I am a LADA, misdiagnosed as T2 in 2015, rediagnosed at T1/LADA in 2017. I still have significant insulin production, as I currently take 6U Lantus for basal, and take bolus Humalog only for meals above 30g carb, at 1U/30g above the first 30g. However, this insulin:carb ratio is literally a SWAG. My question is how do other LADAs determine if they have a good/correct/optimal bolus dosing.
It seems there is little or no information available on how best to care for LADA diabetes. Insulin calculations for T1s have an inherent assumption of no pancreatic insulin production, e.g the 500 Rule for carb boluses, which would give me an I:C ratio of ~1U:70g
Until recently, I have been trying to bolus based on carbs, starting out at 1U/30g for carbs above 30g, but if I go low after the meal to reduce the bolus for subsequent (identical) meals. This strategy is inherently flawed, since my body produces enough insulin that, for any reasonable meal, my bg is back to normal at about the 2 hour mark, but any remaining bolus can drive me low in the second 2 hours.
The possible solutions to this are:
Don’t bolus, or only do minimal boluses.
Do something to shorten the duration of the bolus.
Or, always plan to have a snack (currently 15g) at the 2 hour mark, to give the leftover bolus something to work on. This is similar to early diabetes management in the era of “Daily Fatal Dose”, where diabetics had to have meals of a certain size at very specific times to match the response curve of the single (large) daily insulin shot.
However, solutions 2 or 3 still leave the question of how to determine whether a bolus is the right or optimal size? My current thought is to try to test at the expected peak (1 hour?) and keep the bg reading below a certain high level, and test again at the 2 hour mark and make sure it is not below a certain low level, but what levels?
Have any LADAs found a good solution to this dilemma?