LADA after ketoacidosis crisis

Type 1 and LADA
1

Greetings from the UK. I was diagnosed with type 1 eight months ago at age 48, after the typical two months' rapid onset - thirst, hunger, excessive urination, weight loss - and with high blood sugars and ketones. My doctor sent me straight to hospital, and tests confirmed HbA1C around 12, high levels of GAD, no other antibodies. I suspect it is (almost) the end of LADA as I've had exhaustion, and a series of infections over previous 12 years or so. My endocrinologist cannot confirm this, as has no clear diagnostic criteria at this stage, but says it all fits.

I'm on normal diet (about 150g carbs per day), but have reduced HbA1C to 5.6% - was told this is too low as I may be having hypos in my sleep. Steadily reducing insulin, down to 6 units of Lantus, about 10 units of modal/bolus insulin per day. Meter readings still too perfect.

My problem is poor concentration, tight head, weariness, etc., especially after an hour's walk with the dog - can take three days to wear off. Never have a day feeling normal. Reducing insulin again, and meter readings still in normal range before meals. It's as though my pancreas is waking up again after eight months.

Two questions:
- is this variability and feeling unwell normal for the honeymoon period?
- do others have problems with exhaustion brought on by exercise (who are otherwise fit and munching dextrose while exercising)?

2

Sure sounds like you're in a honeymoon right now with insulin needs rapidly dropping.

If you are munching dextrose during exercise, I wonder if you are actually going hypo. Especially for me extended or repeated hypos can be physically and mentally exhausting. Can you try "running high" during the exercise (making sure bg is comfortably high, maybe 130 ballpark, before starting) and see if this helps?

3

Hi Phillip, It sounds like a honeymoon to me. My needs dropped a lot after dka but not as low as that and or as some other people here. I do have those feelings a lot on insulin also, I feel weak etc. and I drop very easily at times. Yesterday I went to 130-40 twice and then with a tiny bit of activity I dropped quickly to the 60's. If I'm going for a walk I often have a snack first if I'm in range and or if my basal is going to kick in and drop me.