High blood sugars all of a sudden.

[purrpleness]

Hi everyone,
wasn't sure what to call the subject of this post, basically i was diagnosed April last year hba1c of 50 - Type 2 for pretty much a couple weeks before i got my GAD positive results and have been on Basal pretty much since then. I saw my Endo in January, she thinks i should start 1 - 2 units of fast acting with my Lunch, as whatever i eat i linger between 16-21mmol for up to 4hours afterwards, and by that time its heading towards being in range, its time to eat again!! I have been a little bit worried to start this, so i have agreed to see a dietician next week for better understanding. I had my Hba1c tested a few weeks ago and it is now at 63. my CGM shows i am in range pretty much 30% of the time. My wake up levels would be between 6-7 but now they are around 9-10.
I haven't really changed my diet/routine, i start the day with a coffee with sweeteners - have done since day one, previously it would spike me ever so little to about 10mmol and drop within minutes back to a normal level, but now my coffee spikes me to 15 and it lingers for an hour or more. Basically whatever i consume i rise and linger.
I have a call back with the nurse today to speak about last weeks results, not that i can imagine she has anything that would be helpful for me.
I guess what i am asking is: Am i being ignorant to the fact my insulin needs are changing so soon? I do believe i am still in denial that i even got this diagnosis , which i believe was pretty much accidental. Although i was prediabetic a few years ago. I suppose i thought things wouldn't change much so soon and expected at least 5-10 years of holding off injecting multiple times a day. How soon after a LADA diagnosis did your insulin needs change?
Hopefully this post makes sense, i do tend to waffle on abit and don't really get out what i'm actually searching for lol
Thanks for taking the time to read.
Sarah

 

[In Response]

Hi @purrpleness
Are your insulin needs raising fast?
There is no right or wrong speed for us to need insulin. You will often see that "we are all different".
As you have "got the hang" of basal insulin, and not afraid of needles, in terms of injecting, bolus is just more of the same.
I was diagnosed 20 years ago and was started on a mixed insulin, which included some short acting, from day 1. This was changed to basal bolus after 6 months. My doses were small and very very slowly increased over 8 years. I see this as the time it took for my insulin producing cells to finally die off.
I have read that studies have shown if you inject insulin as soon as possible, it will take the strain off your remaining insulin producing cells and these will last longer. So, as well as reducing your BG (which will make you feel better), the bolus will help you.
I know the unknown is scary but, believe me, it is worth it.

 

[Antje77]

How soon after a LADA diagnosis did your insulin needs change?

I started basal a month after my (T2) diagnosis because it was clear that the gliclazide didn't do much. The insulin worked well, unless I ate something, so after another month I begged for mealtime insulin.
The amount of insulin I need (both basal and bolus) has steadily gone up for the first 4 - 5 years, and seems to have more or less settled in the last 2 - 3 years.
Rediagnosed as LADA two years after my initial diagnosis.

I suppose i thought things wouldn't change much so soon and expected at least 5-10 years of holding off injecting multiple times a day.

It's very unusual to not need both basal and bolus for years.

I saw my Endo in January, she thinks i should start 1 - 2 units of fast acting with my Lunch, as whatever i eat i linger between 16-21mmol for up to 4hours afterwards, and by that time its heading towards being in range, its time to eat again!! I have been a little bit worried to start this, so i have agreed to see a dietician next week for better understanding. I had my Hba1c tested a few weeks ago and it is now at 63. my CGM shows i am in range pretty much 30% of the time. My wake up levels would be between 6-7 but now they are around 9-10.

I would very much want to be able to dose for those meals, it must be so frustrating to see those high numbers all the time and not being able to do something about it.
You might want to look into the DAFNE course, which could be a great help in learning how to adjust your doses:

Home - DAFNE

DAFNE stands for Dose Adjustment For Normal Eating. It aims to help adults with type 1 diabetes lead as normal a life as possible.

dafne.nhs.uk

 

[ATB123]

Hi everyone,
wasn't sure what to call the subject of this post, basically i was diagnosed April last year hba1c of 50 - Type 2 for pretty much a couple weeks before i got my GAD positive results and have been on Basal pretty much since then. I saw my Endo in January, she thinks i should start 1 - 2 units of fast acting with my Lunch, as whatever i eat i linger between 16-21mmol for up to 4hours afterwards, and by that time its heading towards being in range, its time to eat again!! I have been a little bit worried to start this, so i have agreed to see a dietician next week for better understanding. I had my Hba1c tested a few weeks ago and it is now at 63. my CGM shows i am in range pretty much 30% of the time. My wake up levels would be between 6-7 but now they are around 9-10.
I haven't really changed my diet/routine, i start the day with a coffee with sweeteners - have done since day one, previously it would spike me ever so little to about 10mmol and drop within minutes back to a normal level, but now my coffee spikes me to 15 and it lingers for an hour or more. Basically whatever i consume i rise and linger.
I have a call back with the nurse today to speak about last weeks results, not that i can imagine she has anything that would be helpful for me.
I guess what i am asking is: Am i being ignorant to the fact my insulin needs are changing so soon? I do believe i am still in denial that i even got this diagnosis , which i believe was pretty much accidental. Although i was prediabetic a few years ago. I suppose i thought things wouldn't change much so soon and expected at least 5-10 years of holding off injecting multiple times a day. How soon after a LADA diagnosis did your insulin needs change?
Hopefully this post makes sense, i do tend to waffle on abit and don't really get out what i'm actually searching for lol
Thanks for taking the time to read.
Sarah

As soon as I got my LADA diagnosis i was put on bolus as well as the basal I had already been taking. I was pretty much like you before I started bolus. Spiking high after meals, taking ages to come down, A1c 3 months after starting basal was 64. However it took me much longer than you to get to the point where i was prescribed insulin, before that was treated as a T2 and boy did I struggle. I don't take much insulin, 8 units of basal and 2-4 units of bolus but it's made a massive difference to how I feel. I don't know whether eventually I will need more insulin, I'm assuming I'm not making much if any of my own as my Cpep was very low, but there's always hope that my pancreas isn't as useless as I thought it was! I don't find it too much of a chore to take insulin because I know how much better its made me feel!

 

[Finnlee]

I was diagnosed 2.5 years ago and put straight on a basal-bolus regime.

I was in DKA and had an HbA1c of 101, so my diagnosis was clearly Type 1. Three months after diagnosis, I had brought my A1c down to 57 and have been hovering in the low-mid 40s since then.

After figuring out my initial insulin needs, I haven't found they've changed much in the last two years besides monthly fluctuations related to my cycle.

On MDI, I was taking 8 units of basal a day and 4-6 units of bolus per meal. That's stayed pretty consistent in the last two years. Now I'm on a pump, so my insulin usage has reduced a bit and I use about 18-25 units per day (basal and bolus combined).

MDI is no one's idea of fun, but it (along with carb counting) gives us T1s a lot more freedom with what we can eat while keeping our blood sugar under control.

Also, insulin needs is like shoe size - you need what you need. Just like there's no point in trying to squeeze into a pair of shoes that's too small for you, there's no reason you should try to stay on a lower insulin dose than what your body needs.

 

[Antje77]

Another thing you might find interesting, @purrpleness , is how vastly different the amount of insulin needed is from person to person.

I don't take much insulin, 8 units of basal and 2-4 units of bolus but it's made a massive difference to how I feel.

@ATB123 only needs 8 units of basal, I need around 100. I need a lot more bolus than their 2-4 units as well.
It doesn't matter how much you need, it only matters that the dose is the right dose for you. I'm quite happy on insulin, it works well for me.

 

[purrpleness]

Thank you all for your responses.
I take 6 units of Lantus in the morning and it seems to keep me steady overnight, unless i have a snack in the evening of course. I think I'm a little worried that I'll get it wrong and the fact the odd injection does sting and i really don't look forward to jabbing myself whenever i eat.
My sister has been type 1 since childhood, she's 18months older than me, so i am not a complete newbie if you know what i mean, but now that it's my turn to take advice, i find it hard? or maybe just odd!
I was offered the course through my endo but unfortunately as much as i would like to do it, i have severe anxiety and can't think of anything worse than sitting in a room with a group of people - i literally have to drag somebody with me to every appointment i have had. The anxiety is nothing to do with my health, it came on suddenly, i have had therapy, changed jobs and i am getting there I have a pretty active job cleaning operating theaters in a hospital 4 nights a week, plus cycling too and from. I do get Hypos and have done for years, so if i don't eat at all, i drop. Mentioned it to my doctor years and years ago and she was like, it's nothing to worry about and dismissed it... so i know exactly what they feel like. I mention my job cause whatever carbs i eat for tea are fine due to going to work not long after eating. I am looking forward to seeing the dietician next week as i am hoping she can just explain more going by my cgm data and just help me with my confidence on the matter going forward.
I always have a good read through this forum and through the facebook groups, its amazing how everyone is different and i do understand no 2 diabetics are the same. I'm still learning and i thank alot you for all your knowledge