Since you are LADA, you might be still in some kind of HONEYMOON PERIOD. To be certain that your pancreas beta cells are all dead, you need to do some test. GAD test is just one. There are other tests that they can do to confirm your beta cells condition. If some of your beta cells are still functioning, this will throw your insulin injection regimen out of whack.
Sorry, diabetes is such pain.
You are doing the right steps. Keep fighting.
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First, I must say I think you are doing pretty darn well. And I think maybe a mind shift here might help. Over the years, I tried to ācontrolā my diabetes. It beat me up mentally trying to make it work day in and day out. I took every number as a failure and beat myself up for it.
I have finally realized I will never control it. I manage it. And I will not let it control me either. We manage each other as best we can.
I get a high number, I take action to bring it in line (walk, Afreeza for those stubborn highs, a small correction) trouble shoot the number and move on. Low number, I correct with number of carbs I think will bring it back into line, trouble shoot later and move on.
Knowledge is power with this disease and it sounds like there was some missed during your struggle to get a correct diagnosis.
So my suggestion is books if you canāt find a good CDE to help you with some of the tools we all have in our toolbox.
Timing on any injection can make a huge difference. Type of insulin can help. CGM is one of the greatest tools out there and will give you so much info. Diet and how to take insulin for what you are eating. Many have great results with low carb. Many realize they have to take insulin for night fat/ protein (which we were never told to do).
Everyday is an experiment in the making. Just keep trying new things. And keep learning from all those new things. I thank God everyday for all the advancements that have happened over the years.
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Thank you all, iām truly overwhelmed by the amount of support i received from you guys in a matter of hours. @Sally7 i think youāre right in that i was short on information on my own disease and that information was never communicated by my GP or endocrinologist. Iām definitely getting the Libre to help me with a complete picture of my blood sugars.
With regards to timing the dose for fat and protein i tried that last night at dinner and this morning just two hours ago with breakfast, here are the results:
Dinner(1 unit 5 minutes before dinner and 4 after):
Breakfast(2 units 5 minutes before breakfast and 3 after ):
dear Mo16
since you are LADA, there is several thing you should know about things.
my case, it take for 12 year to finalize as LADA T1. here is the my A1c last 6 year between 5.8 to 6. last 2 year A1c between 5.4 to 5.2. i spend many years to study all diabetic books, articles include Dr. bernsteins book. here is things you should in mind and keep track.
- you are 11-15 unit lantus as basal. it look like not the half of total insulin.
if you are in full stage of T1 your total insulin requirement will be 38.5unit ( base on 70 kg weight) as start point. it will set up as 19 unit basal insulin. This will lead that you are not full stage of T1 yet. - since your doctor test for LADA antibody, you know which antibody cause and how many antibody have problem. there is the article publish for detail relationship for how many antibody typically time line go to T1 final stage. you could find internet to read this paper.
- you should test c-peptide level to monitor how much of internal insulin capability remaining. my case first c-peptide test was 0.6 and four year later undetectable level.
so my doctor change from T2 to T1. my insurance is very strict to test LADA antibody. - here is thing you should understand that you must change your living method as diabetic person not like normal person. I see and meet so many diabetic peoples. they are not live like diabetic people and all end up so much problems and pass away with very bad situation.
- then you may wonder what is diabetic peoples living procedure. there are so many books
teaches how to make daily food selection and you must measure food quantity and record.
it give to good understanding of how you could keep track your A1c level well even thou your LADA progress to final stage. - Since you read Dr. bernsteins book, you could go back look at how you should split lantus
and any bolus shot base on max 7 unit. let say you are going to shot 14 unit lantus than you should shot 7 unit and other area for 7 unit, in this case you will get error late of lantus less than 5%. if you one shot with 14 unit will cause more error rate and very inconsistent insulin level. please you could read this behavior of max shot amount at book.
i always use max shot amount Dr. bernstain finding for shot case. when i am using pump, i use other book finding that pump can use 9 unit max for less than 9% error late. - you should find actual duration of lantus, novolog. For Novolog, you should find actual start time, peak time, and duration. so you could adjust your bolus injection time to avoid short time to low level of glucose if you know your insulin behavior and food contents.
hopefully this give you some kind of start point for your journey.
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@kn1
thank you so much for the detailed tips, iām still not finished with Dr Bernsteinās book and by now iām starting to believe that rapid acting insulin is perhaps not in my best interest and that i need to be using short-acting or regular insulin to cover fat/protein highs.
iāll be doing more tests soon and iāll ask the doctor to check again for antibodies.
Do not think either/or for rapid acting versus Regular short acting. Thereās a time and place for each of those. I also like to use the ultra fast acting inhalable insulin, Afrezza. As @kn1 writes, each insulin has its own onset, peak, and duration time profile. I like being able to use various tools for different jobs.
I use a pump and for many years, in addition to my customized basal profile, I dosed an immediate bolus for the carb content of the meal and then started an extended bolus to cover the fat and protein. It worked very well to keep my blood glucose line relatively flat. At 60-75 grams of carbs per day, I eat a lower carb diet.
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@Mo16 - Youāre already doing one important thing that you can controlā¦learning, questioning reaching out to other Diabetics! For us, itās not a sprint to the finish line. Keep your head up.
I know it was mentioned earlier about splitting your basal into two daily doses. If/when you try that you onāt have to split it exactly in half. For example, you take 5 in the morning and 9 at night (or whatever works for you). You may need to experiment to find the right split dosages for you.
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As others have already said, I think you should start by acknowledging that youāre actually doing a good job as is. Looking at your numbers, they arenāt horrible by any means, definitely strive to improve, but donāt beat yourself up so much if itās not as consistent or easy as you think.
In relation to your question earlier about the level of control Dr Bernstein talks about, I also donāt think itās unattainable, but one think I think he really misses in his book is simply the fact that itās not so easy. When you read his book it sounds like all you have to do is reduce your carbs and then bingo youāre having flat line blood glucose levels all the time. Certainly reducing carbohydrates is key to that, but there are dozens of other factors, many of which are not at all related to food consumption.
As a rule of thumb, Iāve always followed the approach that I need to give half the amount of insulin per gram of protein that I do for carbohydrates. For instance, I give 2 units of novorapid per 15 grams of carbohydrates. So I then give 1 unit of novorapid per 15 grams of protein.
Iām not sure how well that would work if I actually ate heaps of protein, because in my experience I then really need to string out that insulin. For instance, if I ate 100 grams of protein, I donāt think I could just straight up give 6.5 unites of novo rapid. I suspect that would need to be administered over many hours, potentially 4-6 hours after eating, and incremental.
Typically, most my meals contain 30 grams of carbohydrates and 30 grams of protein, and from testing I found that I give the bolus for the carbohydrates as I eat, and the bolus for the protein 2 hours post meal.
If I drastically changed the composition of my meals though Iād need to do a lot more testing and experimenting to work out what worked for that level of macronutrient break down.
Hopefully once you get the libre you can do some solid Basal testing, and really start exploring what works best for you.
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Thanks for sharing those insights. Sometimes I just canāt help but feel that numbers are like grades and I should be shamed of bad ones, I try to fight this mindset but I guess Iām still quite new at this.
Thanks for sharing the dose timing, I use novorapid as well and I think this is the most important tip I ever new about diabetes and insulin injection, it had an immediate effect in last nightās dinner and todayās breakfast. Iāll continue following that since today has been such a good day so far 
Iām guilty however of not counting whatās in every meal, especially salads I think sometimes I just eat too much of it and although it might not be too much carbs but Bernstein speaks about ā Chinese restaurant effectā in his book and it makes sense especially with the addition of protein it will just mess up everything.
Iām going on vacation in three days for three weeks and then Iāll get the liver once Iām back and will start another phase of diabetes troubleshooting with the help of the new continuous measurements.
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Hi kn1,
I just spent over an hour trying to search the article you mentioned in point #2, correlating GAD-65 levels to time before fully type 1. Couldnāt find it. Since I have recently been diagnosed as very early LADA/1.5 I would really like to read it. Could you please link it or give a title or more info on how to locate it?
Thanks
There is a lot of testing, and trial and error to getting insulin doses fine-tuned perfectly. This takes time and practice. So be gentle with yourself. Numbers on your blood sugar are just information to act on, or to choose not to act on. Nothing more, nothing less. They donāt deserve your emotional attention, just your scientific logical attention.
Youāve had some great information here already.
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I second the basal testing. Perfect to do during fasting. Once the basal is fine tuned, a good portion of the battle is well addressed.
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Rising sugars 2 hours after eating could well be due to protein digesting. Those of us who eat low carb, may need to adjust for this. For me, I dose for meals, but if I see numbers rising after 2 hours or so, I just do small corrections (1 or 2 units of insulin) based on where I want my numbers to be.
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Freestyle libre may be a really good choice. Itās accuracy varies but it is great at showing trends and getting to understand what different foods do. This was a game changer for me. Cheaper than other CGM options in Australia.
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Splitting the lantus into 2 doses (not necessarily the same for each dose), may help. This would be trial and error. I use Levemir and take 20 units a day, 10 as soon as i wake up in the morning, and 10 just before sleepingā¦ This keeps me pretty flat.
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Numbers are data! Period!
Numbers are data, data is information that help you take action (or not). They are NOT bad.
Put another way, numbers are a messenger ā
Donāt Shoot The Messenger!!
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I think no matter how long youāve had diabetes you always have those days or moments when you feel angered, frustrated or just beaten by blood sugar readings outside of your desired range. Iāve had it for 20 years now and that hasnāt changed.
You certainly learn how to take those moments though, and hopefully learn from them! Having said that, I donāt think youāll find anyone on here who wonāt from time to time have days were things just donāt work! And you canāt find any reasonable explanation for it.
With regards to counting carbohydrates, itās a lot of effort at first, but if you eat similar stuff over time then you start to get a feel for portions and things like that. Some people keep to the gram for their whole lives, some might measure for a few days and then get a āfeelā. Personally, I fall somewhere in between. I try and measure most of my food, but sometimes I eat out and you just have to guess, or sometimes a house mate cooks a curry for me and I donāt know how many carbohydrates of vegetables are in the curry. Iāve definitely become better at making those guesses overtime though.
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I guess I can be one of those, I always have salad with every single meal, I kinda binge on salad actually till Iām feeling very full which now I think after reading Dr Bernsteinās book is hurting my BG. My only concern though is that someone like Eric Berg says you need 7 cups of salad per day at minimum and Dr Bernsteinās diet will allow you max 5 with no allowance for a dessert. It will definitely take time getting used to
Depends what your salad is made of. Dr B target for most people is 30 g of carbs per day.
That is actually quite a lot, split between 3 meals if your carbs are coming mostly from veges.
For example:
1 cup of chopped raw green cabbage (89 g) - 3.2 net g carbs, 2 cups of lettuce (98 g) - 1.2 g of net carbs, 2 cups of raw spinach (60g) - 0.8 g net carbs, cucumber - 1 cup sliced (104g) - 2.6g of carbs, 1 medium tomato - 1 thick slice (27g) - 0.7 g carbs. This is 6 cups of veges described here for a total of 8.5 g of carbs. Add a few more grams of carbs from a no sugar mayonnaise dressing and a big steak, and you are set for an incredible dinner and still under the target 12 g of carbs for that meal.
You can get a really large amount of non-starchy veges into 30g of carbsā¦
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