Hi everyone! Since I've found out I likely have early LADA, I've been trying very hard to restrict my carb intake. I've read that it's important to stay under 140 as much as possible. To do that, I'm down to eating 25 carbs per meal or less. I'm hungry, irritable and lost 4 pounds in one and a half weeks (I'm only 109 lbs on a 5 ft petite frame). I'm beginning to wonder that I may be going to extremes. My question is how important is it to remain under 140 at 1 hr. postmeal? If I am slightly over 140 at 1 hr (eating 30 grams carbs),I usually come down to under 140 at two hours. I would really appreciate any advice because I feel like I am being overly cautious in my efforts to preserve beta cells.
Unfortunately, bjm, there are no black and white answers. The fact is the less time spent at over 140 the better, but Type 1 is a hard disease to manage and when you come out of your honeymoon it will be harder. If you spend an hour here or an hour there over 140, that is not unusual or extreme. We do our best and the results are not perfect.I only test at 2 hours because that is when my peak usually happens. if you find your peak happens earlier than that is when you might want to test. You can correct if high but you do need to keep in mind the Insulin on Board.
I'm feeling discouraged because I'm left with diet and exercise to manage at this time. Maybe it's my imagination, or the fact that I wasn't testing at 1 hr before, but it seems like when I think I have the magic number of carbs to eat, suddenly I need to go even lower :( I should hear back from the nurse I contacted last week in the next few days. She said she was going to contact another endo to get her opinion since the endo I saw said there is no treatment for LADA.
Welcome to diabetic purgatory where some docs do not know what LADA is. I can tell you just fight that high blood sugar no matter what the label. If it takes insulin, ask for it if needed. It does not discriminate...no matter what the weight, frame or history of family, it is there. Carb counting is important but you need carbs to function. I had to go on insulin to get mine below 140. When I tried to cut out almost all my carbs my glucose levels were worse than ever! Every case is individual as a fingerprint. We have to master our own bodies.
One of the side-effects of a lower carb diet is weight loss. Perhaps you don't need to lose any weight. And you shouldn't feel deprived when it comes to eating. You need to extract nourishment from your food and insulin makes that happen. You probably have a healthy residual native insulin but it may also be lacking at times. If it were me, I'd have a serious discussion about starting insulin.
Do you measure your blood glucose after most meals? How about fasting numbers. Gathering a good cross-section of glucose data will help inform any therapy decisions. I think it would be interesting to use a continuous glucose monitor for 72 hours. I'm sure it would help the doc, too.
You don't look like you need to lose much weight. If your weight loss continues, I would consult your doctor.
Many people that start on insulin remark about how much better they feel. They feel more energy, more alert. If you don't need it, don't use it. If you do, don't feel intimidated to start.
Right now I am testing a lot, so I know what I can eat. My fasting readings have stayed the same although still somewhat low--104 to 115 range. I really don't need to lose weight, but have been down as low as 103 in my younger days :) so if I go that low then I will be concerned. Since I'm getting the impression that I should be under 140 at 1 hr and will have to eat 25 carbs to maintain that, I won't go much longer without pursuing some kind of medication because I am feeling deprived and frankly a bit tired too! Thanks for the good advice..sometimes it helps to know you aren't being too radical.
This might sound harsh: but not using insulin and trying to preserve beta cells is a losing battle. You're stressing your beta cells when you're forcing your body to use the little insulin you have left to handle all of the work it has to do to even handle a few carbs.
You should really look into insulin. It might seem scary at first, and you keep wanting to reject it, but it's better to spend less time at 140 mg/dL than worry about how insulin might make you lower. If you do go on insulin, you aren't going to be using large doses. Chances are your starting i:c will probably be one unit of insulin per 15-20+ carbs where you might only use one unit per meal if you continue to low carb diet. I wouldn't recommend it if you're losing weight (because ketosis, I don't know if it would happen at 75 carbs a day but it might?) but that could also be due to poor glucose control . You might not even be seeing the full picture and it's likely doing more damage to your body when you're mentally resisting insulin and refusing insulin instead of going on a very low dose of insulin. Ask for a reusable pen with half units (like a novopen junior or echo for novolog or a humapen luxura hd for humalog) , and ease yourself in with half units of meal time insulin? Also possibly a very small dose of lantus or levemir every day ? (like less than 4 units of either?) . Chances are you'll honeymoon after starting insulin and might have to ditch it for a while again or use even less like one unit of anything per day but you still need to keep in mind that the day will come that you will need it and need it right then and there . So you need it in your fridge at least.
Seriously, I'm not trying to be harsh or mean, you'll do yourself good by asking for insulin. I've been in a similar place, though I wanted insulin but wasn't getting it with a previous doctor and I was starving myself to maintain high but not deadly high numbers every day. You're not gonna get better and have better numbers until you suck it up and get on some insulin. If you're feeling hungry and irritable , it is at least time for a very conservative small dose of insulin so you don't feel so crappy and can eat food and maintain your weight.
"No treatment for LADA?" LADA is Type 1 and there is treatment for that. The treatment is insulin. Studies show that insulin should be started as soon as possible to protect beta cells.
You might find the Low Carb Dietitian's website useful. Franziska Spritzler has been successfully controlling a pre-diabetic situation like you report. She uses diet and exercise to control her numbers.
Insulin helped me a lot more than anything. Finding a doc that was not scared of putting me on it was an issue for a while. My 1st Endo did not want to delve into insulin because I lived by myself at that time. Knowledge is the best way to arm one's self though. Learn your body and do not be scared of shots. They are so much better over the years.
You've received very good advise and I agree that you should consider starting on insulin even if it's just a bit of basal. But in response to your question - 140 at one hour might be harmful over the next forty years but the incremental damage that you're doing to your body over the course of a few weeks or months is probably minimal.
You can slow your blood sugar rise by increasing the fat you eat with meals. Peanut butter, olive oil and avocado can help you keep weight on and slow the blood sugar rise which in your situation may give your pancreas a chance to catch up. But again, using insulin to give your pancreas a break can preserve beta cells and make your diabetes easier to manage for YEARS.
My doctor was a bit reluctant to put me on insulin even, mostly because he wanted all of the lab work to go through first before giving me any, but it was pretty clear I needed it on the first appointment and he honestly hated not giving me any , my cde got him to put me on lantus first at least and I was on humalog shortly after that (though I switched to novolog for MANY reasons...) . I think I've already told the OP this but insulin was a life changer, I went from starving to eating what I want and feeling mostly better (I have a few other health battles that make it still less than great a LOT of times). My other conditions might make me feel bad in other ways but the feeling I had when I wasn't on insulin is gone. Unless I'm dealing with the one issue (that usually only comes once a month) I'm energetic and perfectly healthy feeling.
Yes don’t forget exercise. Exercise greatly increases my insulin sensitivity. But many people aren’t as sensitive to exercise as I am.
Hi BJM: As others say, and as I have said to you, insulin will make all the difference. There is simply no reason to go extreme low carb (and exercise a lot) when what you really need is exogenous insulin, IMO. I at one point tried a very low carb diet, and I was crazed hungry, had horrible headaches, and was really crabby. So I don't low carb, because I don't want to live like that. Regarding the "magic" 140 (or IMO more like the mythical 140), that is a concept promoted on BloodSugar 101 but not backed by science. First, if you look at all the references the BS101 uses for the "Magic 140," not one reference actually says that damage will occur above 140. As TuD member FHS says, it's just a matter of reading through the actual papers and seeing that nowhere in any of the methodology, results, or conclusions do the papers actually say anything about finding, or even looking for a threshold BG where damage starts to occur. Second, every single reference uses only Type 2s for study subjects, and as stated in The Type 1 Diabetes Sourcebook (ADA/JDRF 2013), it is not appropriate to extrapolate from studies on Type 2 subjects to Type 1 patients because T2D and T1D are different diseases. So I would say, 140 is not a magic number, but the way to preserve beta cells is to initiate intensive insulin therapy (whatever that means for the particular individual--it may mean just a few units of long-acting insulin).
140 at 1 hour is probably not harmful as long as its coming back down instead of continuing to skyrocket— like others have said though if that’s the absolute best your pancreas can do, if its totally maxed out to manage that—its a little like saying you’re trying to keep a 30 year old wreck of a car running as long as possible but then driving it as fast as it can possibly go constantly… It needs new parts, new oil, like a diabetic needs insulin…
I'm so glad I read this thread - to see that you're advising someone with such levels to already go on insulin, now I know there is no question for me whether to start insulin or not. My levels got a bit better last few days (I'm thinking it might have bit a rebound stress response) but are still higher than 140, actually, I haven't gotten post-meal reading under 155 for some time now and my BG is usually around 160 at 1,5h-2h.
We should strive for setting achievable goals and then seek to meet them most of the time. The 140 mg/dl idea is backed by a range of studies and observations. The DCCT found that complications rise dramatically as your blood sugar rises. And many blood sugar control goals were established based primarily on that landmark study. The ADA adopted 7% and the AACE adopted 6.5% as HbA1c goals. Guess what an A1c corresponds to as and average, 140 mg/dl. There are a range of studies that suggest that 140 mg/dl is probably in the range where bad stuff starts to accumulate. And damage is proportional, the higher the blood sugar the more accumulated damage.
But you should be meeting goals (whatever you choose) most of the time. If you are 140 mg/dl at 2 hours then you have probably spent 2 hours above 140 mg/dl. And if you eat three times a day and have two snacks then you are spending nearly half the day above 140 mg/dl. The concept of "time-in-range" is gaining momentum and it makes sense. Damage over 140 mg/dl is cumulative and proportional. Don't worry about your reading at 1 hour, worry about 2 hours and set your (achievable) goal and try to get your readings most of the time be in that range.
ps. And realize some people here struggle to get a before meal reading of 140 mg/dl let alone feel like they can control their blood sugars after eating so tightly.
I think the two hour reading is the one you need to worry about most. I have tested myself and my spike is sometimes at 45 minutes to 1 hour, but sometimes at 3 hours, it varies quite a bit. You can tell with more frequent testing or an accurate cgm how long you actually are spending at a higher or lower levels than at the numbers you would like to be at most.
I actually have not read the studies about where damage starts to occur and it would be nice if people who feel 140 is or is not the danger level would list those studies. I do start to feel not so great at 150-160's and above usually though.
However even with low carb, insulin and more I still cannot stay in the range I would like to be in all of the time: I aim for 70-120 most of the time. The thing is on insulin, there are many other factors you have to take into consideration, your activity, when basal will kick in and run out, will this overlap with mealtime fast acting insulin, are corrections far enough apart from each other and mealtime and basal insulin in order to stay stable and to avoid bad hypos. This isn't simple to do at all if you fluctuate a lot and have dp as I do.
I hope you get to a doctor who will put you on insulin soon, I think that could help you a lot and you probably will only need very low doses at this point.
This is an important point.. I don't think it's a good idea to correct at all until at least 3 hours after your bolus, unless you suspect you miscalculated and you may spike more etc., because you can cause a hypo or even a spike with more insulin- the insulin on board and the basal will probably end up dropping you down on their own.
Thank you everyone for the support..I've checked out a few other Diabetes forums and always come back to this one because of the vast knowledge and experience :) I'm not opposed to insulin although I think I have numbers that are too low to go that route yet (because of potential hypos). My problem like many is getting to see an endo that is local to me (the one at NIH was part of a study and is out of state. I can try again to get a referral from my family doctor with the new information I received about being GADA positive, but he is a country doctor who is used to treating type 2. I actually had to see a doctor an hour and a half a way who would treat my thyroid issue since my levels returned to subclinical on the labs after my bout with thyroiditis. I see the doctor treating my thyroid problem on Monday and I will tell him about the LADA and hopefully he will be up to date on treatment for it. Other than that option, I did object about the endo who saw me to the RN who is the protocal nurse for the study at NIH and she said she will contact another researcher to get another opinion. In the meantime, I'm just concerned about slowing the progression if I can. If I don't test at 1 hr, I miss some of the spikes. This morning my fasting was higher (119) even with the reduction in carbs, so it's frustrating and doesn't make sense to me.