I am going to meet my endo in December and want to make sure I make the most of the appointment since it is tough to get in appointments. My endo believes I have LADA due to a low c peptide (0.6) and high postprandial even though I was negative for GAD, IA-2, Insulin and ZnT8 antibodies. She said that not everyone has antibodies and so will treat me like a LADA patient. I did retake my c peptide test because I was curious since I didn’t have antibodies and the first time I fasted for 15/16 hours and also exercised that night - so with an 8 hour fast I got a 1.3 (range is 0.8 to 3.85) but my endo said that to her a 0.6 and 1.3 were the same and considered low so it was still LADA. My glucose at the time of the cpeptide were both mid 90s.
I read that LADA patients can prolong beta cell function with insulin so would like to start if it can be done safely. My endo gave me some fast acting insulin (novolog) samples to use with meals but didn’t explain much to me so I’m a bit hesitant to use it since I don’t even know what I:C ratio I should expect. She just told me if I go over 60 carb meals then use a unit or two and I don’t feel comfortable with that right now since even though I can spike to 180/190 I do come back down to 80-100 at two hours. I am okay keeping up my low carb meals (I aim for 15-20g a meal except breakfast I try to do less than 10g). I did have a 130 at one hour when I splurged and had a higher (not high but higher than I’m used to) carb dinner - (I walked on my treadmill for 15 minutes after the meal so I assume without that it would have been in the 150/160s if I didn’t exercise) - is that when I should use the fast acting or is that still risking going too low? I got back to 94 at two hour with that meal.
My fasting numbers were trending in the mid 80’s to mid 90’s but for the last week or so are in the low to mid 70’s so I am not sure if I should ask for basal or that will just send me too low.
So in summary - what sort of insulin should I ask for? Just keep the fast acting meal ones? At what level is fast acting appropriate? Should I use it when I assume I’ll get to 150 at one hour? How do I safely test if one or two units is appropriate for me when I do eat higher carbs? Should I ask for basal too to protect beta cells or the risk of lows too great right now? I have so many questions and my endo is a bit hard to get information from so I want to make sure I have a well thought out plan before I see her. I am going to discuss all of this with her as well but want to have a better idea of things to think about/ask.