New Type 1 (LADA)

Hello everyone! I am a 26 year old active and seemingly healthy woman who was recently diagnosed (about 2 months ago) as a LADA Type 1. My numbers were in the upper 200's, low 300's on average and had an A1C of 9.2 upon diagnosis (up from 6.1 only 10 months prior). I have been on 7 units of Lantus a day and Humalog 2-4 units per meal. Since starting insulin, my sugar levels have come way down and I feel a lot better (more energy, not so thirsty all the time, etc). I have also gained back a few of the pounds I lost - I was told this is normal? Partially due to rehydrating my body? Has anyone else recently been diagnosed with Type 1 or LADA, started insulin and gained weight? Does it taper off eventually? Also, I have caught myself being scared to eat many carbs. I have been limiting myself to around 30 per meal because I am so afraid of spiking my sugar. I know this is not good and I met with a nutritionist last week who told me I should be eating around 150 carbs a day. Can anyone share their experience with carbs when they were new to this?

Welcome to TuD. Nutritionists are fond of pushing carbs on people. The less carbs you eat the easier to manage your blood sugar, so eat what you're comfortable with. But one thing I want to suggest: You say you take "Humalong 2-4 units per meal". That sounds like some sort of sliding scale? That's an outdated way of dosing insulin and doesn't work too well. The idea is to dose for the carbs you are eating. So you need more insulin for a plate of pasta then you do a salad! The way to do this is by figuring out your Insulin to Carb ratio (I:C). That is, one unit of insulin to cover how many carbs. Most of us have different ones for different meals. Mine is 1:5 breakfast, 1:10 lunch and 1:16 dinner. So for breakfast I take one unit for every 5 carbs I eat (I eat less carbs for breakfast). The way to figure this out is by trial and error, starting cautiously and seeing how your blood sugar is two hours after eating. A good book that talks about all you need to know is Using Insulin by John Walsh.

So once you know your I:C you won't have to be scared of carbs. And yes, a bit of weight gain is normal, your body was burning fat and very unhealthy before and now it's returning to healthy; it should level off shortly.

As Zoe said eat the carbs that you're comfortable with but remember carbs are energy. Carbs are important if you live a very active life that's why she probably told you how many carbs to eat, especially if she's aware of your life style.

The key to stable blood sugars is to match the insulin you take to the carbohydrates you eat. Some people find it very helpful to minimize the number of carbs to prevent large dosing errors and to minimize post meal spikes. I tend to do best if I eat between 45 and 75 carbs per meal. Dosing is an art and a science and you'll eventually find your own way. If you are currently using a fixed dose of insulin per meal, you should be eating about the same number of carbs each meal. If you're doing OK with 30g of carbs don't just increase the number to 50g without adjusting your insulin or you will go very high. You can have a healthy and balanced diet while eating low carb.

Your medical team may be starting you out with a simple system until you get the hang of testing and using insulin but you eventually will move on to carb counting and using ratios. If you're up to it now, you might ask your nutritionist or CDE to teach you about carb counting or you can get "Think Like a Pancreas" by Gary Scheiner or "Using Insulin" by John Walsh to learn what you need to know by yourself.

Good Luck!!


Right now my I:C ratio is 1 unit for every 15 carbs, so depending on the number of carbs I am eating, I take between 2 and 4 units of Humalog at meals. I think we meant the same thing, but thank you for clarifying and for the additional advice! I really appreciate it. Good to know that nutritionists are carb pushers.. I thought she was nuts for telling me to eat that many.. :)

Very true. Thank you!

Thank you for those recommendations, I will definitely look into both. I've been carb counting for a few months now, but still have a lot to learn.

Oh good; glad you have an I:C ratio. I see what you mean that it comes out to between 2 and 4 depending on what you're eating. My suggestion is to keep testing at the 2 hour mark and see how it is working. If you end up high a lot then try going down to 1:14 for a couple days if low go up to 1:16 and just keep working at it until you end up in range most of the time. 1:15 is a standard starting point for an I:C ratio but then you have to test from there to see what works for you as we're all different. Most of us find we have different ratios at different times a day.

Yes, not all, but many nutritionists and CDE's are negative about low carb eating or just ignorant about it imho. I have a friend who is RN and I have trusted her extensive medical knowledge for years. When I mentioned low carb, she said "for diabetes? I've only heard of that for weight loss". Well, yes, of course for diabetes! I'm not a strict Bernstein follower by any means but his "law of small numbers" makes sense to me. The more carbs you eat, the more insulin you need, the less predictable the results.

I think Dr. Richard Bernstien's latest book is worth taking a look at. The reason I say that is it sounds like your pancreas may still be producing a certain quantity of insulin, thus the LADA diagnosis. He believes that you can preserve and maybe even enhance your current functioning--not a cure but a preservation of some of your pancreatic functioning. His book explains how high carb diets burn out the last of a diabetics functioning islets. If you want a lot of good information on research regarding low carb diets, read Gary Taubes books. Long story short, the tighter you can control your blood glucose (reduction of spiking/dipping) to that of an average healthy adult, you may be able to avoid long-term diabetes related complications.

I gained weight for 20 years after I was dx'ed w/ T1 but I didn't keep track of things. I started losing weight and then got a pump which made it a lot easier however the main thing I learned from pumping is that insulin is strong stuff and if you have even a whiff "extra", it will knock your BG down, you eat, get the munchies, etc. I agree with everyone's suggestion to do what's sometimes referred to as "eat to your meter." I'm not a dietitian/ nutritionist but I agree that eating 30G is very reasonable and my suspicion is that it would be a lot easier to control your BG with a moderate amount of carbs like that. To me, BG control is "good". No one has ever yelled at me for not eating enough and, as long as my A1C is cool, they will let me do pretty much whatever I want.

We're all different. I was dx'd as type 1 as an adult about 4 years ago. Yes, you will put on weight (compared to how it was during your pre diagnosis stage). Especially if you don't watch what you eat. I'm fairly active (heavy exercise 4 times a week and daily workouts) and I still have issues with weight gain on insulin. The key to keeping it down (which it sounds like you are doing) is to count your carbs and watch the intake. I'm 6'1 and around 210 and 150 is a heavy day for me carb wise. Most days I try not to hit 120 if I can. As said though, different strokes/different folks. Certainly there are days where I will hit more, and others less, but I usually strive to keep it lower. Almonds, egg whites, yogurt (sugar/fat free), lean protein and veggies will all become good friends :D

Also, a few things to read up on are the glycemic index (how different types of carbs effect your body) and also how to adjust insulin for fat/protein.

I ordered Dr. Bernstein's book this morning, thank you for the recommendation. It seems to make sense to me.. lower number of carbs, lower units of insulin. May be able to avoid long-term diabetes related complications? Not will be able to? :(

Thank you for your feedback! Do you think that diabetes/insulin treatment is accountable for weight gain or do you think it is more related to one's lifestyle? Diet, exercise, carb count.. etc?

Thank you! I'm 5'9" and as an adult have usually weighed anywhere between 130-135 pounds. At the time I was diagnosed I was around 125-130 pounds, which may not seem like a big change, but for an already thin person to lose 8-10 pounds was quite noticeable. My eyes were so sunken in and my wrists, ankles and neck looked like twigs. It was pretty scary. I've been on insulin for almost 2 months and am back between 130-135, though I did notice last week when my nutritionist told me to eat more carbs and give myself more insulin that it was easy to creep up to almost 140 pounds, which is still a healthy weight for my height, but not a number I am use to seeing. I will keep my carb count low and thus use less insulin to keep my BG where it needs to be.. this has seemed to work for me so far. I just miss being able to eat as many carbs as I wanted.. :(

In answer to your questions, "May be able to avoid long-term diabetes related complications? Not will be able to?" I am a clinical psychologist and I have the habit of speaking like one. Nothing is for certain in research, so we tend to speak in terms of probabilities. And yes, I think it is highly probable that you if manage you blood glucose levels well, that you will not have diabetes related complications. On the other hand, managing BG levels well depends on the individual. My 10 year-old Type 1 diabetic son is not bothered by the Bernstein diet at all. I think that being diagnosed at a young age, he didn't develop the same neurological addiction to "bad" carbs. It was actually a relatively easy transition for him. So, he is able to maintain fairly tight BG levels and good A1Cs as a result.

Hey good for you on having your son on a low(er) carb diet. Seems like so many parents feel it is punishment to deprive their children of "goodies" and they are not, imho, doing the kids any favors by helping them develop bad habits they'll have to fight later. Come to think of it, it's sort of like the attitude the medical profession has to adults with "D": Don't expect too much of them and let them know they can eat whatever they want and cover it with insulin. (Then send them to another doctor when they gain weight and develop IR?). Ok, I'm being a bit cynical today. I've been stuck in the house for 10 days!

Since my diagnosis, I have dramatically changed my diet and overall lifestyle. I had always been able to eat anything I wanted and not gain an ounce, so it was a little ironic that I developed Type 1 Diabetes and now have to watch every little morsel of food I put in my mouth. I have probably consumed more lean protein, veggies and fruit in the last 2 months than I have the last 2 years. As a result of the changes in my diet combined with starting insulin injections, I received news from my endo this morning that my A1C has dropped from 9.2 to 7.9 in 8 weeks. I know that's still far from where I need to be, but it made me feel hopeful and recharged about getting there.

I was two months before my 30th birthday on diagnosis, 499 b.s. 13.9 A1C, was LADA as well. I was about 12-15 lbs below my normail weight since high school, around 123 lbs as opposed to 135-140 lbs. I didn't start insulin right away as I went to an emergency care clinic and got prescribed oral meds to start until I got my endo appointment. Did a follow-up three days later and had already gained 6 lbs. The weight gain back to your normal range probably happened within two weeks based off my experience and as long as you stay in that range there should be no fear of your insulin/diet contributing to the weight gain as much as your body being able to process nutrients better rather than expelling them through your urine.

I was also diagnosed as a T1 as a young adult, age 30. I am probably LADA as well but back in 1984 they didn't do antibody tests to confirm.

You received lots of good advice here. Eating too many carbs is trouble for many T1's. The medical establishment and dietitians are so indoctrinated with fear of dietary fat that they reflexively, almost without question, push a high carb low fat diet.

After 28 years with T1, I finally tried a low carb approach (about 50-70 grams per day). I dropped 20 pounds, took only half as much insulin, and my number of hypos went from two or three per day to two or three per week. In addition, my overall control and A1c dropped. Bernstein's law of small numbers means that taking lower doses of insulin leads smaller mistakes.

Counting carbs and dosing accordingly is a good practice. Unfortunately, your body's sensitivity can fluctuate day to day and from morning to night. Even very accurate carb counting, using a scale, will still produce out of range BG's. So, the less insulin you take will mean milder lows and highs.

Congratulations for your aggressive curiosity about diabetes. Even back in 1984 the doctors told me that they noticed that education and knowledge about diabetes made a big difference in the long-term outcomes.

And yes, insulin can make you fat! You are smart to keep an eye on the number of carbs, the amount of insulin, and the trend of your weight.

I'm sorry you got this diagnosis but you seem to be a smart and practical young woman. Good luck to you!

I think that it's a combination of factors. I don't seem to melt off weight when I run negative calories (e.g. running 20 miles or whatever...) so I don't think exercise is as much of a component of that. I think exercise is more mental health for me. I think a lot of it is the timing of food which people with diabetes naturally get a feel for. My friend who is really into P90X (straight, no D...) is very precise in his eating habits, controls calories, fat, types of food, pretty much says "I don't eat anything that comes in a box..." and has had great results with it. Some of it is working out like a beast but he's said 90% of his results are from diet.

(he "peaked" at 266 lbs. I saw 275 on the scale once and that got me going in a new direction...)