Type 1.5's: Start with Basal-only, or Bolus? - Page 3

foxl · #31 (**permalink**) 07-19-2009, 04:46 PM

Quote:

Originally Posted by Rich G

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 · #32 (**permalink**) 07-21-2009, 01:35 PM

Quote:

Originally Posted by Subby

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.

P

foxl · #33 (**permalink**) 07-21-2009, 01:38 PM

Poppy read the post above yours

e||ement · #34 (**permalink**) 07-21-2009, 02:09 PM

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 · #35 (**permalink**) 07-21-2009, 02:15 PM

Quote:

Originally Posted by 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.

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

thanks!

sofaraway · #36 (**permalink**) 07-24-2009, 12:20 PM

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 · #37 (**permalink**) 07-27-2009, 07:09 PM

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 · #38 (**permalink**) 07-28-2009, 08:39 AM

Quote:

Originally Posted by 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?

What, who? Me?

SB_Krista · #39 (**permalink**) 07-29-2009, 12:21 PM

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 · #40 (**permalink**) 07-29-2009, 12:45 PM

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 · #41 (**permalink**) 07-29-2009, 04:51 PM

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 · #42 (**permalink**) 07-30-2009, 07:33 AM

Quote:

Originally Posted by 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..

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 · #43 (**permalink**) 09-15-2009, 10:46 PM

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 · #44 (**permalink**) 09-16-2009, 07:44 AM

Quote:

Originally Posted by 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......

I WILL! I will follow your progress with interest!

lorilei · #45 (**permalink**) 09-16-2009, 10:53 PM

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...