[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]

Originally Posted by 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.

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....

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]

Originally Posted by foxl

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]

Originally Posted by 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?

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]

Originally Posted by foxl

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]

Originally Posted by 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.

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

[Rich G]

Originally Posted by 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?

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