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<blockquote data-quote="smidge" data-source="post: 289258" data-attributes="member: 29301"><p>Hi Julie and welcome to the forum!</p><p></p><p>I have read your post and agree with Jopar on the issue of which type of insulin regime would be best. In my opinion, bolus/basal is a much more flexible system.</p><p></p><p>Let me tell you a little about myself and then I'll make a few suggestions for you. I have a condition called LADA (Latent Autoimmune Deficiency in Adulthood). This is often referred to as Type 1.5 diabetes. It is an autoimmune form of the condition like Type 1, but comes on more slowly like Type 2. It is often misdiagnosed as Type 2 and then treated completely inappropriately. I was (mis)diagnosed with type 2 about 3 years ago and had a terrible struggle getting the medical world to see that I was not Type 2 and that I really needed to go on insulin. It took me a year to make them listen and I was very ill by then. So I know how frustrating it is when no-one listens to you!</p><p></p><p>OK, so firstly, 18 is absolutely NOT OK between meals. 18 is never OK. If you are Type 2, levels that high will be doing long-term damage. If you are type 1/1.5, it can be very dangerous as you can get a condition called ketoacidosis which needs urgent medical attention. So, my first suggestion is to make an appointment with your GP (not the nurse) and ask to be referred to a specialist diabetes clinic for tests to establish what type of diabetes you have. There are two main tests: GAD antibody test looks for a range of antibodies and if they are present that is usually indicative of an autoimmune type of diabetes (1 or 1.5); c-peptide test shows how much insulin you are producing. If you have high levels of insulin and high levels of glucose you are probably Type 2; if you have low levels of insulin and high levels of glucose you are probably Type 1/1.5. There are many reasons why you need to know this, but basically, Type 2s are often insulin resistant (i.e. produce insulin but cannot use it) and so if they inject insulin, often need much higher doses than Type 1/1.5. Type 1/1.5 produce little or no insulin and must inject insulin to cover background (basal) and any food we eat (bolus).</p><p></p><p>As Jopar said, with the type of insulin you are on, you must inject an amount and then eat the right amount of carbohydrate at the right times to match the insulin. With the bolus/basal regime, you will need to inject 4 or 5 times a day. I inject basal in the morning and evening and bolus with every meal. This means that i can count the carbs in my meals and inject just the right amount of insulin for each meal - this helps to avoid hypos and enables me to get good control of my glucose levels. If my blood glucose does go too high occasionally, I can take a correction injection of bolus and bring them back under control. I would suggest this might be a more suitable insulin regime for you. Counting carbs seems daunting, but it isn't as bad as you might think - it takes a while to get used to, but it becomes secoond nature - there are books you can buy that give you the carb value of almost all the foods you eat.</p><p></p><p>Make sure you test your blood glucose (BG) at waking, before and 2 hours after each meal. Keep a diary of everything you have eaten (including amounts - weigh your food). Write down all your test results. This is your evidence that your current regime is not working for you - take this diary to your GP, diabetes nurse or any specialist you might see - it will help them decide on an appropriate course of action. I am afraid you need to make a fuss - don't be fobbed off, this is your health we are talking about and your current treatment is not good enough. If your doctor will not refer you to a specalist, call your PALS (Patient Advisory and Liaison Service) and see if they can help.</p><p></p><p>Take care and ask any questions you need to - there are always some of us Type 1/1.5s around to share our experiences of controlling BG with insulin.</p><p></p><p>Smidge</p></blockquote><p></p>
[QUOTE="smidge, post: 289258, member: 29301"] Hi Julie and welcome to the forum! I have read your post and agree with Jopar on the issue of which type of insulin regime would be best. In my opinion, bolus/basal is a much more flexible system. Let me tell you a little about myself and then I'll make a few suggestions for you. I have a condition called LADA (Latent Autoimmune Deficiency in Adulthood). This is often referred to as Type 1.5 diabetes. It is an autoimmune form of the condition like Type 1, but comes on more slowly like Type 2. It is often misdiagnosed as Type 2 and then treated completely inappropriately. I was (mis)diagnosed with type 2 about 3 years ago and had a terrible struggle getting the medical world to see that I was not Type 2 and that I really needed to go on insulin. It took me a year to make them listen and I was very ill by then. So I know how frustrating it is when no-one listens to you! OK, so firstly, 18 is absolutely NOT OK between meals. 18 is never OK. If you are Type 2, levels that high will be doing long-term damage. If you are type 1/1.5, it can be very dangerous as you can get a condition called ketoacidosis which needs urgent medical attention. So, my first suggestion is to make an appointment with your GP (not the nurse) and ask to be referred to a specialist diabetes clinic for tests to establish what type of diabetes you have. There are two main tests: GAD antibody test looks for a range of antibodies and if they are present that is usually indicative of an autoimmune type of diabetes (1 or 1.5); c-peptide test shows how much insulin you are producing. If you have high levels of insulin and high levels of glucose you are probably Type 2; if you have low levels of insulin and high levels of glucose you are probably Type 1/1.5. There are many reasons why you need to know this, but basically, Type 2s are often insulin resistant (i.e. produce insulin but cannot use it) and so if they inject insulin, often need much higher doses than Type 1/1.5. Type 1/1.5 produce little or no insulin and must inject insulin to cover background (basal) and any food we eat (bolus). As Jopar said, with the type of insulin you are on, you must inject an amount and then eat the right amount of carbohydrate at the right times to match the insulin. With the bolus/basal regime, you will need to inject 4 or 5 times a day. I inject basal in the morning and evening and bolus with every meal. This means that i can count the carbs in my meals and inject just the right amount of insulin for each meal - this helps to avoid hypos and enables me to get good control of my glucose levels. If my blood glucose does go too high occasionally, I can take a correction injection of bolus and bring them back under control. I would suggest this might be a more suitable insulin regime for you. Counting carbs seems daunting, but it isn't as bad as you might think - it takes a while to get used to, but it becomes secoond nature - there are books you can buy that give you the carb value of almost all the foods you eat. Make sure you test your blood glucose (BG) at waking, before and 2 hours after each meal. Keep a diary of everything you have eaten (including amounts - weigh your food). Write down all your test results. This is your evidence that your current regime is not working for you - take this diary to your GP, diabetes nurse or any specialist you might see - it will help them decide on an appropriate course of action. I am afraid you need to make a fuss - don't be fobbed off, this is your health we are talking about and your current treatment is not good enough. If your doctor will not refer you to a specalist, call your PALS (Patient Advisory and Liaison Service) and see if they can help. Take care and ask any questions you need to - there are always some of us Type 1/1.5s around to share our experiences of controlling BG with insulin. Smidge [/QUOTE]
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