Replies to This Discussion

Permalink Reply by Zoe on March 28, 2012 at 10:09am

Welcome to the board, and you've definitely come to the right place. I was also misdiagnosed Type 2 in 2007,but the oral meds only worked for 15 months before my numbers started rising and I figured out I was Type 1. LADA is just a slower onset form of Type 1. I also have thyroid disease (common in Type 1's) and I also lost 40 pounds.

A couple suggestions. First: Don't go anywhere without your meter. My guess is you were low by your description and the bread pulled you up. You also need your meter with you to test before eating. Alcohol is complicated. Beer is pretty high carb. I bolus for 14 units for a beer. Other forms of alcohol don't have carbs (unless they have sweet mixes) but can bring you high for awhile and then crash you low. You need to test a lot when drinking.

My second piece of advice: Get the book Using Insulin by John Walsh. It will answer many questions, and by the time you read it you will have more of a handle on this thing. Then you can re-read it..lol

Now, your treatment: You say "bolus 18 units". Per meal? Over three meals? Unfortunately "set doses" don't work very well. (As you are discovering!). What you need to do is learn how to count carbs. Then you have to figure out your Insulin:Carb ratio. Some people start with an average 1:15. That means for every 15 carbs you eat, you need 1 unit...30 carbs, 2 units, etc. Try that for a couple days. If you are consistently high 2 hours after your meal, try 1:13 for a couple days, etc. You may find that different meals need different ratios. (To give you an idea, mine are 1:5, 1:10 and 1:20 for the three meals.

It is an awful lot to learn, and can be overwhelming. But once your numbers come down you will feel much better and as you learn how to manage your D, you will get more confidence.

In addition to the c-peptide, the other test the endo will (hopefully!) do is antibody testing; that is the determinant if you are in fact Type 1 (which I also assume you are!) Hang in there and keep asking questions.

As for the job, I'm sure you can do it in time. People with Type 1 do every sort of job successfully and learn to manage around their work situations. But now may not be a good time to take on added learning and stress. If you can postpone your schooling I would suggest you do.

As for complications. Damage can develop from long periods of time spent high, so I wouldn't worry about it too much but just work on learning what you need to do to start getting your numbers down.

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Permalink Reply by DiabeticWarrior on March 28, 2012 at 10:32am

Thanks Zoe,
Your advice is very appreciated.

yes i take 18 units divided in 3, so 6u in morning, 6u at noon and 6u at dinner.
Is it better to take it 30 mins before our meal?

For the school, i think i will postpone it to next year because i want to focus on my diabetes and plus i will be going to a lot of doctor appointments and will probably miss classes and if i don't feel my diabetes is under control i will probably also fail classes.

And maybe during the year if i keep working on my portfolio i might find work in my field, i am a 3D modeler and animator.

For the beer, maybe was because i drank on an empty stomach, i heard eating protein before having a beer helps. Like you said alcohol is tricky because it can bring your sugar down too and quickly. Sometimes when i had red wine in the evening, the next morning i was in a low.

For the book, i bought 'Think like a pancreas' it explains how to use insulin pretty well and also for those using a pump too. The author was also diagnosed with Lada and was thin body type.

i am trying to stay in a 1:12 ratio, the Endo told me to take 3U morning, 10U lunch and 3U dinner, but this created a Hypo after my noon shot, i went down to 3.2 mmol/L so that's why i decided to do 6u-6u-6u.

In the end i think we know our body more and the right dosage we need.

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Permalink Reply by Zoe on March 28, 2012 at 11:23am

You are absolutely right that drinking on an empty stomach is worse. Mainly with drinking, test, test, test and eat something is the only way to stay out of BG trouble.

Yes, Think Like a Pancreas is the other good book people recommend.

For the carbs you're better off thinking in a ratio and tweaking your ratios for the different meals. That way you can eat different foods. You definitely wouldn't use the same dose for a salad vs a burger and fries! You might want to start with 15-20 minutes before the meal and see how that works. I wait 20 minutes myself unless I'm lowish, then I might bolus and eat, or even wait until I'm done eating and my blood sugar comes up a bit.

You are also on the mark when you say we know our body more. It's a 24:7 thing, and then it changes! I personally don't know how people manage that wait for their endo before tweaking numbers!

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Permalink Reply by Terry on March 28, 2012 at 10:55am

I also think Zoe's advice is sound. I think your decision to postpone school is a good one. I was in school studying electronics when I was diagnosed at the age of 30. For a few weeks before my T1 diagnosis I started to have a hard time understanding new concepts even though I had always been a strong student academically. Once I got my blood sugar under control my cognitive impairment disappeared.

If you want to learn how your body reacts to various food and insulin doses, keep a detailed log for a month or two. It reduces the "can't see the forest for the trees" syndrome. Trends become easier to see.

Become a keen observer of your metabolism and make changes that make sense to you. It's not practical to consult with a doctor every time you make an insulin dosage change. If you did that, you would be on the phone with the doctor multiple times every day. I've never met a doctor that can give that kind support.

Good luck! You've come to the right place for the kind of questions that you've posed.

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Permalink Reply by DiabeticWarrior on March 28, 2012 at 11:15am

Yes i agree with you on the cognitive impairment, i was feeling this in class on monday, was like simple things to understand became confusing and complicated, i was always a great student too, but now i feel it's getting harder to stay focused with this high blood sugar i am experiencing.

I also went through the blaming part, where i tried to analyze why i got this and how did i get it? Was it a cold virus? Was it a food poisoning that triggered it. Was it because i ate too many sweets in the past and sometimes had 2 dinners in one night? I tried to find what caused me to get this with no answer.

All you can do is accept you have it and live with it.
Now i would like to know was metformin helping me while taking insulin?
i find my readings were much better, now i tend to spike more, since they removed metformin.

even though i take 18 units of Lanctus at bedtime, i still wake up with 11 mmol/L

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Permalink Reply by Zoe on March 28, 2012 at 11:27am

I did well on Metformin when I was misdiagnosed for Type 2 for 15 months. Some Type 1's do take it with insulin if they have some degree of insulin resistance. It's unclear that you do. Your c-peptide will tell you how much insulin you are still making on your own.

You may need more Lantus if you are waking up that high. Some people get better results with a split dose, because as you raise the dose to eliminate that high fasting, you might experience lows at other times. Another option if you can't regulate well with Lantus is to try Levemir which some people feel has a smoother action.

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Permalink Reply by Terry on March 28, 2012 at 11:31am

I've learned over the years that T1D is an autoimmune triggered disease whereas T2D is characterized by significant resistance to insulin.

I've also learned that T1 diabetics can become insulin resistant and T2 diabetics can lose the ability to produce insulin and thus need insulin.

I am more insulin resistant in the morning. When I exercise regularly (walk 2-3 miles/day) my insulin seems to work as expected. When I haven't exercised in a few days my BG runs run higher given the same insulin and food.

I had a doctor prescribe Metformin several years ago. I had some scary and unpredictable lows, so I stopped taking it. For me, I know that the insulin resistance solution means losing about 20 pounds of weight.

As I said before, keep a log. Experiment, write things down, review, and take another incremental step. If 18 units of Lantus at bedtime doesn't do the job, try 19 units and see what happens. Sometimes you need to leave a change in place for a few days before you judge the effectiveness of that change. You need to become an expert about you!

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Permalink Reply by DiabeticWarrior on March 28, 2012 at 12:02pm

Thanks for the tips Terry.

I will try 19 units tonight and see in the morning if it helps.
What really worries me too is that i have been an anxiety sufferer for 10 years now and i hope this new diabetic stage i am in won't trigger new panic attacks and anxiety.

I had frequent heart palpitations and feelings of suffocating and sweating when i was in my late twenties. So my family doctor prescribed me 100mg of Luvox back then. Now i take only 25mg. I tried to discontinue it but the withdrawal effects are too strong, felt like anxiety all over again x 100. I decided to keep taking them as they help me with my daily routine.

Is there a test to see if your body is resistant to insulin?

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Permalink Reply by Zoe on March 28, 2012 at 12:28pm

Unfortunately, both anxiety and depression are more common with people with D than the population as a whole. Now would definitely not be a time to discontinue your anxiety meds. If you are having increased symptoms you might want to see your provider and consider therapy as well....a therapist experienced with Diabetes or other chronic illness is best. If you have to increase your dose a bit for now, as things smooth out with your D management you will probably be able to decrease it again. Meanwhile use whatever tools you have learned to soothe yourself and deal with stress. This stuff is stressful, especially at first!

No, there is no test (that I know of) for IR. Mainly it can be recognized by several factors -Insulin sensitivity including dose of insulin - people with IR need significantly more, I:C ratios and weight loss (which is much harder with IR) and ISF (how much . Your TDD is low for someone with IR, but you are not yet controlled so may need more, making it fairly marginal. Your I:C ratio (if it is correct, that is effective in staying in range) is not indicative of IR (again that may change). Finally you lost a fair amount of weight which is more common with Type 1's. Insulin Resistance is the key characteristic of Type 2. However, Type 1's can develop it, but it is usually after several years of (imho) eating too many carbs and bolusing too much insulin as well as weight gain. You may have a bit of insulin resistance but not a lot. (Most of us have some, that's why we need more insulin in the morning)Let's say, for example you round out at about 40units TDD - for comparison (we are all different of course) my own TDD is around 20. But a Type 2 on insulin may take 100 or more.

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Permalink Reply by Randy on March 28, 2012 at 1:59pm

Zoe, you are gold! Warrior, you are getting great stuff here. The one thing you have been doing as I did in the beginning, is using a set bolus. Drove me friggin nuts. I was having to eat way too much and way too many carbs. The worst part was it made my BG next to impossible to control.I cut WAY back on the carbs and started with a 1:15 ratio. Once things stabilized a little(and I started to figure out insulin) I carefully expanded my menu. Kind of like cutting out the variables and going to the basics while training. I also did just what you are and learned as much as I could as quickly as I could. I can't say enough good about TuD and the folks here. They made all the difference. Another site that helped me understand my BG better was Blood Sugar 101. Take a look for yourself and welcome to TuD.

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Permalink Reply by DiabeticWarrior on March 28, 2012 at 7:31pm

it's nice to be here, i will be glad to help if i can and learn stuff too. I have been diabetic for about 5 years now and i have learned a few things about type 2 and now learning more about type 1.

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Permalink Reply by MyBustedPancreas on March 29, 2012 at 4:21am

Welcome! Sorry you were diagnosed, but at least you've acquired a disease that has some really cool social networking ;-) It definitely sounds like you're a T1 (1.5 is just a fancy term for type 1 when adults get it, which generally happens a little more slowly than when we develop it as kids). Given your insulin dosage, you don't sound as if you're insulin resistant (a characteristic of T2s, who generally require MORE insulin to bring down BGs). Also, given that you already have hypothyroidism, that too points to a T1 diagnosis (these autoimmune diseases sometimes come in groups).

Anyway - the next year or so is going to be tough, as you are going to have to figure out how to manage things, what foods do/do not work for you, how to dose insulin, etc. But I would NOT give up on pursuing something that you want to pursue. T1 is not a death sentence, nor will it incapacitate you if you take care of it.

Being diagnosed at an older age means that your body has likely not had decades of fluctuating BGs -- so this bodes well in terms of complications. It is the sustained highs that damage kidneys and other organs. There are plenty of folks walking around who have had D for 20, 30, 40 years and don't have any complications. So don't worry about that too much. Just focus on getting your blood sugar to an acceptable level.

Experiment with eating low carb. For a lot of people, this really seems to help. It definitely helps me keep things more under control. Learn how to count the carbs in what you're eating.

Remember that what works for one person may not work for another. Sometimes with D, you just have to experiment and find what works for you.

Log everything - keep track of BGs, insulin, carbs, etc. This will help you find the right dose.

Stress does cause BGs to go higher, but that "stress" for me can be just about anything - an argument with my spouse, a bad day at work, running to catch a bus, etc. You have to learn how to just live with stress. I like to joke that I bolus for marital discord.

Alcohol - ah, beer and wine, how I love thee. But my diabetes does not. Alcohol causes your BG to spike up very high and then come crashing down because it suppresses the liver's release of glucagon (the hormone that RAISES your BG). With a lot of experimentation, I have found that one glass of wine or a bottle of beer are OK, but anything more than that and I am in for a wild ride (including a wild ride to the nearest ER). Drink with caution. When you do drink, make sure your friends know you're diabetic and that if you start acting funny, they need to check your blood sugar.

You're in the worst of it now and things will get better. Read "Think Like a Pancreas." Read all the old posts on this site. Read whatever you can get your hands on and experiment with diet and exercise regimens to find what works for you. Even an endo is not going to have all the answers. With diabetes YOU have to be the expert in managing your condition. And when you have questions, come here and ask, because there are so many of us who have been there and done that.

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