Treatment for Early LADA

Brian, I have been consistently staying under 140 2 hrs post meal, while only going over occasionally if I exceed my carb limit. I have noticed that if I have a snack before bed or exceed my carb limit at dinner my fasting will be higher the next morning. If it isn’t the post meal spikes why would my fasting reading go higher?

Your fasting can go higher for a number of reasons. The signaling just becomes out of balance with diabetes. Your system is just not as finely tuned. And most doctors wouldn’t even say you have impaired fasting unless your fasting blood sugar was over 126 mg/dl.

I dream about such A1c numbers! I need to tell you I made other changes to diet and exercise. One big thing was to not eat dinner late. I began increasing the hours I sleep and the steps I walk every day. It all helps.

Good luck, Christopher.

Hey Jenny:

My experience with Byetta was nothing short of miraculous. I’d be hesitant to say conclusively that I was benefiting from beta cell rejuvenation, but my glucose control was stellar and it certainly felt like it. In fact, my control was getting measurably better with time. You can read the original post here: Byetta: Miracle drug for perfect BG control for recently diagnosed T1’s?

My Endo is Bernstein, so as you probably know well, he’s the last to buy into anyone’s hype - especially the drug companies’. I ultimately discontinued it because of the UCLA study, but have yet to find anything since that study that validates the concerns raised, and Bernstein’s take is that the sample is too small to be conclusive.

Regardless, I’ve been cautious in my use of GLP-1’s, and will use it intermittently. What’s working the best for me now is a combination of injected and inhaled insulin. The former for the basal/bolus regime, the latter for the occasional surprise spike or high-glycemic treat.


You’re right Tony_S - good sleep hygiene, eating dinner early (and at the same time every day), and regular exercise makes a significant impact on glucose control. Keep up the good work!

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Christopher, how does Dr. Bernstein feel about Afrezza? And can’t Afrezza take the place of a bolus shot of insulin?

Last time I discussed it with him, he was not supportive of it at all and would not prescribe it to me. He doesn’t feel it offers the same level of precision in dosing as injected insulin, which is true. I asked my local Dr. to prescribe it and found it to be an excellent tool in correcting surprise highs quickly, dawn phenomenon, and every so often if I enjoy a high glycemic treat. Yes, it can be used to bolus, but because it is so fast acting - I see the effects in 15-30 minutes, and because it clears so quickly, you need to match it to the type of food you’re eating. I follow a very low-carb diet 99% of the time, so it is not a good bolus choice for me, as it would hit my bloodstream far in advance of my meal. However, with a little trial and error, I’ve used it in combination with injected quite effectively to mimic a first and second phase response with a mixed glycemic meal such as a cheeseburger with a bun. I use the Afrezza to neutralize the spike of the bun and the injected to cover the rise by the meat and the rest of the ingredients.

@christopher5 I don’t agree that it doesn’t offer the dosing precision of injected insulin… It’s really not comparable in that regard, to me at least… Apples and oranges.

Do agree about the challenges of how ultra fast it clears…

Hey Sam19

Fully agree - we all respond differently. I’ve just found with injected I have a much greater certainty when correcting - but I have to wait an hour. With the inhaleable, I’ve found even if I get it wrong it’s easy to adjust because it clears so quickly and acts so quickly.

I’m grateful for both. Modern insulins make this disease so much more manageable.



I have heard from a few people who had a similar, very strong response to Byetta to what you experienced However, from my email discussion with Dr. Hattersley about this class of drugs, it seems that a response to Byetta suggests that you would also respond very well to Prandin (repaglinide). I responded extremely well to Januvia, which I stopped taking when I learned it turns off the immune cells that fight melanoma. However, I later learned that I have a very similar response to a micro dose of Prandin. Prandin is now a relatively cheap generic. Prandin is also heart safe, unlike the sulfs. Prandin stimulates insulin release for only the length of a meal, though if you take metformin it may have a very slight effect that continues on.

The reason that the two drugs may work for people with the same metabolic flaw is that Byetta won’t work unless you have pieces of the insulin signalling pathway intact, with a flaw early in the cascade that leads to secretion. Prandin does the same thing The only thing about Byetta different than other insulin stimulators is that it only kicks in when blood sugar rises over a threshhold, which helps avoid hypos.

As far as why you haven’t seen follow ups to Dr. Butler’s autopsy studies, the answer should be very clear. Industry put out a huge effort to counteract that research and I am sure that they have made it clear to institutions that do endocrinology research that the huge grants they give will disappear should the schools choose to do that kind of research.

To understand the kind of pressure that companies profiting from incretin drugs can bring to bear, read the history of how Glaxo intimidated the research community into not publishing any research about Avandia for many years after troubling signs had emerged. Among other things, they threated a university with a billion dollar law suit if they published one study that made it clear that there were heart-related dangers with the drug.

There is just too much money in the incretin class of drugs for them to be stopped now. When the patents expire we’ll learn the truth, as we did with the statin-diabetes relationship.

Finally, I see that this thread is labeled “treatment for early LADA”, but with LADA none of these insulin stimulating drugs should make a difference. A response to them suggests that something else is going on. Problems with the HNF1A and HNF4A genes are among those that respond most strongly to stimulation of this kind. These are the genes involved in MODY-1 and -3, but defects in these genes are also common in some Northern Europeany populations and in Ashkenazi Jews who are not diagnosed with MODY.


Brian, another reason for higher numbers: We just had an unusually hot heat wave here in SF, CA. I believe my Levemir, which was left out on the nightstand, became degraded. I tried researching hot weather’s impact on Type 2, and the overwhelming consensus was that B/G usually went down in such weather, due to disruption in one’s routine, fasting due to heat, drinking more water, etc. Mine only went back into my “normal” range when I began using a new pen. I also began storing the pen in my Frio pen sack to keep it cool.

@Christopher5, are you on a pump or MDI?

I switch between pumping and MDI. I use an Omnipod when I travel, especially internationally. It’s more discreet, and I find that my basal requirements can change dramatically between significant time zone differences. However, when I’m home I prefer MDI, as I’m not a big fan of having too many things stuck to me too long.

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Agreed! I wanted a break from wearing the Dexcom; and took a break for about 3 weeks.

Have you found your pump basal requirements to be different from Levemir MDI basal?

When I pumped using Omnipod, my basal was 2.7 units. With Levemir shots, I use 10 units split 5 in the morning and 5 at night.

I am curious if anyone else find the pump insulin requirements to be different from MDI shots.

Yes. I find MDI basal requirements are always higher than pump basal settings. It’s never a 1:1 for me.

Some people find the opposite to be true. It’s a YDMV sort of thing.

Indeed. There are very few absolute truths in managing this frustrating disease.

There is one absolute truth: No one’s diabetes is the same.

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me too! what did you think about it?

Hey Stephanie

I found that Trulicity had some pretty impressive results initially in flattening my BG, but that benefit went away after several weeks of use. It does, however, still help in dampening my appetite between meals.

Interestingly, I find that if I use Symlin for a little while it will improve the efficacy of Byetta, but it’s just too much hassle managing all those injections and I usually default to insulin only in managing my BG.