Basal insulin for LADA


#1

I am thinking about starting on a basal insulin since my fasting BG is creeping up and I also seem to be rebounding during the day. So far I have only used fast acting insulin with meals. Those of you with LADA, were you started on a basal right away, or when did you start? Also, I have heard to stay away from NPH. What are your experiences?


#2

Hi Libby,

I’m still new (less than a year since dx) but I see no one else has posted so I’ll tell you my experience if you take it with the grain of “she’s not an expert”).

My doc started me out with 10 U Lantus basal insulin and that was too much. I was getting quite a few hypos plus a few symptoms of excess insulin (such as swollen legs, excessive hunger) so I backed it down (slowly) to 7 U. That seemed to do well for the summer. Now I find that (maybe because I’m less active in the winter) I need about 8 U. I only recently started bolusing with Novolog if I know I’m going to be having 30 g carbs or more. I’ve probably only bolused with Novolog about 6-7 times. So I mainly get by with 8 U Lantus basal insulin and a low-carb diet. I try to eat no more than about 15-20 g carbs/meal. I’ll eat more if I’m exercising.

If you are on basal insulin you have to watch it with the exercise because it doesn’t get turned off like your own insulin would. I can’t go for more than 30 minutes of cardio without a small supplement of carbs (5-10 g).

Some people claim that it’s good to split your Lantus dose. I’ve tried that (5 U in pm; 3 U in am) and I don’t think I saw a difference between that and injecting my 8 U at night. I hear that sometimes Lantus quits after 16 hrs so that’s the rationale behind splitting the dose.

Some people say that Lantus causes them to gain weight. Maybe. I eat so low-carb that it would seem like the weight would be falling off me and it isn’t…but it hasn’t made me gain excessive weight either.

Best wishes,
Maria


#3

Hi Libby. I just joined this site yesterday and I also have 1.5.

I take Januvia pill daily, (which replaced Byetta 6 montha ago. YUK!). I also take Levimir (long-acting insulin) at bedtime. I had horrible dawn phenomenon. That has really helped keep my FBG down. Love it! My endo has now started me on 4 units Levimir in the morning too to help me throught the day. Today I started taking Novolog more often with my afternoon meals & based on carbs counting & my pre-meal BG. So far so good. No low’s yet. I really like the Levimir and have had a harder time accurately calculating carbs for the Novolog. They are both pens- and they look exactly alike- which got me in a heap of trouble one night when I woke up 1/1/2 hours after my injection in a puddle of sweat and panic- my BG down to 37. I had given myself the wrong shot. OOPS! I won’t make that mistake again.

Good luck. I’m here for you if you need a LADA to vent to/ or with!


#4

I was also started on 10u Protophane (NPH) and it was too much - but at that stage I was dealing with doctors who thought I was a simple T1 not a 1.5. Actually, as far as I can tell, no docs etc seem to know how to treat a 1.5 differently.

Anyhoo… yes, I went on basal as soon as they realised I wasn’t a Type 2. I’d suggest it - well, I’d suggest doing anything you need to keep your numbers in range and keeping yourself comfortable. Just keep an eye on the dosage and be sure to start low.

There are people who do great on NPH so don’t be scared of it - but it certainly wasn’t good for me.


#5

Maria,

Actually it is Levemir that quits after 16 hours if you use the small doses characteristic of Type 1 or 1.5.

Lantus lasts about 22 at those doses.

After years of happily using R insulin with zero weight gain, I switched to Lantus/Novolog and promptly packed on 5 pounds faster than you can say, “So THIS is why people associated wieght gain with insulin!”

I’m currently going without insulin doing a 20 gram a day low carb diet (the only way to keep blood sugar normal. I have a form of MODy where I make some homemade basal insulin but do not secrete insulin in response to rising blood sugarl.)

What’s really impressive is that after a couple years on mostly R insulin I am getting completely normal blood sugars on the very low carb regimen. In the past this wasn’t possible. Even with a low carb diet my fasting bg would be around 108 and meals would push me near 140. My fasting blood sugar now is low 90s high 80s… So I’m sold on the idea that using insulin properly can reinvigorate beta cells.


#6

Thanks for the feedback everyone. I see my endo on Monday and I’ll see what she thinks. The problem might be that on my good days I wake up with a fasting BG of 85 and the basal might push me too low overnight. I am going to ask about injecting in the morning. I currently do 2 U Novolog with each (low carb) meal and can stay mostly between 80 and 100 but I do sometimes get hypos in between meals, plus I can’t eat anything with carbs without injecting or I go higher than I like. I’ll let you know what happens.


#7

Hi Libby,
I am a type 2 who uses Humalog and Lantus. My FBG was horrible every morning so my doctor started me on the Lantus with 10 units at night. By the time we had started it, I had not been sleeping at night time for a very long time. I was always dying of thirst and awake after about an hour or two, not to go back to sleep for the rest of the night. Over time we gradually increased my dosage to cover my night time peaks. Now my night time works very well, but the day time had truly unexplainable peaks that made no sense. I maintain a strict low carb diet and do not cheat. So we use a smaller Lantus bolus in the mornings as well as the Humalog after my meals. I don;'t snack but do make sure I keep up with well balanced meals My thoughts on this are that whatever it takes to take care of you is worth the effort to try it. Each of us is different. Another thought is that if your BG is low before going to bed you might try a small bedtime snack that is sugar free, but will take several hours to digest. And i don’t mean the hypo low, but under 100. I like to say that nothing is written in stone and we can always change what doesn’t work. Good luck. I will be waiting to hear how things go for you


#8

Sandra,

Your unexpected peaks are probably caused by the fact that Lantus contrary to its advertising does NOT last a full 24 hours, especially in lower doses. For those taking 100 units, yes, it lasts. But for small doses it burns out around 22 hours.

That’s why many people who use Lantus split the doses into 2 a day.


#9

I was on NPH & regular for many many years. I was switched to Lantus/Hualog by the local diabetes center last Occt. I ot my basal & bolus rates down great by using the method used to adjust a pumper. I tale 1 unit of Lantus per 6lbs body weight and 1 unit of Humalog per 10 grams of carbs. My insulin sensitivity worked out to be such that 1 unit of Humalog lowered my BS almsot 25 points (I use 25 for calculations) I ahve it donw so my BS is normal adn LEVEL all day and night as long as I do not eat or exercise. My Humalog/carbs ration brings me right back down to my base range, NO MORE SPIKE & DIVE roller coster. If I am say about 50 points high before a meal I take my carb/insulin ratio plus 2 units (ie 7units for a 50 gram carb meal) same if I am a little low (NOT HYPO), I will take 1 unit less. . and I am back on track.

I DO SPLIT my Lantus per the endo at the diabetes center and works great. I don’t fix unbroken things.

I took a Humalog overdose by mistake last month, now I use a Humalog pen, but stayed with teh syringe/vial combo for the Lantus, to AVOID that mistake. My personal opinion is that should b standard practice. Lets face it, I take more shots of Humalog than Lantus and usually wehn eating out the Humalog pen is easer, no need to run for the bathroom to take it.

(&( GOMER


#10

I am 38 years old and was diagnosed with LADA about 3 years. My doctor initially prescribed 4 units of Lantus at night. Within the last year, we added Novolog with meals (1 unit per 25 gms of carbs). I’ve found that if I eat very low-carb, I don’t need the Novolog and can keep my BGs within normal range. But if I eat more than 25 gms at a time, my BGs shoot way up so I do try to take the Novolog before I know I’m going to eat dessert. I do agree with one of the other posts, that the more insulin I use, the harder it is to control weight (but I’m also eating more carbs, so that could be why too) and that once a vigorous exerciser, I have had to lower my intensity and duration of workouts over the last few years or I drop too low. Good luck!


#11

I realized I had not posted an update after I saw my endo. She thinks I am absolutely crazy because I try to keep my BG normal. She did give me Lantus, but I didn’t start using it. My BG has been so good that I have cut back even on the small amounts of Novolog I was using. My fasting BG is between 78-85 most mornings and I started getting some scary lows with 2 units of insulin taken before meals. This happened to me back in November and I took a break for a while but with the stress of the holidays and an international trip my fasting levels had risen and I was getting some highs around 200 . Plus my A1C went up to 6.1, which bothered me but was more evidence that I was “extreme” according to my endo since she thought it was just fine. One thought I had was that using insulin gives my pancreas a break and I end up regaining some function (I’m still in the honeymoon phase.) Then I start to deteriorate again and numbers get higher. I start using insulin and after a while I get hypos. I am coping with this cycle right now by using insulin about once a day, and taking regular rather than Novolog. This gives gentler coverage.It is an interesting process :slight_smile:


#12

Libby,

These frigging doctors who act like there is something WRONG with us trying to stay healthy. Sorry you had to deal with THAT. You don’t deserve it.

You are extremely lucky to have so much function left and you are absolutely right to keep fighting to keep it.

I wonder if backing off the insulin got your beta cells secreting again and that ramped up the autoimmune attack. OTOH, hard to say. I did 6 weeks with no insulin and a very low carb diet starting right before New Years and for the first couple weeks I was seeing much better readings than I had ever seen without insulin–ever. So I thought maybe my betas had gotten new life. Then they started to tank, and eventually I saw the very worst fasting bg I’d ever seen. And I don’t have anything autoimmune going on.

Now I’m doing a mixture of very low carb meals with no insulin and one moderate carb meal a day with insulin, and using a very low dose of Lantus every other day which sounds wacky but seems to make a difference in the fasting bg without getting me shot out of sleep with my pulse pounding. which happens if I use it every day no matter what dose.


#13

That’s an interesting thought. I am seeing my GP in April and thought I might ask her to check my antibody levels. I am very curious. I was just borderline on Islet Cells and negative on the rest. I wonder what my diet and keeping BG low has done. I did see a reduction in my TSH level on my raw food diet. I have only had the thyroid antibody test done once but I am guessing that if my thyroid is functioning more normally there has been improvement in that area. I wish I could have someone follow this (other than me) because it’s rare to catch LADA at such a beginning stage.


#14

These discussions are REALLY helpful. I really like hearing what other people do for insulin and diet. I recently started splitting my Lantus dose (6 U PM and 2 U AM) and it seems to be helpful this time. I’m still doing about 8 U Lantus and occasionally I bolus with .5-1 U Humalog if I know I’ve eaten something that will make me go higher than 140. My new endo gave me Humalog, which seems gentler to me than Novolog was. But I have a pen now for Humalog whereas for Novolog I had these horrible syringes and it seemed harder to be accurate with dosing.

My problem is that I’ve gained 7 pounds since Christmas! I did up my carb intake a tiny bit and I’m not exercising as vigorously (hard semester). I want to lose weight though. I’ll try to post on the main page to find some weight loss strategies with insulin. But what is y’all’s experience?

Speaking of experiences with medical professionals…I have studied low-carb diets for years as part of my academic research. I’ve published on it and I go to conferences with the “big guns” who write all the books about low-carb diets and I read the primary literature on it. It is SO painful for me to be given a nurse practitioner and listen to her lecture me about how awful low-carb eating is and how I should have my diet be 65% carbs and how “if I want that Easter chocolate bunny I should go for it.” I can’t get any support among the medical professionals who are in charge of me for this way of eating. They keep saying my cholesterol is high (just over the limit for high). But meanwhile my HDLs are great, my triglycerides are great, my blood pressure is great, my HbA1c was the lowest they’ve ever seen in a diabetic patient…

Maria


#15

No matter how much any one person studies any subject, they can not KNOW IT ALL, published or not.

As for the go for it Easter bunny, its a matter of typical human nature, Almost all diabetics resent not being allowed (or told they should not have) candy. Its also human nature that when a person is denied something, for ANY reason, they are more likely to rebel. Yes adults, aka grow-ups rebel in their own ways, its not just kids you know.

When I first became diabetic it was a lecture how sugars were poison for me, today’s approach is so much better these days. There was no room for any “if you want it” on anything, it was do or die from complications. Over the years they have learned that when people are given a little breathing room, they are less likely to feel guilty and stay astray for long periods. There is so much more to managing diabetes than the mechanics of diet and insulin balance.

Just because YOU do well on a low-carb diet, does not mean others do, keep in mind most diabetic patients that PN sees is not a published researcher on anything. You post sounds like you really have invested a lot of time and effort into your research into the subject, and you know how YOUR body handles your choice of diet, but from reading your reply, you are not your average patient in this aspect either. I am kinda odd myself, or so I thought because much of the old methods did not fit my system well, or work well for me, and that has changed as well.

I ask, WHY is it SO painful for you to deal with another person who ALSO has invested in learning to help others? Sounds to me more like two well-meaning intelligent minds knocking heads with little mutual respect.

BTW what kind of great BP & a1c numbers are you getting? My BP is not great even with meds, but my a1c has been running 5.7 to 6.0 now with 5+ shots/day, a far cry from the 8.6 on 2 shots a day.

(&( .


#16

Hi Maria…I use the Humapen memoir, which I love, but it does not let me dose in .5 increments. Which pen do you use? What caused you to split your Lantus? I take 8 U’s as well, and my #'s are harder to maintain in the evening…will splitting help?

I have been low carbing for a few months (with breaks for Easter candy, etc.) and I have lost weight without dieting. For me, the carb/insulin/fat thing must be true. I always thought a low carb diet sounded fad-ish…not healthy. A lot of knowledgeable people seem to feel otherwise.

One last thought. You have put a lot of time into working out what is best for you. The lack of support you feel is frustrating, but to me, your #'s say it all…Good job.


#17

Hi, I also have a memoir pen, never use it, Px never got the carts in, so used disposeables. Neither offer 0.5u increments, but there is another pen w/o the digital stuff that I hear does. Lantus is not a true flat curve even after it becomes effective. I though I was gonna get away with one basal shot/day when I was told I was being switched from NPH to Lantus…then was hit with SPLIT the dose and its working great for me.Some people are advised to do a slightly uneven split morning/evening. That is to reduce the dawn effect many people have.

Elane, I guess I missed the NUMBERS, msut have been in another reply. Problem with numbers is what might be great numbers for one is not so great for another. My doc considers anything under 7.0 great for me, but I actually do much better…

YOu also said you thought a low carb diet sounded fadish, problem what makes a diet “low carb”? There again what might work for one person can be downright dangerous for someone else. The number of available pigeon holes is limited, the variances among people are infinate and one size does not fit all, not even me.

(&(


#18

The Novopen junior lets you dose in 1/2 units. Plus it comes in fun colors! That’s why I’m on Novolog rather than Humalog. I don’t do less than 2 units as it doesn’t seem to absorb consistently, but I do use 21/2 or 31/2 often. I like the flexibility.


#19

Maria,

The great thing about diet, is your doctor and his idiot nurse can blab on all they want about how you should be eating all those healthy whole grains, then you can go home and eat what you know is healthy.

Good thing we don’t need scripts for meat!

I’ve been low carbing since the days when doctors were convinced a low carb diet would give people with diabetes heart attacks and kidney failure. My doctors have seen me lose weight and keep it all off. They’ve sent me for test after test to prove I must have heart disease and so far they all come back normal. After a few years I was told I must have been misdiagnosed, so I went to the lab after eating a single muffin and demonstrated that yes, I am diabetic. My A1cs have all been in the 5% range for 10 years except maybe 3 times when they were still under 6.4%.

Not a single doctor has ever asked me, “What the heck are you doing to get those numbers?.” Not one.

Sometimes I wonder what they do to people in medical training to wipe out any curiosity they might have ever had about health.


#20

Your insurance sounds wonderful.

I’m gearing up more a major effort just to get my insurance to pay for Novolog. The pen is a second battle. I will have to get letters from my doctor to get either, and my doctor isn’t shall we say, “proactive” so it’s not certain she’ll go to bat for me.

Humalog totally didn’t work for me. Not sure why, but I’d see highs followed by lows every time I used it. Novolog works perfectly when I inject before the first bite.

I’d LOVE the 1/2 unit pen, but I would be happy with a pen prescription period that doesn’t end up costing me a $180 of whatever obscene amount they charge for them now.