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Okay, a little back ground here. I am 27 y/o and when I was 23 I was diagnosed by my PCP as a type 2 diabetic, simply because I was over the age of 18 and had an A1c of 8.0. I was put on all sorts of different oral meds then Byetta, then Victoza, then back to Byetta. I began working out feverishly and eating a very low carb diet... I lost 60lbs! But all these things did not keep my b/g from steady rising more and more. So, after 3.5 years my PCP finally agreed to let me see an Endo. After reviewing my chart and talking with me she said I am DEFINITELY type 1, not type 2. She said if I hadn't gone low carb and started exercising like I did they would have figured it out much sooner. She immediately adjusted all my insulin (which I began taking in Nov. with my PCP cause everything else had failed). And she wants me on a pump which I am all for an incidentally have am just waiting on the paperwork to go through.
Okay, so last night I was very very upset because they keep decreasing my insulin doses to increase my blood sugars because they are too low, I am frustrated because my sugars are all over the place and I hate that! My CDE says its because I work out so much that I am very sensitive to insulin and require extremely small doses. Some days I just feel like maybe I shouldn't be taking any insulin but with none it shoot right up into the 300s within 24hrs. I'm frustrated and confused at the moment.
I suppose what I really want to know is, I am taking only 16u of insulin total 6u Lantus, 10u Novolog that just seems like an outrageously small amount considering how the "standard" is 0.5-1u/kg/day. Thoughts? I mean is it possible that I can honeymoon 4 years after because I just started on insulin. Incidentally when I first started I was on 18u Lantus and 7u Novolog.
And finally, all these fluctuations are making me nervous about getting my pump. Is having a pump going to help with all these lows?
I understand about the I:C ratios. Pump should help a lot with that... if you weren't getting the pump, I'd say there are some insulin pens that do fractional units.
As far as Lantus, I can try to explain.. it's really just a game of staving off the high readings that come when it peters out.
Although it's labeled for once a day, it has a high variability from one individual to the next. In any given individual, it may last from 18 to 26 hours. So some people it might last the 18, some people it may last the 26.. and then there's a bunch of us in between that range. Mine seems to last about 22-22.5 hours before my numbers start creeping up. My problem is that I would eat dinner around 6pm, have a decent reading at 8pm, and then all of a sudden at 10pm my numbers would be like 250.
With the split dose, I take it at 10am and 10pm. So let's say I'm ready for my 10am dose. My numbers may have creeped up a little from 8:30am, but because I still have the 5 units on board from my 10pm dose, they don't creep up way past 200 like they used to. When I go to take my 10pm dose that evening, my numbers don't fly up to above 200 between 8:30pm and 10pm because I still have the 4 units on board from my 10am dose. It just helps prevent my sugar from skyrocketing when the Lantus wears out 22 hours in.
I hope your CDE can help with this, julianne, because having to eat more carbs than you like to "match" the insulin is called "feeding the insulin" - suiting the food to the insulin, rather than the opposite. There are people who are especially insulin sensitive or still in their honeymoon who use ratios like 1:40 or even 1:60. If you had a syringe with 1/2 unit markings you could eat say 30 carbs and take 1/2 unit. But yes, I think it's clear you are a great candidate for the pump!
I'm an insulin resistant T2 on much higher doses than you take, but as others have mentioned, I also use my long-acting (Levemir) in an uneven split dose. I inject 30 in the morning and 32 at night. That way, I get a little bit extra coverage in the morning when I'm likely to go high, and a little less coverage in the late afternoon/early evening, when I'm likely to go low. It used to be more un-even (28/32) but I've been tweaking it.
I think you'll do much better on the pump. You'll be able to fine-tune things like various basal rates and tweaks for your exercise and post-exercise.
I look forward to hearing how it's going.
Okay so I am posting this in the same thread as my original post because it still has to do with the type 2 misdiagnosis.
I went for 4 years with a misdiagnosis for type 2, I am curious if now that I have had the blood work to confirm anti-bodies, and am using insulin instead of oral medications, will I now have a honeymoon period. I only ask because I seem quite sensitive to insulin at the moment but it seems kind of weird that one would honeymoon 4 years later.
Also, update- No LOW's in 2 days, not since the addition of the 2 15g carb snacks. So at least that's better for now.
Glad things are going better for you. I'm also a LADA though I only had the misdiagnosis for 15 months before the oral meds stopped working and I had to figure out what was going on. No, I don't believe you will have what is technically a honeymoon period. Some people refer to the period of time LADAs can go without insulin as a "honeymoon" but to me that is not exactly correct. Much more gradual onset is simply the nature of how LADA works.
I do think you will, in time, need more insulin, but probably not dramatically more. I've been on insulin now for 3 years and it went up a bit, but not a lot. When I went on my pump, like most people, the amount I needed actually went down some, so my net gain isn't an awful lot. Unless I gain weight and/or develop insulin resistance (knock on wood....loudly...for both!) I don't expect it to change much, just the usual tweaking. I take about 20 units a day. One difference might be how advanced your beta cell destruction was when you started insulin. For me, I waited a couple months too long as I was hitting the 300s and even 400s regularly by the time I started. My c-peptide when I started was either .38 or .70 (different labs) so I was no longer making much insulin. You may have started insulin a bit earlier in the process than I did (the 4 years vs 15 months is just individual variation). But even if that's the case, I don't think it will be dramatic.
Hang in there! Call and torment them until they send it in :)
Hi: Unfortunately, having a disease like diabetes means you have to be a pit bull! As in persisting until you get the best care possible for yourself. You are doing so great, keep it up!
UGH. That is terrible! I am sorry it is taking so long to get it sorted out. Have you tried contacting your doctor's office or the pump company?
SUPER excited today... Pump Update! After calling everyone under the sun repeatedly for the past 4 days in a row, the insurance company has finally received everything they need and I should hear back from them very soon. The guy said they an take up to 14 days, but are averaging 7 right now and are looking to move mine through even faster. The guy said he was going to call them tomorrow and monday to "remind" them since it has been taking FOREVER! He also said he is fairly confident it will go through as my endo did an excellent job filling out the medical necessity forms. I can finally start getting excited again!