Just curious...how many carbs are you taking in per meal and snack with those numbers ? over 35 grams put me at those numbers 2 hrs post meal.
I would suggest that the only way you're going to know if you're at the point of needing insulin is to start eating a diet more in tune with where you want to be regarding the number of carbs and continue keep track of your post-meal numbers. Even if you skyrocket some of the time, I think seeing those numbers on paper may be the only thing that will really help an endo feel that insulin is necessary. I tend to be less conservative than the average TuD member when it comes to my numbers and I don't feel that even going up to 180 after some meals is a problem, provided I'm coming back down after that. Avoiding carbs to keep your numbers down at this stage of the game seems to be primarily serving to keep the doctors from seeing you actually have a problem. I was a very slow onset LADA and needed only bolus insulin for the first 18 months or so after diagnosis. My insulin to carb ratio in the beginning averaged about 1 to 20 and sometimes 1 to 25.
Good luck in finding the right doc who will listen to you!
This response reflects my experience with endos giving out insulin. I'm also slow onset LADA, caught early, diagnosed ~18 months ago and still on 3 units of basal and no bolus. I can control my post-meal spikes with low carb, <20g per meal, but sometimes I indulge with a starchy veggie or fruit. As a result, my 2-hour numbers range from 100-180 mg/dL. My endo is looking out for my best interest; her primary concern is to not cause lows when my A1C is great and most of my glucose readings are acceptable with a few random highish numbers. I'm happy with a lower carb diet, so happy with that decision, but it sounds like low carb isn't working for your body. I suggest eat what is healthy for your metabolism and give your endo some relavant readings to work with. Best wishes!!
well, my last meal was just around 35-40g carbs and my 2h post meal reading (+I walked for 15min in this time) was 160.
No.
I respectfully disagree with Zoe. There are some black and white answers.
I feel quite comfortable stating with confidence there is no reason to be concerned about 1 hour at 140. Many, many non-diabetics spend an hour up there postprandial.
That being said (just looked at your profileā I would be surprised if youād find a doctor whoād prescribe you insulin at this point-- with an A1C of 5.6 I suspect they would not be willing toā¦ So Iād keep doing what youāre doing and keep close tabs on thingsā if you are truly LADA you will need insulin, but I doubt theyāll rush to put you on it unless you start seeing substantially elevated by levels and a1c
She has had 200 mg/dL+ readings before, and has type 1 autoantibodies. She's not telling the story here entirely, but she's eating very little just to maintain the 140 mg/dL reading because if she eats anymore she goes much higher.
krisa, I've followed the discussion you started on this.
There is no question at all in my view that, based on your numbers, you absolutely need to be treating your condition with insulin.
Stripping away all the labrynthine subthreads in that discussion, it boils down to these simple rules: Be under 110-120 before eating. Never go over 200. Back under 110-120 within 3 hours postprandial.
If you can't meet those criteria, you need to change your treatment protocol. For T2s, there are a variety of non-insulin drug treatments that can achieve these goals, but many of us believe (backed by research) that this is exact wrong way to go -- stimulate beta cells and burn them out; rather, insulin, taking pressure off beta cells, is far superior.
Also, you have much much more control with (bolus) insulin. You can be both proactive and reactive. Pills aren't really any sort of "control" in my opinion, but rather a very blunt instrument to get BG in line. However, this approach will control you, forcing certain eating schedules, for example, and seriously limiting diet flexibility.
For a T2, basal insulin as a treatment really isn't any different from a practical standpoint than pills. It as the advantage of relieving beta cells, but otherwise it's the same as pancreatic stimulants.
The best approach for ALL diabetics is bolus insulin. Any diabetic, at any stage of progression of the disease, should have fast-acting bolus insulin available as a treatment option if they're willing to learn to administer it properly for meals and corrections.
It is the only option available that can get a diabetic as close to a non-diabetic's BG metabolism as possible.
BJM, are you keeping a food journal of everything you eat and documenting when you check your BGs? You may be like my mom who sometimes eats the right thing but may over indulge the amount/size/portion.
In my case, I can't have any starchy carbs or my BGs go up. I also have to be careful of how much I indulge in a variety of good complex carbs in one meal setting. Once you keep a record for about 2 weeks you will see a pattern of what foods affect you in different ways.
In addition, I have several food allergies that also affect my body in various ways, but I have yet to figure out if these allergies also affect my BGs. I am sure they do, since they adversely affect my RA through increased inflammation, and we know increased inflammation impacts the endocrine and vascular systems.
I wish you the best of luck and I agree with the previous posters that long-term highs are the danger (based on my family history).
Still I think they'll have a hard time convincing most doctors to start insulin with an A1C of 5.6.... which is well within the "normal" range, maybe she'll find a forward thinking one who'll do it, I don't think any I've ever worked with would have... Best of luck to her
If she was just having 140 mg/dL readings 1 hour post meal I wouldn't be concerned either, to be honest. She fails to mention though in this thread that she's had 200's , including (at least ) one I think was a 265 or 256 mg/dL in a previous thread (and I think she said it was 1 hour after eating THOUGH sometimes 2 hours) . That's pretty high. From what I remember that's with normal eating habits but that's still a sign of a problem and is still causing a losing battle with her goal of preserving beta cells. The thing is the fact that that type 1 is autoimmune it's a losing battle anyway but using insulin slows that down.
The thing about A1C. I don't know if I'm right on this, but I would think it's entirely possible for a type 1 to onset between a1c tests where someone might have a 5.6% in March (like she does) and by the next a1c test she could have something higher, march was 5 months ago and all. Without her current diet modification it seems she goes pretty high and stays there for at least 2 hours. My first a1c wasn't particularly high (it was a diabetic one, 7.2% that's still an average of ~160 mg/dL) though despite my near constant 200-300 mg/dL readings. My first a1c was taken though 3 months after diagnosis when I was on a 60 carb a day diet that felt like starvation and Metformin alone (if I ate normally I'd be very close to 400 mg/dL after every single meal) . So I really don't feel like a1cs tell the story as well as 200 mg/dL+ finger sticks ever do.
I agree, A1C doesnāt tell the whole story but Sam is right, endoās give it a lot of weight when deciding whether to start insulin. I routinely go over 200 as seen on CGM, meter, and blood serum if I eat 40-60 gm carb lunches or dinners. I will be over 160 2 hours later, maybe higher, maybe lower but my A1C is weirdly low. Could be a problem with how my blood glycates or my reactive hypoglycemia, who knows, but so far I have to manage with a low carb diet or oral meds if I stray from low carb eating.
Is your A1C "weirdly low" in comparison to your CGM average? Given how high my BG goes at times and the fact that I have to routinely get it over 200 before I do cardio exercise so I don't bottom out before I'm done, I'm surprised that my CGM average isn't higher and that it actually accurately predicts my A1C.
IMO, basal before bolus is backwards.
Doctors do this because it is much, much simpler to administer, hypo risks are lower, and (pardon the term) patient "compliance" is usually better.
However, none of these considerations have anything to do with what treatment modality is most effective. The moment one's pancreas can't cover BG rise from eating, the solution is to supplement the insulin needed to fully respond to that stimulus, in a manner that mimics actual behavior of the system in healthy metabolisms.
This is bolus insulin for meals and corrections. Not continuous background addition to what the pancreas can already handle.
LADA, T2... treating these conditions with too much basal insulin -- the "start with Lantus" approach -- is no different than a full-blown T1 trying to manage their condition with their basal deliberately set too high on their pump.
Good question Shadow Dragon. The CGM I used was just a 1 wk trial last summer. That doc looked at the results, highs over 200 and reactive lows and told me I should go to the Mayo Clinic or my local teaching hospital, he didnāt know what to do with me. Iāll have to look back at the paperwork and see what the average was, although it was a year ago so not sure it would apply to current BG control.
I agree with all of the above that a1c doesnāt tell the whole story, but its the standard that the medical industry goes byā¦ And as far as I know its entirely unknown and not understood if damage in your body is actually caused by transient blood glucose or by glycosylsted hemoglobinā which is what is actually measured by the A1C-- is there any convincing research one way or the other on that that Iām not aware of?
If my car makes a funny noise when making left turns, I make sure that the mechanic tries taking some left turns before he tells me "there's no treatment for that". Having the mechanic drive it around the block making only right turns won't actually get the broken stuff fixed.
Similarly if you are starving yourself to death to get decent numbers, this might be preventing the doc from seeing what the real problem is. And could also inspire "there's no treatment for LADA". Getting a big stack of pancakes at IHOP an hour or two before getting a bg test done would be entirely equivalent to making sure the mechanic tries to make some left turns with my car.
There is research that indicates blood glucose excursions are harmful, that post prandial hyperglycemia raises the risk for diabetes complications, particularly atherosclerosis. And since hyperglycemia is the biochemical hallmark of diabetes, not the glycation of protein, patients like myself who oscillate between states of hypo and hyper BG levels perhaps need (deserve?) a closer look, A1c levels aside. The problem is patients like me havenāt been studied much because we are only ādiscoveredā by accidental random high glucose lab levels (despite many D symptoms), not A1c or fasting BG. I wonder how unusual I really am though. Iām guessing there are a lot of people with unacceptable BG swings who are dying from sudden heart attacks in their 60s and 70s like my grandmother and 2 of her sons (2 other sons were diagnosed with adult onset diabetes). My doc still thinks early onset LADA, time will tellā¦
I thought you were currently using a CGM. Yes, any numbers you had are probably no longer applicable.