Replies to This Discussion

Permalink Reply by Paul Curwen on June 28, 2010 at 6:27am

Hello to a fellow Ontarian!

Have you considered you might be LADA (Latent Autoimmune Diabetes in Adults)? You are probably still producing insulin so I assume this is why you could be getting the lows you are experiencing? I think I could also be LADA at 45 and have been slim all of my life.

I would test and test again...

Hope it works out for you!

Permalink Reply by Nyxks on June 28, 2010 at 5:35pm

I've heard of LADA and I know of a couple people who have been told they have that, but it didn't come to mind when I was writing about my confusion, but its something to ask about and look into ... thanks for the reminder.

Permalink Reply by Kelly on June 28, 2010 at 11:42am

If you were to draw clear lines between T1s and T2s, T1s is an autoimmune disease and T2 is a metabolic disease. T1 occurs when your body attacks the cells in your pancreas and kills them. You must take insulin to make up for the insulin your pancreas can no longer produce. With T2, your body is resistant to insulin, so you take meds to make your body more sensitive, and depending on severity, you also take drugs to prevent your liver from releasing glucose, slow the digestion of carbs and spur your pancreas to produce more insulin.

The trouble with these definitions is that there are many people who fall in between: T2s can progress to needing insulin when the oral meds are no longer enough; a T1 could have insulin resistance. And, in the case LADAs, they are T1s who lose their ability to produce insulin over a longer period of time.

I can see why you would be confused in your situation. You could ask for antibody testing to see whether your diabetes is caused by an autoimmune disease, but if you live in Canada, it could take 6 months to get the results back (my experience). You could also ‘test’ your insulin sensitivity or your insulin to carb ratio. Offhand, I don't have the formula, but you can look it up on the internet.

If I could guess, I suspect you are a T2 but that you’re taking too much mealtime insulin. It would explain why you gained weight since you started taking insulin. Until you see your doctor, you should carry around with you some quick-acting sugar like rockets candy or a juice box to take when you are low.

The more important issue for you at this point is understanding how to use your insulin safely and properly. The amount of insulin you need is not just affected by what you eat and how much exercise you do, but also the time of day, stress, hormones, weight loss/gain and a bunch of other factors.

Permalink Reply by Nyxks on June 28, 2010 at 5:57pm

Yes I am here in Canada, Toronto actually.

i don't know if the glumetza is working or not with me, anymore then the regular met did (the side effects from it are something I wish I didn't have to deal with). I've tried to the the carb ratio thing but I never could figure it out all I know is that I have a max of 50 grams of carbs per meal and most snacks are 15 to 20 grams depending on what I have. I do eat more carbs then normal for many diabetics but I also have a condition known as AIP (Acute intermittent porphyria which is a rare autosomal dominant metabolic disorder which effects my production of heme - which also means one of the way to prevent attacks it to keep to a high carb plan not going below 150 grams in a day, which means I try to go no higher then 200 if I can well help it in a day).

My endro has me on a set amount of insulin with meals - 10 breakfast, 10 lunch and 10 dinner with 30 units of Lantus at bed. He said he wonted me on that and not to change it till he finds out what works best for me, but its been slowly going up with each visit started out with 4 units across the board and every 4 months its gone up by 2 on average.

Sighs I feel really bad when it comes to insulin ... don't feel I got enough info on it when I was put on it as I was. Was put on it the day before I got married and I never got a follow up about it because I only had a little over a week in country before I had to move to the US with my hubby (I married an American, and he couldn't stay in country for various reasons - we've applied for him to get his Canadian PR status but its not been an easy road, we're still waiting, but he's now here in Canada waiting for his status to come though so less stressful, but still its in the background never going away it feels) was living outside of Denvor for 6 months and my levels where though the blasted roof mmol 12 was normal waking numbers and mmol 15 to 20 was normal thought the day save on rear occasion when I took to much insulin and dropped like a stone (i'm just glad i'm no there anymore it was a nightmare with my levels running as they where and not being able to get them down to a safe level on my own.

Anyhow, I'm thinking I might see if I can get back into the TRIDEK program and see if they can actually be of help when it comes to taking the insulin since they where of no help when I was first told I was diabetic 6 years ago.

Permalink Reply by Kelly on June 29, 2010 at 11:11am

Congrats on your wedding! Hope you and your hubby can be together soon.

I think your doctor is trying to simplify things for you but it the end, it's not working, it should change.

Test your blood sugar before you eat. Take your insulin, and then check it again two hours after. The numbers should be close to the same. If it's higher, you didn't take enough insulin. If it's lower you took too much. This is what insulin to carb ratio is about. It's ensuring that you're taking the right amount of insulin for the carbs that you eat. If you don't eat carbs in a meal, you shouldn't take insulin for it. You'll have much more freedom if you can adjust your insulin.

Test your blood sugar before you go to bed. If you're taking the right amount of Lantus, it should be close to the same upon waking. If it's different, same as above. To test it further, one morning, get up, test, and then don't eat for three hours. Test every hour and it should all be the same. If it's different, again, same as above.

I recommend picking up a book called "Think Like A Pancreas" by Gary Scheiner. It will give you a much better understanding of how insulin works. I borrowed my copy from the library.

Permalink Reply by Nyxks on June 29, 2010 at 12:33pm

I do check before I eat, then take my shot, then test 2 hours afterwards depending on what I've ate as if the number goes up or down. today for example before breakfast it was mmol 8.7 then 10 units of insulin and 2 hours later my number was mmol 11.2 higher then it should be yet I only took in 43 grams of carbs for breakfast. The higher reading after breakfast again isn't uncommon, its very common that after breakfast I'll be higher then I was a breakfast. Lunch I tend to run high then after lunch I'll tend to be lower then what I was at lunch, and dinner it is almost an even deal half the time high other half normal and the same goes for after dinner.

My number waking are always lower then when I go to bed, its extremely uncommon that my numbers are the same as when I went to bed, I can even wake with my numbers higher then when I went to bed, but thats less common of late. List this morning, went to bed with a level of mmol 10.6 woke up to it being mmol 8.5 .. this type of variance for me is very normal for me.

I always pair a carb and protein for every meal and snack, that is something which was drummed into me as a child, and it just how things are in my life when it comes to food in general.

My endro will not allow me yet to change my insulin dosage, he wont's to find a good base line to work from and go from there, which I can understand but at the same time I feel like I'm on a rollercoster ride that I am stuck on and can't get off and the tracks have yet to level out.

One thing I had read from the ADA site was to take your current number and the number of carbs you have and count them together - if you are mmol 10.7 and you need to be at mmol 6 then you count down from the 10.7 to the number you should be at, then you look at how many carbs you are eating if it says 53 grams of carbs then ever 10 carbs equals 1 unit of insulin so it would mean taking 5 units of insulin plus the number needed to get you to target mmol ... in this case 10.7 - 6 = 4.7 + 5 = 9.7 sounded up to 10. is that similor to what your talking about when it comes to the carb radio?

I'll look at my local lib to see if I can get the book in as I have no income to buy anything beyond the essential basics at the moment

Permalink Reply by Kelly on June 30, 2010 at 8:06am

Like I said before, I understand why your doc is doing what he's doing, but you can adjust your insulin if you choose to for better control.

It is very common that your insulin needs change throughout the day. I can get away with murder at breakfast time, by dinner I have to take double or triple the amount of insulin, even if I eat the same thing.

The ADA formula is a general formula that doesn't work for everyone. But you've got the right idea.

Permalink Reply by Emmy on July 1, 2010 at 11:01pm

Hi Nyxks!

Ok, to start with, the student doctor is wrong. Using insulin does not make you a type 1. You'd be surprised how many people in the medical profession make that mistaken assumption!

As your pancreas wears out and your insulin resistance increases (this happens with type 2), you will need insulin and need more of it. Unless you can lose weight, this is pretty much unavoidable with aging, and as the disease progresses. Most type 2's will need insulin when they get older, or gain weight. There are some exceptions, but not that many of them, unfortunately.

Type 2's do not become type 1's. Its a myth. It doesn't happen.

If you are type 2, which I think you are, based on your body type (same as mine) and your age, and you need insulin, then you are an "Insulin Dependent Type 2 Diabetic". Needing insulin doesn't mean you have become type 1. It means your body is becoming less able to produce its own insulin and more resistant to it, so that you need to inject it.

Unless you have antibody tests proving you are type 1, its safe to assume that your doctor is right, and you are type 2.

Stress, exercise and illness can all affect our blood sugar and our insulin needs too. Diet has a huge impact too. Digestion problems can also have a huge impact. Sometimes a reduction in stress will reduce our insulin needs too. Also, stress can cause lows and highs. Some stresses make my blood sugar high, while other types of stress make it go very very low, very quickly, dangerously!

It can take time to get your insulin dose, diet, etc figured out, so be patient! You'll get there, it just takes time and lots of testing.