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is it time to start insulin?

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#1
Ohana

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Hello,

I have been on this site for a couple of months. My Endo thinks I am a type one, but the more I read on here the more I think I am 1.5. (Ok, well Dr. did say "slow onset" type one, so maybe he meant 1.5 and I didn't know any better at the time to catch that ;))
Anyway, I have been posting on type 1, but after reading, I think this forum much better fits me. So, I hope you don't mind me posting here for a while :).

Negative GAD antibodies (Dr. said they may be initially absent)
he said he could run other tests or wait to see how I progressed. I initially said lets wait (IE: save money)
now I am thinking I want a c-peptide and islet cell antibody.

Is a way to tell if you are insulin resistant/sensitive?

Here is my question.

At what point did you start insulin, or meds?

I have great fasting blood sugars (used to be 70, now more like 85-90)
My post prandial can be anywhere from 120 to 210 depending. I tend to run 180ish at 2 hrs if I have around 40g carbs.
I really was wondering if starting a fast acting insulin for meals would be feasible. I feel awful if I am over 150.
When I do get that high, I stay there for a couple hours - then rapidly drop to 100-120.

Does anyone think I should talk about getting on insulin for meals? Does this sound anything like when you were diagnosed?

Sorry for the long book! any advice would be helpful, thanks :)
OHANA


Type: TBA
Dec. 08.
Humalog and Prandin
A1c: 5.4

:T


[SIGPIC][/SIGPIC]

#2
lorilei

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I just restarted insulin this past month. Since Thanksgiving I was having a hard time staying below 200on diet and exercise alone and was feeling pretty run down...if my doc had it her way, i would have been back on 18 mos ago...I think several members here also helped to sway me with info on cpeptide benefits and all (have you read up on that yet?) as mine had dropped in Nov labs. I do have GAD antibodies..somewhere around 8 I think..and have entered into the other indicators, but did not have the IA2 and IA at first to my knowledge...i'd have to look.

I went on because i felt like i was letting the train run away so to speak...so far, with just fast acting, i have been bouncing around with highs and lows but am hoping the holidays were to blame for that...understandably it is a big decision, but i feel that, hopefully, i have avoided a bigger and more dramatic and damaging slide in the long run...it is a relief to cross DKA off the immediate list i guess...just need to keep a closer eye for those darned hypos again...

lori ;)


Novolog ~ mm523..
ACCOMPLISHED

Still riding...
MS Ride 75 miles on 9/24/11:)
Tour de Cure June 2011, June 2012, June 2013
Livestrong 10k on foot Aug 2011
Treasure Island Tri~ Sept, 2010, Oct 2011

YOLO~ so live....


#3
soso

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Hi Ohana
IMHO now is the time for bolus fast acting for you... you are following the same course as I did, only I started bolus when my pp results were consistently over 7 even on 6-7 g carb.. I just have no interest in damaging my cells more than can be helped.
My fastings stayed good until about a year later, as soon as they were climbing over 5.8 on a reg basis I added basel.. my A1c is 5.2 and I have never had a serious low.. though about 1 per week in the low 3's(today ggrrr) and the odd one sub 3 throughout the year.

Recent study showed that some beta cell activity delays the onset of retinopathy..check out diabetes in control... and as Lori mentioned C-peotide is thought to have several beneficial effects upon the body..

Also.. it is way less stressful to be able to control one's bg and eat a reasonable diet...
SoSo


Dx Sept 2004
A1c 5.5
MDI

#4
David_S

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My PCP started me on a pill for type 2.. at his office when my reading was simply HI.. to high for the meter. The endo started me on insulin in his office that week.. he gave me my first injection right there. The pill did nothing for me at all. I wasn't insulin res. I had no insulin.
[SIGPIC][/SIGPIC]Diagnosed 1.5 10/20/06
Pittsburgh,PA.
Lantus 10 units PM
Novolog to scale and 2 units at dinner

A1C 10/23/2006 14.2 :eek2:
A1c 03/23/2007 6.3 :nurse:
A1c 02/25/08 6.1 ;)
A1c 06/26/08 6.3 :smile:
A1c 10/23/08 6.5 :dontknow:

#5
soso

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Hello,


Is a way to tell if you are insulin resistant/sensitive?





A C-peptide test is useful there.. a very high score in conjunction with high pp tests implies insulin resistance (pancreas pouring it out as body unable to use it)
A very low score obvious for lack of insulin production (though could still conceivably be IR as well)

In the middle still anybodies guess...
Once I started on insulin it became obvious that most of the time I am pretty sensitive to insulin.. not needing big doses for control, finding my doses effective.. that can turn and bite one too though.. a bit too much activity and I have to watch for lows.. I have the odd week here or there where I don't seem as sensitive, esp if I am less active..
Most of the time moderate exercise makes no diff at all to my readings though.
SoSo


Dx Sept 2004
A1c 5.5
MDI

#6
dbc

dbc

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Here is my question.

At what point did you start insulin, or meds?

I have great fasting blood sugars (used to be 70, now more like 85-90)
My post prandial can be anywhere from 120 to 210 depending. I tend to run 180ish at 2 hrs if I have around 40g carbs.
I really was wondering if starting a fast acting insulin for meals would be feasible. I feel awful if I am over 150.
When I do get that high, I stay there for a couple hours - then rapidly drop to 100-120.

Does anyone think I should talk about getting on insulin for meals? Does this sound anything like when you were diagnosed?


Yes, talk about it with the Dr.

WHen to start and which one (basal/bolus) first is not so easy. Your Dr may be hesitant about starting insulin therapy if your PPs are not too sky high and your A1c is still reasonable - he'll worry about hypos. (It seems medical professionals generally are really hung up about hypos.... As a diabetic I get more paranoid about high PPs, but then so far I haven't experienced a "medical emergency" type hypo.....)

As to which one first :confused: :confused:!! When I was at that stage, I felt (from reading up on this forum) I should start by bolusing tiny amounts to manage the highish PP readings, my Dr (diabetes specialist) was quite adamant that "we get the basal right first". In the end I went with his call, but started bolusing for meals as well within 6 months of starting on basal insulin. Maybe it's not desperately important which one (basal/bolus) gets to be first, but I think the general principle is to start insulin sooner rather than later

So, lots of angles to discuss with your Dr!

#7
matingara

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hi. i started insulin 2 months ago. it was my decision. my doctor agreed (as he should - i had done a lot of research).

i started with basal - but added bolus a week later.

i did this because i was getting fasting numbers between 126 and 144 (7-8). i was getting PP numbers of 144 to 180 (8-10) on low, low carb meals.

i would get a number like 162 (9.0) and the fast and fast and exercise until i got the number down to 90 to 108 (6-6). this got difficult and frustrating.

i have remained on a low carb diet - but eat some things that i never dreamed i would again! tonight i had 1/2 a fresh ear of corn on the cob!!! yay!

i am still learning how my body uses food and injected insulin. i have learned that even with NovoRapid (Novolog) i am best to wait a full hour before i eat.

the lowest i have been is 54 (3.0). but i can recognize a low as i get strong hunger pangs and it is relatively easy to correct.

i recommend that you at least discuss this with your Doc. the injections are so, so easy and painless (i am using pens). i actually quite look forward to injection time as i can declare a bit of quiet "me" time where i can calculate my NR dose.

but i am a bit weird.

:)

-- Joel.
[SIGPIC][/SIGPIC]
do not click here...
___________________________

NUMBERS
-----------------
May 2010 : A1C (home) 5.5%: Feb 2010: A1C (home): 5.2% Oct 2009: A1C: 5.7%;
Triglycerides: 53 (0.6); HDL chol: 50 (1.2); LDL chol: 19.5 (0.5); total cholesterol 87.5
Lantus before bed - 30u; Novorapid for meals (averaging 20-30u per day); Lowish carb diet

#8
fgummett

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My inclination would be to start insulin early: based on the logic - mentioned above - that you may help to save some of your remaining beta cell function by effectively "resting" them.

Your Pancreas does a much better job of insulin management than even the best injected insulin, so it is in your best interest to hang on to that for as long as possible. :)

#9
matingara

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My inclination would be to start insulin early: based on the logic - mentioned above - that you may help to save some of your remaining beta cell function by effectively "resting" them.

Your Pancreas does a much better job of insulin management than even the best injected insulin, so it is in your best interest to hang on to that for as long as possible. :)


yeah. i meant to say this as well. it was a major influence for me starting insulin,,,

:)

-- joel.
[SIGPIC][/SIGPIC]
do not click here...
___________________________

NUMBERS
-----------------
May 2010 : A1C (home) 5.5%: Feb 2010: A1C (home): 5.2% Oct 2009: A1C: 5.7%;
Triglycerides: 53 (0.6); HDL chol: 50 (1.2); LDL chol: 19.5 (0.5); total cholesterol 87.5
Lantus before bed - 30u; Novorapid for meals (averaging 20-30u per day); Lowish carb diet

#10
soso

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that was my thought as well.. in my case my fastings were absolutely fine.. in those good old days, it was very rare for my bg to be above 5.6 fasting, quite often in the mid 4's....
I took that to mean my pancreas could handle the small trickle needed to run the background stuff, but just did not have enough oomph to give the big squirt I need for the first phase response to a meal, or any appreciable input of carbs really.
I was able to start on just a unit or two of Fast acting per meal and almost immediately saw my fastings improve to the low to mid 4's as well... this just proved my theory in my mind.
I have seen studies that said that people who still have some c-pep consistently have lower A1c's despite a certain amount of spiking.. that seems like a given to me though as if I spike and for whatever reason do nothing about it, logic says that the insulin production I do have will go toward fixing that eventually, wheras a person who has no insulin production left (or less Ins prod) would not have that facility.
SoSo


Dx Sept 2004
A1c 5.5
MDI

#11
lorilei

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all true Soso...but the spiking is tricky! and can make some feel as if they are losing their minds at some moments...lol...am i talking from personal experience or what...Ohana, i do believe taking insulin to be the right choice for me, at this time, despite the current fluctuations...i'm looking at the big picture!

lori ;)


Novolog ~ mm523..
ACCOMPLISHED

Still riding...
MS Ride 75 miles on 9/24/11:)
Tour de Cure June 2011, June 2012, June 2013
Livestrong 10k on foot Aug 2011
Treasure Island Tri~ Sept, 2010, Oct 2011

YOLO~ so live....





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