I was just diagnosed LADA today. I have high post meal numbers into the 200s that tend to stay for a few hours. My fasting numbers are around 100-120. Though I have some days that are great and I don’t really spike at all. I know the best thing for LADA is starting insulin asap. I’m wondering if anyone has any tips on how to start this conversation as it makes me nervous. I’m currently on Metformin and I hate how bad it hurts my stomach. I’m very interested in starting insulin and would love to soon get on Omnipod. Any tips would be appreciated!
Would you feel more comfortable sending your doctor a message/email if available? I felt the same way asking first for a prescription for Dexcom and then letting them know I was interested in starting on a pump, but I found they were super receptive and didn’t push back at all like I anticipated they might.
I would approach the first insulin discussion with your doctor in a matter of fact tone. Tell the doctor that you know that LADA is a type 1 diagnosis and that means an absolute deficiency of insulin. Your post-meal glucose levels definitely need insulin to bring them into a more normal range.
Are you using a CGM? (Sorry, I don’t remember your previous comments in other threads.) If not, you might request an Rx for one even before the insulin discussion. A CGM will be a great learning tool for dosing insulin. Adjusting insulin doses is an art that involves lots of trial and error. You will soon be well beyond the experience of your doctor. Keep notes and it will shorten your learning curve!
Approach the insulin conversation with confidence as you have a right to normal blood sugar levels, the same right that each of us have to nutritious food to eat and oxygen to breathe. You are not asking for some exotic medication. Your doctor is there to help you achieve that.
Be aware that many doctors have little experience with treating T1Ds as 95% of all diabetics are T2Ds. Insulin dosing for T1Ds is not the same as it is for T2Ds!
Treat insulin with respect, not fear.
I recommend buying a copy of “Think Like A Pancreas: A Practical Guide to Managing Diabetes” By Gary Scheiner, MS CDCES. A very solid foundational book on diabetes and insulin therapy. It covers info on LADA.
Did you get a C-Peptide and GAD blood work? The C-Peptide test will tell you how much insulin your body is producing.
You have a right to request insulin. getting on insulin therapy soon after diagnosis of diabetes will preserve beta cell function. Usually there is a honeymoon phase (the body is still producing some insulin) that will decrease over time to the point where you will definitely require insulin. Honeymoon phase can last as long up to five years or more after diagnosis. I’ve heard some people have gone ten years in the honeymoon phase, but that is rare.
Again, you have a right to ask to be put in insulin. Ask your doctor about it. If he/she refuses find one who is willing to help you.
Great! Thank you! I do currently have a Libre cgm but would love the Dexcom but I won’t be approved for it until I start insulin so maybe I can get both at the same time.
@mag1819 – You probably already know this, but I will say it just the same. The Dexcom product is materially different from the Abbott Libre. Dexcom displays glucose levels without any electronic inquiry. It pushes data to the display every five minutes and is capable of generating an alarm for both highs and lows to get your attention.
The current Abbott Libre product is called a flash glucose monitor in that the user must interrogate the sensor by waving remote unit nearby to request an update. This is a critical difference, especially while you sleep. The Dexcom G6 will sense both lows and highs and wake you up with an audible and/or vibration alarm.
I know Abbott intends to release a true CGM soon but I’m not aware of their latest timeline.
I encourage you to apply for the Dexcom CGM as soon as you start insulin. It is a valuable and crucial tool when using insulin, especially when you start.
Edited to add: See my comment down-thread that acknowledges that my understanding of current Libre technology is incorrect. The Libre 2 can raise an alarm to high and low blood sugar levels.
No need to be nervous. Just tell your doctor what you told us. You have good reasons for wanting to try insulin. If he doesn’t agree, and you don’t agree with the doctor’s reasons then find another doctor. Remember that the doctor works for you.
HI, @mag1819 I am insulin dependent type 2, but looking at your numbers I suspect that your doctor might start you on a basal (long) insulin, once per day.
LADA is often very slow progressing in destroying the Beta cells. For you to have fBG in the low 100mg/dl and that your postprandial BG does come down suggests that you do have some insulin response.
Another possible therapy would be to use a rapid (bolus) insulin before meals. When I began MDI doing Lantus (basal) and Humalog (bolus) my primary care physician gave me a sliding scale for dosing the pre-prandial bolus. That might work for some, but not me. I came up with my own units/carb gram ratio that works very well.
Having a CGM is really helpful. The Libre is less so, but is not worthless. I find the Dexcom G6 quite good, especially now that I am using a T:Slim pump with C-IQ.
Speak with your doctor, and if they are not an endocrinologist seek a referral, hopefully one who is a diabetes specialists.
I got an endo when I started using a pump. I get tested for a lot of stuff qurterly including C-Peptide, thyroid levels (I am low) and thyroid antibodies. I think you should have all of the antibodies that target the Beta cells tested, 4 or 5 iirc, and the C-Peptide to determine how much endocrine insulin your body makes.
Sorry for running on and on.
I appreciate your response! Thanks for all the good info. I’d love to get started on a pump because I feel it will better suit my lifestyle. I hope to get a Dexcom soon too!
If your doc is a GP or internal medicine doc, see an endocrinologist They usually follow a protocol that is less invasive to more invasive ff the less invasive fails.
You should already be in insulin. You are type 1, tell your doc you want to start insulin before more damage is done and you end up in dka. No need to suffer with metformin. 200’s is too high.
When you are in the honeymoon period it can be erratic to what you need. But a lot of US doctors want to start you on a low basal dose at first, Yet in another country they usually start you on a bolus insulin. If you have normal days, I’m not sure you want a basal insulin yet. But a bolus insulin when you shoot up, you could take a small dose to help. It would also start getting you used to using insulin. Which you will have to have no matter what at some point. If you start insulin, make sure you always have a quick sugar fix that you carry with you and have it near your bedside, like glucose tabs or gummy bears etc.
Doctors are intimidating, Lots of reasons for that I guess. But one of the best things to learn is to speak up for yourself. Unfortunately as a type 1 you enter a world of having to see the doctor on a regular basis. So you need to like them and their treatment, or switch doctors. So you might as well start learning to ask now! Because as time goes on you will want to switch insulins, switch CGM’s, try pumps, and you have to ask because the doctor doesn’t know you want something until you ask!
I totally agree because many of us have been misdiagnosed, even by our endicronoligists, or we do not fall squarely into any of the currently accepted “type” buckets which has been my case for the past 32+ years.
Maybe not as different as you think…
So does the Libre 2.
It sends a reading to the phone/scanner every minute, and will alert for both lows and highs with an alarm like the Dexcom. It definitely has no trouble waking me up.
They seem to have similar abilities, but report to the user differently. Even though the data is being sent to my phone 60 times an hour, nothing is shown to me, or recorded unless I scan the sensor, it’s only being used for alarms.
Apparently other generic (non Abbott) apps can capture those readings. I’m trying to find a good way to get the live readings to my watch, but it seems like all the solutions were made for non US versions of the sensor.
I was just diagnosed LADA myself, but when I found out I was in the ER with DKA, so I’ve been on insulin from day one. While I was there they started me on both basal and bolus insulin. I’m currently on Walmart 70/30 for the cost, but I’d like to get the better control of the split shots back. Thankfully even the 70/30 is allowing me good control at this point. I have been playing with the dosage too to get tighter control.
I’ll pile on with everyone else and say to be your own advocate. I plan to ask for scripts for the better insulin myself when I see my primary next, just trying to work out which specifically to ask for to keep the cost under control as I’m paying out of pocket. Even if i can’t pick up the viles for a bit I’d like to know they’re there when I can.
Learn, don’t count on doctors. Don’t be afraid to ask for what you need, or to change the dose when you find the need. You’ll know yourself what you need far better than they.
It appears that my understanding of the Abbott Libre system, now the 2 version, is dated. I stand corrected.
Alarms are a critical safety function. I’m glad to read the Libre 2 system can alarm the wearer when they occur.
Welcome to TuD, @Kennufs!
Here’s a 2020 article that covers this change.
I was diagnosed with LADA at age 78, and became instantly insulin dependant. The biggest help initialy was a Diabetic Nuitritionist, and then ultimately the FreeStyleLibre2 because I am completely asymptomatic with highs and lows and the alarm warns me. I am resistant to a pump and do find that the ability to scan after meals helps Me to figure out my carb vs insulin dosage. As someone else pointed out, after awhile we get better than the Dr at making those decisions.
I salute your resilience and ability to cognitively and emotionally pivot to form the best possible response to this setback. A diabetes diagnosis is a shock for anyone to hear. Avoiding or minimizing denial is a major victory. There are many younger people who struggle to make this transition. Well done!
Your brain is an amazing asset, especially when dealing with diabetes.
Like Kennufs, I never had a “conversation about starting insulin” because I was in DKA coma at the time they started me.
I do want to add, that in the past decade I have discovered that all my GP’s (internists) refuse to even renew my prescription for insulin even though I have been T1 for 40 years at this point. They say I have to see an endo for that. So if your doc is unwilling to engage in a conversation about starting insulin, you probably have to see an endo.
In 63yrs I have never used an endo to fill my insulin prescriptions Tim. Is it a state law where you live that only endos can prescribe insulin?