What type of insulin should I ask for?


#24

My endo mentioned that pregnancy can stress out the body so much which triggers LADA. She said the same thing happens with Hashimoto’s. She did say she was surprised I wasn’t on my way to T2 and initially suggested metformin/losing weight/diet control but said that insulin was the better course after the c peptide results.

Maybe I will get a second opinion but she seemed so certain of it and I am barely recovering from the shock of hearing it from her on my birthday of all days.


#25

The c peptide, A1C and antibodies were all run after this.


#27

My GDM nutritionist told me to do it and I asked about it. But my endo said she doesn’t believe in the OGTT she said that it isn’t “real world.”


#29

She said no one sits and drinks 75g in a sitting and so rather have me track my meals to see what happens.


#30

She made it seem like I was risking my beta cell function if I didn’t take it so I took her samples and put it in the fridge until I was ready to think about using them. I wanted to try diet control but she said that was typically only for her older LADA patients.


#31

Thank you for sharing - I hope I would be able to be manage like you with diet/exercise. My endo made it seem like that was a bad idea since I was risking my beta cells but maybe like others mentioned I should just go get a second opinion. She didn’t even think metformin was a good idea now but just insulin.

How often did you go back to see if things got better/worse?


#32

I agree


#33

We are not suggesting that you not listen to your doctor. What we are suggesting are some good questions to take to her.


#34

Yep I understand - I just want more questions/thoughts to take back since my last appointment was so rushed which is why I was feeling very apprehensive about just watching youtube videos on how to use the pen and give myself injections. My appointment is in 3 weeks so not that far and since I test so frequently on my own I’ll know if I start heading off the deep end and need insulin ASAP.


#35

This makes sense to me, but I am not LADA. if your total insulin per day varies from 20-30 units, taking 10 by injection (long acting, once/day), means your pancreas only needs to provide 10-20, and can adapt timing to when you need it. May allow you to be less restrictive in your diet.

Why do you think diet control is better for you ?

Can you ask your doctor for studies or research supporting early use of insulin? I think there have been discussions here about that.


#36

Clearly there is something missing in translation here… the OP’s descriptions here don’t meet diagnostic criteria for any type of diabetes, let alone T1 and immediate insulin therapy-- not even close in that regard. Something is either being lost in translation, or this is VERY unconventional treatment and advice she’s being given… I really hope she’ll get that second opinion.


#37

It looks like your endo said the novolog was for high carb meals so since you are fine with eating low carb and your BG’s are doing great with that regimen I personally wouldn’t use insulin unless I was going to indulge (like for holidays or special occasions).

You could try eating what most Americans consider a normal meal that includes a serving of protein, vegetables and some sort of carby food like potatoes, pasta, etc. to get a more “real life” testing environment. That to me would be a much more realistic test than trying to determine if anything needs to change than just theorizing.

Plenty of people who are considered non-diabetic go up to the 180’s after carb heavy meals but drop back down to the normal range within 2 hours so unless you are trying to follow Dr. Bernstein style rules then I wouldn’t worry a whole lot for right now.


#38

Right now all she has provided me is fast acting and I was curious if I should ask for longer lasting. I do have variable fasting numbers and can get low 70s but could still ask my endo about longer lasting insulin when I see her.

Diet controlled just seems easier to me since I wouldn’t have to worry about calculating what my numbers were before a meal and then watching to see how things go with finger sticks watching for potential lows (I know right now I can get one and two hour results in the high 80s to 100s eating low carb). I don’t necessarily mind lower carb eating/exercising after I eat while I know others may. However like you posted about there seems to be evidence that taking insulin may protect my beta cells so if that’s what is best long term then that’s what I would like to do but am I sure if the guidelines. Like is it better to eat more carbs and take insulin for my beta cells rather than eating low carb? Or since I know some meals will take me to 120s should I try to prevent 120s as well. Or like you mentioned should I instead try to incorporate a longer lasting insulin. So I was just curious what sort of insulin related questions I should ask my endo when I see her next.


#39

I don’t have anything extra I can think of that I am not sharing. My endo did not make it seem like doing a diet/weight loss/metformin approach was going to help me in the long term and that fasting acting insulin didn’t seem like a big deal to her. She said my cpeptide results mean LADA because if I was prediabetic/headed towards T2 my coeptide would be higher and that a 0.6/1.3 indicated that I didn’t have T2.

I will say one big consideration for me is with the LADA diagnosis I was leaning on not having more children. I wanted one more but if I had LADA I do not know if I want to risk having a child with T1 (I can’t do anything about my current daughter besides monitor but may not have another). I am okay with T2 which I know is more genetically linked than T1 since in general it should only affect my child(ren) when they are older versus very young. So the distinction does matter to me for that purpose (I don’t know if this makes sense). I have shared this with my endo so she is aware but still believes it’s LADA (had called a week after to get her opinion on genetics of passing down T1).


#40

I can eat about 30-40 grams of certain carbs and get up to 120s. Some carbs like short grain white rice tend to be worse so a 1/2 cup of short grain white rice will send me to 140s at one hour but 35 grams of carbs from potatoes or pasta will be 110s/120s. I understand this is normal to be sensitive to different types of carbs though.

I honestly never questioned my endo’s thoughts that I didn’t have something wrong. I do believe I have something wrong with me so want to know the best long term approach for managing it. She said insulin would help protect my beta cells so wondering what’s the best approach for using insulin like should I eat a bit more carbs so I take the insulin or as someone else mentioned should I ask for longer lasting insulin too.


#41

I’ll just shoot strait with you. Based on what you’ve described here it doesn’t sound like you have diabetes. The numbers you’ve shared don’t indicate diabetes. It doesn’t sound like, based on what you’ve described here, that you should be on any sort of insulin whether short or long acting imo. I’m really surprised that any doctor, let alone an endo would just toss you an insulin pen and act as if it’s no big deal to just initiate insulin therapy for someone who, based on what you’ve described here, aren’t even anywhere near needing it. If you’re having thoughts like you shouldn’t have children because of this, you need to see a different doc. At this point I’m of the impression that your first doc was a total idiot. You don’t want to live your life on insulin if you don’t need insulin— it is a big deal, it’s a huge deal even. Insulin dependent diabetics can not manage their blood sugar as well with insulin as your body is doing naturally without insulin.

I don’t expect you to take my word for it because I’m just a random guy on the internet; but please get a second opinion from a doctor not involved with the first one… it could make a huge difference in the future of your life.


#42

@Ashley30 -

I concur with Sam and his opinion(s) of your doctor. In my opinion, any doctor who prescribes & gives you a drug like insulin with so little consideration and consultation is not worth seeing. Especially when you’re paying to see them.

If I were in your shoes I’d also look for a 2nd opinion


#43

Thank you for the time you took to reply back to me- I do appreciate your thoughts (and everyone else who provided me some information). I am likely going to do both - talk more to my endo when I see her in a few weeks and also see if I can find another endo to get a second opinion so even if they confirm LADA they can find someone to spend more time with me on how to properly use any insulin provided to me. I do check pretty frequently so I don’t feel like I’m in any real risk in the short term and would obviously defer to my medical professional if things changed.


#44

a 2nd opinion definitely wouldn’t hurt. I’d try to find someone that can spend more than 5 min with you. Education is very important as well, particularly if you’ve never used insulin before.


#45

A 20 oz fat coke has 75g carbs, but they are roughly 45-55% glucose. A 40oz coke has roughly 75g of glucose-equivalents, and is hardly unheard of.