In the absence of antibody and C-peptide testing, nobody can say for sure what type you are.
But the fact that you are only on basal insulin means that your pancreas is still making some of its own insulin. Believe me, once your pancreas starts pooping out, you notice it immediately in your numbers. So the nurse was partially correct there. As for the insulin resistance, well she has no concrete proof of this but chances are, she saw an overweight person in front of her, and in general, the heavier a person, the more insulin resistant they are. Also you are on quite a high dose of Lantus, high enough to suggest insulin resistance.
None of that is reason enough for her to treat you so rudely and she certainly has to work on her patient care skills.
BTW it’s perfectly sensible of you to be adjusting your Lantus in reaction to your sugars. But I’d like to suggest that 70-80 is not low at all. In fact, 70-80 is comfortably within my target range for morning fasting blood sugars. I’d be thrilled to wake up at 70-80 every morning.
Lila, I just want a baseline so that I can understand where I am, especially if there are any changes in the future. I feel 100% sure that I am producing a decent amount of insulin, thank goodness.
Regarding the 70-80 range, it is funny because when I first started getting some decent numbers, I remember feeling really awful and thinking, wow I bet I am hypo. I checked and my BG was like 130, which of course is great, but I could not understand why I felt so bad. It was explained to me that I had had bad numbers for so long that my body was just getting used to more normal numbers. It took a few months, but I did get to where “normal” numbers were comfortable.
I have a little wheel that is a dosing guide, and when I hit 80 for morning fastings, I am supposed to dial down 3 units, take my numbers for three days, and then adjust accordingly. I actually feel pretty good at 75-80, but any lower than that I am miserable. My goal is to get some weight off, and if I still need to be on insulin, I’m okay with that, I just hope it can be a nice low dose. It’s all a work in progress I guess!
Sparkysmom: It does sound like your family history would indicate testing for T1. That being said, I totally get the need for a baseline. Nel, the rep for the CDA on TuD copied a CDA document which stated that T2 is also progressive. So I’m not sure what this means: Is the insulin resistance progressive? Does the pancreas also give out? or Do the oral meds such as the sulfonylureas burn out the beta cells? In any case, one would like to know how much function is left. What I don’t get is whether these tests will show this or whether they just show the autoimmune problems. I understand why Zoe and others were happy with the T1 diagnosis because they were finally able to get appropriate treatment. I do however, share your hope for the T2 diagnosis because it most likely means that there is still some function. The bottom line is that everyone deserves to know what is happening in their body and these weight/age issues just get in the way.
I had a similar problem - to do with my hypersensitivity to a particular insulin and wanting to go on pork. Her excuse was that “we always prescribe human insulin”, another was, “Pork insulin is found to be dangerous and is therefore no longer available!” When I brought evidence to her - including case studies where people have died because of the “human” insulins and being overly sensitive her last lame excuse was “You might be allergic to the pork insulin!” Er, hello, my favourite meat is pork (thank God I am not of a religion where they do not eat pork!) and I have never had a problem with it. I said that perhaps they could let me try it and if I did react badly to it then I promised that after 6 months I would go back and eat humble pie. She did not like that.
So, I went back to my doctors and asked to be transferred to a hospital further afield. After a few tests they decided that yes, I might do better with pork - which was available, and I have since discovered that several other people in our town where I live are on pork insulin!!! On the bus on the way home I could have shouted “YESSS!” but then thought better of it because I might have been arrested and put in a strait jacket!!
I had up to 9 hypos a day on the human insulins, I had lost my hypo awareness - so did not know that I was hypo until I was 2.3 mmols, I was exhausted and irritable and there were so many swings and roundabouts in my sugar levels …
Since going on pork insulin (much to that nurse’s disgust!) I have been a lot better - not perfect, but 1 hypo or sometimes 3 are all I have. The oversensitivity to human insulins has since been confirmed when I have been on insulin drips while in hospital for operations and they have not been able to get my blood sugars up and stable. Now I have a document made up of how I wish to treat my diabetes, that I will do it all myself (with pork insulin) while I am still conscious and that under no circumstances am I to be given human insulins. You can refuse things if you want to - whether the hospital likes it or not - if they do what you ask them not to, then it is a case of assault!
I would, if I were you go back to your doctor and ask to be referred to a different Endo practice. You have rights. You know your body better than anyone!
People typically do require less insulin with the pump than with MDI. But that is more because when you use a pump, your body absorbs the fast-acting insulin better so you need less of it to get the job done. Unfortunately, most people gain weight when they go on the pump (at least, that’s the case for T1D folks). I went back on the pump this past year and did put on about 4 pounds. BUT, I honestly don’t know if my weight gain was from the pump itself or from the fact that I was no longer running high all the time before going on the pump and now I’m in range more often (high BGs for T1s result in weight loss).
BUT, if you’re finding that, because of your basal insulin, you have to eat often to keep your BGs up, then yes, the pump could potentially help with weight gain. The nice thing about the pump is you can adjust your basal rates throughout the day. I always had a lot of trouble with basal insulins because I’m very physically active. The pump has pretty much solved that problem (along with my dawn phenomenon battle).
Another thing I wanted to mention - I remember my endo saying in passing one time that T2D folks don’t typically experience hypoglycemia because of the presence insulin resistance. Yet you mentioned in your post that you had a few lows. Just caught my eye.
See, that is what was confusing me this past month. I had been taking my regular dose, everything was going along just fine, and then suddenly I start getting these morning lows. It took me a few days to figure it out, but once I did I started dialing down the insulin dose. Then Boom, I had the really scary low.
I just wanted to ask my doctor if maybe my insulin resistance was decreasing or if my pancreas decided to have a little party. Clearly this nurse practitioner was not in the mood to be asked any questions!
Yes, I am positive I have a large component of insulin resistance. I have not really diagnosed myself as LADA, but I do suspect that I have some components of type 1.5, which is why I want the antibody test. I feel that the health care provider I use is taking a look at me visually, seeing that I am overweight, and sticking me in the type 2 category, without any regard for my family history and several other red flags that are too long to go into. I am not saying I am “special” or anything, but my family history is so strong not only my father’s side, but with my mother’s autoimmune disease and two of her sisters having autoimmune disease, I just feel it is necessary, if only for my own peace of mind, to have all of the information that is available out there to be gathered about me and my body.
I have read a really good article that explains the variability of results on C-peptides levels and how the resuls can be misleading, etc. I totally understand that. But if I am willing to pay for it, and I am still going to abide by my doctor’s wishes and do what they tell me, then I say what’s the harm in them ordering the tests? Even if it is just to shut me up, LOL.
When I experienced that low, I took care of it and and worked a full day that Friday and went on about my business. I was not bedridden or anything. I just felt like I had been drug through the mud and was tired. I had not experienced anything that low ever in my entire life so it knocked me for a loop.
I am taking the 40 units of Lantus and 1.8 of Victoza, which by the way is down 20 units from about a month ago. I have been diligently taking my readings, counting my carbs, getting up and moving about and being as active as I can be, my blood sugars have been consistently in the 120 range all day.
I still feel really tired, but I feel much better than I did last Friday! I haven’t been quite as miserably hungry today which is nice. I’m just going to keep doing these things and go to my PCP Wednesday and get her to order those blood tests.
I am just hoping she can explain to me why I suddenly need less insulin over a months’ period when I had not been doing anything different (no weight loss, no carb restriction, etc) to explain it. Is my insulin resistence decreasing (that would be great!)? Maybe she can answer that.
Hi, Sparkysmom. Are you just taking basal insulin or are you also using a fast acting insulin at mealtimes? I am wondering because if you are feeling very tired it might be because you are getting some spikes after meals. When I tested at 2 hours and sometimes even at 1 hour, I would see normal numbers but I felt terrible. Turned out that I was having huge spikes and swings after meals- up to 200+ and then down to below 100 within the hour. I have LADA and still make quite a bit of insulin but the first phase is impaired which is often the case.
Libby, I am on basal only, and I do have some pretty decent spikes after meals. I believe I need to be on some mealtime insulin, but it has never been addressed. I think this is the reason: About a year ago, when I was switched to Lantus the doctor (not the NP), wanted me to work simply on getting my morning fasting down, then she said we would work on the mealtime spikes if there were any. Okay, got the morning numbers under control, actually too good of control given my recent lows. The past 2 times I have been there over the past six months, they stick me with this new NP and nobody ever addresses the mealtime spikes. They just tell me to exercise and get the weight off. I have to hear over and over again how to count carbs, blah, blah, blah.
As an example, last night I ate dinner, a grilled chicken breast and some roasted carrots, water to drink. Before meal was 127. Two hours after was 188. Personally, I think that is high, and sometimes I do eat are more carb heavy meal because, let’s face it, I am human and sometimes just want some bread, gosh darn it! I am so anxious to get to my regular doctor.
188 is definitely too high 2 hours later. You should also check at 1 hour and see where you are, just so you know. You can always do a little experimenet yourself with some regular insulin (which can be purchased OTC). In the 30 years I’ve been dealing with doctors and D, I’ve sometimes found that it’s better to test something yourself and then go to them with the results. D is a lot of trial and error. Everyone is different and sometimes you have to just try it, see if it works, and go from there.
I don’t think that just because you are taking 40 units of Lantus means that you are T2. There are a lot of T1s that take far more than that. At one point, I was taking about 60 units of Lantus and I am Type 1. The problem with Lantus and doctors is that most of them don’t understand that it is not a 24 hour insulin for most people. To get it to last longer, they keep adding more and more and it is very easy to start getting high doses to make it last. I landed in the hospital for my foot and an endo came in. That was before I found the DOC and learned about all the fun stuff we should be doing to get our levels set right. He did a very basic form of basal testing by having the nurses check my BS every hour for a couple days (that was real fun trying to get some sleep). He did not stop my meals though. He said that I was taking way too much Lantus (which I do agree with him now) and I really should be taking about 17 units a day, not 60. That is what he sent me home from the hospital with - 43 units less than what I went in the week before with.
I also have to wonder if you are actually taking more Lantus than you need since you have lows. It is very possible that since you are not taking a fast acting insulin for meals, you are taking Lantus to cover for both basal and bolus. In fact, I would be willing to bet some $$$ on that! I am not sure how basal testing works for someone that is probably still producing some insulin. I have some stuff going on the next couple days, but I already put on my calendar for next Monday to try and find the answer to that question.
Insulin resistance is not only a Type 2 problem. The more weight I (or most people) gain, the more insulin they need. There are a lot of factors that go into what amount of insulin you need. You shouldn’t ever compare yourself to anyone else. There are T2s that don’t take much insulin and there are T1s that take the mega doses that some T2s take.
I also have to wonder if you are actually taking more Lantus than you need since you have lows. It is very possible that since you are not taking a fast acting insulin for meals, you are taking Lantus to cover for both basal and bolus. In fact, I would be willing to bet some $$$ on that!
I am wondering that myself. Since I can’t get anyone to address it at this clinic, you can bet that will be one of the things I will ask my regular doctor.
Ask your doctor for a prescription for humalog and give it a try. I’ve found sometimes that you have to just come right out and ask for what you want to try, and most of the time, if the request is reasonable, docs will write the Rx. Worst case scenario is it doesn’t work and you go low for a bit. As long as you know how to identify and treat a low, you will be ok. Because I think KellyWPA is right on the money in that you’re relying on Lantus to cover both your basal and bolus. In my experience, this is something that can lead to weight gain, because you have this long-acting insulin in your system and you have to “feed” it in order to go avoid a low.
Basal insulin is really tricky because the amount of time it lingers in your system can really vary from person to person. Also, its uptake is highly impacted by so many factors (activity level, weather, etc).
Because I think KellyWPA is right on the money in that you’re relying on Lantus to cover both your basal and bolus. In my experience, this is something that can lead to weight gain,
Absolutely! And in my case, difficulty losing weight. Boy, is it a struggle! I will add the fast acting insulin topic to my list to things to talk to my PCP about. She is going to get an earful from me, so I am trying to document everything so she can have something to look at. I am writing down every single thing I put in my mouth, every dose of medication I am taking, and all exercising that I have been doing.
I am going to ask her opinion about whether using a pump with small secretions of insulin throughout the day, with bolusing for meals, would help me not put on weight or retain weight. We’ll just see.
Actually, Lynne, Apidra is the most rapid of the three bolus insulins. Are you sure your I:C is correct? You shouldn’t have to wait that long to eat and if you are spiking all the time (or all the time after a particular meal) it tells me the I:C for that meal is not correct. Try tweaking the I:C ratio until you get better results. It does sound like your needs are changing rapidly.
Lynne, I know what you mean about being able to feel a spike after a meal. Of course, if I have had something that is too carb heavy, I can understand that, but if I have eaten something low carb, I don’t like that feeling of going up and down.
Lynne- Stop comparing yourself to others on this site! If there is one thing I know for SURE is that everyone responds to all this differently and there is no one size fits all that would allow us to compare each other side by side. Keep doing the best you can with the tools you have and at the same time keep striving for more tools to fight the battle with. That is all any of us can do right?
If you are spiking and then coming back down to normal maybe it is not the I:C ratio but the timing of the insulin dose. If you went up and stayed up maybe I:C but since you come back down I would guess you need to take your dose just a bit sooner before you eat.
