At this mornings doctor appt I asked my Dr. what my insulin levels were and he said 9 months ago it was 2.6 and since my numbers have become progressively worse and harder to control it is probably even lower than that and that I AM LADA. I broke down...I am FREAKING OUT!! My biggest fear since diagnosis is the thought of ever going on insulin it is just a huge fear of mine. Looks like all of you were correct. I will get my new insulin levels back along with my islet results in 2-3 weeks but my Endo said the sooner we start insulin the better and when I asked about a pump he pointed to my blood sugar log and said "Well we are not there yet" so I am assuming I will have a little more time before being forced into insulin which is a blessing because I want to know everything that there is to know before I start. I can't imagine going on insulin right now though, I already have low blood sugar without insulin! Wondering how much longer I have... do some LADAs go on meds first?
It was 130 this morning, guess I didn't exercise enough before bed ugh! BUT I still do not think thats high??
No, it's not real high, but it's not normal, either. And it might have been higher during the night. Did you test for ketones on your first morning pee?
Yes first morning pee...I may have eaten less than 70 carbs though because 20 of them were calculated from green beans and broccoli, a cup of each.
I go into ketosis at carb levels of 100 g/day or below, but only measure trace or marginal on ketostix. There are things that will increase your generation of ketones, and exercise is one of them. I can get a surge of ketones following exercise. I beleive that my body starts burning fat during the exercise and then when I stop, it just dumps excess ketones leading to seemingly high levels. Everything is always back to normal the next time I check. So I just don't bother checking after exercise. And Natalie is right, T2s and LADAs for the most part are protected against DKA as having "some" circulating insulin inhibits the liver from overproducing ketones and glucose.
A good general rule is that you are only at risk of DKA when you have an elevated blood sugar (> 250 mg/dl) and are observing ketones. I think most people only test for ketones when they have an elevated blood sugar. I found that I just did not care anymore about whether my low carb diet put me in ketosis.
Yeah thats the point I got too and stopped testing but my vial of ketone strips is about to go bad so I figured hey why not use them?? I did test after my breakfast oatmeal and had none so it may have been from low carbing.
You can buy individually wrapped ketone strips -- I'm sure your pharmacy can order them -- and then they don't go bad so quickly!
Does basal insulin not help with mealtime numbers at all?
In a perfect world, no, the basal insulin would cover only the amount needed to keep your bg in the target zone in the absence of carb intake. The bolus insulin would then complement that by covering food intake. This gives you more flexibility. If you covered your meal time with basal insulin then you would end up running low if you didn't eat at that specific time (very common in the days of NPH). By separating them, you can eat whenever you dang please. BUT...
In the real world, it gets murky. Basal needs change around the clock (activity, dawn phenomenon, sleep, etc, etc) and even with the pump that can be very difficult to perfect if your schedule is at all variable. It's not uncommon for people on any given day to be covering part of their basal needs with boluses (in the form of correction boluses when your bg is too high). Using basal insulin to cover food intake is less common now than it was before Lantus/Levemir, but it is still sometimes 'happens' unplanned when your basal dose brings you low due to any number of things that may happen outside of your routine.
Sorry for the confusing 'yes and no' kinda sorta answer. Actually, you can probably scrap the second paragraph if it isn't helpful. Shoot to have them as separate as you can possibly get them on your 'typical' day, it will give you the most flexibility and the best results, but if the world was perfect then we wouldn't have to deal with this crap to begin with!
lol no that makes sense..so if your basal needs change around the clock but you have already taken a shot that lasts like 12-24 hours then how does that work??lol you just fight highs or lows all day? haha no you didn't confuse me...everything about insulin already confuses me but I'm startin to piece it all together little by little with all of your responses. And yes in a "perfect" world I would just be NORMAL!! lol oh what I would give to not have diabetes for just ONE MORE DAY.
That is one of the good things about the pump. I have 7 different basal settings. I have DP so I have my pump set to start cranking out more basal at 3 AM so it helps with the DP. If you decide you want to go on an unplanned shopping marathon at the mall, you can also temporarily lower your basal so you don’t crash. Those aren't things you can do on two shots a day of basal!
lol it's not quite as bad as it sounds, i promise! the changes are usually small. mild lows easily corrected with a glucose tablet or 2, and mild highs easily corrected by a small blip of fast acting insulin.
i hope that you're blessed for as long as possible with a low dose of basal insulin that will have neither problem and you can ease into it. with such small doses your body can respond better to lows so they shouldn't present a big problem. when and if one day it does become a struggle, Kelly is 100% dead on about the pump.
i think you're going to do well because you're asking the right questions, so you shouldn't sweat it at all. basal v bolus is probably THE most essential element of insulin therapy, yet so many dr's muddle it up (and many primaries don't even understand it). the fact that you get it now says a lot about your ability to handle this.