For one an a half year ago I was diagnosed with diabetes type 2, which was odd because I was not overweight and I was already doing lot of exercise. I was told to cut down on carbs and sweets. I kept my levels low for about a year, they were 5-6mmol fasting and almost allways beneath 10mmol after meal. When I got a new doctor in october 2014 he took some tests to see if I might have diabetes LADA, and I tested positive for anti-GAD, but my c-peptide levels were fine. I was sent to an endo and had my first appointment with him in late January.
Since december my numbers have been running high, the last two months I`ve had fasting levels at 8-9 mmol, and post prandial levels have been between 11 and 15 mmol. I am a sports climber and I exercise strenght almost three times a week. I also recently started thai boxing. This means that I exercise almost four times a week. I am still keeping low on carbs. Why is my numbers running high when I have a c-peptide level within the normal range?
The first time I saw the endo he told me that I have diabetes LADA, but since my a1c was under 7% there was no need for medication. After I had been to the diabetes nurse they told me to start injecting insulin, 2 units of Insulatard morning and evening. I started injecting on Monday, but my fasting bs is still above 8 mmol, and post prandial level above 10 mmol. What`s the point of injecting this small amount of insulin? I was not told to level up the dosage. I find everything very confusing and I am so sick of keeping track of my blood sugar, why should I keep track on it when I`m not supposed to upp the dosage on the insulin?
Could somebody please comment on this, I am really confused and sad about this whole diabetes nonsense.
The medical profession is overly fearful of hypoglycemia. For this reason their insulin recommendations are conservative to a fault. You obviously need more insulin. Is it your doctor’s intention to slowly move to a higher level or do they seem content to let your current dosages persist?
If I were you, I would undertake personal study so that you can become the one to makes these decisions. Most patients that do well make their own daily adjustments. Doctors, as a whole, are not very good at this. It requires daily communication with the patient and the patient needs to keep good records, too.
I recommend reading Think Like A Pancreas by Scheiner and Using Insulin by Walsh. Good luck.
Thanks for your reply Terry. My doctor hasn`t said said anything about slowly move to a higher level, nor how I should interpret my results. I also believe that I need more insulin, but I do not quite understand the risk I`m running if I don`t, especially since my doctor where reluctant to give me insulin at all.
I see that many people in here recommends this book, I will look it up :)
You can’t depend on your doctor to respond in a timely manner. Neither can you depend on his expertise with insulin. You need to become the expert and then seek no permission from anyone to change your treatment. You’ll have diabetes for the rest of your life. Educating yourself about insulin will pay you countless benefits. Do it now!
High blood glucose levels can cause debilitating complications over time. Don’t get in the habit of accepting hyperglycemia. Its effects are insidious and harmful.
Because you've tested positive for the GAD antibodies, it means your immune system is slowly killing off your beta cells, which are the cells in the pancreas that produce insulin. As you lose more beta cells, your insulin production decreases and, at some point, you need to start using injected insulin. As the nurse apparently determined, you're at that point. Although I'm not aware of any definitive studies, there is some suggestion in the research that starting insulin early on in the LADA process can preserve some of your own insulin production for a longer time. When our bodies are producing at least some insulin, it makes our BG control somewhat easier.
And as Terry suggests, the more you can learn on your own rather than relying on the medical folks, the better off you'll be.Carro, here is a helpful post for you
It must be very frustrating. I'm glad you found us, we are here to help you!
Hi, Carro,
Keeping a log does seem like a big pain sometimes but I used mine to show that I needed to
shift from sliding scale to meal-time bolus to get control over post-meal spikes. Thus my a1C dropped from 8.5 to 7.3 over a 4-month period that included the holidays and a vacation! So stick with it because that will give you the information you’ll need to modify your meds as needed. And eventually you will feel confident to make adjustments on your own.
Here’s a book you will find helpful: The Diabetic Athlete’s Handbook by Sheri Colberg. She gives recommendations for basal/bolus and pump users for many athletic activities.
CatLady
Before I was diagnosed - in the old ages - my type 1 diabetes had fully developed. There was no question that I need exogenous insulin or will die within a few days - I knew and felt that too. Today patients are diagnosed earlier but this often leaves them with doubts about their condition.
In the early stages it needs multiple more expensive tests to differentiate between t2, t1 or the actual type of attack that is going on. These tests are sensitive but are known - like all tests - to produce false positives and false negatives. Your doctor came to the conclusion that you are LADA despite of normal C-peptide levels. This makes sense because T1 diabetes (LADA is the early stage of T1) is an autoimmune condition. This autoimmunity is working against the beta cells in your pancreas and the blood vessels supplying them. It is an ongoing battle and in the beginning the beta cells can compensate to some degree. This is because we usually have more beta cells than we need to produce sufficient amounts of insulin. A healthy person can produce 20 units of insulin per hour and more. With your LADA you are somewhere in between. Still not fully glucose intolerant, still capable to produce insulin and thus showing a significant level of c-peptide. Usually you start to become seriously glucose intolerant after you have lost more than 70% of your beta cells. This translates to something like 6 units of insulin per hour or less. This low amount will not be sufficient for greater amounts of carbs. More seriously this puts maximum stress on the residual beta cells because they have to produce their maximum capacity all the time. At this stage the beta cells will have no resources left to reproduce themselves. But reproduction is the best defense against the ongoing attacks of the immune system. This is the reason why the introduction of exogenous insulin is believed to be of great help at this stage. The beta cells are believed to regenerate and reproduce better. If this strategy works it will prolong the phase called honeymoon where exogenous and your own insulin will work together. Of course this depends on the mercy of the autoimmune response. At least it does not hurt to support the beta cells in their battle. Seen from this perspective exogenous insulin might have a more positive appeal to you. Ok, it sucks, it is life changing an overwhelming. Just hang in there...
You have, it seems, late onset type 1 which is getting worse. It probably would've been better to start something even sooner. I would start on the dose your doc has recommended, is it a basal insulin? See how it goes and you can adjust it as needed. I'm sure that is most likely the plan of your nurse/doc. When I started on insulin in the icu and then switched to mdi, I was on a much higher dose at first which was lowered as my body recovered.
Hi Carro: You haven't posted to this thread since February 11, how are you doing? I hope okay. You have been given some excellent advice from others here. Have you been able to increase your insulin doses, perhaps get meal-time insulin? It is important to increase slowly, but good to get to a point where you don't have the hyperglycemia. Let us know how you are doing!
Thank you all for your replies!
I am so sorry for not responding until now. Just a short update: I called my diabetes nurse since my bs wouldn`t go down after starting with insulin, and she told me to increase the dose by 2 units every third day until i reached bs between 4-7 mmol. So now I inject 12 units in the evening, and 2 units in the morning, bs this morning was 7.3 mmol. She also gave me a prescription for humalog, and told me to try out with very small doses at first. I started with humalog yesterday, and was very pleased when I learned that my bs was 10.4 after three slices of bread (usually it would have been around 15 mmol) :)
So things have worked out so far, and I have not experienced any hypos yet. I am exercising between 3 to 5 times a week, so I have to adjust my insulin according to my exercising regime, but as for now things seem well balanced :)I will check out the book you recommended, Catlady06, thanks!
It is still a mystery to my why my bs is running high when my c-peptide levels are within the normal range (I tested in January, and my level was 598), but I get the results from a stimulated c-peptide test in the next month, so maybe it will bring some answers.
Thank you for your clarifying answer! This makes good sense :)
I would agree with most of the others here. You have to be your own doctor to manage insulin. If you listen to what that Drs say, generally speaking, they will tell you to use FAR less than you need. I was told to start on 10U of lantus 10 days ago. Today I am using nearly 60/day because 10 didn't even make a dent.
I test A LOT and keep logs, and I showed them to my Dr. yesterday and he agreed that my insulin resistance is high. You will just have to be disciplined and figure it out, but if you take the time then you will get it. I suggest the Reli-On meter and strips at Walmart, as much as I hate that place, but for testing like crazy, if you don't have a CGM, you don't find less costly supplies. Ohh shoot, I just realized you're using the mmol measurement, so you likely don't have access to those strips =\
Anyways, stay disciplines, and you will figure out what dose you need. Learn to count carbs. Learn how much 1U of insulin lowers your BG and all that. You will be ok :)
Thanks Pat!
Luckily I live in Norway, and we have a really good health system here, so when you have reached a limit of 2100 norwegian kroners (which would be 255.10 USD)in medical expenses, you get what is called a free card. This means you don`t have to pay for the rest of any of your medical expenses during the rest of the year.
I usually test before and two hours after every meal. Why did your doctor advice you to take such small doses? Going from 10U to 60U seems like a lot!
Dr's are so afraid of hypos that they underdose new insulin patients. I had taken insulin for 2 years about 10 years ago, so I know how to manage it well.
What I did was start with 18, the next day did 25, 30, 35, 40, 42, 46, 52, 56, 60. I'll probably be in the 80s be next week =\
PS, I am super jealous of your healthcare! I've already spend 3k this year :(