When do you know it’s time to start insulin?

Hi @GoldFinch how are you doing? just wondering if you’ve started insulin therapy. My experience: I was diagnosed with LADA 4 yrs ago, for the past 9 months my fasting blood glucose has been higher than usual, around 135, 160. I got a CGM device and highly recommend it; so you can see how high your blood glucose gets after meals and at night. I am about to start using small doses of rapid acting insulin to cover meals, I do/try to eat low carb usually 15 to 35 g per meal
@truenorth when you started insulin would you do 0.5 units injections of rapid acting insulin?

Hi Taty- just had a visit with my endocrinologist last week. My A1c was up a little more to 6.2%, but he thought that was still good. Fasting glucose was 122. He said there is some data on Januvia helping to sustain beta cell function and offered a prescription for that. I looked into that online and found that to be somewhat encouraging, so I agreed to try 25 mg per day. I showed him my recent Libre CGM data. He worries about lows with insulin. Just yesterday I took the first Januvia. Fasting BG was 99 this morning, so it seems to work , at least in the short term, for me. However, I do have concerns based on the potential pancreatitis side effect and some studies that show abnormal growth of pancreas cells in people who have taken Januvia or similar meds. Since I rarely have peaks above 140/150 and they occur only in the morning after dawn phenomenon, I think insulin would be tricky to dose. It is my baseline BG throughout the day and night that leads to my “prediabetic” A1c. It rarely ever drops below 100. BTW, I have consistently been on a keto diet for the past 3-1/2 years.

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Sometimes. After I was diagnosed I still produced some insulin so during honeymoon it was nice to be able to inject, say, 1.5 or 2.5 units. But after about a year the honeymoon was over, so while I’m still doing MDI, there isn’t much use anymore to half-unit increments.

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Hi! I was diagnosed with LADA in June. My a1C at the time was 6.8. I was in sort of an unusual position because my son was diagnosed with T1 at age 3, and is now 16. So while I was a new diagnosis, I’ve also been doing this a long time. I could not find an endo to see me until August, so I popped on one of my son’s Dexcom sensors to see what was happening with my BG. I made it three days before I decided I couldn’t stand to see those BG spikes any longer, and started myself on insulin with one of his old insulin pumps.

I think sometimes people see insulin as “failing” or as more scary than it is. With a CGM, it’s pretty easy to avoid symptomatic lows and bring down highs safely. (Certainly much easier than trying to control BG in a 3 year old!) My daily dose is pretty low, but with insulin and a CGM, I brought my a1C down from that 6.8 to a 5.4 in a little more than 2 months. In your shoes, I’d find an endo willing to prescribe insulin and get it going.

Edited to add: I wouldn’t worry about your low insulin needs being tricky to dose. Babies are diagnosed with T1 and use tiny doses - the pump is great for that.


Insulin isn’t a sign of failing, it’s an inevitable conclusion to LADA
I hope you can get in soon because your doctor should know what you are taking.
You are right now off label for insulin and the pump and also the dexcom.

Hi Timothy:
Interesting that you should have replied to my old post today, on the day I just had training for injecting insulin! The Januvia wasn’t working well, I have stopped that and will be starting levemir as soon as the pharmacy sends me the insulin. Glucose has been going up pretty quickly since December. My fasting glucose has been 130 to 170 recently. Still, I had to convince my endo to go with insulin. He still thought I had “good control”. Not looking forward to injections, but looking forward to getting my glucose back in the normal range, which should be possible since I plan to continue my very low carb (keto) diet. You must have a 6th sense for picking today to respond. :wink:

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It just showed up. It’s weird how old posts do that