[kimbo]

Geoff,thanks for your help.I understand what you mean,I will study the carb values on lables now and see if I can get a good understanding of portions ect and get a head start before I see the dietician next tues.

I think I will need a calculator before each meal

[kimbo]

I saw the dietician,she told me 1 unit to 10grams of carbs.Sometimes I am ok with that and sometimes I think its too much but that could be my inexperience of carb counting.I am playing around with the insulin at the moment and keeping a food diary so eventually I may work it out for myself.

[lottadata]

Knowing what kind you have can make a HUGE difference in figuring out the right insulin dose to use.

My doctor assumed I was type 2 because I was diagnosed in my late 40s and had put on a bit of weight at the time. (It all came off with a low carb diet.)

When my family doctor decided I should start Lantus because my fasting bg was rising despite metformin and a very low carb diet, he prescribed the usual starting dose for a Type 2: 10 units.

Because I've had bad experiences with overdoses of drugs at normal levels, I started much lower, which was a good thing, because at 6 units I was hypoing. I never got up to 10 which probably would have put me in the hospital.

If you have MODY-1 or MODY-3 (which we suspect I have), another important point is this: The defect here is mainly in the ability to produce insulin in response to incoming glucose.

I do much better injecting fast acting insulin to cover meals than I do with any basal insulin. When I keep my meal time blood sugars normal (85 by 2 or 3 hours) my fasting blood sugar will be normal too.

My usual dose of R or Novolog (I use both depending on circumstances) is 2-3 units which works out to an insulin/carb ratio of 1:15.

I still take Metformin, btw. It keeps me from gaining weight and it makes it much, much easier to get to completely normal numbers without risk of hypo. It reduces my need for insulin by about 1/3. That's only a unit or so, but the insulin works so much better with the metformin, as far as lowering the blood sugar swiftly that I wouldn't be without it.

[Funnygrl]

Type 1s are often started at 10 units, or even more as well of Lantus. Less than 6 units is an insanely low dose for anyone but a small child.

[lottadata]

That is the point. My very strong response to very small doses of insulin are characteristic of several of the MODYs. That's why it is so important to know the diagnosis.

The other characteristic of several kinds of MODYs (MODY-1 and MODY-3), which I was told by someone at the Exeter UK clinic that has published the most research about them, is a very strong response to tiny doses of a drug like Amaryl. I took 1/8 of a 1 mg amaryl pill, ate 1/2 of a large bakery scone (50 grams of carb) and promptly dropped to the 70s within an hour after eating. I spent the rest of the day chugging carbs to stay in the 80s!

I've heard from other people with MODY who have had similar experiences. They've also had a heckuva time getting support from doctors who think they are nuts or imagining that they have diabetes because of the benign fasting blood sugars and 6% a1cs.

In my case, to defuse the idea that my diabetes was all in my head, I asked my endocrinologist to run a non-fasting test. When I came back to see her after she'd seen the test result she said, "What on earth did you eat????" I told her I'd only eaten one small whole wheat muffin from the health food store cafe. (It's a small town and she eats there, too, so she knew exactly what I was referring too.). After she saw the diabetic level blood sugar reported on that test, (despite a full dose of Metformin) she became very helpful to me, though she admitted she wasn't at all sure how to prescribe insulin because she'd never had a patient with this response.

She was even more supportive when my A1c started to drop after 2+ years of refusing to budge no matter how much Metformin or Avandia was thrown at it.

[sofaraway]

Originally Posted by lottadata

If you have MODY-1 or MODY-3 (which we suspect I have), another important point is this: The defect here is mainly in the ability to produce insulin in response to incoming glucose.

Originally Posted by lottadata

The other characteristic of several kinds of MODYs (MODY-1 and MODY-3), which I was told by someone at the Exeter UK clinic that has published the most research about them, is a very strong response to tiny doses of a drug like Amaryl.

I've heard from other people with MODY who have had similar experiences. They've also had a heckuva time getting support from doctors who think they are nuts or imagining that they have diabetes because of the benign fasting blood sugars and 6% a1cs.

i found this, for several years my A1c was below 7% and my fasting blood glucose was non-diabetic range, as soon as i ate my blood sugar would rise. i had a GTT to confirm the diagnosis.

i started on gliclazide 20mg (1/4 tablet) and had awful hypo's (2-3 days hospitalized), when i took 2 whole tablets.

now i've ended up on insulin as it has been progressive and i produce little of ym own insulin anymore.

[Kimber]

Funnygrl,
I am currently on 6 units lantus and have had too many hypos at 50 BG. I am wanting to go to 5 units or even 4 and will ask at my upcoming appt. I am 44,
"double diabetes -or- type 1.5" depending on who you ask, 1000 mgs metformin, actos, synthroid, daily. I am hoping this "insanely low dose" will stop my low bg events.
Kimber

[Funnygrl]

Originally Posted by Kimber

Funnygrl,
I am currently on 6 units lantus and have had too many hypos at 50 BG. I am wanting to go to 5 units or even 4 and will ask at my upcoming appt. I am 44,
"double diabetes -or- type 1.5" depending on who you ask, 1000 mgs metformin, actos, synthroid, daily. I am hoping this "insanely low dose" will stop my low bg events.
Kimber

You don't have double diabetes. Type 1.5, probably. Double diabetes- no. Double diabetes is when a person has marked insulin resistance, and an obvious autoimmune attack on the pancreas.

[Kimber]

Funnygirl,
My endo tells me test results show GADantibodies, (autoimmune disoder) and insulin resistence. Am on both metformin and Actos for the insulin resistence. Also have antibodies against my thyroid (Hashimotos disease). Am on Synthroid for that. Woke up again today with BG of 60. I suppose better low than high but still, I would like to find a happy medium (like us all.)
Kimber

[BlueSky]

Originally Posted by Kimber

... My endo tells me test results show ... insulin resistence. ...

What test did he do to show this? The fact that such small amounts of insulin are causing hypos suggests that you are very insulin sensitive.

[Funnygrl]

Originally Posted by BlueSky

What test did he do to show this? The fact that such small amounts of insulin are causing hypos suggests that you are very insulin sensitive.

Well, she's on Actos and Metformin too, plus Lantus, I can see her not needing much.

[Kimber]

Funnygirl,
My endo said the hope with the orals was to not need much insulin. We were hoping to protect what is left of my pancreas for as long as possible. We have already scaled it back once from 8 to 6. Yesterday was confusing, started the day out at 60, then went to 160 (before dinner!) so ate no carbs for dinner and promptly went to 58. Something needs to stabelize, perhaps I need less orals? I have read that type 1's should not take actose, I am thinking I need to move up my next appt and ask because I have too many lows and I drive a lot. Makes me nervous. Have just switched to the lantus pen and loving it. So much easier to use than the syringes for me. By the way, thanks for the conversation. I love to hear other's opinions.
Kimber