Replies to This Discussion

Permalink Reply by Brian (bsc) on December 16, 2010 at 5:18pm

I know that it is very scary.  Insulin.  Being dependent on insulin for life.  But you need to look in the mirror and just say "It is going to be ok."  You need to remind yourself of your "extreme" good fortune.  You live in an age where insulin is no big deal, everyone who needs insulin can get it, you can get a pump, and we are on the verge of automated systems that will automatically manage insulin levels.  And most of all, you were blessed with an early diagnosis.  There are so many of us who "struggle" with diagnosis.

 

You may not technically need insulin for a decade, but getting an early diagnosis means have an opportunity to start appropriate treatment early and have a better long term prognosis.  Many people with LADA struggle for years attempting to get a proper diagnosis.  Some LADAs start on oral medications, but when you become insulin deficient, it is appropriate to start insulin.  But in any case, you need to remind yourself, you are going to be ok.

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Permalink Reply by LiL MaMa on December 17, 2010 at 4:47am

Thanks :) I needed that. So most LADAs do not automatically have to go on insulin, just when their insulin becomes very low or their numbers get very high or what??

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Permalink Reply by Anthony Holko on December 16, 2010 at 5:32pm

The problem with waiting for insulin is that more and more of your pancreas dies when it would be to your great benefit to keep as much of it alive as possible for as long as possible.

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Permalink Reply by LiL MaMa on December 17, 2010 at 4:49am

Thats what my endo said. But what I do not understand is how can I go on insulin with an A1C so low on diet and exercise alone? Won't that cause me to have a lot of hypos?

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Permalink Reply by Brian (bsc) on December 17, 2010 at 6:16am

There are many that believe that when your blood sugar gets high, it can harm your beta cells (glucotoxicity).  Jenny Ruhl argues that this starts to occur at levels above 140 mg/dl.  After you eat, you can have a spike in blood sugar and although it comes down, it can still be high enough to cause problems.  The HbA1c is just an average.  If you average a normal fasting blood sugar of 85mg/dl, shoot up to 200 mg/dl for an hour after meals, but then come right down to 85mg/dl that would give you an average blood sugar of 99 mg/dl and an estimated A1c of 5.1%.  You should still be concerned about those after meal spikes.

One should always be prudent about the risk of hypos.  And as a LADA, you may have a variable insulin response.  But having a remaining insulin response can actually make control easier, you are just supplementing the large insulin demand and your body can still kick in for the final tuning.

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Permalink Reply by Natalie ._c- on December 17, 2010 at 1:40pm

Early on, it was my experience that taking insulin suppressed my own production, which then became available as needed to maintain my BGs in a very good range. I really didn't need to work very hard the first few years I had diabetes. I don't know if that's true for anyone else.

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Permalink Reply by LiL MaMa on December 17, 2010 at 4:48am

Thanks so much for all of the replies so far! The more I know the more confident I will be, thank you so much for taking the time to share your experiences you all are such a blessing and I know I cannot do this without the grace of God and your guys support!!

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Permalink Reply by Kelly WPA on December 17, 2010 at 6:40am

I agree that if you want a pump, you are ready.  It took me a long time to take that jump and I wouldn’t push anyone if that is not what they want.  From talking to other people with LADA, I would think your body is certainly ready.  You are going to have days that your body spits out more insulin than other days.  Once you take that shot of Lantus or Levemir, you can’t take it back.  On a pump, you can change your basal rates as often as you need it.  If you get up in the morning and your body starts spitting out insulin, you can cut back your basal but you can’t do that with a shot of Lantus or Levemir – you will be fighting lows all day because you are getting a double whammy of insulin. 

 

I disagree with the people that said you need to learn MDI before jumping into a pump.  There are plenty of people doing MDI that have no clue what they were doing.  It used to be that doctors would only prescribe pumps to people in bad control.  Now they seem to want people in good control before they prescribe it.  Some insurance companies will grant it to people with bad control.  There are a lot of mixed messages out there.  There are also plenty of people that start pumping right off the bat and do well.  Like AR said, they train you how to use it and understand what insulin is doing.  I would get Pumping Insulin like Kristin suggested.  Some people need their hands held every step of the way but you don’t come across as someone that needs that. 

 

If you want a pump, I would push for one. 

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Permalink Reply by Brian (bsc) on December 17, 2010 at 6:59am

I guess I disagree with Kelly's disagreement on pumps.  There are certainly people that have no clue about MDI, but I am not clear that giving these clueless people even more buttons and switches to mess up is any improvement.  If someone comes to tudiabetes like LilMama and learns, they are going to be successful.  But someone who won't take the trouble to bolus for what they eat is given a button instead of a pen, I'm not clear they are going to be any more successful.  Pumps are a limited resource and are not available to everyone, give them to people where it will make a difference in the outcome.  Just my opinion.

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Permalink Reply by Kelly WPA on December 17, 2010 at 7:09am

BSC, I didn’t mean that clueless people should be given pumps so even though you disagree with me, I agree with you on that statement!  I just meant that some people think that is a qualifier for pumps. 

I also think that people could do better on MDI if they actually had the proper training and were taught how to basal testing.  Unfortunately, most people aren’t taught that.  Regardless of which method they use, they should get training.  A pump is not some magic cure-all that you just hit a button and everything is fine.  It takes works and if someone is not going to put that work into MDI, they won’t be any more successful with a pump than they were on MDI.  I just don’t feel that someone needs to learn MDI first before being able to master a pump. 

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Permalink Reply by Kelly Rawlings on December 17, 2010 at 7:10am

I do agree it's important to be determined to use the pump as more than a fancy way to inject.

 

The one thing I always like to mention to women with diabetes who are considering the pump: the ability to set temporary basal rates or other basal rates is EXTREMELY useful in dealing with monthly changes in hormones, which can cause highs and lows. Also, in dealing with overnight hormonal shifts that contribute to dawn phenomenon (this affects males and females). With enough basal rate testing and experience, it's much easier to precisely target those areas with a pump than with MDI.

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Permalink Reply by acidrock23 on December 17, 2010 at 7:17am

I dunno though, if you are nervous re hypos, a pump would seem to make a lot more sense?  I have never used Lantus nor Levimir as I went straight to a pump from R/N (!!).  My doctor indicated that N had only a 53% chance of peaking when it's supposed to.  I understand that Lantus/Levimir are not supposed to have peaks but, largely from what I've read on message boards, it seems that there are still peaks and that they can vary?  A lot of people manage to work around this successfully and it's certainly not impossible however I have found hypos to be much more easily managed on a pump because I am very certain about the IOB and the basal rate and, in certain situations, can turn the basal down or off if, for some reason, there's too much insulin in the mix?  I also understand that the goal is not to have any 'situations' ever but well, stuff happens?  To me, the 'logic' of pumped insulin makes a lot more sense than a 'curve' on a graph and trying to balance things around long term insulin peaks that are not guaranteed to hit when they are supposed to?  Even when I stupidify myself (BAC > .2 maybe?), I find it easier to keep track of what's going on with my pump than to remember, "oh yeah, I took a shot 12 hours ago, ran high because for some reason it didn't peak when it was supposed to but NOW ITS PEAKING"?  I'm trying to be lighthearted about it and I think there's a general consensus that N pretty much sucks so perhaps it's absurd to try to generalize that a pump will be smoother but I think that would be the case for anyone? 

 

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