Need advice

Thank you for your comments and suggestions.
I will definitely look into screening markers for potential risk for my child.

You mentioned that you live in Mexico. What kind of health plans does Mexico have, any single payer? I know that in the U.S. there are programs for assistance in getting insulin and needed supplies, but I am not at all familiar with them. Maybe someone else can jump in here and offer assistance? Finally, Walmart has inexpensive insulin, supplies, and blood glucose testing equipment/strips. Do you have a Walmart nearby?

Well I don't have any insurance here in Mexico. When we go to the doctor we pay out of pocket. There is Walmart nearby, will see what they have.

There is assistance to diabetes patients in Russia where I am from and where go to once or twice a year but I'm not sure what exactly they provide. I have a feeling Russian doctors will be quite difficult to deal with - my online research didn't help in finding any reliable professionals. But I'll definitely check that in person when I get there in a month.

So, I could only have 2 antibody tests done here in Mexico - GAD and ICA, both negative.
My C peptide is kind of low - 1.55 ng/mL (reference 0,9 - 4,0 at fasting glucose 105)and insulin also 4.4 uUI/mL (reference 3.21 - 16.32).

I guess I should have C peptide tested while OGTT and test for 2 other antibodies soon.

I've seen 2 endos and one of them suggests taking small dose of januvia (doubt I start doing that given the side effects), the other endo thinks that as for NOW my numbers are not in diabetic range I should just relax, carry on with the diet and some time later have another antibody test...

Tati, do some searching in the forum on "Dawn Phenomena", if you don't already know what it is. In short, it's a glucoblast from the liver when waking up, the theory being the body getting ready for action.

DP wreaks havoc on some diabetics. I have it bad. A pump is nearly the only way to really get it under control (well, and still eat pretty normally).

Also, coffee raises BG in some people (again, I'm among the cursed!). If you have these problems, and are not treating diabetes with insulin directly, there's not much you can do about it.

After 15 years of quite variable control and then going completely off the reservation for about a year and a half, I voluntarily chose to change to treating my T2 D with insulin, and dumped all the other meds except for metformin. It was the best thing I have ever done in my life, only exceeded by marrying my wife and having my kids.

The bottom line is, oral meds are a very blunt instrument. You have very little control at all, so must "go with the averages". With insulin, you can "think like a pancreas" (Gary Scheiner's book), and "act like a pancreas" (Dave's rhetorical variation). With the most advanced technologies for measuring BG -- a Continuous Glucose Monitor -- and administering insulin -- a pump -- you can achieve close to normal BG metabolism/levels, and to many of us it's a relatively minor burden.

Although I still have enough pancreatic function that, with oral meds, a very restrictive diet, and a vigorous exercise program I could achieve good BG averages (read: a1c numbers), and make my doctor happy, I still wouldn't be knowing how much of a roller coaster my BG would be.

With insulin administered smartly, I can have an In 'n Out Double Double for lunch (my once a week treat for lunch, then back to rabbit food :-)), never go over 135, and be back down in the 80's by three hours postprandial.

With no treatment at all (insulin or meds) but just immediate vigorous exercise after lunch, I'll shoot up to over 200 every time, and take 4-5 hours to get back down under 120. With beta cell stimulants (I used to take glipizide), I'll still soar to 180 or so, and eventually get back down to the 80s within 4-5 hours -- but I'm usually having another meal by then.

The only way to really fully treat this disease is with insulin, no matter what type, or stage, one is in.

immune-mediated attached
Melitta, pretty sure you meant "immune-mediated attack" and this was a typo, but I wanted to check to make sure there wasn't something new I didn't know about, and need to learn...

Tati, you'll find that with each question, like a Hydra, the questions multiply

"Insulin" is not as simple as it was 20-30 years ago. Back then, there were really just two types in practice: Regular, and intermediate-acting, a.k.a NPH. These two insulins formed the "old school" treatment regimen for insulin using diabetics for decades.

In the 90's and last decade several insulin "analogs" were developed through recombinant DNA technology that are slightly altered from normal human insulin, have the same potency and action, but have faster or longer on-set. These fast-acting and slow-acting analogs now form the modern treatment regimen. A good overview of different insulins can be found here.

I covered all that for this reason: Insulin pricing is all over the map. In the US, the fast-acting and long-acting (with no peak) are covered by patents, so are very, very expensive. I use 30ml/mo of humalog, at a retail cost of about $600. Fortunately, insurance covers most of that.

Contrast that with 30ml of Humulin-R from Walmart -- $75.

I imagine the price of the high-tech insulin analogs is quite a bit less in Mexico than it is here in the US, but you'll have to check. In any case, a person can manage their diabetes quite well with R and N insulin -- both comparatively very inexpensive -- if on a budget. The protocols for administering are different, but there are plenty of people here on TuD who, "been there, done that" and can help if that's where you end up.

Wow, that's a lot of info to take in 5 minutes, thank you, Dave!

$600 cost os humalog - niiiiiice :[

I don't know... if I had known what I know now 15 years ago, I would have started "casual" bolus insulin use right away.

By "casual" I mean that your D is not advanced enough yet that your pancreas can't handle basal needs, and with stimulants seems to be able to put out enough to cover digested carbs.

So, you could dump all the meds except metformin, and work out a regimen with injected insulin -- preferably via insulin pen, they're easy and convenient -- to cover meals. Perhaps even operate in a "correction only" mode from time to time when the activities of your day don't facilitate meal-time bolusing.

The "casual" part is you could be much more "sloppy" with the timing of the injections, and not nearly as precise about counting and then calculating to cover carbs. Rather, you could just "low-ball" it and supplement your beta cells, rather than replace their function.

I've never heard of such an approach for a T2 -- has anyone? It's an intriguing idea however, I think, and has the promise of preserving beta function much longer and better than the sulfonylureas and uther stims.

Despite the perception, diabetes is a complicated thing. Pure T1 with antibodies and nearly zero insulin production is easy to specifically diagnose. But diabetes is complex, one leading researcher suggests that there are eight separate defects involved, of which insulin deficiency and insulin resistance in the muscles are just two. In the end, all that really matters is that you are able to manage your condition to keep your blood sugars as normal as possible and lead a long full healthy life. If you are able to keep your blood sugars at normal levels (< 100 mg/dl fasting and < 140 mg/dl 2 hours after meals) then you are doing great. When you can't, then use medication and as Dave suggests you can start insulin as well if some of those classic T2 medications don't work.

Thank you Brian.

That looks like I cannot keep my blood sugars normal without meds that's why I'm trying to figure out my type and the appropriate medication.

As you say "you could dump all the meds except metformin" I should probably mention I'm not on meds yet - I'm trying to find the right ones.

See you point on insulin treatment.

In fact, during the day I cannot get my BG below 100. It might be lower when I wake up, lower after I exercised but then it just hovers there. I get so frustrated and hopeless and don't want to test.

I would recommend seeing a doctor. Your numbers sound like pre-diabetes. Keep in mind that type 1 is hereditary and sometimes gets diagnosed in adults.

I've seen two! There's my comment on another page - it got kind of lost in this thread.

"So, I could only have 2 antibody tests done here in Mexico - GAD and ICA, both negative.
My C peptide is kind of low - 1.55 ng/mL (reference 0,9 - 4,0 at fasting glucose 105)and insulin also 4.4 uUI/mL (reference 3.21 - 16.32).
I guess I should have C peptide tested while OGTT and test for 2 other antibodies soon.
I've seen 2 endos and one of them suggests taking small dose of januvia (doubt I start doing that given the side effects), the other endo thinks that as for NOW my numbers are not in diabetic range I should just relax, carry on with the diet and some time later have another antibody test..."