I’m a newly diagnosed LADA diabetic, less than a month. The endocrinologist can’t see me until June so I’m trying to figure a lot out on my own with the help of my primary care doctor. After finding myself in the ICU in ketoacidosis, I was discharged less than 48 hours later with instructions to eat ~60g of carbs a meal, to inject 9 units of lantus in the morning and 3 units before every meal. My numbers were quite high that whole first week until I saw my primary care doctor who gave me the pre meal sliding scale. I’ve modified it a bit and I’m having much better numbers. My biggest issue/question is that I am now testing in the no coverage range often at mealtimes, but I know if I don’t take any insulin that it will spike at the next check, yet I don’t want to take it if I don’t need to or if it will end up lowering my BG too much, late night it’s been falling low enough (65-85) that I get concerned about going to sleep and I have to have a small snack. I’ve started taking 2 units anyway when it’s in the 100-150 range, but I don’t really know what I’m doing, just going on instinct with a bit of an educational guess. Any advice or tips based on your experiences.
Are you keeping a log? I think it’s the best way to learn how your glucose metabolism works. It’ll help to track insulin dose size and type, when given, what you eat and blood glucose numbers with their times. I think you should make a goal to learn how to eventually adjust your insulin doses on your own. You need to be able to make many decisions every day. Doctors can help you but they are seriously limited in their availability.
You won’t need to keep these records forever but can accelerate your understanding of how insulin works for you. I also suggest that you start reading about how insulin works and the basics of a basal/bolus regimen. Think Like a Pancreas by Gary Scheiner is a good first book to read.
Good luck. You can do this. This community is willing to help answer all the questions that you may pose.
Well, you came to the right place for community, information and lots more!
Use the search function on this forum liberally – there are lots of great insights and discussions for background. You’ll probably also want to read a book or two (Think Like a Pancreas comes to mind, but there are lots of good ones).
As Terry suggests, the best way to know is to test frequently and log your BGs before and after meals. If you are early in LADA stage, your pancreas may be sputtering, which may mean each day you get various amounts of insulin from your pancreas. That makes your injection doses trickier.
Since you went into DKA, you may have exhausted your pancreas, but now it may be producing more insulin again, or maybe not. Some refer to this as the honeymoon stage, and you can search that for more ideas.
Is 60 carbs about what you ate before diagnosis, per meal? You may want to try lowering that and insulin dose, or be sure to include fats and proteins so that digestion of meal will better align with action of insulin. Most injected insulins don’t work fast enough with meals of primarily carbs alone.
Thank you so much. I will get the book ASAP. I have been keeping a log, and a food diary with carb counts and have just begun to adjust my dosages based on what I think versus the doctors directives and my BG levels are much more ‘normal’ but that brought me to my dilemma of the insulin chart I’ve modified stating I shouldn’t take any. I knew if my BG was 110 before lunch and I didn’t take insulin, it would spike up late afternoon but I’m scared of taking too much insulin and going too low. I know people also calculate their dosage based on the number of carbs they are going to consume and they also might correct the dose after, but I don’t know if those who do it this way also use a correction of sorts based on their pre meal BG if it’s not within a certain range (eg 100-150); deducting units if it’s under and adding units if it’s over. Do people commonly take extra shots for snacks (assuming maybe that the snack is at least 15-20g)? I also wonder what a safe BG is to go to bed with?
I think the 60, which is meant to be mostly complex carbs with fats and protein may have been to get me stared and help gain back some weight. In DKA I lost a lot of weight and I was skinny before. I was sickly thin and dehydrated. I rarely eat 60 carbs a meal, often it’s more like 30. My doc increased my lantus dose from 9 units to 11 and gave me the pre meal BG sliding scale for my Humalog mealtime doses and since then my BG levels have been better, but even better still since I’ve started adjusting on my own within that scale. I just don’t want to make any major errors in trying to figure this all out.
Basal bolus is a more accurate way of dosing than sliding scale.
In basal bolus dosing, you adjust your basal insulin (lantus) to keep you steady when you don’t eat. Then you dose your bolus (fast acting) insulin to correct (correction dose) for any high blood sugar and to cover the carbs that you are eating (carbs / food dose). After some experimentation you will come up with your own ratios for how many grams of carbs (and protein) are covered by 1 unit of insulin.
Think Like a Pancreas can explain the basics of this, and how to start testing for this.
Dr. Richard Bernstein at “Bernstein Diabetes University” on U-tube also has a lot of sessions about how to dose insulin. He is also a strong proponent of eating low carb to help control blood sugars and to minimize the amount of insulin that is required (less carbs = less insulin = less risk of both high and low blood sugars, otherwise known as “the law of small numbers”)
I second that. Make this your top priority. Either get the book today or order it today from Amazon.
When you get it, read through the whole thing. Don’t get hung up. Just read through. That will give you a very good overview.
Then go back and read through much more slowly and take time to consider how you can apply or use the approaches. Bear in mind, you DO NOT have to agree with everything. I have never found a book that I agreed with everything. But it is all information. You pick and choose what works best. However you need a base of information before you can have that opportunity to decide what is the best approach for you.
And when you get questions, come back and ask. Or just let people here know how you are doing. Or lurk and read. Just be aware that the number of approaches being used on these forums are huge. Many people are using quite advanced techniques that take time to master. Start out easy.
You are right to respect the power of insulin. Too much fear, however, can prevent you from learning what your body needs. We all make dosing errors; this is natural. Frequent testing will help you respond appropriately.
When you read Think Like a Pancreas, you will learn how to make a blood glucose correction. It’s a relatively simple bit of arithmetic involving something called an insulin sensitivity factor or ISF.
Many of us will add insulin for any food eaten, including snacks. Certain situations, however, may require a snack uncovered by insulin. You will learn what you need with experience.
A safe BG to go to bed with is not an exact science. Again, you will need to learn what your body needs through trial and error. Logging will help shorten the time you need to learn this. Don’t be afraid to set an alarm to wake you up and check your blood sugar. This will help ensure your safety.
Just remember, diabetes is a dynamic disease and there are few rules that are not subject to exception. Learning what you need and when you need it is your new job. Don’t get overwhelmed. It seems like an awful lot to learn but it will become more familiar soon.
Lantas is long acting. I don’t see what splitting it or taking it before meals would do. I have always taken my long acting insulin at night before bed. And my short acting insulin before meals. You should find out with your doctor how to best manage your sugars, because all the ups and downs constantly is very bad for your kidneys and will eventually affect how your kidneys work and function properly.