I'm exploring this discussion, having been diagnosed during TrialNet. I have a child with T1D, and no symptoms myself. (But test positive for antibodies and can't pass an OGTT.) I'm curious how you/your healthcare people knew when to start you on that one unit of basal? I have seen my fasting BG creep up over the past several months from 100-110ish to now 115-125ish; the doctor I see for TrialNet says once I get to 130ish fasting or have symptoms I should get ready to start treatment.
Currently I just eat low carb, and feel fine. I know what you mean about feeling like you're about to fall off a cliff!
Wow--me too. I've always noticed carb sensitivity. For years if I had a breakfast like oatmeal I'd be ravenous and shaky and sweaty an hour later (now I know this is hypo!)
I'm glad to be reading this discussion---glad it's here!
My endo said there is some evidence that taking insulin early on helps restore beta cell function. She said it's hard to tell if that is from having better blood glucose control or if the exogenous insulin helps in some other way. She thought we'd go with insulin just in case it could help. But I don't think the 1 unit has any affect on my fasting blood sugars. I skip it sometimes, or take 2 units just to see what happens, and you wouldn't know from my test results. My fasting numbers are usually under 120 no mater what. This article is long but makes some interesting points about insulin in LADA http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2811444/
But, it also gets the point across that this whole disease is pretty mysterious. Good luck to both of us!
There is a fair amount of evidence that early insulin therapy, essentially starting intensive insulin therapy as soon as possible, preserves beta cell mass and leads to better health outcomes. In ADA/JDRF's Type 1 Diabetes Sourcebook, they recommend starting insulin at diagnosis. After all, LADA is Type 1 diabetes, and Type diabetes is treated with exogenous insulin.
Same here Katy, I had to stop eating Rice Chex years ago for breakfast or snacks cuz it would cause hypos hours later. Didn’t realize I was going high first then low, just thought it must be low blood sugar from too many carbs because I was weirdly sensitive to them for some reason. Diabetes didn’t occur to me even though it is in my family.
Just reading the words RICE CHEX made me a little shaky-sweaty.
Me too! I was always wondering out loud to anyone who'd listen "I wonder if I am just really sensitive to carbs." (Also: caffeine/Ativan...) It never, ever, ever occurred to me that I could have (GASP!) __________.
I do not have diabetes. My adult son was diagnosed with LADA in 2011. He had been on type 2 medication for about 5 months. He began insulin when he was correctly diagnosed. He began Low Dose Naltrexone in early 2012. This is a generic drug that stops auto immune attacks. There have been trials for Crohn's and MS but not diabetes. Since that time he has had no further progression so we are hopeful that it is working. He takes 10 to 16 units of insulin a day depending upon what he is eating and how much exercise he is getting.
I was diagnosed back in February 2012 at the age of 57. My vision became really blurred and my eye doctor told me that he usually did not see such fast deterioration unless it was diabetes. I was diagnosed as type 2 even though I had no family history and was not overweight. Eventually found a a doctor which realized that I may be a type 1. For about a year and a half I was able to control things with diet, oral meds and exercise. However, since last June, I have been on lantus (10 units) and novolog (CR 1:15). I think that things are changing though. For instance, I can eat the same breakfast daily and take the same amount of novolog. One day my BG can be 130 two hours later and on another day it can be 200. It is so frustrating and confusing. My last A1c was 6.6 so I guess I am starting to get this whole control thing. Does anyone else have this problem with inconsistent numbers even though they have eaten the same exact meal? Any feedback would be helpful
I’m still using prandin and diet to control BG but find the same thing happening, apparently this is unfortunately quite common, especially when we still have insulin production coming from our own beta cells. Just when you think you have it figured out, it changes!
I was diagnosed around the same age (58) and was also misdiagnosed Type 2. I managed for 15 months on oral meds before my numbers started to rise and I figured out I was Type 1. I'm now going on 7 years in. My experience being a regular on this board is that we all vary from each other in terms of how consistent we can get our numbers (and most people on here work very hard to do so!). There are known quantities that cause that variation and unknown quantities, what I call "the luck of the draw". I consider myself in the middle because of that. Things have gotten more stable over the 5 years I've been on insulin (and I've gotten better at managing them!) but I still have variation. It's not day to day and I get some periods of great stability. But I do always have sudden unexplained spikes and occasionally a slow drift where I need to do some tweaking. I try to stay ahead of any pattern developing: If I am high day after day for example at a certain time, I tweak my basal for that time zone. (Easier to do on a pump). I keep old school logbook records and each page is about 3-4 weeks. At the end of a page I look for patterns to see if I need to tweak basal or I:C (far less frequent, my spikes are generally outliers, not patterns).
But variability for most of us is what Type 1 is all about and I've learned to roll with the punches, correct, tweak, rinse and repeat. I've limited the time I spend thinking about "why" something is happening (useful to fix it) and then move on to the fix and getting on with life which is more than D!
Thanks for your comments. You are right about variability. Since I am still pretty new to all of this, I still panic a little but have been finding it gets a little easier everyday to understand how everything affects blood sugars. This is the most difficult I have ever had to face in life, but I learned from my mom Don’t Quit. So everyday is a clean slate with blood sugar levels and I don’t plan on giving up.
You are so right…when you think you have it, it changes. A one point I also used Prandin along with Lantus. That was very short lived and I decided to go on novolog at meals. I was so afraid of going on insulin, but the stress of waiting for the other shoe to drop was bad too. I was eating so little trying to keep my levels done that I lost too much weight. It was great when it came to buying those size 4 jeans, but friends were really getting concerned about my health. So now I try and figure out life on insulin and that is certainly a new and challenging experience every day.
I am curious about what "intensive" insulin therapy means
I keep seeing the term and wonder what the word "intensive" is referring to. In other words, what is/are the qualifier(s) for "intensive" insulin therapy vs "regular" insulin therapy?
(Does basal only qualify? Does dose matter relative to the term intensive?)
"Intensive insulin therapy" is a term that was used for MDI (multiple daily injections) when it first came out - bolus and basal-short and long acting insulin used for meals and background insulin needs. It differentiated it from the use of the earlier type insulins. It isn't used much anymore and has been replaced by the term MDI or pumping.
Zoe is correct, it's a term not used much anymore. I don't know the origins of the terms, but in the DCCT (Diabetes Complications and Control Trial), the landmark Type 1 study that was presented/published in 1993 I believe, people were assigned to the "intensive" group or the "conventional" group. The intensive insulin therapy group (mostly on MDI, some on pumps) had a significant reduction in risk of complications, as compared to the conventional, in the DCCT. We have come a long way since 1993. Intensive insulin therapy for someone newly diagnosed with slowly progressive Type 1 diabetes might mean some very small amount of basal insulin. It is a very individual thing.
Personally I would not consider treatment with only basal as Intensive Insulin Therapy (IIT). I think there are many definitions of IIT, but I would consider it a basal/bolus regime with 3 or more injections/day. I think there are many that would consider a sliding scale as IIT. Conventional insulin therapy is using a long acting or a mix, typically with a fixed injection schedule of 2-3 times/day. I think part of the original definition of IIT included the idea that you would test your blood sugar and that you would target normalized blood sugars. There is an old paper from Hirsh from 1990 (before the DCCT report) which talks about all the definitions.
Thank you! I think I am going to put that last sentence on a sticky note; "It's a very individual thing." :)
I feel like I want to "talk to my pancreas" and see what IT would like by way of support. I think that as you have said before "testing, testing, testing" is the best way for me to do that at this point. Test...and see what my pancreas says (via BG numbers).
For the technically minded, here's how the DCCT defined the conventional and intensive therapy:
Treatment and Follow-up Conventional therapy consisted of one or two daily injections of insulin, including mixed intermediate and rapid-acting insulins, daily self-monitoring of urine or blood glucose, and education about diet and exercise Conventional therapy did not usually include daily adjustments in the insulin dosage. The goals of conventional therapy included the absence of symptoms attributable to glycosuria or hyperglycemia; the absence of ketonuria; the maintenance of normal growth, development, and ideal body weight; and freedom from severe or frequent hypoglycemia. Women who became pregnant or were planning a pregnancy received intensive therapy until the time of delivery, after which they resumed conventional treatment. Patients in the conventional-therapy group were examined every three months.
Intensive therapy included the administration of insulin three or more times daily by injection or an external pump. The dosage was adjusted according to the results of self-monitoring of blood glucose performed at least four times per day, dietary intake, and anticipated exercise. The goals of intensive therapy included preprandial blood glucose concentrations between 70 and 120 mg per deciliter (3.9 and 6.7 mmol per liter), postprandial concentrations of less than 180 mg per deciliter (10 mmol per liter), a weekly 3-a.m. measurement greater than 65 mg per deciliter (3.6 mmol per liter), and hemoglobin A1c (glycosylated hemoglobin), measured monthly, within the normal range (less than 6.05 percent). The patients initially chose either multiple injections or pump therapy and could subsequently change to the other method if their glycemic goals were not achieved or if such was their preference. The patients in the intensive-therapy group visited their study center each month and were contacted even more frequently by telephone to review and adjust their regimens.
