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foxl

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

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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!)

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dbc

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. . . .

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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.

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foxl
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.

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Rich G
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?

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foxl
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

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dbaratta
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. :oP

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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.

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foxl
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!

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sofaraway

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.

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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?

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foxl
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?

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SB_Krista

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!

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foxl

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.

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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..:)

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foxl
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?

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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......

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foxl
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!

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lorilei

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...

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foxl

Lori, I saw my Endo, she is strictly clinical in her management! She took me off Actos, and upped my metformin from 1700 mg to 2000 per day (big whoop, huh), and told me to eat -- get this 40 g of carb per meal. Nope, nope, not gonna!

 

But, she also added Ramipril for BP which I apparently needed according to the Retinologist (he saw vascular changes) she later referred me to ... so it was far from a fruitless appointment.

 

Anyhow she suggested adding Januvia would be next, but I told her I would be wanting to add insulin next, and she seemed open to letting me ... so I will continue to go back to her.

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Simon

Well I started on basal then bolus a week later. That was 4 years ago. About a week ago I went to open my new box of basal to find it was the wrong cartridge and I couldn't use it. That's how I discovered I didn't need it anyway. Been off it a week now and all numbers are on target. Still need to bolus though.

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Subby
Well I started on basal then bolus a week later. That was 4 years ago. About a week ago I went to open my new box of basal to find it was the wrong cartridge and I couldn't use it. That's how I discovered I didn't need it anyway. Been off it a week now and all numbers are on target. Still need to bolus though.

 

Interesting Simon! What was your basal, and how many units, if you don't mind the question?

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Simon

Was on Lantus. Averaging about 8 units a day but I had periods when I adjusted it by about 2 or 4 units each way depending on my morning readings. Mornings are about 6mmol/l now. I am a LADA though so I guess it's just down to very slow onset indeed. Having said that I had ketones in my urine at diagnosis so it's possible that I've actually recovered some pancreas function.

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