I've seen several references to other T1/LADAs who say when they were diagnosed they initially needed only basal, but no bolus. I'm just the opposite. I need small amounts of bolus, but my pancreas is still covering my basal needs. If I skip bolusing for a meal that needs it (e.g., >20g carbs), I'll go up into the 200's, but will come down by the four hour mark (which is why I only skip if it's a low carb meal or I'm going to be exercising after I eat). I'm curious if there are others out there like me. I'd also love to hear from the science minded folks why they think it might be that some folks need only basal, but others need only bolus. I know it may simply come down to the fact that every individual body is different, but I always love hearing the theories you all come up with.
I've only read the free parts of his book online. Must get an actual copy!
Thanks for initiating this interesting discussion. I think I would have been like you, requiring only a bolus, not basal. Regrettably, I only became aware of the diabetes after being carbed out on conference food - Carbohydrate Central - all Danish pastry, bagels and fruit, absolutely no green vegetables to be seen - apart from a few leaves of lettuce which disappeared before everyone got through the queue. Without knowing I was LADA (I recognised the symptoms months later), I went on a roller coaster of tons of carbs, and then no time to eat, then another huge dinner, and finally, after my body underwent internal warfare and I ended up in the ICU with a BG of about 1000. Yet my A1C was 7,8. The doctors said they had never seen diabetes develop so suddenly.
Still, they put me on 10 units of Lantus - it sent my blood sugar tumbling into the 30s several nights. They allowed me to lower it, until it was settled down to two units, and still I had low blood sugars in the morning. Sadly, whatever the healthy beta cells I still had were not helped by this treatment and poor advice on diet (ADA - high carb, high target BG). Now I follow the principles of the Bernstein diet, although I eat as much as I like, and fruit when I'm a little low. My insulin needs are relatively low - but mornings I now experience the "dawn phenomenon". However, I rarely have lows (below 60), and do not worry about lows during the night. Good luck preserving the beta cell function you have! I've heard that with the right attention, you can hang on to them forever!
Seems like a lot of it is just the luck of the draw with how the Beta cells decide to act. My A1c was 9.8 at diagnosis, so I was running pretty high for quite a while, but I'm pretty sure I never made it to 1000. That must have been some conference! It must really make Dr. Bernstein feel like all his hard work was worth it to see his principles helping so many people.
My endo says that I'm an atypical T2. I have some features of LADA--Hashimoto's disease (hypothyroid) and other autoimmune conditions. There are also T1 and T2 diabetics in my family. I had been having regular physicals including blood tests at least once a year, for years. My BG had been perfect all along. Near the end of last summer, I got a yeast infection that I couldn't get rid of. I was also noticing that I was thirsty a lot of the time and sometimes had to get up a couple of times during the night to go to the bathroom. I got a rope burn on my right ankle in August that was slow to heal. My partner is a T2 diabetic. One day in October, I decided that the ankle injury needed to be seen by the doctor. I asked my partner to test my BG just for the heck of it. I nearly fainted when I saw the result was 11.1 an hour after eating a cheese omelete and bacon for breakfast--no carbs! I saw my doctor the next day and had the blood work done. I had been perfectly fine in February, but in mid-October my A1c was 13.1.
I immediately went on a very low-carb diet, bought Dr. Bernstein's book and read the Blood Sugar 101 website several times. I started testing 8-10 times a day and noticed that my BG was coming down but that it would spike after meals and stay elevated for hours.
I'm fortunate that my endocrinologist and I get along beautifully. I'm an information-junkie and he likes to have patients who want to know everything about their own health care needs. We talked about what to do about my post-prandial BG. I was feeling frustrated because, if my BG was elevated, I didn't think I should eat a meal that was only going to send me higher. This was creating problems with my family and in my life, generally. I don't want my diabetes to control everything I do. I was already on Metformin, but had a lot of gastric trouble with the regular version of the medication. The endo put me on the ER version and recommended that I start taking Humalog for meals and corrections, only. He reasoned that, if my PP readings came down, my fasting levels would also drop a bit more. I seem to produce enough insulin for that.
I've been taking insulin since after Christmas. It was quite a big learning curve, calculating ISF, I:C ratios, learning how to cover protein and fat and working out the timing for my shots. I'm still testing about 8-10 times a day but I feel like I have a very good handle on my diabetes, now.
I eat 20-30 grams of carbohydrate, maximum, per day and I take between 12 and 18 units of Humalog. I've lost just over 40 pounds and am still losing about a pound a week. My A1c has dropped from 13.1 in October to 8.8 in December and, yesterday, 5.9, with my fasting BG going from 10 in October to 6.4 in December and 4.7 yesterday. I'm feeling very happy with my progress. I want to lower my A1c a bit more, but I feel confident about how to do it and I'm hopeful that I will achieve the results I want.
I don't think I could handle doing only 20-30 g of carb a day, but that's great that it's working for you. The learning curve with all of this is indeed steep, but it's so worth it when we start feeling better!
This discussion makes me soooooo relieved! I have been struggling with insulin sensitivity since I started on insulin back in November. I am currently taking 6u Lantus and Novolog 1:25, 1:30, 1:20. Then eating snack under 15 carbs 1-2x daily with no insulin. I've been struggling with high sugars after meals and then having them tank 4 hours later. So Frustrating! But reading everyone else's comments have helped calm me down tremendously and realize that I can do this. Thank You!
I'm so glad the discussion has helped. I know it's definitely made me feel better to know others are a similar situation. Are you going to talk to your doc about decreasing your lantus?
Hey...just wondering what you usually wake up at in the morning. I had been waking up at 115-120 since off the basal, but after getting my monthly I am 150 to 160. Do your morning numbers change depending on the time of the month? I am wondering how long I should let them be that high in the morning..
I've only had a few mornings over 100 in the last five months and it hasn't seemed to change depending upon the time of the month. However, my I:C ratios change depending upon my cycle - I need more insulin for the couple days before my period. Could be that your experiencing a similar effect, but with your basal needs. If it were me, I'd be nervous about letting it run that high for too long.
I bolus only and my endo is trying to increase carb intake so that I won't burn out in my workouts. So I have to take more insulin. I'm still on a very small dose. My ic ratio is 1:40. Sometimes it works, sometimes it doesn't. Endo also says I'm depleting my glycogen supply when working out and that I should have a snack afterwards to replenish. One that would not require insulin so about 15g-20g. I workout from 7:30pm until about 8:30pm so when I eat my snack that late, my morning numbers are over 100. Almost guaranteed every time. I'm not sure if it's the type of snack I'm eating but you'd think I'd drop back below 100 after 9 hrs. If I don't eat or snack after like 7pm, then I'm below 100 in the mornings. It's weird but that is the only trend I see.
Thanks for the info. I always have a snack at night, so maybe I will try not having one and see if that helps...or bolus more. My CDE said not to worry if I go up to 160 for awhile, but I don't like it. I will give it one more day and see.