About to start insulin on LADA and in need of information


Just a quick brief of my condition. Diagnosed on Oct. 2007 with a fasting BG of 210 and first started on a classic diabetic diet and Glucophage, after two months first HbA1c was 6.3, then discovered low carbing and go on with Low Carb diets. Two months later HbA1c is 5.7. :slight_smile:

GAD antibodies are flying in the air (lab could not detect it, just wrote >30), other antibodies are slightly positive. So a classic LADA condition. Also my mom and grandmom are Type 1’s diagnosed at ages 30-40. (No LADA was known at those times) I have many other autoimmune diseases such as vitiligo, hyperthroid, pernicuous anemia…

My biggest problem with Low Carbing (or maybe sth else) is weight loss. I loose like 4-5kg (11pounds) in two months time.

I have talked with my endo and he said Low Carbing is good if I can manage my BG levels in normal range but weight loss is not acceptable. So we decided to start insulin. So that I’ll be more free to eat and maybe gain weight. His first idea was to start Lantus as basal.

Although I have read many, I really cannot understand whether to start with Basal, or Bolus or both. I’ll be glad to hear your ideas, recommendations and experiences.


Ozgur, from Ankara-Turkey

I had a similar problem to you. I was diagnosed in April 2007 and have one slightly positive reading for antibodies. I am also early LADA and can manage my BG on a low carb diet. But I kept on losing weight. I only weigh 115 pounds and am 5 feet 7 inches! If you want to eat a bit more, you might try a bolus of a fast acting insulin such as Humalog or Novolog before meals. I only need 2-3 units and then I can eat 30-45g of carbs without a high BG after eating. Are you still getting high fasting numbers? If so, you will also need a basal insulin. I have very low fasting numbers so don’t use a basal yet. But I do need Novolog before meals if I want to eat more than a tiny amount of carbs. Hope this helps, feel free to ask more questions.

Thanks Libby,

My fasting BG in the morning is usually like 95 at wake up, rises to 105 till I have breakfast 1 hr later and usually like 110-115 after breakfast. I have a very mild down phenomen.

So I think basal might not be necessary. (However Dr says basal, Lantus)

One other thing is that I can keep my BG under 100 throughout the day if I dont have a real meal but eat nuts (hazelnuts) sparingly. I believe I need no basal.

But maybe I should try basal with Low Carb as my pancreas at the moment is working as only basal. I am really confused.

With LADA, the first thing to go is first phase insulin response. That’s why you go high after eating carbs. Next is the second phase. I still have that intact. That’s what kicks in after you go high and brings you back down. It is also what allows us LADA types (and Type 2s) to manage just fine on a very low carb diet. If you make no insulin at all, you can’t go without injecting or pumping even on low carb. Last of all is fasting. If you are getting 95 in the morning with just a small rise due to dawn phenomenon and you can stay under 100 most of the day on low carb you really don’t need basal insulin. In fact, you might go hypo with a basal. If you just want to eat a little more, you need fast acting to prevent that after meal spike which is so damaging to your remaining beta cells. You said you have low levels of antibodies so you are probably just at the beginning of the process of losing your beta cells. The only way to preserve them is to keep BG normal and the best way to do that is with rapid acting insulin (bolus) before meals AND a relatively low carb diet. So if I was you I would ask for Novolog or Humalog and wait on the basal until you need it.

Hi Ozgur,
I am LADA also and eat low carb as well. But I also use Humalog and Lantus both.
I have a question or several actually. Are you only eating a few hazelnuts for your meals? Are you afraid of using the insulin or just prefer not to? Do you eat any proteins or vegetables at all?

Libby, thank you again. Let me just note that my GAD value is so high. (whatever it means)

Saundra, I consume hazelnuts as snacks in normal days. It differs from day to day. I always keep some nuts (hazelnuts, almonds and walnuts) with me for snacking when I’m hungry and also I believe they help me with the calories I need since I’m low carbing. However, if I cannot hold myself and eat a lot (like 20-30 hazelnuts in one time) that affects my BG. Generally I tolerate walnuts better (higher oil than others) but they are also expensive :slight_smile:

Whenever I know, I will be missing one or two meals like during business trips, I consume hazelnuts more. That keeps me steady and energic. All other times, I eat proteins and low GI vegetables at the meals. I try to adapt/follow Dr. Bernsteins recommendations to my/my families’ local eating habbits.

Thank you Ozgur. I am sorry I misunderstood. I like walnuts for a little snack also. As for the weight loss, do you have access to any whey protein powder? I have trouble digesting more than a few ounces of meat per day and find the protein powder is a big help for me.

Hey Ozgur!
I was LADA too, now full blown Type 1, unfortunately. My doctor started me on a basal as well, and he gave some very good reasons why.

First, because the rate at which your pancreas fails is uncertain and unpredictable, even a small amount of basal protects you from future DKA.

Secondly, you are less likely to have hypos on the long acting insulin. It’s slow release signals your pancreas to stop it’s own production unless needed.

And Finally, Just that weight of producing your basal all day stresses you beta cells, where you can’t store insulin to act as a first phase insulin response. Giving it a break throughout the day, allow better reaction and response to meals. And internal regulation of needed insulin at meals is always better, since food coverage can be tricky. This also slows down the attack on the beta cells throughout the entire day, which may help to prolong their life.

Hi, Mandy,
Thanks for that info. That is very interesting. I hadn’t heard that explanation of why it might be helpful to use a basal insulin. I recently asked my endo about whether I should start using a basal and she didn’t think it would be all that helpful for me because of my low fasting rate. But now I think I might give it a try. What happens for me is that I use insulin for meals for a while and then start to get hypos because my beta cells have been getting a rest. Then I stop taking insulin and my levels creep up again. Seems like a low level of basal might be the missing link! What did your doctor start you on in the beginning?

Thanks Mandy,

Great description! That was what I need. Also can you, if possible, give me some hints how you have converted from LADA to T1?

I just want to see my road to T1 though I know everybody is different.



I’m just doing fine with meat at the moment. I will keep in my minde to try whey protein powder. Thanks for the help.

Thanks Mandy,

One small question? Do you gain weight with basal insulin? I lost very much. I’m like 170cm and 59kg. (i.e. 5feet 7inches and 130 pounds) and I need to gain at least 5-6kg to look OK. I was 73 kg (165 pounds)

Ozgur, I was diagnosed with Type 1 ( LADA ) almost 2 years ago and was placed on insulin right away ( Novolog and Levemir ). Are you averse to taking insulin? What is the reason? Insulin and eating the right amount of carb has been the key to keeping my A1C under 6 ( I started at 8.2 ). Low carb has no meaning to me. Low, high etc is relative to some “medium”. I need 1500 calories a day to maintain my weight but obviously you need more.

Originally, when I started honeymooning, he placed me on just 4 units of Levemir in the morning. I’m about 5’4" and under 100 lbs for dosing reference. Later, when my sugars started edging up to the 200’s again (about 2 months) he increased me to 5 units and added Novolog to meals. I’m really insulin sensitive, so a little of that stuff goes a LONG WAY!

I can only tell you what happened to me, so here goes.

I do not recomend following in my footsteps. After the initial DKA at diagnosis, I went into a honeymoon rather quickly. Hence the Levemir dosage above. That small dosage really seemed to work for about 2 months, and then it started creeping up into the 270 range. Hence the above increase and addition of Novolog again. Again, it really seemed to work, but I started feeling like my numbers were so good, I didn’t need the insulin (thought the DX was a mistake!). When I started having astronomical post-meals spikes, I got depressed and just stopped taking the insulin and checking my blood sugar ALL together one weekend. By Monday I was above a range my meter could register and spent a week in the hospital for DKA. Apparently, I was also getting an infection which sped up the Acidosis.

From what I understand, usually it’s gradual, but any kind of illness or stress can quickly bring you out of the honeymoon.

I’m still on a relatively low dose of 22 units, but I’m a serious runner and pretty small. I have tried to decrease my insulin “just to see” a couple of times since then, but I always wind up in the 400’s with moderate ketones.
As the Doc says, “the honeymoon had ended and your on insulin for life, you need to accept it.”



Thank you Khurt,

I"ll be at the hospital tomorrow and start insulin. :wink:

Mandy, that was great info. At least I know that I wont follow your footsteps for DKA. :slight_smile:

Thanks again. Tomorrow I"ll start insulin and shall see what will happen.

Insulin will help you gain weight, but you also need to eat more! Carbohydrate is readily stored as fat, but you probably lost a lot of muscle due to inadequate insulin. And the only way to build muscle is with resistance exercises. Join a gym and get a trainer to work out a muscle-building program for you. I had success with this, but only after I started having a protein shake after workouts. Building muscle is definitely worth it, IMO. In addition to looking and feeling better than excess fat, increased muscle mass also improves insulin sensitivity. It makes balancing insulin requirements and what you inject a lot easier. Good luck with it!

I stated on Levemir basal today! My fasting had crept up to over 100, up from high 70s at diagnosis. My endo recommended 2-4 units to start so I am trying 3. I am excited about this and will keep you posted on the results. I am hoping to get the dosage right to bring my fasting BG back to normal (around 80) and to allow me to eat small snacks (10g or so) without a spike. I also use 3-4 units of Novolog or Novolin regular before meals.

I had an exciting day yesterday. I started with 3U Levemir in the AM and had my usual breakfast- strawberries, nuts and yogurt. I did 4U regular 45 minutes before eating. Two hours later I was at 60. I over corrected and half an hour later was at 150 and an hour after that back to 60. Same thing happened at lunch even though I took 2U Novolog instead of 4 of regular. By dinner, I was back to a more even keel. Woke up this morning with fasting at 109, which is higher than usual.
Today was much better: 3 U Levemir and 3 U Novolog at breakfast and I stayed between 115 and 90. Fasting of 88 before lunch so no insulin and my usual raw food salad which does include an apple. Without insulin my BG was 100 at an hour, 90 at 2 hours and 84 at 3 hours. Had 1/2 an orange for a snack and BG is 102 at 45 minutes which is the peak for me. Looks like the basal is allowing me to eat a small lowish-carb snack or meal without adding any more insulin and getting completely normal BG. I’ll try one more night to see what my fasting does and then I may try splitting the dose and doing 2 in the AM and 2 in the PM to see if that brings the morning level down.