Did my 1st Insulin last night... but what next should I expect.?

Hey all, Just wondering some thoughts and of course experience on LADA.
I was diagnosed 2 years ago at the age of 40, and like most was assumed I was type 2 for the 1st year.
Then found out I was a type 1 when I saw the specialist. ( which was not a surprise to me, but a horrible feeling that Oh boy this IS FOR LIFE ! )
Anyhow the Dr, doesn’t seem to want to use the 1.5 name with me?? From all that Ive read here I pretty much fit into the LADA discription. I understand that he goes with 1 because in the end that is what I will be.

Im not overwieght, I have hypothyroid for 20yrs +, and can pin point when I got sick with the flu 2 years ago and 1 week later I was diabetic. I’ve been on Metformin for 2 years because it actually does work, but the Dr did warn me eventually it won’t. 4 Months ago I also started Onglyza. Last Hg A1c was 6.2 !
So I’ve been managing pretty well, except for the metformin side effect with me of nasty BM’s that are no fun, and I’ve had them for the entire 2 years. The big breaking point was on a trip to Vegas, you all know the size of those hotels, when OH Oh, I gotta go. Of course being a private person hustling to my room 28 floors up so I wouldn’t kill the public washroom !!
So fed up I saw the Dr yesterday, he was so happy with my 6.2 as I am too. But I explained my situation.
He was quick to offer other medications, less metformin ect… When I flat out said why just not put me on insulin? He was more than happy to, he just knows so many people resist making that jump so he didn’t offer it before. I did my first injection last night, Novolin ng 4 units at bedtime. I was happy to have a 5.8 this morning. But he warned me I will crash in the night at some point and then will switch me to a better kind??? So with extended health I said just give me the best you can. But apparently in Canada they make you start on Novolin until you have a low overnight, Only then is he allow to give me the good stuff. Sorry I don’t know what the name of it is yet. I’m to start increasing by 2 units everynight. My numbers were pretty good today… I’m not sure at what point I should stop increasing the dose. Then I also wonder is the metformin still working in me for awhile? It’s all just a little confusing… ok maybe alot confusing.
I read so many of you take different types of insulin and at different times.
He wanted me to continue taking the Onglyza daily for now. Does anyone else out there have the same Meds as me? any insight would be helpful

Crashette, I know the Canadian health-care system is different from that of the U.S., so some of the health-care procedures for treating your diabetes are going to be different than what I would expect here in the U.S.; however, the disease is the same, so we can relate at least on that level. As for your 5.8 morning reading, that is great. My endo has me target 6.1 (110), so your 5.8 (104) is even better. He would want you to hold that number steady!

My endo took me off all oral diabetes meds once I switched to insulin; however, I use both general types of insulin: the basal (long-acting) at night, and the regular (fast-acting) before each meal. That therapy has eliminated my need for oral meds. The added benefit is that I no longer have to put up with the nasty side effects. You may want to consider going strictly on insulin if that option is available to you. It has sure made my life easier being on both. As long as you watch what kinds of foods you eat, how much you eat, and keep up reasonable exercise/activity, you should not have a problem with weight gain. I haven’t, and I’m 52 years of age.

You new course of treatment will all make sense very soon. You are doing fantastic!

Thanks for your experiences BDM.
You are right I know things will make sence as each day goes by. In addition learning from this website will help.
I did 6units of Novolin last night, and Woot 5.4 this morning !!! I will continue to test throught out the day to watch what happens after each meal. My Dr did say I would gain tighter control with the insulin. So far day 2 is starting out of a very positive number… GOOD BYE METFORMIN ! hello insulin
I think I will stay at 6 units again tonight???

Boy, Crashette, your story could be mine! Down to the 20 years with thyroid first! I was diagnosed in 2007 at age 58 so they assumed Type 2; did fine on oral meds until late 2008 when my numbers started to climb and climb and I figured out I was LADA and started insulin. The Novolin is an older form of insulin. There’s actually another thread by Julia running currently on that insulin. It’s not as effective as the modern basal/bolus insulins. I suggest you get put on a long acting such as Lantus and Levemir and a short acting for your meals such as Apidra, Humolog, or Novolog asap. I’m always jealous of countries that have universal health care until I hear stuff like they start people on outdated insulin regimens!

Welcome to the happy world of LADA/Type 1 (doctors don’t acknowledge LADA so they just call us Type 1 which is what we are except for time of onset). I was overwhelmed at first, but poco a poco (little by little) it gets easier. You are on the best website in the world for knowledgeable diabetics!

Hi Crashette – A lot of us were misdiagnosed as T2s. You are among the many that have been there. My doctor doesn’t use the T1.5 either. She just calls me a T1 – that’s pretty typical. A few docs will make the distinction but really 1.5 truly is T1 – just with a slower onset. I guess my first question is whether your doctor is an endocrinologist or a GP. If he’s not an endo, I recommend that you start seeing one for your diabetes. Do you have a diabetes educator? One could really help you with figure out dosing. A doctor should never be ok with you crashing. Typically, a T1 will be taken off of oral medications and put on two types of insulin – long acting and short acting (for meals). Did your doctor run a c-peptide test? Perhaps he kept you on oral medication because you are still producing enough of your own insulin - -that test will determine that for you.

Hi Crashette: You have received some good advice from others here. I would also recommend two books, “Think Like a Pancreas” and John Walsh’s “Using Insulin.” I agree with others that it is preferable to be on a better insulin regime, which would be basal/bolus. It’s important to be cautious at the beginning because you don’t want to have hypos. Good that you are now on insulin, and use this forum to get support and advice and understanding!

Hey Thanks everyone for thoughts and suggestions.
Just a bit more info, I did ask for the best insulin out there, I would even pay out of pocket. The dr explained the governments has tied his hands, he well aware the novolin, not the best , his exact words " unfortunately you will need to have just one overnight low, then call him asap , then the government will allow you the better stuff" So that 's what I have to have happen… kind of sucks, …hmmm I could call and say I had a low ! lol …but what ever. He is an Endo ( it took 1 year to get into his office btw for my consult ! ) He has run all the appropriate tests,C- peptide, including heart stress test, eye exams, at 5’7 and 133lbs even with out the tests he was 100% convinced Im type 1 prior to getting the results
Yes indeed my production of insulin is limited , and I was doing well on the metformin do to strick dietary control, but as mentioned I couldn’t take the side effects. I was really relieved to get started on insulin, and he said I would gain even better control on it and it is really the best for my body. I also felt why put it off any longer I was mentally spent with the metformin. I feel so much more upbeat even excited about starting insulin, From reading all your posts everyone says life is better on insulin. So here only at day 2 and I understand what they mean.

I had GD and took insulin for 7 months, so I’ve had some experience with injections, although GD is a different beast all together and way harder to control in my opinion. It was 7 years ago but I do recall taking both N and R, I also know I had to take a little over 350 units a day towards the end of the pregnancy !
He felt I was more than capable of getting started on my own, I’ve register for the carb counting/education course, which I know once Im on the newer types of insulin I will need plenty of help getting it all sorted out.
Im clueless to what basal/bolus is??
But I will find out that is for sure, thanks for all the suggested books.

Hi Crashette: I wrote a TuDiabetes blog about autoimmune gestational diabetes; check it out if you are interested. LOTS of women here on TuD had gestational diabetes which was in fact autoimmune gestational diabetes and became Type 1 diabetes. Pregnancy can be “the straw that broke the camel’s back.”

Take good care of yourself; it can all be overwhelming at first.

Melitta, we really have to give you the crash course on hyperlinks. Here is a link to the now infamous blog post on “Autoimmune Gestational Diabetes.”

My story is almost yours to the t. I was diagnosed Jan 2010 with “type 2” as a very active underweight 24 year old with an A1C of 6.0 and fasting bg of 126. I too have hashimotos thyroid for 14 years now. I never took any meds but continued to deal with diet and exercise and by the following January2011 I was only eating about 20 carbs per day and exercising about 2 hours daily and still have high blood sugars. My A1C from the end of December to February went from 6.2 to 6.9 and my post prandials were in the 200s after eating about 5 carbs at a time with exercise. I was finally diagnosed as having LADA and started on mealtime insulin first as my fastings still were not horrible usually under 120. Within 2 weeks of starting humalog meal time insulin I was put onto 2 units of levemir at night. I am now 3 months later still only on 2 units of levemir. If your fasting this morning was 5.8 then I would stay at the basal dose you are currently on until your fastings start to creep up.

I also had “gestational diabetes” at the age of 20 with my pregnancy 4 years before diagnosis. I believe it was the beginning stages of LADA that they actually caught and my beta cells just continued to burn out.

Chrashette …a note about Lantus insulin in BC and what I understand : one needs special authority from one’s Endo for it to be covered by Pharmacare ( your taxable income is the guide of how much Pharmacare will pay ) …as you mentioned, however one can purchase it out of pocket , as you seem to be willing to do in your second sentence.
Are you covered by your Employer through an Extended Health Plan as PBC ? If yes, then you may want to call them and find out about their coverage of Lantus.
Next step is to Advocate with the Provincial Government for better coverage …another story !
PS Welcome to Tu …I live " down the road " from you :slight_smile:

Thanks, Brian! I do need that crash course…

thanks Nel : )
Thanks to my great hubbys extended health plan @ 80% coverage I know when ever I get the Lantus it won’t put me out of pocket too much.
I’m currently very please with my new numbers 5.2 this morning WOOT ! and 2hrsPP of meals are between 8 @ 9. and at 3 hrs Im in the 6 range- So at this point day 4 Im very pleased with my numbers and only 1 evening injection. I have noticed the trend of every evening I go up 2 units and every morning my numbers are down 2 units. … Is this true for everyone, cause if so It makes it easy to make unit corrections

At the beginning of the week, I didn’t know what to expect starting long acting insulin. I am pleasantly surprised at my morning numbers … and through out the day ! 5.2 this morning. Why oh why didn’t I push for insulin sooner?

I’m currently testing a little more than normal just seeing where my numbers are at… How much do the rest of you test?
And when do I know it’s time to add a bolus before a meal ( I learnt what basal and bolus was this week )
My assumption is when after a meal 2 pp numbers are over 10 then you start?
I have so much to learn and have enjoying reading other stories on this website. For those of you that have been around longer what seems to be the average honeymoon phase? Also is it common to stay only on long acting while honeymooning?
Thank you all again.

You are doing great! I was put on mealtime bolus insulin when my post prandials got over 200. It happened very quickly over a period of a month I went from diet/exercised to death controlled to being on a basal/bolus regimen. I test about 7-10 times per day. I also was just approved about 4 weeks ago so only 3 months after starting insulin for a Dexcom 7 CGM that tells me what my blood sugar is every 5 minutes and what direction it is going in. I only had to pay about $200 out of pocket and it really gives me a sense of security in reguards to always wondering “what is my blood sugar doing?” Best of luck!

Crashette, I check my BGLs 7-10 times per day on average: once when I first get up, just before a meal, two hours after a meal, and before bedtime. If my numbers have been running too high or too low during the day, or if I have eaten something that I feel may impact my numbers in an adverse way, then I check more often.

As for the pre-meal bolus with fast-acting insulin, there are a couple of things that one needs to consider in determining the amount of insulin to inject: (1) your BGL and (2) what you are going to eat. First, I check my BGL. My target is set to 6.1 (110). If I am near that mark, then I am set to bolus for 8ml of NovoLog. If my number is below my target, say at 5.2 (93.5), then I would decrease my insulin to 6 or 7ml. If my number is higher, say 10 (180), then I would bolus for 11ml.

However, I also need to consider what I am about to eat. That’s when I figure the carbs and adjust my bolus for that. For example, if I am on pre-meal target, and I expect to eat a relatively light meal with about 15g of carbs, I may drop my bolus amount from 8ml to 6ml. If I need to cover a more substantial meal, say 60g of carbs, then I would add a couple of units and inject 10ml. This process may seem complicated, but it becomes second-nature so quickly that you won’t even have to give it much thought. The trick is to match your bolus to the food you eat. Over-bolusing can cause a low, and you of course want to avoid that. Not enough insulin, and your numbers run high. By doing a lot of BGL testing, you will discover just the right amount of insulin that you need.

Maybe you can think of taking a part of it in the morning if your BG goes low? Split dose? Then you might not have a hypo at night? I guess I’d stop increasing a dose when a test during the night gets to 5 mmol/l. Then I’d go back to a prior dose so it could settle around 5 - 6. I don’t like things too low at night, and riding low is not the way to go.

I’m glad you’re onto insulin, and free of metformin side effects. Don’t expect the endo to treat you differently from a normal T1. That way you’ll have good blood glucose.
What can you expect next? Feeling great, having great numbers, normal existence! It sounds like you don’t need boluses for food. You may choose low glycemic foods as well as low carb. Learn about your options and you may be able to forestall the need for short acting boluses a bit longer.

I spoke too soon ! I posted last night and it was time for bed. I did my test 10.7 ! ack, my snack was 12 cherries, that were firm and not sweet at all. I’ve actually had cherries in the past few years since diabetic and they didn’t do much to my BG. I did 12units before bed and of course 7.2 this morning. A bit too soon to panic, I was 45 mins late doing my injection, I’ve been trying to stay on the 24hr mark… well it’s a busy day ahead of me I will just to have to wait and see.

For more precise matching of insulin to carbs you are eating, you might want to learn what your Insulin:Carb ratios are. I recommend the book Using Insulin by John Walsh.