You have received some really good advice but you don’t seem to be familiar enough with the health risks associated with diabetes to put their advice to effective use. Your blood sugar levels are not just way too high, they border on ER treatment consideration (any levels above 400 mg/dL). You can begin by reading Adam Brown’s book, “Bright Spots & Landmines.” It is available as a free PDF download (a donation is requested but not required). If you have a Kindle eReader, the Kindle version is available on Amazon for a couple of dollars. But don’t stop there. Continue with reading two other books: “Dr. Bernstein’s Diabetes Solution” and “Blood Sugar 101” by Jenny Ruhl. The information they provide will enable you to construct your own plan and goals to get your uncontrolled blood sugars into manageable levels again.
I am also insulin-dependent and have been for over 20 years. Most of my insulin is mealtime (bolus) insulin to counter blood sugar rise after meals. I only use the long term (basal) insulin to cover fasting blood sugar levels, not BG increases from meals. My own target is in the 5% range or less (my own A1c has been 4.7% for the last two years.) Perhaps this chart will motivate you to learn more and explain why the medical profession recommends keeping blood sugars LESS THAN 7%:
Dogdemon,
I am also frustrated by poor or no instruction/information from medical professionals. I have done a lot of googling and I’ll summarize what I think I know and others can correct me. I’ll also share a few things I’ve learned the hard way.
If you are T2, your c-peptide test will probably be high and out of the normal range. C-pep is a surrogate measurement for insulin production so a T2 will be high because their body is making lots of insulin to address high blood glucose that is due to insulin resistance. The insulin is not effective due to the resistance and that is what the Metformin attempts to address.
If you are a T1, your c-peptide test will probably be low and possibly out of the normal range. This is due to your body not making enough insulin. As far as I know, the only recourse for low insulin production is shots or a pump. Oral insulin is not possible as it does not make it through the digestive tract.
An antibody test can help you figure out if you are T1 or T2 but it may be misleading. A GAD test is often the first one ordered and it is looking for the antibodies that result from your body attacking its own insulin-producing cells. It’s possible to misinterpret the results if your cells have been damaged by something other than antibodies – you may not be making insulin but not because of the typical reasons so a doctor may miss it (happened to me). Consider the GAD and c-peptide results together and try to make sense of them. I had very low c-peptide and normal GAD and an A1C of 15 – the doctor insisted I was T2 but I later figured out I was T1 due to early-age cancer treatments (abdominal radiation).
Type 1.5/LADA has elements of both T1 and T2 and I would think the only way to diagnose accurately it is with the c-pep and antibody tests. With 1.5 you might get benefits from both the insulin injections and Metformin-like orals.
I understand there are several antibodies that can be tested for but I do not know what they all are or how to interpret them.
An endocrinologist is the appropriate specialist to consult. I’d recommend seeing one rather than relying on a general practitioner if you’re not getting the information you need.
I cannot agree more with other’s comment recommending a continuous monitor. As you are trying to figure out what your insulin protocol needs to be I would suggest to you that “lows” are going to be very likely. I’ve been terrified of going low in the middle of the night and not knowing it, waking up too confused to correct it, etc. I changed to a Libre2 with alarms for that reason. The smartphone app does not support the Libre2 version with alarms; the one supported by the phone app (also called Libre2) does not do alarms. Other people seem to like the Dexcom G6 which also has alarms and does connect to your phone but I have no personal experience with it.
Lantus is often injected once per day. My understanding is that twice per day is appropriate/indicated if you find your BG consistently going high before your shot (e.g. the shot is not lasting the entire 24 hrs in your case). Also, where you inject it has an impact on the onset time (e.g. arms are fastest, hips are slowest). This may be more important for fast-acting and may have less of a practical impact for Lantus.
Your post indicated you are going to insulin because of issues with Metformin. Be aware that there are other oral meds (glipizide, for instance) that act on other mechanisms in the body. Insulin may not be your only non-metformin option.
One more thought. When I was prescribed Lantus I was also given a “titration schedule” (up/down by x every x days). My endo, however, put an upper limit on it and said “call me if you get to x units/day” – I didn’t see that for you in your question/comments.
LADA or type 1.5 is type 1 diabetes. Full stop. However it comes on slowly over a period of many years. You will slowly lose insulin production until you need injected insulin for all of your body’s needs. This is why it is common to misdiagnose LADA for type 2 as type 2 meds will often work for a while but either side effects will force you off of them or they will stop working.
Type 2 is insulin resistance. Your body makes insulin oftentimes a lot of insulin but it doesn’t use it properly. Diet and exercise can treat type 2, as well as type 2 meds as they target the insulin resistance by either stopping your liver from producing glucose or preventing the glucose in your food from being absorbed into the bloodstream.
Try to find an endocrinologist to meet with.
I am trying to get my nurse practitioner to send me a referral to one. She put in a referral to a dietitian again for me.
I too 2nd going to an endocrinologist that’s on your plan. if you have a few to choose from, interview them first and see if they would be a good fit. A good endo is worth his/her weight in gold! They will work WITH you and educate you and make sure you understand everything and not just dictate and tell you do things because I said so. Been there done that.
Dexcom G6 is the gold standard, so if covered by your insurance, I’d get that one if I were you.
Test strip wise, I agree to check the Reion Prime by Walmart. Last time I checked the meter was like $9 and test strips started at $9 for 50 and much more reliable than One Touch. And you don’t need a prescription.
And of course run everything by your Doc first.
let us know how it goes.
I will get the ReliOn Prime and the BG testing strips. I got my One Touch “for free”. It’s the Verio Flex ones.
It’s $20 for the meter and then the test strips. I can just use my lancing device for the One Touch to save further $$$.
Edit: I got my referral to endocrinology sent, may take 1 week or so for his office to call me.
Just a warning note…endocrinologists are in high demand and it’s not uncommon in a lot of areas to wait 3-6 months to get an appointment. Sometimes they have cancellations and will ask if you want to be on a call list. But sometimes your doctor can word it as more of an emergency situation and get you in sooner.
Possibly new to insulin and your higher numbers might work to get you in faster.
My kidney specialist was booked for 2-3 months and got an appointment set for June. My surgery for my urologist to do more kidney stone work took months due to various reasons which included him catching COVID.
I expect a long wait though due to short staffing, high demand, etc.
A certified diabetes educator may be very helpful in teaching you about living with diabetes. Nancy
So basically I was referred to see a dietitian when first dx in 2019 with Type 2 diabetes. She taught me how to use my meter and did tell me where sugar levels should be etc. This was so long ago, and that paperwork has since been lost due to spring cleaning or somebody throwing it away. At the time I was on only Metformin though.
I can see if a certified diabetes educator is something covered under my insurance. I am guessing it likely is.
I also recommend a CDE. Most insurance companies cover it, at least a few each year. But check before making an appointment. Don’t want to get stuck with an unexpected bill.
A CDE can give you more time, injection procedures, blood testing procedures, set some goals and a treatment plan for when things are not where they should be.
Please don’t beat yourself up. This is not an easy disease. But please give it the respect it needs and demands. It is a disease that is easy to ignore but while you ignore it, it is doing its damage. But remember having a high once in awhile is not going to kill you. It is just telling you something you are doing is not working, so you can change you treatment plan. Each number is just a result in how well your plan is working.
You just need to keep plugging along. As the numbers come into a normal range, you will realize how crappy you were feeling before. I find when my sugars get high, I feel horrible.
So find yourself a good CDE who can spend some time with you. And hopefully they will have email or portal system so you can ask non-emergency questions. It is my favorite why to get to my doctor versus fighting with phone calls. Good luck. Keep us posted on how things are going and keep asking questions!
My sugars were never higher than the 200 range. This surgery I had for the kidney stones is what they’re (nurse practitioner) saying likely caused the high spike in sugar levels etc. While that alongside being an idiot and not eating healthier…that’s also a high risk for high BG too. I haven’t changed any diet in recent months or anything, but this time when I go see the dietitian I plan on following the plan.
While it could be true the surgery caused it, not changing eating habits or exercising has not helped my case. I did forget to mention I did physical therapy for low back pain, and it seemed to work for a while. Maybe finding exercises for people with low back pain could help so I’m moving alongside other exercise videos at home.
I’m not sure what some of you guys do who suffer physical limitations for exercise, but anything would be helpful.
dogdemon are you open to diet/exercise changes? That might help. One very good site for eating less carbs is https://www.dietdoctor.com/ . They have a free side, free trial and a paid side. THey have some great recipes out there.
Another great site is https://integrateddiabetes.com/ . They have virtual CDEs there that won’t bill your insurance but give you a bill to submit for CDE training that perhaps your insurance may cover a portion of out of network.
Lastly, if you are into podcasts, look up the JUICEBOX podcasts ! Scott B. has a CDE from Integrated that gives a TON of tips.
@dogdemon I have a thrashed back and am limited on what kind of exercise I can do. So the exercise I do…
I have a recumbent exercise bike at home I ride 10 miles every day. A lot of gyms or physical therapists have recumbent bikes too.
I swim several times a week. Now I swim in the ocean but back in Calif off and on I belonged to gyms that had the larger pools to do laps in. But Ymca is good, it’s cheap or even free in some cases to swim laps.
The other thing I have been doing the past year is the online physical therapy program called SpineZone Online. It’s actually very impressive. They tailor exercises to what you can do and to target muscles to strengthen your back. They adjust an exercise immediately if it bothers your back and have been excellent about figuring out good exercises for me. You go at your own pace and do as many as you feel comfortable with. This has helped me. They would pause the program when needed because of my back issues off and on. This has been completely covered by my insurance, no cost to me at all. Blue Cross covered it before I went on Medicare and now it’s still covered but I’m not sure if it’s still Blue Cross or Medicare who is covering it.
The Nurse practitioner could be right about the surgery causing the 400. Stress raises Blood Glucose (BG). And surgery is definitely a stressor.
I second the recommendation for ‘Dr. Bernstein’s Diabetes Solution.’ It’s an excellent book and it’s the one I’ve modeled my own self care on. You should definitely read it. It goes into everything, diet, testing, insulin, exercise, the whole enchilada. I’ve been a Type 2 for 30 years. Still have all my fingers and toes and my retinas still work. My recent A1c’s have been running 6.0 to 6.5. I’m on Tresiba, a long acting insulin like Lantus. Bernstein is heavy reading though.
For a good introduction that is lighter leading, I strongly recommend is ‘The First Year, Diabetes Type 2’ by Gretchen Becker. It’s a great place for a newbie to start.
If you know year of diagnosis and age, an educated guess as to what type he was can be made. Health conditions (overweight/obese?) and other family history of diabetes can help. That’s how I figured out that my grandmother and siblings’ Adult-Onset Diabetes was really T1/LADA.
I had 2 sisters that were originally misdiagnosed as Type 2 but they were both Type 1. One sister was in her 40s the other was in her 50s. All of my sisters (4 of us) are Type 1.
Great advice. These foods are often highly palatable and encourage over-consumption. They also usually contain a list of unpronounceable ingredients that are not healthy. Finally, they usually include unhealthy “vegetable” oils like soybean and canola oil.
This is not a universal and not true for me. Many people find that these foods make glucose control difficult. I can, however, eat smaller portions of “above ground” veggies.
Grains, whether processed or whole, are problematic. In human nutrition, there are essential amino acids (protein) and essential fatty acids (fat), but there is no such thing as an essential carbohydrate. The definition of essential that is taught to dietitians is that it describes a nutrient absolutely required for survival and the human body cannot make it. If we fail to eat essential nutrients, we will soon develop disease and die.
The healthy way to lose weight is to change your way of eating first and then decrease the insulin dose to produce normal post-meal glucose levels. Reducing insulin first in an effort to lose weight can cause lots of trouble in managing glucose and lead to disordered eating in some. Your diabetes, of course, may vary.