About to start insulin on LADA and in need of information
Hello,
Just a quick brief of my condition. Diagnosed on Oct. 2007 with a fasting BG of 210 and first started on a classic diabetic diet and Glucophage, after two months first HbA1c was 6.3, then discovered low carbing and go on with Low Carb diets. Two months later HbA1c is 5.7. :-)
GAD antibodies are flying in the air (lab could not detect it, just wrote >30), other antibodies are slightly positive. So a classic LADA condition. Also my mom and grandmom are Type 1's diagnosed at ages 30-40. (No LADA was known at those times) I have many other autoimmune diseases such as vitiligo, hyperthroid, pernicuous anemia...
My biggest problem with Low Carbing (or maybe sth else) is weight loss. I loose like 4-5kg (11pounds) in two months time.
I have talked with my endo and he said Low Carbing is good if I can manage my BG levels in normal range but weight loss is not acceptable. So we decided to start insulin. So that I'll be more free to eat and maybe gain weight. His first idea was to start Lantus as basal.
Although I have read many, I really cannot understand whether to start with Basal, or Bolus or both. I'll be glad to hear your ideas, recommendations and experiences.
Thanks.
Ozgur, from Ankara-Turkey
Just a quick brief of my condition. Diagnosed on Oct. 2007 with a fasting BG of 210 and first started on a classic diabetic diet and Glucophage, after two months first HbA1c was 6.3, then discovered low carbing and go on with Low Carb diets. Two months later HbA1c is 5.7. :-)
GAD antibodies are flying in the air (lab could not detect it, just wrote >30), other antibodies are slightly positive. So a classic LADA condition. Also my mom and grandmom are Type 1's diagnosed at ages 30-40. (No LADA was known at those times) I have many other autoimmune diseases such as vitiligo, hyperthroid, pernicuous anemia...
My biggest problem with Low Carbing (or maybe sth else) is weight loss. I loose like 4-5kg (11pounds) in two months time.
I have talked with my endo and he said Low Carbing is good if I can manage my BG levels in normal range but weight loss is not acceptable. So we decided to start insulin. So that I'll be more free to eat and maybe gain weight. His first idea was to start Lantus as basal.
Although I have read many, I really cannot understand whether to start with Basal, or Bolus or both. I'll be glad to hear your ideas, recommendations and experiences.
Thanks.
Ozgur, from Ankara-Turkey
Replies to This Discussion
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Permalink Reply by Libby on
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I had a similar problem to you. I was diagnosed in April 2007 and have one slightly positive reading for antibodies. I am also early LADA and can manage my BG on a low carb diet. But I kept on losing weight. I only weigh 115 pounds and am 5 feet 7 inches! If you want to eat a bit more, you might try a bolus of a fast acting insulin such as Humalog or Novolog before meals. I only need 2-3 units and then I can eat 30-45g of carbs without a high BG after eating. Are you still getting high fasting numbers? If so, you will also need a basal insulin. I have very low fasting numbers so don't use a basal yet. But I do need Novolog before meals if I want to eat more than a tiny amount of carbs. Hope this helps, feel free to ask more questions.
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Permalink Reply by Ozgur Ulupinar on -
Thanks Libby,
My fasting BG in the morning is usually like 95 at wake up, rises to 105 till I have breakfast 1 hr later and usually like 110-115 after breakfast. I have a very mild down phenomen.
So I think basal might not be necessary. (However Dr says basal, Lantus)
One other thing is that I can keep my BG under 100 throughout the day if I dont have a real meal but eat nuts (hazelnuts) sparingly. I believe I need no basal.
But maybe I should try basal with Low Carb as my pancreas at the moment is working as only basal. I am really confused.
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With LADA, the first thing to go is first phase insulin response. That's why you go high after eating carbs. Next is the second phase. I still have that intact. That's what kicks in after you go high and brings you back down. It is also what allows us LADA types (and Type 2s) to manage just fine on a very low carb diet. If you make no insulin at all, you can't go without injecting or pumping even on low carb. Last of all is fasting. If you are getting 95 in the morning with just a small rise due to dawn phenomenon and you can stay under 100 most of the day on low carb you really don't need basal insulin. In fact, you might go hypo with a basal. If you just want to eat a little more, you need fast acting to prevent that after meal spike which is so damaging to your remaining beta cells. You said you have low levels of antibodies so you are probably just at the beginning of the process of losing your beta cells. The only way to preserve them is to keep BG normal and the best way to do that is with rapid acting insulin (bolus) before meals AND a relatively low carb diet. So if I was you I would ask for Novolog or Humalog and wait on the basal until you need it.
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Permalink Reply by saundra barragan on -
Hi Ozgur,
I am LADA also and eat low carb as well. But I also use Humalog and Lantus both.
I have a question or several actually. Are you only eating a few hazelnuts for your meals? Are you afraid of using the insulin or just prefer not to? Do you eat any proteins or vegetables at all?
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Permalink Reply by Ozgur Ulupinar on
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Libby, thank you again. Let me just note that my GAD value is so high. (whatever it means)
Saundra, I consume hazelnuts as snacks in normal days. It differs from day to day. I always keep some nuts (hazelnuts, almonds and walnuts) with me for snacking when I'm hungry and also I believe they help me with the calories I need since I'm low carbing. However, if I cannot hold myself and eat a lot (like 20-30 hazelnuts in one time) that affects my BG. Generally I tolerate walnuts better (higher oil than others) but they are also expensive :-)
Whenever I know, I will be missing one or two meals like during business trips, I consume hazelnuts more. That keeps me steady and energic. All other times, I eat proteins and low GI vegetables at the meals. I try to adapt/follow Dr. Bernsteins recommendations to my/my families' local eating habbits.
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Permalink Reply by saundra barragan on
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Thank you Ozgur. I am sorry I misunderstood. I like walnuts for a little snack also. As for the weight loss, do you have access to any whey protein powder? I have trouble digesting more than a few ounces of meat per day and find the protein powder is a big help for me.
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Permalink Reply by Ozgur Ulupinar on
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Saundra,
I'm just doing fine with meat at the moment. I will keep in my minde to try whey protein powder. Thanks for the help.
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Permalink Reply by Mandy on
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Hey Ozgur!
I was LADA too, now full blown Type 1, unfortunately. My doctor started me on a basal as well, and he gave some very good reasons why.
First, because the rate at which your pancreas fails is uncertain and unpredictable, even a small amount of basal protects you from future DKA.
Secondly, you are less likely to have hypos on the long acting insulin. It's slow release signals your pancreas to stop it's own production unless needed.
And Finally, Just that weight of producing your basal all day stresses you beta cells, where you can't store insulin to act as a first phase insulin response. Giving it a break throughout the day, allow better reaction and response to meals. And internal regulation of needed insulin at meals is always better, since food coverage can be tricky. This also slows down the attack on the beta cells throughout the entire day, which may help to prolong their life.
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Hi, Mandy,
Thanks for that info. That is very interesting. I hadn't heard that explanation of why it might be helpful to use a basal insulin. I recently asked my endo about whether I should start using a basal and she didn't think it would be all that helpful for me because of my low fasting rate. But now I think I might give it a try. What happens for me is that I use insulin for meals for a while and then start to get hypos because my beta cells have been getting a rest. Then I stop taking insulin and my levels creep up again. Seems like a low level of basal might be the missing link! What did your doctor start you on in the beginning?
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Permalink Reply by Ozgur Ulupinar on
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Thanks Mandy,
Great description! That was what I need. Also can you, if possible, give me some hints how you have converted from LADA to T1?
I just want to see my road to T1 though I know everybody is different.
Ozgur
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I can only tell you what happened to me, so here goes.
I do not recomend following in my footsteps. After the initial DKA at diagnosis, I went into a honeymoon rather quickly. Hence the Levemir dosage above. That small dosage really seemed to work for about 2 months, and then it started creeping up into the 270 range. Hence the above increase and addition of Novolog again. Again, it really seemed to work, but I started feeling like my numbers were so good, I didn't need the insulin (thought the DX was a mistake!). When I started having astronomical post-meals spikes, I got depressed and just stopped taking the insulin and checking my blood sugar ALL together one weekend. By Monday I was above a range my meter could register and spent a week in the hospital for DKA. Apparently, I was also getting an infection which sped up the Acidosis.
From what I understand, usually it's gradual, but any kind of illness or stress can quickly bring you out of the honeymoon.
I'm still on a relatively low dose of 22 units, but I'm a serious runner and pretty small. I have tried to decrease my insulin "just to see" a couple of times since then, but I always wind up in the 400's with moderate ketones.
As the Doc says, "the honeymoon had ended and your on insulin for life, you need to accept it."
TIL THERE'S A CURE!
Mandy
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Originally, when I started honeymooning, he placed me on just 4 units of Levemir in the morning. I'm about 5'4" and under 100 lbs for dosing reference. Later, when my sugars started edging up to the 200's again (about 2 months) he increased me to 5 units and added Novolog to meals. I'm really insulin sensitive, so a little of that stuff goes a LONG WAY!
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