Replies to This Discussion

Permalink Reply by Jessica Apple on October 10, 2011 at 3:22am

It's really interesting, Sheila, that you thought you were diabetic although your fasting bg was normal. Did you have any symptoms?

Permalink Reply by Sheila Fitz on December 19, 2011 at 8:33am

Sorry, I was rereading this thread and see that I did not respond. Yes, I had symptoms, especially extreme thirst. At first, the Endo did not believe I was diabetic, but I did go low carb, anyway. Someone turned me on to Dr. Bernstein. After reading his book, I adjusted my diet to really be low carb, excluding high sugar vegetables. I could see the thirst coming and going with the rise and fall of sugars. My eyes used to water, and I was getting fuzzy thinking. My goodness, I started arguing my case for diabetes June 2009. It is now, Xmas time, 2011. My restriction on having to use my glasses for driving was *removed* a couple of months ago because good control removed a lot of symptoms. My last fasting glucose was 89, but I had four times as many GAD antibodies to say I was Type 1, or LADA. I am strict Dr. B low carber and do Zumba until I am soaked and red in the face. I must exercise hard to keep my numbers normal. I just started glucophage xr because I am experiencing slight elevations of 100-107 in the am, but it only brings it down to 95ish. I am 58yo with a lot of arthritis, so I actually have to alternate hard exercise with a recovery time because the pain will make my bg rise. I may be batttling rheumatoid. IDK,...I have antibodies for that going on, too. It's hard to keep a balance. I have a busy life....How did I know? My older dds health improved when they went gluten free. We are Irish. I got the genetic testing and knew the link between celiac and type 1. I reread the journal articles on LADA and could not believe that I had the common gene. It was more reason to trust myself. BTW, I was probably lower carb than most people before I was diabetic. It may be why I lasted so long. I had a precipitating factor. I had an adrenal tumor causing Cushing's. When I finally was off of all replacement cortsol, and my remaining adrenal gland was functioning, my body exploded with autoimmune. I feel that that pushed me over the edge. All those years of hypercorticolism kept the autoimmune suppressed. Surviving one disease and getting another motivates me to keep well. It was a Cushie, a nurse, who helped steer me on the right path. Otherwise, I would have no idea. One person changed my life. I can feel shifts in my bg in either direction. Because of being a Cushie, I am also very aware of diurnal rhythms of cortisol, which affects glycemic control. Does that answer your question?

Permalink Reply by Brian (bsc) on October 12, 2011 at 8:04am

Actually, I believe the studies have shown that the most LADA are on insulin within 6 years, but that some went as long as 12 years. That is a long-time. That is different than saying when one should start insulin for the "best outcomes." I actually believe that as a LADA as soon as one starts to find their blood sugar over 140 mg/dl after meals, then insulin should be considered.

ps. I am diagnosed T2, but started insulin 5 years after diagnosis. I was not prescribed insulin until after I started insulin.

Permalink Reply by edinborochick on October 12, 2011 at 8:39am

i was diagnosed in April of this year and i'm now just starting insulin.

Permalink Reply by russell.stamets on October 12, 2011 at 8:42pm

Jessica,
I'm a bit of a different story here. Dx in May 2009, age 49. My extremely evidence-based DO put Type 2 on the chart but suspected LADA, later confirmed by a GAD test. He said insulin was inevitable, and any Endo would do it immediately, but he said he found NO evidence of any better outcomes for immediate insulin use. He respected my desire to buy all the time I could. Until early this year, my DOs predictions were exactly right. Metformin and glipizide and lifestyle changes had brought an 11.1 A1c down to around 6.5 until fall of 2010 when it began to rise. At this point, the DO said we can double the metformin to (2000/day), but it won't go down as far or for as long. And he was right. But as soon as my daily fasting BS (all I track) flattened out after the drop from the extra metformin, I motivated. Western medicine only had one road, and it sucked. I explored East in terms of acupuncture and meditation and researched intensely, picking up diet and supplement clues. If you want the detail, it's here. Something (or combination) is working. After an 8.8 on 1/11/11, my A1c trended down to a 7.2 on 4/12, By the time we had the 8/5 A1c result of 6.3, my daily fasting numbers were steady around 110. We cut out the glipizide. My 90 day average right now (116) equates to an A1c of 5.5. I won't know for sure for years if I've really restored Beta function and stopped the autoimmune attack. But I've got no complications, and won't in this A1c range. And as strict as my diet is, it seems infinitely less of a lifestyle hit then the 24/7 rigamarole surrounding insulin. And I've bought 2 and a half years already. My original goal was just to hold on until some miracle pump, or islet transplant, or...whatever. But now, down near normal and holding, when the only conceivable graph line was supposed to be flat at best, trending up, it's undeniable my Betas are holding their own. Sorry for the length of this. Usual disclaimers: everybody's different, not everyone will choose to forego beer and chips. I don't wish to disrespect anyone, but I question the knee jerk use of insulin. Ask. Learn. Take charge of your health.
Russell

Permalink Reply by Melitta on October 12, 2011 at 11:41pm

Hi Russell: There are studies that show better outcomes with early insulin use/intensive insulin therapy in new-onset LADA, and no studies that show better outcomes by delaying insulin therapy--your doctor simply didn't do his research. Personally I don't think it is really appropriate to use the term "knee jerk use of insulin" when LADA is slow onset Type 1 diabetes, and the appropriate therapy for Type 1 diabetes is exogenous insulin. I don't disagree that there can be unusual cases, and you may very well be one. But for most people with adult-onset Type 1 daibetes, the sooner they get on intensive insulin therapy, the better the outcome (improved metabolic control, prolonged functioning of remnant beta cells, decreased risk of complications, decreased risk of DKA).

Permalink Reply by russell.stamets on October 13, 2011 at 4:57pm

Hi Melitta, My DO didn't say he couldn't find any studies. He just couldn't find any he thought were good science. I completely stand by the term "knee jerk". I'm being reached out to by people with appalling stories of being thrust onto insulin with no information, inadequate testing, and in no immediate danger. For the Type 2's this happens to, it's even more unconscionable. And I must say, I've never heard anyone assert that insulin prolonged beta function. But I'll take your word that some study shows that too. But the point is, the epidemic's upon us. I can guarantee you that all 300 million+ diabetics will not choose the same path even if they could afford it. The odds that I'm utterly unique in terms of my holistic solution are almost nil. I'm finding that many people, like me, find the compromise of an insulin lifestyle to be an absolute last resort. I just can't stand the fact that people who should, aren't being given the choice.

Permalink Reply by Melitta on October 13, 2011 at 6:17pm

Hi Russell: Bruce Buckingham MD at Stanford has had incredible success in prolonging beta cell function in newly diagnosed Type 1s by using intensive insulin therapy (pumps) coupled with CGMs as soon as possible after diagnosis. Dr. Buckingham spoke about his study results at a Taking Control of Your Diabetes (TCOYD) conference in Santa Clara CA in 2010.

Here's some information from my Bill of Rights blog: "In the Diabetes Control and Complications Trial (DCCT), all subjects with adult-onset Type 1 diabetes had some residual beta cell function (Bernard Zinman MD, DCCT). Those who were assigned to the intensive insulin therapy group were slower to lose residual beta cell function than the conventional therapy group (risk reduction 57%). Clearly, early intensive insulin therapy has enormous benefit. As demonstrated in the DCCT, “intensive therapy for Type 1 diabetes helps sustain endogenous insulin secretion, which, in turn, is associated with better metabolic control and lower risk for hyperglycemia and chronic complications.” LADA researchers in Japan (Kobayashi et al, 2002) have conclusively demonstrated that better preservation of beta cell function occurs with exogenous insulin compared to sulfonylureas, and that sulfonylureas hasten beta cell destruction."

For most people with new-onset Type 1 diabetes, at any age, initiating intensive insulin therapy as soon as possible after diagnosis does have tremendous benefits and better outcomes. I am talking specifically about people with immune-mediated destruction of the beta cells. But people do need appropriate training and assistance, that is for certain.

Permalink Reply by russell.stamets on October 13, 2011 at 9:34pm

Thanks for the data. I'm a packrat with this stuff for the archives.
I found this on Dr. Buckingham's profile at Stanford:
"Consulting: Dr. Buckingham receives fees of $5,000 or more per year as a paid consultant for the following companies: Medtronic Minimed"
You klnow Medtronic makes CGMs and pumps, right? I imagine they'd love everyone to have a set. Can you say "conflict of interest"? And it's rampant. Insulin and insulin-delivery is HUGE money. Some would argue that these studies find what they were designed to find.

But getting this cynical is not productive. It's not going to change anything. This whole issue with insulin is only one small part of my message. I'm really more interested in how we change stress, diet, and lifestyle to live better, regardless of the state of our pancreas.
OK, I find this discussion is depressing enough, that I think I'll attend to my other, and new threads, and let you have the last word, should you choose.
Russell

Permalink Reply by Jessica Apple on October 16, 2011 at 3:19am

Russell and Melitta,

I think you both bring up very good points and each of you is saying things that make sense to me.

Early insulin therapy may indeed preserve some beta cell function. But... if a change in diet can eliminate the need for insulin or other medications, at least for a few years, I think that's also a pretty powerful thing. Every day without medication, even if you know it's coming in the future, is a blessing!

Permalink Reply by Shawnmarie on October 15, 2011 at 9:14am

I was diagnosed two weeks ago and my immediate reaction was that I never wanted to go on insulin, but it became readily apparent I might have to re-think that position because my body seems to need some help, at least right now. I started basal insulin a week ago and did my first bolus this morning and am very curious to see how it goes. I found the debate between Melitta and Russell very interesting. I'm extremely diet and exercise conscious, so I might be able to get my numbers down with very rigid controls in that area, but I've decided the middle way is probably going to be right for me - a mix of diet, exercise, and insulin.

Permalink Reply by AndyJane on October 16, 2011 at 2:58am

way to go Shawnmarie . . . totally agree :-)

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