At what A1c or avg fasting did you start insulin?

[foxl]

Okay, it appears to be up to me ... I do not want to start insulin yet, not with fastings in the 80's and 90's and rarely, peaks over 120 ...

But, when DID you start, as a LADA or whatever, using insulin to preserve your beta cells? What criterion or criteria did you or your MD use?

[jtausch]

When I was in the hospital the had a endo see me and he put me on insulin because of my foot and because my insulin was at greater the 160 said insulin for better control. I agree it gave a lot better control

[butterflykisses]

By the time I was properly diagnosed I was already on insulin. :( Had I known from the beginning I would have asked to start bolusing with meals when my BG's started growing after meals. In the beginning my fasting BGs were okay, after breakfast I would rise, maybe come down a bit by lunch. Then came lunch, you get the picture. I think some mealtime insulin would have preserved beta cell function for a while...but then who really knows for sure?

[retired60]

My a1c's were running 7.2 to 7.4%. I asked the doctor to put me on insulin. With a little insulin it is very easy to control as you can see by my a1c's.

[foxl]

I find what the endo-on-call did to be less than appropriate and think even the new Endo is not too impressed and he was a partner ... he had me on insulin for 2 days in hosp, but sent me home on oral meds, not even knowing how I would tolerate them. No beta cell rest there! I probably could be on a minuscule basal or just bolus and do okay now ...

[luckharm]

My A1c was 8.9 and my fasting BS was 180 to 250 when I started on 10 units of Latus 1 time per day. This was only a few days ago and already my numbers are improving. My fasting Bg this morning was 124. I wish I had done this sooner instead of denying myself carbs for months just to keep under 200.

[foxl]

My A1c was 8.9 and my fasting BS was 180 to 250 when I started on 10 units of Latus 1 time per day. This was only a few days ago and already my numbers are improving. My fasting Bg this morning was 124. I wish I had done this sooner instead of denying myself carbs for months just to keep under 200.

OMG that is high! Was it because you were insulin-phobic, or ... ?

[Subby]

OMG that is high!

Is this a respectful and tactful tone when discussing someone elses possibly tricky situation? I don't think I'd want anyone using that tone with my trends whatever was going on.

[foxl]

Sorry Subby, I did not mean it impolitely, I do not know Luckcharm nor she me, so I guess it did sound rude.

I just know I would have been freaking out, way before hitting that point.

As someone who was at 447 at DX, I did not mean she was using poor judgment or was on the verge of dying or anything! I just know I would have been upset. And I am asking for info so I can base my decision (since it appears to be MINE, not my Endo's) to go onto insulin on others' experiences, and worrying about not being there yet ... so yeah that sounded high to me - maybe as in wow your nubers are high, but also as in, well if your MD let you go that high, I have a ways to go.

[Subby]

No worries - and no need to apologise or explain. I just know, when you've been struggling with difficult BGs for some time whether you are doing the right things or not, that such throwaway lines (usually not meaning anything too judgemental - but you never know) can be very negative sounding, a real kick in the guts. Not always, but sometimes.

[zoelula]

I had been stable on oral meds for a bit more than a year (misdiagnosed as Type 2) when my numbers started a slow but steady climb (last September) I waited perhaps longer than I should have to go to the doctor (December) and say, ok, this is no longer working. Then my doctor wanted to try one more oral med first (again thinking Type 2) then started me on bolus only at too high of a dose so I was hypo by mealtime and still very high postprandial. I would have to look at my old notebooks to remember what happened when. I think by the time I went to the doctor and said we have to change something my fastings were around 140, and my post prandials were in the 200s. Right before the time I actually got on the right regimen (diagnosed myself as LADA) my postprandials were spiking into the 300s and even 400s a couple times. But like I said I waited too long.

But remember, Linda, I was not controlling my carb intake AT ALL in those days (only not eating sugar). Besides being more recently diagnosed than me (I just had my two year anniversary), I wonder how your numbers would look if you were eating without any consideration of carbs?

[foxl]

But remember, Linda, I was not controlling my carb intake AT ALL in those days (only not eating sugar). Besides being more recently diagnosed than me (I just had my two year anniversary), I wonder how your numbers would look if you were eating without any consideration of carbs?

I tried to argue that with Endo ... she said she wanted me on 40 g carb per meal, in part b/c I told her when I "tested" with that my peak BG was around 120. I told her I thought I would exhaust my insulin reserves more rapidly at 40 g per meal and that 120 would then not be the case!

AND she wants me to lose 10 - 20 more lb ... how would TAHT work?

I definitely think low-carbing is keeping me from being prescribed insulin ... but, is that a BAD thing? I think not. And I do not really want to prove myself right by eating higher carb and gaining weight, in order to do it! Or going DKA again ... another possibility.

[dbc]

But, when DID you start, as a LADA or whatever, using insulin to preserve your beta cells? What criterion or criteria did you or your MD use?

When the A1c drifted up to 6.5% after being down at 6% on diet, exercise and metformin for about a year. Doctor's criteria was the 6.5% threshold on an upward trend.

We had discussed starting insulin before, when the A1c was around 6.3% (on a VERY restrictive low carb eating plan). At that time he wasn't in favour because of possible/probable hypo issues. We also didn't know each other well enough at that time, and I suspect he had me labelled as a 'normal' patient who would not apply himself properly to managing things and would therefore be likely to experience hypos. He now knows otherwise and largely agrees with everything I suggest ;)

[tealas]

I definitely think low-carbing is keeping me from being prescribed insulin ... but, is that a BAD thing? I think not. And I do not really want to prove myself right by eating higher carb and gaining weight, in order to do it! Or going DKA again ... another possibility.

Just a suggestion, along with low-carbing you may want to explore ratio of raw to cooked foods in your diet.

I've been on Humalog for about 5 years, and was starting to feel like I could not control the post-meal spikes and was unhappy with this. I tried Byetta which controlled the spikes but I had horrible GI problems from it. Then I stumbled into doing more raw foods (I aim for about 75% - mostly salads and green smoothies or veggie soups made in a VitaMix). I was really surprised to see that I could eat 2 fruit exchanges in a green smoothie, (but blended with two large handfuls of spinach or chard and 1-2 tbls chia seeds), and see my blood sugars go down to 78! For me at least there is something very restorative about getting more raw greens. If you search on YouTube they have some documentary films about a 30 day raw diet challenge for diabetics and how it helped many (mostly Type 2, but some Type 1's) to lower their levels of medications.

FYI - I'm not personally in favor of the 100% raw vegan approach all at once. Natalia Rose has a great book (avail on Amazon) about stages of incorporating raw foods into ones diet, "Raw Food Detox Diet: The Five-Step Plan for Vibrant Health and Maximum Weight Loss." This book has excellent reviews on the Amazon site - the reviews alone gave me a good bit of information about the benefits and potential pitfalls of shifting to a diet with more raw foods. You can get most of the benefits of raw foods just by shifting 2 out of 3 meals raw, and then having good quality cooked poultry/fish/meat OR starch and veggies. Rose is big on food combining - and I think it is very important for detoxification, which I think as diabetics we are always needing (due to oxidative stress).

[foxl]

Just a suggestion, along with low-carbing you may want to explore ratio of raw to cooked foods in your diet.

I've been on Humalog for about 5 years, and was starting to feel like I could not control the post-meal spikes and was unhappy with this. I tried Byetta which controlled the spikes but I had horrible GI problems from it. Then I stumbled into doing more raw foods (I aim for about 75% - mostly salads and green smoothies or veggie soups made in a VitaMix). I was really surprised to see that I could eat 2 fruit exchanges in a green smoothie, (but blended with two large handfuls of spinach or chard and 1-2 tbls chia seeds), and see my blood sugars go down to 78! For me at least there is something very restorative about getting more raw greens. If you search on YouTube they have some documentary films about a 30 day raw diet challenge for diabetics and how it helped many (mostly Type 2, but some Type 1's) to lower their levels of medications.

FYI - I'm not personally in favor of the 100% raw vegan approach all at once. Natalia Rose has a great book (avail on Amazon) about stages of incorporating raw foods into ones diet, "Raw Food Detox Diet: The Five-Step Plan for Vibrant Health and Maximum Weight Loss." This book has excellent reviews on the Amazon site - the reviews alone gave me a good bit of information about the benefits and potential pitfalls of shifting to a diet with more raw foods. You can get most of the benefits of raw foods just by shifting 2 out of 3 meals raw, and then having good quality cooked poultry/fish/meat OR starch and veggies. Rose is big on food combining - and I think it is very important for detoxification, which I think as diabetics we are always needing (due to oxidative stress).

tealas, I am an ovo-lacto vegetarian. And I have a family of 3 kids, and work fulltime. Sorry but until I see something evidence-based in favor of it, I am not going to further complicate my diet and meal-planning.

[zoelula]

I definitely think low-carbing is keeping me from being prescribed insulin ... but, is that a BAD thing? I think not. And I do not really want to prove myself right by eating higher carb and gaining weight, in order to do it! Or going DKA again ... another possibility.

Nope, definitely not a bad thing. I was just pointing out that my pattern of increase in blood sugar would be very different than yours because of the diet aspect. It does seem, though as though the protocol for insulin usage is still based on need (high blood sugars) not the concept of slowing beta cell death, doesn't it?

[foxl]

Nope, definitely not a bad thing. I was just pointing out that my pattern of increase in blood sugar would be very different than yours because of the diet aspect. It does seem, though as though the protocol for insulin usage is still based on need (high blood sugars) not the concept of slowing beta cell death, doesn't it?

Ohhhh, yes it is. And I am not altogether thrilled ... but we will see!

I will be interested to see how long I last (without pushing it) until I have another beta-cell loss. Perhaps low-carbing will help, according to some studies it should, but who knows what causes the occasional episodes of attack on them by T-cells?

One theory is that it is episodic and triggered by viral infection or other immune-system stressors ... maybe, a nadir of Vit D? So many variables involved. Perhaps your diet post initial dx had NOTHING to do with it, Zoe!

[RobinP]

My A1c was 8.9 and my fasting BS was 180 to 250 when I started on 10 units of Latus 1 time per day. This was only a few days ago and already my numbers are improving. My fasting Bg this morning was 124. I wish I had done this sooner instead of denying myself carbs for months just to keep under 200.

Your numbers sound like what mine are now. The pills I'm on aren't doing much and I'm eating the best I have in years. Low carb and no junk foods. My dr did mention insulin at my last visit, so we shall see. I go back later this month.

[foxl]

When the A1c drifted up to 6.5% after being down at 6% on diet, exercise and metformin for about a year. Doctor's criteria was the 6.5% threshold on an upward trend.

We had discussed starting insulin before, when the A1c was around 6.3% (on a VERY restrictive low carb eating plan). At that time he wasn't in favour because of possible/probable hypo issues. We also didn't know each other well enough at that time, and I suspect he had me labelled as a 'normal' patient who would not apply himself properly to managing things and would therefore be likely to experience hypos. He now knows otherwise and largely agrees with everything I suggest ;)

dbc, I overlooked your post earlier. This is exactly what I was looking for -- and your detailed explanation of "why that threshhold" was very helpful! I tried to get my Endo to answer this -- at what A1c would you suggest starting insulin, and she kinda dodged it but I am sure she has a level in mind, too! And I am sure some of that does have to do with concerns over hypos.

Thanks!

[sarahspins]

Like others, I was already taking insulin when I was finally correctly diagnosed... there really wasn't any time after my initial diagnosis of GD where I didn't really "need" insulin... however there was a time when I was told to stop taking it and my #'s were constantly in the 300+ range... my doctor really didn't seem to be concerned with that, even though I definitely was (and I felt horrible... and it's no wonder since I was likely on the verge of DKA several times).

I really think some doctors are just complete idiots, and that's the explination for why some people are "allowed" to run higher numbers (sometimes VERY high) before starting on insulin or even having it recommended to them. A lot of doctors really see it as the last possible option and want to avoid it at all costs - seemingly even if that cost is the patient's health. I was asking to take insulin and being told no... that still just baffles me.

If I hadn't self-medicated I am sure I would have gotten very very sick in a short time.

Despite all of that I had a relatively long honeymoon if you count from my initial GD diagnosis.. following that pregnancy I needed very low doses of insulin for about a year.

It's really something that seems to be unique to everyone... even for a classic T1 and not a LADA/1.5, there's still quite a lot of variability in progression and insulin requirements. Some people don't honeymoon at all, others honeymoon for quite some time.

Even though my diagnosis took a while and my honeymoon lasted nearly 18 months, I still consider myself a T1 and not a 1.5. I had positive antibodies for everything.. which sealed the T1 designation for me. I think being on insulin immediately while I was pregnant likely did preserve quite a bit of my beta cell function.. and I was diagnosed before going into DKA. I had low-normal c-peptide results for a year... which I think is part of what served to confuse my first doctor and convince her I had to be a T2. Clearly I did need some additional insulin, but she was convinced my body was making "enough" based on lab results when it clearly was not.

My personal advice? I would request an RX for insulin (at least rapid) and keep it on hand in case you need it... since you test often and seem to be on top of things, you'll know when you start seeing #'s that you just can't manage with diet. Murphy's law says that when you need it, it's going to happen on a weekend or some other time when it's inconvenient to get ahold of your doctor and get a prescription called in. I don't know that I would start on insulin "just because" - if you're comfortable with your current management then there's no reason to change things, only to be prepared for the unexpected.

[SB_Krista]

My Endo started me on Lantus last week based on my HbA1c being steadily stubborn to dropping below 6.5% with my low carb diet, exercise, and trial periods on metformin er and now Januvia. I seemed to be stuck around 6.7% and he doesn't want me to lose any more weight and would like me to not be so restrictive with carbs. My morning readings, before Lantus were conisistently 120-140 and I don't think I ever dropped below this range.

[Ategeler]

Well I started insulin when I was diagnosed during pregnancy. Then went off after having baby. Then when my fastings starting increasing from the 80's into the 120's they put me on long acting. Since then, I have progressed to needing fast acting with certain meals too. I seem to be creeping. My Dx came in Nov. 2006 and I just started taking the Levemir Dec. 2008. So I guess it was about 2 years from diagnosis that I needed to take the long acting. Ironically, I never took long acting in pregnancy since it never effected my fastings. I only took fast acting with meals. When I started taking insulin after pregnancy it was opposite--first long than short.

[tealas]

tealas, I am an ovo-lacto vegetarian. And I have a family of 3 kids, and work fulltime. Sorry but until I see something evidence-based in favor of it, I am not going to further complicate my diet and meal-planning.

Yes, I bet my message came across differently than I intended. It can be hard to communicate 100% accurately via message boards and emails. I wasn't so much saying "here jump on the raw bandwagon because it worked for me," as "Hey look at how much of a difference this seemed to make for me, keep an eye out for it."

Realistically I doubt there would be enough double-blind, controlled studies to allow for an evidence-based medicine review on raw foods & diabetes. I did a quick search and there was a successful (though small) double blind study on raw foods and Crohns. But as a MODY3 I have spent my life dealing with a disease that no one new much of anything about - so I'm probably more comfortable with being off the beaten path so to speak.

I can also understand about having a busy family/work life - I am a mostly single parent of a 4 year old (also a MODY3), and my 69 year old handicapped father lives with us (I basically case manage or perform all his care). I work full-time in a high tech job where I commute 2 hours a day and often do work from home late at night/early am. So I would be the last person to manage a dietary change that was labor intensive to implement!

[MrsMia]

Okay, it appears to be up to me ... I do not want to start insulin yet, not with fastings in the 80's and 90's and rarely, peaks over 120 ...

But, when DID you start, as a LADA or whatever, using insulin to preserve your beta cells? What criterion or criteria did you or your MD use?

Linda, these are some good questions. As you know, there are alot of similarities between our cases of diabetes. We both were in DKA when diagnosed and both are currently on just oral medications. I know that if I get off the medications or have them reduced and my A1c and other BG numbers start going up then I will want to be put on insulin. Truth be told, I'm not crazy about the whole, medications/diet/exercise routine that I must go through every day just to get some decent numbers. I don't have a life and the pressure is incredible to keep up all this. I can't even imagine what my numbers would be like if I slacked off just a bit. I'm not shrinking from hard work for my health. It's just that it doesn't seem to get easier even to maintain what I'm doing. It's always difficult.

[zoelula]

Actually from everything I read about LADA/1.5, my beta cell death/rising blood sugars were well within the expected time frame of a few months to 4 years. (I was around 14 months when it started).

[foxl]

Actually from everything I read about LADA/1.5, my beta cell death/rising blood sugars were well within the expected time frame of a few months to 4 years. (I was around 14 months when it started).

Oooh, yes well-within! And most stuff I read says about one year is typical ...

[foxl]

Linda, these are some good questions. As you know, there are alot of similarities between our cases of diabetes. We both were in DKA when diagnosed and both are currently on just oral medications. I know that if I get off the medications or have them reduced and my A1c and other BG numbers start going up then I will want to be put on insulin. Truth be told, I'm not crazy about the whole, medications/diet/exercise routine that I must go through every day just to get some decent numbers. I don't have a life and the pressure is incredible to keep up all this. I can't even imagine what my numbers would be like if I slacked off just a bit. I'm not shrinking from hard work for my health. It's just that it doesn't seem to get easier even to maintain what I'm doing. It's always difficult.

Totally understand! I am not too crazy about it either it is time-consuming and I have 3 pretty time-consuming kids!

I WILL say ... one week off the Actos, no change in blood sugars, yet! Kelli said she saw it after about two weeks, though ....

[zoelula]

[QUOTE=sarahspins;49526

My personal advice? I would request an RX for insulin (at least rapid) and keep it on hand in case you need it... since you test often and seem to be on top of things, you'll know when you start seeing #'s that you just can't manage with diet. Murphy's law says that when you need it, it's going to happen on a weekend or some other time when it's inconvenient to get ahold of your doctor and get a prescription called in. I don't know that I would start on insulin "just because" - if you're comfortable with your current management then there's no reason to change things, only to be prepared for the unexpected.[/QUOTE]

For me, my rising blood sugars were much more gradual than this. I started seeing a slow gradual but steady trend higher in September and they weren't crazy high until December. I don't know how typical or atypical LADA this is.

[foxl]

Yes, I bet my message came across differently than I intended. It can be hard to communicate 100% accurately via message boards and emails. I wasn't so much saying "here jump on the raw bandwagon because it worked for me," as "Hey look at how much of a difference this seemed to make for me, keep an eye out for it."

Realistically I doubt there would be enough double-blind, controlled studies to allow for an evidence-based medicine review on raw foods & diabetes. I did a quick search and there was a successful (though small) double blind study on raw foods and Crohns. But as a MODY3 I have spent my life dealing with a disease that no one new much of anything about - so I'm probably more comfortable with being off the beaten path so to speak.

I can also understand about having a busy family/work life - I am a mostly single parent of a 4 year old (also a MODY3), and my 69 year old handicapped father lives with us (I basically case manage or perform all his care). I work full-time in a high tech job where I commute 2 hours a day and often do work from home late at night/early am. So I would be the last person to manage a dietary change that was labor intensive to implement!

Tealas, you sound VERY busy, too! Okay, I will try to be more open to that kind of eating ... but it still sounds kinda intimidating to me, to change that radically from what I am doing.

[foxl]

For me, my rising blood sugars were much more gradual than this. I started seeing a slow gradual but steady trend higher in September and they weren't crazy high until December. I don't know how typical or atypical LADA this is.

Zoe, just from reading your experience, this is kind of what I would expect. But ... we know that post-prandial control deteriorates first, so Sarah's advice is also important ... and makes me think, maybe I will need to keep doing my MMTTs every once in a while to monitor my progress.

[tealas]

I don't have LADA, so I can't speak from direct experience but I would think you have (at least) two aspects of beta cell damage to watch out for; continued autoimmune destruction, and beta-cell damage mediated by raised blood sugars.

There have been good posts about the second issue, and the recently published "Blood Sugar 101" book has a chapter on this. From research it sounds like fastings over 100mg/dl and post-meal spikes over 140mg/dl are certainly capable of triggering beta cell damage. I found it interesting that while pregnant I was supposed to keep my fastings below 90mg/dl and my post-prandials below 120mg/dl. So once I gave birth I was told I could relax those to 100 and 180! If it is good enough for my baby, I think it might be better for my pancreas most of the time :cool:

Elsewhere someone mentioned their doctor using a 6.5 HbA1c as a cutoff for starting insulin therapy. A 6.5 HbA1c corresponds to an average blood sugar of 154. So at that point your average would well over the minimum level that beta cell damage is occuring at, for about three months. :( Looking at it as best we know about beta cell damage, I would think you would always want an HbA1c of at least 6.0 (136 avg) or below - but of course with risks & tradeoffs of hypoglcemic events factored in.

I think the autoimmune component of the beta cell damage is probably much more important for LADA's, and unfortunately has no approved treatment as far as I know. My Endo pointed me to this research page last year: TrialNet - Information for Patients (http://www.diabetestrialnet.org/patientinfo/studies.htm) If you are within the first 100 days of diagnosis, you may be eligible to enter a trial for autoimmune drugs that could help delay the autoimmune damage to the pancreas.

So if you are past 100 days and you want to actively work on the autoimmune risk you would probably have to go into an alternative medical system or consider anectodal-type evidence.

For many people this is probably not how they would approach their situation. But for sake of sharing information, the two main areas I know about in this regard are Traditional Chinese Medicine (TCM), and using raw foods (some anecdotal stories of Type 1's preventing further damage and not requiring insulin on a raw food diet). But because I don't have LADA, I have no comprehensive TCM information to share. I did find this article, apparently they have identified a potential autoimmune drug for Type 1 diabetes from the chinese herb hydrangea: New Lead For Autoimmune Disease From Chinese Medicine (http://www.sciencedaily.com/releases/2009/06/090604144328.htm)

[foxl]

Tealas, apparently from the articles I am retreiving off PubMed, the high blood sugars are presumed to be a component of the autoimmune damage, as well.

[tealas]

Tealas, apparently from the articles I am retreiving off PubMed, the high blood sugars are presumed to be a component of the autoimmune damage, as well.

You mean high blood sugars initiating the autoimmune damage to beta cells, or further fueling it once it starts?

[lilituc]

I had normal fasting, but super high postprandials. My endo knew me pretty well, so when I called and told him my postprandial bg was up to 300 and wouldn't come down (this was on all the T2 meds), he agreed that it was time to start insulin.

[foxl]

You mean high blood sugars initiating the autoimmune damage to beta cells, or further fueling it once it starts?


My understanding is that the high sugars lead to increased insulin secretion, leading to more attack on beta cells by T cells ...

[foxl]

I had normal fasting, but super high postprandials. My endo knew me pretty well, so when I called and told him my postprandial bg was up to 300 and wouldn't come down (this was on all the T2 meds), he agreed that it was time to start insulin.

A good reason for documenting my response to a carby meal, once in a while ... ONCE. IN. A. WHILE.

[tealas]

My understanding is that the high sugars lead to increased insulin secretion, leading to more attack on beta cells by T cells ...

But why does the blood sugar go high to begin with? Due to some initial autoimmune damage to the beta cells? Or are they saying there are other reasons that blood sugars starts to go up and that rise then initiates the autoimmune damage? I guess I'd heard the hypothesis that there was virus which triggered attack to a similar antigen on the beta cells (in some families, hence the genetic component to the disease).

[luckharm]

Hi all,

No offense taken by the replies to my prior post. We are all here to share information and learn from each other.

My Endo was trying different medications before making the insulin decision. I have been on 10 units of Lantus now for about 1 month and my BS numbers are still a little high, averaging about 160 in the morning. I called my DR. yesterday and she has now upped my dosage to 15 units per day. We'll see how that goes.

This disease is like trying to hit a moving target. Just when you think you have it under control , it gets away from you. I had a honeymoon period of about 8 months when I had BS numbers of about 110 just with Metformin and I was eating a sensible diet with about 2 servings of carbs per meal. Then, slowly, my numbers started to climb even though I was not changing my diet or exercise. My Dr. said that my pancreas is now producing less and less insulin, thus the need to go on Lantus.

I get really frustrated sometimes and just want to get this under control!

I am 5' 4" and weigh 120 lbs. Is 15 units of Lantus OK? Maybe I even need more? I am now limiting myself to 1 serving of carbs per meal just to get my numbers down.

[Ti-Jae]

Not sure whether to pipe in or not since I'm type 2, but when I was diagnosed at the emergency room in January and admitted to the hospital that night, my BG was over 400 mg/dL and my A1C was 13.54%. The endocrinologist on call, who is still my endo today, immediately started me on a couple insulins. When I last saw him for a checkup in August, my A1C was down to 4.9% so he said I could discontinue the insulin; we'll see how I do without it. I'm very grateful he put me on insulin. Between the insulin, having a supportive endo on my side and lurking in these informative forums, I felt I had much more control than I would have otherwise during a nearly overwhelming time filled with many lifestyle changes.

[foxl]

Margie, are you still on metformin with the Lantus? You of course are THIN (I need a green face for envy ;) ), so it might not be any insulin resistance affecting your insulin needs ... or it STILL could be ... but that is not a huge dose of Lantus, either.

Ti Jae, I do appreciate you chiming in here, since you were DKA, you too have KPD -- ketosis prone diabetes, and it is possible you, like I have got beta-cell insufficiency as well as IR ... some diagnosticians by the way categorize T2 = non-insulin dependence; T1 = insulin dependence or NO insulin secretion. It it a very loose definition.

Please keep us posted on how you do without insulin! It does take about 6 months for beta cells to rebound after a DKA episode, according to one study Mike (Rekarb) posted somewhere in the T1.5 forums ... it sounds to me like your endo followed the protocol I wished MY Endo had followed ... better for your betas. I now see his partner and suspect she would have discharged me on insulin.

have you had antibody testing at all?

[luckharm]

Linda,

No, I stopped the Metformin when I started the insulin, so right now I am only taking 15 units of insulin. This morning my BS was 94 so I was thrilled! Maybe I have finally found the right dosage. I'll keep my fingers crossed.

[foxl]

Linda,

No, I stopped the Metformin when I started the insulin, so right now I am only taking 15 units of insulin. This morning my BS was 94 so I was thrilled! Maybe I have finally found the right dosage. I'll keep my fingers crossed.

Excellent!

.................................................. .................................

[Ti-Jae]

have you had antibody testing at all?
Yes, testing for antibodies was among the first battery of many tests he performed right away while I was in the hospital. The results were negative.

[foxl]

Well we still are dealing with the same issues --possible insulin resistance, and possible insulin insufficiency in unknown quanitities, right Ti-Jae?

[Rekarb]

But why does the blood sugar go high to begin with? Due to some initial autoimmune damage to the beta cells? Or are they saying there are other reasons that blood sugars starts to go up and that rise then initiates the autoimmune damage? I guess I'd heard the hypothesis that there was virus which triggered attack to a similar antigen on the beta cells (in some families, hence the genetic component to the disease).

From what I'm slowly gathering, at least for ADMs, is that the first phase starts going slightly off the track at about adulthood. It then lies low as a mild but persistent hyperglycemia that slowly erodes this first phase as glucose toxicity increases. Of course ADMs typically don't have antibodies, now that I think about it.

Mike

[foxl]

? ADMs? Can you spell out, please? I am learning a lot from you, Mike, and do not recognize that acronym.

If 30% of those initially termed Type 2 do turn out ot have some antibodies, as Joslin quotes ... and what percentage of people are never tested for them ... I am not sure we should assume their absence in any Type 2's.

[Rekarb]

Oh sorry, that's Atypical Diabetes Mellitus. It's another term for Ketosis Prone T2 before they came up with the AB classifications.
It's a good term to keep handy when you're doing searches on KPD being that it is still used widely.

Mike

[eliza0104]

I just saw my Endo last week. She said if my A1C comes back at 6.4 or 6.5% that I need to go on a low amount of insulin (if antibodies/c-peptide show LADA)

[Rekarb]

Don't get me wrong - insulin is fine but you need to have a baseline of bgs to guide your therapy. The A1C is an over all number but your diabetes is day to day. Spikes are my problem, other people have basil problems. Everyone is different. You should do tests to see how high you spike, how long the spike lasts and what you spike on. Try to walk into your Doc's office as fully informed as you can be. You have to be the pilot and let the Doc know they're the navigator.

[liz]

perhaps I was unlucky but my HB1ac was 12.5 last night and i am now on lantus from today previously my results were always in the 12s for the last 2 years, lets hope I get the reduction I need.