this already..:)

Lori, I DON'T! Glad to see your experience as it will help me! It could be a wild time, or easy ... who knows?

[luckharm]

My doctor started me on 10 units of Lantus only, but she just increased it to 15 units as my numbers were not coming down enough. So, so far it is just basal one time per day, but stay tuned......

[foxl]

My doctor started me on 10 units of Lantus only, but she just increased it to 15 units as my numbers were not coming down enough. So, so far it is just basal one time per day, but stay tuned......

I WILL! I will follow your progress with interest!

[lorilei]

hi linda..what did you end up doing? in re-browsing i see my cpeptide was much lower than yours at dx and certainly much lower when i could no longer control my bg on diet and exercise...( which for me was pretty short..ie..read honeymoon between the lines here)...just curious..also, if you went on insulin..which first and most imprtantly how do you feel? my first month back was a rollercoaster..but for the MOST part i have evened out despite a bumpy ride here and there...

[foxl]

Lori, I saw my Endo, she is strictly clinical in her management! She took me off Actos, and upped my metformin from 1700 mg to 2000 per day (big whoop, huh), and told me to eat -- get this 40 g of carb per meal. Nope, nope, not gonna!

But, she also added Ramipril for BP which I apparently needed according to the Retinologist (he saw vascular changes) she later referred me to ... so it was far from a fruitless appointment.

Anyhow she suggested adding Januvia would be next, but I told her I would be wanting to add insulin next, and she seemed open to letting me ... so I will continue to go back to her.

[Simon]

Well I started on basal then bolus a week later. That was 4 years ago. About a week ago I went to open my new box of basal to find it was the wrong cartridge and I couldn't use it. That's how I discovered I didn't need it anyway. Been off it a week now and all numbers are on target. Still need to bolus though.

[Subby]

Well I started on basal then bolus a week later. That was 4 years ago. About a week ago I went to open my new box of basal to find it was the wrong cartridge and I couldn't use it. That's how I discovered I didn't need it anyway. Been off it a week now and all numbers are on target. Still need to bolus though.

Interesting Simon! What was your basal, and how many units, if you don't mind the question?

[Simon]

Was on Lantus. Averaging about 8 units a day but I had periods when I adjusted it by about 2 or 4 units each way depending on my morning readings. Mornings are about 6mmol/l now. I am a LADA though so I guess it's just down to very slow onset indeed. Having said that I had ketones in my urine at diagnosis so it's possible that I've actually recovered some pancreas function.

[houzaizi]

put on a basal and bolus immediately upon diagnosis.
http://www.photosnag.com/img/4713/n09x0302vnsn/clear.gif

[foxl]

put on a basal and bolus immediately upon diagnosis.
http://www.photosnag.com/img/4713/n09x0302vnsn/clear.gif

At what A1c, and how much basal and bolus, please?

[Rekarb]

My endo was setting me up for basal before it all fell through. Now, as I look at my numbers, basal doesn't make much sense. I've been adjusting my carbs and boy I can really spike but given a few hours and I'm back down again. It seems my basal is doing most of the work.

The problem with my type of diabetes is the loss of an effective first phase insulin response leaving the basal to bring down the bgs. Overtime, the basal can't keep up and glucose toxicity takes out more and more beta functioning.

When we revisit the insulin issue, I'm going to ask my endo about a bolus to mitigate those spikes.

Just my two cents

Mike

[foxl]

Mike have you seen this on FPIR?

Diabetes - First-Phase Insulin (http://www.healthcentral.com/diabetes/c/17/11129/firstphase-insulin/)

I did not realize it was important to suppressing gluconeogenesis!

[soso]

Well I started on basal then bolus a week later. That was 4 years ago. About a week ago I went to open my new box of basal to find it was the wrong cartridge and I couldn't use it. That's how I discovered I didn't need it anyway. Been off it a week now and all numbers are on target. Still need to bolus though.

I was taking about 7u of basal per day until a few months ago.. then I had to start reducing..over time I got down to 3 u per day and stayed there.... a couple of times I thought why bother and stopped, but within a few days I started getting higher fastings so I resumed the 3 u.
Then on holiday I started getting low every afternoon so stopped it and it has now been 2 weeks . Just tthe last few days I have seen that climb again though, so I don't know... it seems such a small amount..worth noting as well that my recent a1c was 5.5 up from 5.2...

???

[Delphinus]

I started on a basal regimen at first. I couldn't get below 10 mmol/L doing just basal shots. I expected that anyway since my pancreas doesn't work at all.

I quickly learned I was gonna need more, and added rapid/regular insulin to cover carbs and make corrections.

Sorry, I am Type 1, but I wanted to jump in anyway. ;)

The one thing we all do have in common, is our insanity. :T

Diabetes is cool!

[foxl]

I started on a basal regimen at first. I couldn't get below 10 mmol/L doing just basal shots. I expected that anyway since my pancreas doesn't work at all.

I quickly learned I was gonna need more, and added rapid/regular insulin to cover carbs and make corrections.

Sorry, I am Type 1, but I wanted to jump in anyway. ;)

The one thing we all do have in common, is our insanity. :T

Diabetes is cool!


Still, Jason, your reply is still relevant b/c it is about what MD's are deciding to do ... I enjoy our insanity and hope you are enjoying it too!

[conguitos]

Lori, I saw my Endo, she is strictly clinical in her management! She took me off Actos, and upped my metformin from 1700 mg to 2000 per day (big whoop, huh), and told me to eat -- get this 40 g of carb per meal. Nope, nope, not gonna!

But, she also added Ramipril for BP which I apparently needed according to the Retinologist (he saw vascular changes) she later referred me to ... so it was far from a fruitless appointment.

Anyhow she suggested adding Januvia would be next, but I told her I would be wanting to add insulin next, and she seemed open to letting me ... so I will continue to go back to her.

Hi Linda,

the first docs put me on lantus 15 IU at 22:00 every day, then they prescribed me metformin and sulforienas, after 3 days I stopped all medication. The next endo wanted to give me rapid acting insulin, which I declined.

My first A1c was around 14, the second around 7 the third 5.6 and my last one 5.8. The first one was in January, the last one 4 weeks ago.

Last thursday we did the "sugar test", which I failed miserably, went up to 20 (around 400) in 2 hours, but 6 hours later I was again at 4,5. We'll see how much insulin there was in the blood, but I'll have to wait a month for the results.

What I've noticed until now is that when I stop eating for 1 day, the next 3 to 4 days my body will tolerate carbs quite well and if I go on a raw food + meat diet, I will be around 2.5 to 6, it looks like it doesn't matter how much I will eat. Sometimes I event had 3 to 4 before meal and a 3 to 4 pp, weird...

Just out of curosity, your C-Peptide results, what is the reference frame for the test you did? And your GAD-65? I hat at dx around 2500, the reference frame for my test was given as <9.

Thanks in advance.

[Rekarb]

Nope, I had not seen this. Thanks. I remember reading a paper on this but it was so loaded with jargon that I finally got lost. Now I understand better. They were essentially talking about the failure of the trigger mechanism that shut down the liver.

I've said before that a shot of whiskey does more for my blood sugar than any drug I've been prescribed. Basically, all this does is impair the liver's ability to put out glucose. What I was wondering was there a drug that really concentrated on that, especially when carbs have been taken in. Is that what Byetta is supposed to be about?

Mike

[Subby]

I've said before that a shot of whiskey does more for my blood sugar than any drug I've been prescribed. Basically, all this does is impair the liver's ability to put out glucose. What I was wondering was there a drug that really concentrated on that, especially when carbs have been taken in. Is that what Byetta is supposed to be about?

Mike

Metformin. You can see what has been happening since I've been taking metformin for two weeks, here: http://www.diabetesforums.com/forum/type-1-diabetes/44010-metformin-findings-one-t1.html

Interestingly my overall dose has still not reduced a great deal, so I think it's fair to say these effects are not the kind of ones associated with metformin helping with "visceral insulin resistance".

My theory about the main action of the metformin radically changing the gluconeogenesis processes (and probably similar or related liver functions), and hence leading to a marked change in my bg stability and needs on a daily biological cycle level, is largely supposition, in that I can't prove it nor has a doctor told me this is the process currently occurring for me. Please bear that in mind.

[tealas]

I've said before that a shot of whiskey does more for my blood sugar than any drug I've been prescribed. Basically, all this does is impair the liver's ability to put out glucose. What I was wondering was there a drug that really concentrated on that, especially when carbs have been taken in. Is that what Byetta is supposed to be about?

Mike

Byetta has several key actions. It increases the levels of GLP-1 Glucagon-like peptide-1 - Wikipedia, the free encyclopedia (http://en.wikipedia.org/wiki/Glucagon-like_peptide-1). My understanding is that this essentially triggers more insulin release, but only when blood sugars start to rise over 120mg/dl (i.e. it will not cause hypo's), it suppresses glucagon release (from the pancreas, not sure about the liver) and it slows gastric emptying.

It can really work well for some Type 2's and MODY patients. For me it basically halted my digestive processes - so the side effects were not acceptable even though the blood sugar control was wonderful.

[Rekarb]

I've been digesting this information and Subby's supposition of a "broken liver" makes more and more sense as I look through my numbers under various conditions. Gluconeogenesis seems to be very much at the center of this process, at least for me. I am, however, on Met and it wasn't until the Actos was added that my bg started down. I am will to believe that some part of the metabolic processes are being affected by this combination but it takes a shot of brandy to bring me down into a normal range. This suggests to me that another part of the gluconeogenesis process is still largely unaffected.

Of course, I'm thinking out loud here but I seem to remember reading somewhere about a research suggesting that glucotoxicity shutdown or altered some port or signalling that might affect this. Gonna have to go digging some more.

I'm sick with the flu right now so my bg has gone awry. The only thing that sets things back - you guessed it, a shot of brandy.

Mike

sick but kind of enjoying the brandy thing.