I would say that your dose is too high, you're not eating enough or eating to long after bolus, those would be the most obvious. I'm concerned that your doctor has prescribed such large doses but yet doesn't know what type you are? Type 2 normally take much higher doses than type 1, which would overdose many type 1. Most people measure the amount of insulin to the amount of carbs now depending on insulin/carb ratio and insulin sensitivity etc.
I totally disagree about not worrying about the type: you need to figure out what type you are if possible(some people seem to be a gray area, but not too many), and then treat accordingly as well as follow the carb/insulin ratios that work for you. Have you had antibody testing? Your c peptide has decreased a lot. I also wouldn't use 70/30, most people whatever type find it harder to manage things and type 1 are not put on that.
Yes, you do wear the pump all the time, as it gives you basal doses 24/7. But it is something you will get used to very easily. Wearing a pump does not interfere with anything you want to do in daily life, like engaging in sports or anything else. On the contrary, it helps you to live a more normal life. I have an Animas Ping which uses a meter/remote. When I am in public I just test and press a bunch of buttons for my meals. I don't have to worry about people watching me doing shots or going to the bathroom to do it. I can eat whenever I want and don't have to worry going low if meals are delayed because the basal keeps me steady. I change my infusion set every 4 days instead of taking several shots a day. I can precisely dose. Pumps are very freeing and the best way to manage diabetes. But yes, as you said, MDI is the way to go if you can't get a pump or aren't ready to do so. The skills you will learn from reading those books such as I:C, carb counting, ISF are ones you will need to know to use a pump anyway.
Its really nice to know that pump doesnt cause any problem in daily activities and manage diabetes a lot better than injections. I will definitely ask about using it. For now, these terms I:C, carb counting, I have to learn to be ready for pump in future.
I think bolus portion in pre-mixed insulin(humalogmix50) was acting quickly after meal and my bolus insulin sensitivity has increased. I tried to lower the doses but still getting lows immediately after meals. Then, I skipped insulin for evening, after dinner and morning fasting levels reached to 200. That may be because there was no basal insulin to cover that. Doc said to try changing the pre-mixed insulin from 50-50 to 75-25. I have had only one antibody tested, Thytoid Peroxidase(TPO) came out +ve (>600) one year ago(on diagnosis). I also had abnormal TSH, which has come to normal value now. I asked him about GAD Antibody test, he said, its not compulsory to do, its up to you, it may or may not help in deciding the type. I think there are 3 or 4 tests for antibodies, some or all of them can confirm the type. Only those can confirm type 1, so I am not really sure that I am type 1. I will have to see other endocrinologist for these tests.
From the TPO test it seems you may have or may be on the way to graves disease or hashimoto which are also autoimmune conditions so you may also have type 1. I would get the full panel of antibody tests for type 1(see melitta's blogs), c peptide and I would switch endos- get the tests first since your doc is willing to do them, while you look for someone else. I would also ask to switch to a fast acting and basal not a mixed insulin and then consult a diabetes educator about how to manage your insulin dosing. But for now I would definitely reduce the doses so you don't go low during meals.
Doc. said once, I dont have hashimoto yet. Sometimes thyroid related antibodies, one may have, just because auto-immune disease(type 1). But I should get those type-1 related tests done for confirming. There are three other antibodies tests including TPO, to be sure about thyroid related disease. My lows are over for now, as I decreased bolus portion of pre-mixed insulin. I will change to separate dosing for both soon.
That sounds like a plan. I would retest for the thyroid antibodies to monitor what's going on there. I'm glad you brought them up because I would like to test for them also due to some symptoms and since my grandfather had graves disease. I would definitely get the full type 1 antibody panel done, there are 4, just check Melitta's blog for that. I'm glad you've got the lows under control now!
I just found the blog, there are 5 tests for type 1 or LADA. I can test for four out of them as I have been using exogenous insulin. Also, There is a book for most thyroid issues named 'STTM'. Its website itself has lot of information on all thyroid diseases(mostly those may occur along with diabetes). They say about lab tests, and how TSH is not the right criterion for diagnosing hypo or hyperthyroid. It can be useful for you.
Thank you ran.peace, I will look for that book. I think you can get the c peptide test also because is measures c peptide which comes from natural insulin production not exogenous insulin(the new man made insulins don't have any c peptide) and shows how much insulin your body is naturally producing. Fasting and non fasting are recommended.
Thanks, i will test for this as well. Though, I tested fasting C-peptide two months back, it was 0.653 ng/ml, it is on low side of the normal range and keeps decreasing since diagnosis. I guess it happens mostly in case of type 1.
Yes, sounds like type 1 to me. Type 2 will decrease eventually too I think but not that rapidly. Fortunately you're in a position to get all of the testing done and avoid a disaster.
