LADA-post prandial spike question

Type 1 and LADA
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I was recently diagnosed with LADA. I’m not on insulin yet but my fasting blood sugars usually hover in the mid to upper 90’s. My endocrinologist said she doesn’t think insulin is necessary yet but we’re going to revisit that topic at our next visit in 3 months based on A1C and c-peptide. Anyway, I wanted insight on what you guys think of these post-prandial numbers. I’ve found that if I eat more than 40 grams of carbs in one meal, I’m guaranteed to spike to at least 150. If it’s a carb heavy meal (more than 60-70 grams of carbs), I spike to at least 170. With higher fat meals, specifically pizza, I spike as high as 200 and stay there until at least an hour after eating. I usually come back down to the low 100’s or upper 90’s within 2 hours but these spikes concern me. I know that attempting to attain perfect blood sugars will just drive me insane but I can’t help but think these spikes can’t be healthy. I am eating lower carb and try to keep all meals below 50 grams of carbs but sometimes that’s difficult. Anyone with LADA dealt with this or know of a good way to manage it? Are these spikes nothing to worry about? I’m not opposed to starting insulin if that would help manage these spikes but I don’t know if that’s premature at this point.

Thank you for any advice!

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Perhaps start with what your definition of perfect blood sugars are. It is most unlikely that everybody has the same concept in mind.

Pizza is its own thing.

Aside from your concern, what would you prefer to see happening within the mentioned 2 hours?

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  1. If I had to define perfect blood sugars in my opinion, I would like to stay between 80 and 120 if that is even remotely realistic.

  2. I figured pizza was an entirely different animal just based on what I’d read on this forum and what I’ve experienced so far the few times I’ve eaten it. ‘Mastering’ that is something I don’t ever expect to accomplish. Lol

  3. What I would prefer to see happening 2 hours post meals is not exceeding 140, regardless of what I eat (with the exception of pizza, of course). Please be honest with me though if that is completely unattainable.

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Aww, the more normal days when I remember spiking to 150-170 concerned me!!!

Okay, joking aside, I don’t like to go above 160 after I eat a 50 carb meal and I’m happy about those numbers. If I properly prebolus though I can keep it lower. But I remember at the beginning before insulin spiking to 250 after I just ate a big salad. (with veggies and beans, carrots, sometimes raisins etc)

But there are different numbers everyone decides they want to stay in. We all have various goals and eating patterns. There are some fibers and herb/vitamin formulas I used to use that kept my numbers down at the beginning. They only worked in the earlier stages though.

Either you use something to help keep the numbers down or you will have to lower your carb intake farther to stop the spikes after eating. As an LADA the numbers will steadily get worse until you start on insulin as you slowly lose the ability to make insulin…

Starting insulin when your fasting levels are returning to normal seems a little tricky to me.
Maybe someone has better input on that than me. I caught my sugar fluctuations very early but I was misdiagnosed for a while so my journey was a little different than a lot of others.

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Hi. I use insulin and I try to keep my blood sugars between 80 and 100 as much as possible, 70 - 120 as outside targets. Mostly I do achieve that, so it can be a realistic goal.

Without insulin as a tool yet, your main option for doing this will be to eat low carb and to exercise.

I follow Bernstein (Book: Diabetes Solutions/ Utube - Bernstein Diabetes University) who targets about 30g of carbs / day for adult t1s, and Ketogains (facebook group) approach - my current net carb target is about 25g/day.

My blood sugar levels spike when I eat and will eventually sluggishly drop if I don’t take fast acting insulin. But my fast acting insulin is used to stop the spikes…

As far as pizza goes: Fathead pizza! There are all sorts of low carb versions of pizza. :slight_smile:

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I think that’s what I’m struggling with the most. I could probably stand to lower my carb intake a bit more (30-45 grams of carbs per meal and 15 grams of carbs for snacks is what my nutritionist recommended) but like I said, it’s hard and I definitely struggle sometimes. Starting insulin definitely feels like a double edged sword. It would stop my spikes and since I’m LADA, insulin is in my future at some point anyway but I’m worried that lows between meals might become more problematic.

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One question I have is, how old are you? It makes a difference if you are trying to avoid complications for 60 years, or only 10 or 20 years.

BG control is a tradeoff. High numbers, over time, will cause complications or in bad cases cause DKA (Diabetic Ketoacidocis), but LADAs still producing insulin don’t have to worry about DKAs yet. Low numbers can kill you quickly, so avoiding hypos is paramount. Studies have been done on both T1s and T2s (ACCORD) that showed that intensive therapy actually increased mortality, but they didn’t follow up to determine exactly why. I presume it was because hypo events increased because their targets were lower. If you have low BG target ranges, make sure you have methodology that minimizes hypo events.

In my case, I was misdiagnosed T2 at age 57, diagnosed T1/LADA at 59, and an currently 61. I take 6U of Lantus per day, and only need to take Humalog for meals greater than 30g carbs, with 1U/30g over that initial 30g threshold. My target BG range is 100 to 130, and I consider anything below 70 as “low”, with the range 70 to 80 as guard band. I typically have ~150g of carbs per day, with one or two meals needing a bolus. My last A1C was 5.7. I figure I am in the extended honeymoon that LADAs get where control is still easy, and I am trying to enjoy things now before they get harder. It took some work to get most of my meals to have about 30g carbs, but now it’s easy to eat that way, with some excursions. Spreading your carbs throughout the day will limit spikes.

You can keep your numbers in line quite well with just diet and exercise, but it is noticeably harder and less fun than if you have the medicines to support it. Getting an appropriate basal insulin would do the most good in keeping your A1C in line, while allowing a more normal diet.

If you want to trim you “spikes” for higher carb meals, you would need to bolus with a fast acting insulin. In some cases, though, the bolus plus your pancreas will handle the carbs before the bolus is “spent”, so you need to test for the possibility and “feed” the insulin to prevent a hypo. This is inherent for early LADAs and not necessarily an indication that the bolus was too large. In my case, I test two hours after my meal and if necessary have a greek yogurt (18g carb) or glucose tablets to cover the remaining insulin. Other LADAs on this site have had good result with Afrezza, which has a reputation of getting out of your system quickly.

As for pizza, I am happy that with 1U of Humalog, I have a reasonable BG curve after eating two slices of pizza (60g carbs), which is one of my favorite excursions. Good luck, and test a lot to learn what works for you.

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Bill,

I’m 23 years old so I have quite a bit of life left to live that I would love to live complication-free. Your statement about it being harder and less fun to minimize blood sugar excursions without meds is exactly what I’m experiencing. I guess I’m just trying to figure out if it’s worth taking the insulin leap so ‘soon’ to enjoy my life and food again. I understand that diabetes in itself is a balancing act and always will be but it’d be nice to have help where I can IF it wouldn’t be detrimental in other ways (ex. more hypos).

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Not sure how you’d prevent post-prandial spikes without insulin if you’re eating ~50 carbs in a meal. It’s either gonna be meal bolusing or cutting the carbs even further. What’s the other choice?

But those spikes in the 150-70 range don’t sound too serious, especially since you say they’re coming back down after 2 hrs. By what you’re reporting it looks like you are still producing insulin. There are claims that starting on exogenous insulin sooner may help preserve/extend what endogenous capacity you have, which will make things easier to deal with going forward. For one thing, it is a big factor in avoiding DKA. So it might be worth discussing with your endo from that p.o.v.

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I think it would be worthwhile to start insulin earlier, both so that you can enjoy life more, and so that you can start learning all the diabetic practices while you still have insulin production making things easier. This includes testing enough, testing and injecting in public, carrying carbs to handle lows, and learning how diabetes affects exercise.

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It’s nice to see someone else facing the same thing. At my last visit, she said she didn’t think that I was at the point of needing insulin yet (I guess since my fasting numbers are on the higher end of normal and my post prandial numbers come down by at least the 2 hour mark). What do your fasting numbers and post prandial spikes look like?

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Thank you for your help everyone!
I think I’ve made up my mind that there are more pros than cons to starting insulin early. Does anyone have suggestions on the best way to approach this conversation with my endocrinologist? At my last appointment (which was with her Physician Assistant), the PA said she didn’t think I was at the point of needing insulin yet. I don’t want it to seem like I don’t trust her judgement but if there are tools that can help me, I don’t see why we shouldn’t at least try it. Also, is fast acting the best insulin in this situation and just using it to bolus for meals over a certain carb count or would this warrant a once a day injection of long-acting/basal insulin?

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My fasting is between high 70’s and mid 90’s. I can go high like 180/190 at one hour and will go back to mid 80/90’s by two hour.

Right now the insulin is the samples she’s been given since she said the insulin would likely expire before I use it. I am still a bit apprehensive to try insulin to be honest and am not sure I’ll use it or just continue to eat low carb.

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Basal insulin is intended to keep your BG level when you aren’t eating anything, while short acting is for dealing with carbs at mealtimes. It sounds like you’re stable in between meals, so fast acting (Novolog or Humalog) is what you’d need.

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I’d go with something like: “I think I can get better control by using insulin, and also live better. Also, I’ve got to learn how to use insulin sometime, so now is as good a time as any.” It sounds like doctors are used to patients that want to put off insulin as long as possible, so they may tend to assume that reluctance until proven otherwise.

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I’m in the Early LADA stage and I have been on Victoza and most recently Ozempic (GLP-1) an injectable medicine since 2/2015. I will get spikes of 200 if I eat certain foods or exceed 35 grams at lunch or 40 to 45 grams at dinner even with the medication. However, my last A1C was 5.1; although I’m waking up a few times at night if my blood sugar drops below 70. Initially when I started the med I could eat more carbs per meal; but that seems to be changing. Has the endo suggested another med?

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DrBB’s response is accurate in describing basal vs bolus, but whether your need is greater for one vs the other is not clear without some test data. Based on your declared concern, short acting insulin for meal boluses is the answer. However, it would be prudent to check that your BGs are stable between meals, particularly between bedtime and when you wake up. In my case, my nighttime BGs crept up significantly, hence the Lantus, and I know to increase my dose when my morning readings start going up again. If you also have this issue, both types of insulin would be indicated.

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I do know that my fasting blood sugars upon waking have been creeping up as of late. I used to be exclusively in the 70’s and 80’s whereas now, it’s not uncommon for me to wake up no lower than 95. I know that isn’t very high by most standards but it’s significantly higher than I’m used to. I don’t have any data as far as the overnight hours go but I would predict that there are some undetected highs happening if I’m waking up higher than I’m used to.

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From talking to my doctor and my own reading starting insulin can slow the decline in insulin production. The longer your body makes insulin the easier it will be to manage.

If your fasting is already under 100 then you probably don’t need a basal insulin right now.

Maybe for high carb meals you could take 1 unit of insulin to start with just to reduce the load on your remaining beta cells.

I’m in the same ball park as you. I take 8 units of basal and wake up between 80-95 fasting sugar. For each 30 carbs in a meal I take one unit of insulin. As a general rule I try very hard to keep most meals to 30 carbs. If a meal is less then 20 carbs I don’t take insulin.

Sometimes I’m a little off counting carbs and I walk half a mile. That brings my sugar down 10-30 points with in 20-25 minutes of the walk.

If you do start insulin a couple of my own rules to share.

  • Don’t take insulin within 4 hours of bedtime.
  • Don’t exercise within 2 hours of taking insulin until you’ve learned how it affects you. (Walking is OK but check sugar before and after).
  • Go to bed with a sugar over 115 all east until you’re used to how insulin works for you.
  • For the first several days I set alarms every 2 hours at night to check my sugar (It’s good I did because I woke up at 50 so if not for the alarm I don’t know what would have happened).
  • If you take insulin carry glucose tablets with you at least for a while.
  • If you can get one a CGM is your best friend (Dexcom G6)

Also I take Januvia (Slow down digestion, slow down sugar spike)
I take 10mg Jardiance which allows your Kidney’s to remove some sugar from your blood.

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