I've seen several references to other T1/LADAs who say when they were diagnosed they initially needed only basal, but no bolus. I'm just the opposite. I need small amounts of bolus, but my pancreas is still covering my basal needs. If I skip bolusing for a meal that needs it (e.g., >20g carbs), I'll go up into the 200's, but will come down by the four hour mark (which is why I only skip if it's a low carb meal or I'm going to be exercising after I eat). I'm curious if there are others out there like me. I'd also love to hear from the science minded folks why they think it might be that some folks need only basal, but others need only bolus. I know it may simply come down to the fact that every individual body is different, but I always love hearing the theories you all come up with.
Are you able to eat meals < 20g of carbs without a bolus? If so, then it seems your pancreas is actually covering at least part of your bolus needs, too. People who are producing no insulin can't eat any amount of carbs without a bolus or their blood sugar goes up. If I ate 15g of carbs without a bolus, my blood sugar would rise significantly (i.e., likely go above 200).
I'm no scientist, but I'd guess it might depend on people's basal and bolus requirements. Since not everyone has a 50/50 split, some people take more of their insulin as basal and some take more as bolus. Maybe it's whichever is the lowest that your body is still able to handle without help.
I didn't start basal until 13 mos. after diagnosis and even no bolus for like 6 mos. although my initial doctor put me on glipizide and metformin but still managed to keep my a1c 7.0 by the time I got my first endo appointment. Few months shy of three year "anniversary" and now only on insulin although have total basal barely over 4 units daily.
I feel like I would have had better overall control, been sub 6.0 a1c since going on the pump, if I had been on insulin from the beginning and may have helped preserve some of the remaining beta function by not taxing them so heavily by using glipizide to increase insulin production. My job was also very active, along with my recreational activities which may have contributed to less insulin requirements initially at diagnosis.
I had noticed from your posts that we seem to be pretty similar. I only take novolog with meals and for bigger snacks and I am very sensitive to insulin. Insulin to carb ratio was 1:60 at first and took a nosedive to 1:20 at the end of November. My pancreas seems to do just fine for my basal needs and even breakfast. Generally I go low after breakfast and have to eat my "second breakfast". I was diagnosed at 46, no positive antibodies fo LADA, tentative MODY diagnosis by my endo, but at my last visit I showed positive for Hasimotos antibodies. I was diagnosed by my A1C of 6.9 because my fasting numbers are always normal. It's nice to see someone else out there who has similar symptoms.
I went to an urgent care clinic after my parents visited after my brother had called them after I visited their place and had commented how I had lost over 10 lbs. while at his place, was getting very close to 120 lbs, being 5'10", they thought I might have had an eating disorder and my mom suggested I may have developed diabetes while out for lunch before work.
I had symptoms for over a month, had excessive thirst and urination, blurred vision, weight loss. I was diagnosed with 15 a1c, 499 b.s. basically fasting, waited in clinic for over 5 hours. Never was DKA to my knowledge, had just enough production left that it never set in.
Hi, I was dx in Sept by a rash all over my torso, blurry vision, excessive urination, thirst, and hunger. My A1C was 12 and my BG 400...I was close to DKA. I kept going to the derm for the rash and they couldn't figure out what it was even after a biopsy. I finally chose to get a blood test to see if there was anything going on there and that is when I found out...the rash was actually what saved me from DKA because I didn't recognize the other symptoms until after dx. But hard to miss a dark red lacy rash all over me. Freaked me out. I exercise a lot, so I tend not to need more than .1 unit of basal an hour. I am on the pump, so I suspend my basal a lot, too. I do need to bolus most of the time. But, I also eat plenty of carbs to fuel my workouts.
I use the flex pen jr. you can dose in 1/2 units with it. Makes it a bit easier! I also feel like I'm just waiting for things to go south. Right now I'm waiting for the doctors office to call to set up CGM testing for the lows I've been having during the night (7-8 hours after last dose of Novolog))and in the morning.
Sorry, haven't been online till now. The instuctions said to start at 1 unit but my endo had me taking just .5 for 30 carbs and I was doing that for a good 6 months before things changed and I was getting good consistant control. I have found that if i'm over 150 even at 1.5 hours after a meal I can barely function.. crashed on the couch until its down to the 120s, I hate that feeling!
I went for months.. kept convincing myself it just had to be the stress I was under.. surely all that PU/PD and weight loss was stress..
I was never in DKA, but had plenty of glucose and ketones on urinalysis in addition to 293 fasting BG and 12.4 A1C..
Could not and still can't believe how much better I felt immediately after starting insulin.
It "starts" at 1 but it takes 2 clicks to get to 1 so I was just turning 1 click. Got to thinking about this and thought I should clarify!
Just thought I would send you an interesting note about me...I have been off my basal for a week now after reading your post. I was having a lot of lows and I was down to .05 basal rate all day and also suspending it a lot too. I was getting depressed because I couldn't finish a workout without going low, gaining weight fro eating tabs and jellybeans all day, and going low just shopping. After reading your post I asked my CDE if I could try only bolus and it has been working like a dream! I have had the best workouts now...never go low and my numbers are good :) I am doing a 1:20 ratio which is working great. So , thanks for posting and giving me the idea :) Hopefully it will last!!!
I use bolus only for now. I'm on a very low dose though because my body is still producing some of it's own insulin. My I:C is 1:40 but soon to change because I'm spiking even with that. I can skip the bolus if I'm eating under 20g of carbs but................it all depends on what I'm eating too. Anything with bread, rice, pasta requires a bolus. Oatmeal, cereal, cream of wheat and bananas are on their way out the door because I spike no matter what with them and am tired of feeling like crap so I'd rather not try to figure out the I:C ratio and just not eat them. I use a Humalog Luxura HD pen and I can dose in 1/2 units, which is nice. I do find it odd how some are on only basal and some are on only bolus..............
Pizza? Trying to remember what that tastes like, hahaha. Doc has me on 45g-60g of carbs for lunch and dinner so I only bolus for that amount. I couldn't eat just one piece of pizza, I'd have to have the breadsticks to go with it! One day I want to be able to sit down and eat carbs to my heart's content without worry of BG spiking............right now, I am just playing it safe I guess. I splurged the other day and ate cake made with splenda. Still had a little spike but I'll know next time to give myself another 1/2 unit and I'll be good.
My endo says that I'm an atypical T2. I have some features of LADA--Hashimoto's disease (hypothyroid) and other autoimmune conditions. There are also T1 and T2 diabetics in my family. I had been having regular physicals including blood tests at least once a year, for years. My BG had been perfect all along. Near the end of last summer, I got a yeast infection that I couldn't get rid of. I was also noticing that I was thirsty a lot of the time and sometimes had to get up a couple of times during the night to go to the bathroom. I got a rope burn on my right ankle in August that was slow to heal. My partner is a T2 diabetic. One day in October, I decided that the ankle injury needed to be seen by the doctor. I asked my partner to test my BG just for the heck of it. I nearly fainted when I saw the result was 11.1 an hour after eating a cheese omelete and bacon for breakfast--no carbs! I saw my doctor the next day and had the blood work done. I had been perfectly fine in February, but in mid-October my A1c was 13.1.
I immediately went on a very low-carb diet, bought Dr. Bernstein's book and read the Blood Sugar 101 website several times. I started testing 8-10 times a day and noticed that my BG was coming down but that it would spike after meals and stay elevated for hours.
I'm fortunate that my endocrinologist and I get along beautifully. I'm an information-junkie and he likes to have patients who want to know everything about their own health care needs. We talked about what to do about my post-prandial BG. I was feeling frustrated because, if my BG was elevated, I didn't think I should eat a meal that was only going to send me higher. This was creating problems with my family and in my life, generally. I don't want my diabetes to control everything I do. I was already on Metformin, but had a lot of gastric trouble with the regular version of the medication. The endo put me on the ER version and recommended that I start taking Humalog for meals and corrections, only. He reasoned that, if my PP readings came down, my fasting levels would also drop a bit more. I seem to produce enough insulin for that.
I've been taking insulin since after Christmas. It was quite a big learning curve, calculating ISF, I:C ratios, learning how to cover protein and fat and working out the timing for my shots. I'm still testing about 8-10 times a day but I feel like I have a very good handle on my diabetes, now.
I eat 20-30 grams of carbohydrate, maximum, per day and I take between 12 and 18 units of Humalog. I've lost just over 40 pounds and am still losing about a pound a week. My A1c has dropped from 13.1 in October to 8.8 in December and, yesterday, 5.9, with my fasting BG going from 10 in October to 6.4 in December and 4.7 yesterday. I'm feeling very happy with my progress. I want to lower my A1c a bit more, but I feel confident about how to do it and I'm hopeful that I will achieve the results I want.
Me neither…I eat around 130-150 grams of carbs, so I can have energy : ). So hoping this only bolus will last!
This discussion makes me soooooo relieved! I have been struggling with insulin sensitivity since I started on insulin back in November. I am currently taking 6u Lantus and Novolog 1:25, 1:30, 1:20. Then eating snack under 15 carbs 1-2x daily with no insulin. I've been struggling with high sugars after meals and then having them tank 4 hours later. So Frustrating! But reading everyone else's comments have helped calm me down tremendously and realize that I can do this. Thank You!
Thanks for initiating this interesting discussion. I think I would have been like you, requiring only a bolus, not basal. Regrettably, I only became aware of the diabetes after being carbed out on conference food - Carbohydrate Central - all Danish pastry, bagels and fruit, absolutely no green vegetables to be seen - apart from a few leaves of lettuce which disappeared before everyone got through the queue. Without knowing I was LADA (I recognised the symptoms months later), I went on a roller coaster of tons of carbs, and then no time to eat, then another huge dinner, and finally, after my body underwent internal warfare and I ended up in the ICU with a BG of about 1000. Yet my A1C was 7,8. The doctors said they had never seen diabetes develop so suddenly.
Still, they put me on 10 units of Lantus - it sent my blood sugar tumbling into the 30s several nights. They allowed me to lower it, until it was settled down to two units, and still I had low blood sugars in the morning. Sadly, whatever the healthy beta cells I still had were not helped by this treatment and poor advice on diet (ADA - high carb, high target BG). Now I follow the principles of the Bernstein diet, although I eat as much as I like, and fruit when I'm a little low. My insulin needs are relatively low - but mornings I now experience the "dawn phenomenon". However, I rarely have lows (below 60), and do not worry about lows during the night. Good luck preserving the beta cell function you have! I've heard that with the right attention, you can hang on to them forever!
Hey...just wondering what you usually wake up at in the morning. I had been waking up at 115-120 since off the basal, but after getting my monthly I am 150 to 160. Do your morning numbers change depending on the time of the month? I am wondering how long I should let them be that high in the morning..
I bolus only and my endo is trying to increase carb intake so that I won't burn out in my workouts. So I have to take more insulin. I'm still on a very small dose. My ic ratio is 1:40. Sometimes it works, sometimes it doesn't. Endo also says I'm depleting my glycogen supply when working out and that I should have a snack afterwards to replenish. One that would not require insulin so about 15g-20g. I workout from 7:30pm until about 8:30pm so when I eat my snack that late, my morning numbers are over 100. Almost guaranteed every time. I'm not sure if it's the type of snack I'm eating but you'd think I'd drop back below 100 after 9 hrs. If I don't eat or snack after like 7pm, then I'm below 100 in the mornings. It's weird but that is the only trend I see.