Jump to content
Diabetes forums
  • Welcome To Diabetes Forums!

    Registration is fast, simple and absolutely free so please, join our community today to contribute and support the site.

Archived

This topic is now archived and is closed to further replies.

foxl

At what A1c or avg fasting did you start insulin?

Recommended Posts

foxl

Okay, it appears to be up to me ... I do not want to start insulin yet, not with fastings in the 80's and 90's and rarely, peaks over 120 ...

 

But, when DID you start, as a LADA or whatever, using insulin to preserve your beta cells? What criterion or criteria did you or your MD use?

Share this post


Link to post
Share on other sites
jtausch

When I was in the hospital the had a endo see me and he put me on insulin because of my foot and because my insulin was at greater the 160 said insulin for better control. I agree it gave a lot better control

Share this post


Link to post
Share on other sites
butterflykisses

By the time I was properly diagnosed I was already on insulin. :( Had I known from the beginning I would have asked to start bolusing with meals when my BG's started growing after meals. In the beginning my fasting BGs were okay, after breakfast I would rise, maybe come down a bit by lunch. Then came lunch, you get the picture. I think some mealtime insulin would have preserved beta cell function for a while...but then who really knows for sure?

Share this post


Link to post
Share on other sites
retired60

My a1c's were running 7.2 to 7.4%. I asked the doctor to put me on insulin. With a little insulin it is very easy to control as you can see by my a1c's.

Share this post


Link to post
Share on other sites
foxl

I find what the endo-on-call did to be less than appropriate and think even the new Endo is not too impressed and he was a partner ... he had me on insulin for 2 days in hosp, but sent me home on oral meds, not even knowing how I would tolerate them. No beta cell rest there! I probably could be on a minuscule basal or just bolus and do okay now ...

Share this post


Link to post
Share on other sites
luckharm

My A1c was 8.9 and my fasting BS was 180 to 250 when I started on 10 units of Latus 1 time per day. This was only a few days ago and already my numbers are improving. My fasting Bg this morning was 124. I wish I had done this sooner instead of denying myself carbs for months just to keep under 200.

Share this post


Link to post
Share on other sites
foxl
My A1c was 8.9 and my fasting BS was 180 to 250 when I started on 10 units of Latus 1 time per day. This was only a few days ago and already my numbers are improving. My fasting Bg this morning was 124. I wish I had done this sooner instead of denying myself carbs for months just to keep under 200.

 

OMG that is high! Was it because you were insulin-phobic, or ... ?

Share this post


Link to post
Share on other sites
Subby
OMG that is high!

 

Is this a respectful and tactful tone when discussing someone elses possibly tricky situation? I don't think I'd want anyone using that tone with my trends whatever was going on.

Share this post


Link to post
Share on other sites
foxl

Sorry Subby, I did not mean it impolitely, I do not know Luckcharm nor she me, so I guess it did sound rude.

 

I just know I would have been freaking out, way before hitting that point.

 

As someone who was at 447 at DX, I did not mean she was using poor judgment or was on the verge of dying or anything! I just know I would have been upset. And I am asking for info so I can base my decision (since it appears to be MINE, not my Endo's) to go onto insulin on others' experiences, and worrying about not being there yet ... so yeah that sounded high to me - maybe as in wow your nubers are high, but also as in, well if your MD let you go that high, I have a ways to go.

Share this post


Link to post
Share on other sites
Subby

No worries - and no need to apologise or explain. I just know, when you've been struggling with difficult BGs for some time whether you are doing the right things or not, that such throwaway lines (usually not meaning anything too judgemental - but you never know) can be very negative sounding, a real kick in the guts. Not always, but sometimes.

Share this post


Link to post
Share on other sites
zoelula

I had been stable on oral meds for a bit more than a year (misdiagnosed as Type 2) when my numbers started a slow but steady climb (last September) I waited perhaps longer than I should have to go to the doctor (December) and say, ok, this is no longer working. Then my doctor wanted to try one more oral med first (again thinking Type 2) then started me on bolus only at too high of a dose so I was hypo by mealtime and still very high postprandial. I would have to look at my old notebooks to remember what happened when. I think by the time I went to the doctor and said we have to change something my fastings were around 140, and my post prandials were in the 200s. Right before the time I actually got on the right regimen (diagnosed myself as LADA) my postprandials were spiking into the 300s and even 400s a couple times. But like I said I waited too long.

 

But remember, Linda, I was not controlling my carb intake AT ALL in those days (only not eating sugar). Besides being more recently diagnosed than me (I just had my two year anniversary), I wonder how your numbers would look if you were eating without any consideration of carbs?

Share this post


Link to post
Share on other sites
foxl

 

But remember, Linda, I was not controlling my carb intake AT ALL in those days (only not eating sugar). Besides being more recently diagnosed than me (I just had my two year anniversary), I wonder how your numbers would look if you were eating without any consideration of carbs?

 

I tried to argue that with Endo ... she said she wanted me on 40 g carb per meal, in part b/c I told her when I "tested" with that my peak BG was around 120. I told her I thought I would exhaust my insulin reserves more rapidly at 40 g per meal and that 120 would then not be the case!

 

AND she wants me to lose 10 - 20 more lb ... how would TAHT work?

 

I definitely think low-carbing is keeping me from being prescribed insulin ... but, is that a BAD thing? I think not. And I do not really want to prove myself right by eating higher carb and gaining weight, in order to do it! Or going DKA again ... another possibility.

Share this post


Link to post
Share on other sites
dbc
But, when DID you start, as a LADA or whatever, using insulin to preserve your beta cells? What criterion or criteria did you or your MD use?

 

When the A1c drifted up to 6.5% after being down at 6% on diet, exercise and metformin for about a year. Doctor's criteria was the 6.5% threshold on an upward trend.

 

We had discussed starting insulin before, when the A1c was around 6.3% (on a VERY restrictive low carb eating plan). At that time he wasn't in favour because of possible/probable hypo issues. We also didn't know each other well enough at that time, and I suspect he had me labelled as a 'normal' patient who would not apply himself properly to managing things and would therefore be likely to experience hypos. He now knows otherwise and largely agrees with everything I suggest ;)

Share this post


Link to post
Share on other sites
tealas

I definitely think low-carbing is keeping me from being prescribed insulin ... but, is that a BAD thing? I think not. And I do not really want to prove myself right by eating higher carb and gaining weight, in order to do it! Or going DKA again ... another possibility.

 

Just a suggestion, along with low-carbing you may want to explore ratio of raw to cooked foods in your diet.

 

I've been on Humalog for about 5 years, and was starting to feel like I could not control the post-meal spikes and was unhappy with this. I tried Byetta which controlled the spikes but I had horrible GI problems from it. Then I stumbled into doing more raw foods (I aim for about 75% - mostly salads and green smoothies or veggie soups made in a VitaMix). I was really surprised to see that I could eat 2 fruit exchanges in a green smoothie, (but blended with two large handfuls of spinach or chard and 1-2 tbls chia seeds), and see my blood sugars go down to 78! For me at least there is something very restorative about getting more raw greens. If you search on YouTube they have some documentary films about a 30 day raw diet challenge for diabetics and how it helped many (mostly Type 2, but some Type 1's) to lower their levels of medications.

 

FYI - I'm not personally in favor of the 100% raw vegan approach all at once. Natalia Rose has a great book (avail on Amazon) about stages of incorporating raw foods into ones diet, "Raw Food Detox Diet: The Five-Step Plan for Vibrant Health and Maximum Weight Loss." This book has excellent reviews on the Amazon site - the reviews alone gave me a good bit of information about the benefits and potential pitfalls of shifting to a diet with more raw foods. You can get most of the benefits of raw foods just by shifting 2 out of 3 meals raw, and then having good quality cooked poultry/fish/meat OR starch and veggies. Rose is big on food combining - and I think it is very important for detoxification, which I think as diabetics we are always needing (due to oxidative stress).

Share this post


Link to post
Share on other sites
foxl
Just a suggestion, along with low-carbing you may want to explore ratio of raw to cooked foods in your diet.

 

I've been on Humalog for about 5 years, and was starting to feel like I could not control the post-meal spikes and was unhappy with this. I tried Byetta which controlled the spikes but I had horrible GI problems from it. Then I stumbled into doing more raw foods (I aim for about 75% - mostly salads and green smoothies or veggie soups made in a VitaMix). I was really surprised to see that I could eat 2 fruit exchanges in a green smoothie, (but blended with two large handfuls of spinach or chard and 1-2 tbls chia seeds), and see my blood sugars go down to 78! For me at least there is something very restorative about getting more raw greens. If you search on YouTube they have some documentary films about a 30 day raw diet challenge for diabetics and how it helped many (mostly Type 2, but some Type 1's) to lower their levels of medications.

 

FYI - I'm not personally in favor of the 100% raw vegan approach all at once. Natalia Rose has a great book (avail on Amazon) about stages of incorporating raw foods into ones diet, "Raw Food Detox Diet: The Five-Step Plan for Vibrant Health and Maximum Weight Loss." This book has excellent reviews on the Amazon site - the reviews alone gave me a good bit of information about the benefits and potential pitfalls of shifting to a diet with more raw foods. You can get most of the benefits of raw foods just by shifting 2 out of 3 meals raw, and then having good quality cooked poultry/fish/meat OR starch and veggies. Rose is big on food combining - and I think it is very important for detoxification, which I think as diabetics we are always needing (due to oxidative stress).

 

tealas, I am an ovo-lacto vegetarian. And I have a family of 3 kids, and work fulltime. Sorry but until I see something evidence-based in favor of it, I am not going to further complicate my diet and meal-planning.

Share this post


Link to post
Share on other sites
zoelula

 

I definitely think low-carbing is keeping me from being prescribed insulin ... but, is that a BAD thing? I think not. And I do not really want to prove myself right by eating higher carb and gaining weight, in order to do it! Or going DKA again ... another possibility.

 

Nope, definitely not a bad thing. I was just pointing out that my pattern of increase in blood sugar would be very different than yours because of the diet aspect. It does seem, though as though the protocol for insulin usage is still based on need (high blood sugars) not the concept of slowing beta cell death, doesn't it?

Share this post


Link to post
Share on other sites
foxl
Nope, definitely not a bad thing. I was just pointing out that my pattern of increase in blood sugar would be very different than yours because of the diet aspect. It does seem, though as though the protocol for insulin usage is still based on need (high blood sugars) not the concept of slowing beta cell death, doesn't it?

 

Ohhhh, yes it is. And I am not altogether thrilled ... but we will see!

 

I will be interested to see how long I last (without pushing it) until I have another beta-cell loss. Perhaps low-carbing will help, according to some studies it should, but who knows what causes the occasional episodes of attack on them by T-cells?

 

One theory is that it is episodic and triggered by viral infection or other immune-system stressors ... maybe, a nadir of Vit D? So many variables involved. Perhaps your diet post initial dx had NOTHING to do with it, Zoe!

Share this post


Link to post
Share on other sites
RobinP
My A1c was 8.9 and my fasting BS was 180 to 250 when I started on 10 units of Latus 1 time per day. This was only a few days ago and already my numbers are improving. My fasting Bg this morning was 124. I wish I had done this sooner instead of denying myself carbs for months just to keep under 200.

 

Your numbers sound like what mine are now. The pills I'm on aren't doing much and I'm eating the best I have in years. Low carb and no junk foods. My dr did mention insulin at my last visit, so we shall see. I go back later this month.

Share this post


Link to post
Share on other sites
foxl
When the A1c drifted up to 6.5% after being down at 6% on diet, exercise and metformin for about a year. Doctor's criteria was the 6.5% threshold on an upward trend.

 

We had discussed starting insulin before, when the A1c was around 6.3% (on a VERY restrictive low carb eating plan). At that time he wasn't in favour because of possible/probable hypo issues. We also didn't know each other well enough at that time, and I suspect he had me labelled as a 'normal' patient who would not apply himself properly to managing things and would therefore be likely to experience hypos. He now knows otherwise and largely agrees with everything I suggest ;)

 

dbc, I overlooked your post earlier. This is exactly what I was looking for -- and your detailed explanation of "why that threshhold" was very helpful! I tried to get my Endo to answer this -- at what A1c would you suggest starting insulin, and she kinda dodged it but I am sure she has a level in mind, too! And I am sure some of that does have to do with concerns over hypos.

 

Thanks!

Share this post


Link to post
Share on other sites
sarahspins

Like others, I was already taking insulin when I was finally correctly diagnosed... there really wasn't any time after my initial diagnosis of GD where I didn't really "need" insulin... however there was a time when I was told to stop taking it and my #'s were constantly in the 300+ range... my doctor really didn't seem to be concerned with that, even though I definitely was (and I felt horrible... and it's no wonder since I was likely on the verge of DKA several times).

 

I really think some doctors are just complete idiots, and that's the explination for why some people are "allowed" to run higher numbers (sometimes VERY high) before starting on insulin or even having it recommended to them. A lot of doctors really see it as the last possible option and want to avoid it at all costs - seemingly even if that cost is the patient's health. I was asking to take insulin and being told no... that still just baffles me.

 

If I hadn't self-medicated I am sure I would have gotten very very sick in a short time.

 

Despite all of that I had a relatively long honeymoon if you count from my initial GD diagnosis.. following that pregnancy I needed very low doses of insulin for about a year.

 

It's really something that seems to be unique to everyone... even for a classic T1 and not a LADA/1.5, there's still quite a lot of variability in progression and insulin requirements. Some people don't honeymoon at all, others honeymoon for quite some time.

 

Even though my diagnosis took a while and my honeymoon lasted nearly 18 months, I still consider myself a T1 and not a 1.5. I had positive antibodies for everything.. which sealed the T1 designation for me. I think being on insulin immediately while I was pregnant likely did preserve quite a bit of my beta cell function.. and I was diagnosed before going into DKA. I had low-normal c-peptide results for a year... which I think is part of what served to confuse my first doctor and convince her I had to be a T2. Clearly I did need some additional insulin, but she was convinced my body was making "enough" based on lab results when it clearly was not.

 

My personal advice? I would request an RX for insulin (at least rapid) and keep it on hand in case you need it... since you test often and seem to be on top of things, you'll know when you start seeing #'s that you just can't manage with diet. Murphy's law says that when you need it, it's going to happen on a weekend or some other time when it's inconvenient to get ahold of your doctor and get a prescription called in. I don't know that I would start on insulin "just because" - if you're comfortable with your current management then there's no reason to change things, only to be prepared for the unexpected.

Share this post


Link to post
Share on other sites
SB_Krista

My Endo started me on Lantus last week based on my HbA1c being steadily stubborn to dropping below 6.5% with my low carb diet, exercise, and trial periods on metformin er and now Januvia. I seemed to be stuck around 6.7% and he doesn't want me to lose any more weight and would like me to not be so restrictive with carbs. My morning readings, before Lantus were conisistently 120-140 and I don't think I ever dropped below this range.

Share this post


Link to post
Share on other sites
Ategeler

Well I started insulin when I was diagnosed during pregnancy. Then went off after having baby. Then when my fastings starting increasing from the 80's into the 120's they put me on long acting. Since then, I have progressed to needing fast acting with certain meals too. I seem to be creeping. My Dx came in Nov. 2006 and I just started taking the Levemir Dec. 2008. So I guess it was about 2 years from diagnosis that I needed to take the long acting. Ironically, I never took long acting in pregnancy since it never effected my fastings. I only took fast acting with meals. When I started taking insulin after pregnancy it was opposite--first long than short.

Share this post


Link to post
Share on other sites
tealas
tealas, I am an ovo-lacto vegetarian. And I have a family of 3 kids, and work fulltime. Sorry but until I see something evidence-based in favor of it, I am not going to further complicate my diet and meal-planning.

 

Yes, I bet my message came across differently than I intended. It can be hard to communicate 100% accurately via message boards and emails. I wasn't so much saying "here jump on the raw bandwagon because it worked for me," as "Hey look at how much of a difference this seemed to make for me, keep an eye out for it."

 

Realistically I doubt there would be enough double-blind, controlled studies to allow for an evidence-based medicine review on raw foods & diabetes. I did a quick search and there was a successful (though small) double blind study on raw foods and Crohns. But as a MODY3 I have spent my life dealing with a disease that no one new much of anything about - so I'm probably more comfortable with being off the beaten path so to speak.

 

I can also understand about having a busy family/work life - I am a mostly single parent of a 4 year old (also a MODY3), and my 69 year old handicapped father lives with us (I basically case manage or perform all his care). I work full-time in a high tech job where I commute 2 hours a day and often do work from home late at night/early am. So I would be the last person to manage a dietary change that was labor intensive to implement!

Share this post


Link to post
Share on other sites
MrsMia
Okay, it appears to be up to me ... I do not want to start insulin yet, not with fastings in the 80's and 90's and rarely, peaks over 120 ...

 

But, when DID you start, as a LADA or whatever, using insulin to preserve your beta cells? What criterion or criteria did you or your MD use?

 

Linda, these are some good questions. As you know, there are alot of similarities between our cases of diabetes. We both were in DKA when diagnosed and both are currently on just oral medications. I know that if I get off the medications or have them reduced and my A1c and other BG numbers start going up then I will want to be put on insulin. Truth be told, I'm not crazy about the whole, medications/diet/exercise routine that I must go through every day just to get some decent numbers. I don't have a life and the pressure is incredible to keep up all this. I can't even imagine what my numbers would be like if I slacked off just a bit. I'm not shrinking from hard work for my health. It's just that it doesn't seem to get easier even to maintain what I'm doing. It's always difficult.

Share this post


Link to post
Share on other sites
zoelula

Actually from everything I read about LADA/1.5, my beta cell death/rising blood sugars were well within the expected time frame of a few months to 4 years. (I was around 14 months when it started).

Share this post


Link to post
Share on other sites

×

Important Information

By using this site, you agree to our Terms of Use.