I have been a slow on-set LADA and I’m currently on 2000mg of metformin. Last year I could control with diet and exercise and stay under 105 all the time. Since Sept. my BG have increased…before meals I’m around 110-117 most of the time (sometimes under). My morning fastings are around 110-128 (yikes. and sometimes lower). This is on low carb 30-50gm daily and 1000mg metformin before bed for Dawn Phen. and 1000mg as soon as I wake. My PP at 2 hr are around 110-125 and some one hr PP are in the 130’s and 140’s. I am aiming at much tighter control…I am due for a trip to endo. and hoped my TuD. friends would make suggestions from your experience. (My LADA friends say insulin and I would like to know with these numbers what kind and how to work it???) Any advice?
The process of sticking yourself (I use a flexpen) is beyond easy. That part you should never worry about. & this comes from a major chicken.
I took a different road. I discontinued the met after 500mg. Went for 2+ months bouncing (high generally in the 180’s, low mid 60’s most of that was at the 1 hour mark) before my doctor’s appointment and then asked her if I could try Levemir. I am considered T2 but I have autoimmunity associated with T1, genetics for T1, lack IR and I am at normal weight. I probably am some sort of genetic mix (since I do think I have T2 genes also). Fortunately I’m not progressing fast and have had the time to think about what to do.
2 Weeks ago I started Levemir 1 unit in the am and then went to another unit mid afternoon. So a total of 2 units. I don’t have dawn issues. My FBS are normal - I have more of a problem with either going low or high after I eat. So far, I have found it has leveled me out - the bouncing is half of what it was before). I no longer see lows or highs - not as tightly controlled as what you are suggesting but I’m taking this very slowly. BUT…the only thing I wonder is I started a med for acid reflux (GERD) a few days after I started the insulin. The paper on that med states in 2% of test subjects it raised their glucose & said nothing about lowering it. I don’t know how that plays into things. I take no other medications (I have normal lipids and BP).
I don’t know if that info helps but that is what I am doing.
Oh…I went back and read your profile…I emailed one of the people you mentioned there and this person suggested eventually I will want to change what I am doing and probably go to fast acting considering my own personal issue. Also…your kids are so cute!! However… TOO MUCH SNOW!!
Use the best tools available. If that’s insulin, well, insulin it is. There’s no reason to fear it. Insulin has improved my control, but hasn’t perfected it.
I’m also LADA and I resisted going on insulin because I thought it meant I was a failure. “No,” said the doctor. “You didn’t fail, your pancreas did.”
The injections are easy to get used to, if you’re worried about it. You barely feel them if you’re trained correctly. The trick at first is to “Just Do It.” As John Wooden says, “Be quick but don’t hurry.”
If you fear going low, a realistic fear, you may have to learn to live with relativley ‘loose’ control while you get used to taking insulin and calculating your bolus.
Good luck,
Terry
Thanks to both of you!! I mostly fear going low and knowing a new constant “lifestyle” adjustment. As I raise my three daughters ages 8, 4 and 1 I barely have time to think of myself…I’ve improved that some but I don’t know if I have the “mind” strength for all of them and their needs plus this lifestyle!!! I fear driving them places (as I may drop low). Or being the only parent home and not waking from a low… Especially since my numbers are high and no good but not THAT high yet. I guess I need to take the plunge and ask for insulin as I know of no other medication options?!! I will have to ask for help from some family as I adjust to all of this…
You feelings are natural. I have a local support group and it turns out discovery health did a show on using insulin. Many patients struggle with the transition to insulin, fear over the needles, feeling that they have failed. You might find it helpful the discovery show helpful, it is part of their CME series (http://discoveryhealthcme.discovery.com/insulin-truth/insulin-truth…). And in case you are worried, I am not in it.
It is interesting to hear you talk about this. My numbers have been worse than yours for quite some time. Medications have basically not worked. Although my repeated requests for insulin have been denied, I accepted I was going on insulin quite a long time ago and decided that I might as well be smart about it. I bought the books “Using Insulin” by Walsh and “Think Like a Pancreas” by Schneider. Being informed took away a lot of the questions. These days, I use injectible medications and it has basically become very routine.
Hope that is helpful.
The low fear is a real one. See what your doctor can do to work with you to slowly get you on it without risking much (high or low). I had some experience using insulin before and learned (as others had told me) take it slow. My experience was giving it to my cat 
In her case…she’s diet controlled now but she’s a cat and we don’t need perfect numbers from her Also I figured it the cat didn’t mind getting stuck with a needle I should either! I didn’t get any instruction from my GP. She handed me the sample and that was that - she wondered if my lows would get worse but was willing to try it. I’ve not seen a low since the first day (before it really took affect). But my experience may NOT be common…I’m still in test phase.
I’m lucky at this point…if I miss a dose I’ll be ok. I also work with my husband with his business and sometimes we are out on a job where it’s not easy to do things like that. But…you know if these singers who are T1 can do it I can do it too (not a singer…we work with people like that but not that).
I appreciate your advice and I will check out the link…Funny because I just bought “Think Like a Pancreas” by Schneider to understand it better too!!! I don’t know if the Endo will even let me to try insulin next I just understand it is the best. So assume I need to ramp up my nerves and ask for it! I don’t feel afraid of needles just the routine so I am relieved to hear you say it is very routine!! This is what I needed you guys! Keep it coming!
Ask your endo to recommend a good educator that you can work with to get your insulin usage adjusted.
To chime in with the others, insulin is just another tool. Whatever it takes to control BG should be the goal. Not that I have a choice being T1, but the side effects of oral meds would be more of a concern to me.
Can understand the worry about lows. Your doctor will be equally, if not more, concerned about lows because it will be his liability. You’ve topped out the metformin & I hope your endo will be open to insulin. Your numbers may not be high enough for his comfort zone, so you may need to be really assertive about insulin protecting your remaining beta cells & that PP in the 140’s are unacceptable. I’d stress that you test frequently, count carbs & will test even more on insulin to allay his worries. Endos are also often concerned about new insulin patients changing their doses & overdoing it. Worth mentioning that you’ve read up on insulin, understand it’s potent & will follow his directions to a T.
Your endo may put you on basal insulin at first for dawn phenomenon & to see how this may effect PPs. If he suggests basal, ask for Levemir over Lantus. For many, Levemir is more level, it doesn’t sting like Lantus & it doesn’t expire as quickly.
He may cut back on metformin, but still want you on it with insulin. He may only want you to use a rapid acting insulin to correct highs at first. So many variations on the way to do this with LADA.
Levemir didn’t work at all for me… and I ended up being allergic to it on top of that. I’d take the slight sting of Lantus over the enormous itchy welts that Levemir gave me… plus Lantus actually worked for me.
My CDE doesn’t recommend levemir for her T1 patients any more.
Gerri -
You know…I never thought of the liability aspect. I wonder if that is the REAL reason my endo said it was too much of a risk of lows. I personally thought that was an odd statement considering it was long acting plus a baby dose at that I was asking for. She also told me in one of our first meetings she likes to take T2’s off of insulin so I already knew regardless of my labs / case it was going to be no.
Now I think liability is the real reason. Good point.
Kathy,
That’s my theory. Doctors are justified in being worried about lows because they pose an immediate danger to us & they could be held accountable. Long term damage from highs don’t seem concern them near as much as it should. The other half of my theory is that it takes a lot of time to educate patients properly on using insulin & it requires constant monitoring & tweaking from them. Easier to say swallow some pills.
Gerri- thanks and I am pretty obsessive! about testing now so I will be a good patient. In fact I wish I could get a hold of a CGM now so I always know what is going on! I totally agree with you on oral meds, that is why I am trying to ramp up my nerves and knowledge before my appt. on May 3 to demand insulin.
With insulin what are your morning fastings?? My other question is do you just spot correct higher numbers?? For instance when I am ovulating or menstrating or premenstural I am higher! Okay there goes 1/2 the month…so is everyday just different or is as my numbers are so variable?? I get to see the lovely 90’s a few times a week. I usually test 4 and sometimes 6 times a day now. How fast acting is insulin? I should just go read a book right! = )
Gerri -
I do think you are right on the money with this. I did really luck out with the GP letting me try the Levemir. Plus she is with a medical group associated with a big hospital - that might have made a difference insurance wise for her???
Dawn -
I’m with you. I would love to try a CGM - only for a week or so and maybe only a few times a year to check. I’ve offered to split the cost with my brother but so far he’s not biting. He needs it more than I do.
I had two appointments with GP before things were a go. The first appointment she knew I went off of the Metformin and she started offering me other drugs (remember I’m listed as T2 - my bio tells all) I kept on saying no but I didn’t offer any solution. Then when I saw her again in a few weeks to see what the heart crushing feeling was (it was getting worse - turned out to be GERD/ acid reflux) she said again I needed to start on another med. That’s when I hit her with it. I knew what I wanted to accomplish - I did my research.
Also before labs were done I told her she will find my A1c would be low due to the bouncing - and that was true. So she had to know I was on top of things. When I was taking the Met it was 5.6 but off of it, it was 5.2 Big leap of faith on the GP to let me go this route considering how low my A1c was. So far so good but I’m too early on to say 100% it’s the best route for someone without IR or weight issues who is mildly diabetic. I do feel it was very much worth the try and I’m very hopeful.
I’ll be with you in spirit cheering you on! Sure you’ll do this, but bring all your records. Endos feel more comfortable with patients who log everything.
Ask if you can get a loaner CGM. Some endos have them for short-term use.
Well keep me posted because I too am without IR and no weight issues, my diet is so boring and consistent very low carb (Bernstein ish) so I am so glad to hear this is working for you so far. I wish you all could come with me to my appt. and whoop it up after wards with a chargrilled chicken salad! JK So can you still have a glass of wine or an amstel light beer on insulin? Or is this only for pros?
Thanks! I will log everything and request a CGM!
Don’t talk to me about diet! HA Mine is low carb but not as low as yours and gluten free. You might find that going gluten free (if you are not already) helps with your numbers. It did mine and my thyroid numbers are looking better too. (endo offered to put me on thyroid meds since I was so tired all the time a little over a year ago but I held off then started GF Dec 2008) I was subclinical thyroid hypo.
That lead to the Celiac diagnosis.
One way I am lucky…my A1c won’t tell if it’s working or not but my psoriasis will and has been.
Psoriasis improved by about 10% on metformin alone. Improved another 50% (yes, that much) on gluten free. Got worse and lost some of the clearing I gained by going off of the Met. Now on insulin it has been improving again.
It’s a funny type of thing. Since I’ve had 3 OGTT I’ve learned a little on what it does. Half way though the test I can look at it on my elbows and the inflammation goes down. Then around 3 days later it’s back even stronger. I thought it was the higher glucose level at first that made it clear (silly me - when I was sick it was really bad) it’s the greater insulin levels that must be making the difference. I’ve had it since I was 16.
That and the melasma (basically darker skin spots) on my face / jaw line - that has gotten slightly better since on insulin. The melasma only started as I got sick but it did clear up some on gluten free so it’s reacting the same as the psoriasis. I think it’s associated or a sign of thyroid issues…??
I took a meter with me to my second appointment and showed the GP what I was doing after eating. I had probably 5 or 6 meter readings after eating 30 carbs.