Finding more difficult to control

If your GAD test came back positive, then you are type 1 and you should go on insulin. The sooner the better.

I was on oral medication for 1.5 years before being put on basal insulin. (Long lasting insulin to keep my levels in check between meals.) After 6 months of dealing with stupid spikes after meals (hitting 11-13 sometimes) I was put on bolus insulin (rapid acting to deal with the food I eat) and taken off gliclazide.

I really regret not having been able to go on a full basal and bolus regime from the moment insulin was necessary. It was really rough dealing with the spikes and not being able to fix them despite my best efforts in my diet. I'm still taking Metformin as there are no side-effects to taking it for me, but I have a much better control over my values now that I'm taking insulin as well.

You have to remember that although LADA generally enjoys a very long honeymoon where the pancreas still produces insulin, it will stop at some point and insulin is necessary no matter what you do. While treatment does vary depending on the doctor, you also need to consider that acting before issues rise is the way to go. Even if your HBA1C is good, the fact you spike as high as 11 after a meal is not. That matters just as much if not more.

There really is no harm in starting insulin now. You might only need very small amounts, but if you can take even 1 unit to manage the post-meal spikes then you're already on track to maintaining good health and minimize your risks of complications down the line. If your doctor doesn't bring it up, I recommend you do.

Boozon said:

Thanks @DaftThoughts and @cz_dave.

Will explain the spikes to my dr on the 1st March. As much as I'd prefer not to inject (as everyone would!) I'd like to get on insulin as soon as possible to prevent what you mention above. I'm surprised my dr didn't start me on insulin 6 months ago!
I hope he doesn't base everything on just my HBA1C results.

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I know what you mean. My HbA1c was horrible but they still tried to put insulin off for the longest time for me.

Just remember that a doctor's advice for treatment is not a final verdict. You know your body best. The spikes are a warning sign that your body doesn't produce enough insulin to cover the food you eat, and while HbA1c can be useful, it's also limited and doesn't necessarily reflect what's happening. Think of it like BMI, it has its uses, but it doesn't always work out for everyone on an individual scale.

If you don't already do this, I'd like to suggest that you write down what you eat and how many grams of carbs are in your meal, what your bloodsugar is before you eat and what it is 2 hours after you eat, ever single day up until your appointment. That will give a very good indication of what's happening with the foods you eat and how your body responds, and help show your health care team that insulin would be a good choice.

Hi. You will be able to delay insulin for a while using Gliclazide or similar tablets to stimulate the pancreas but don't allow anyone to delay insulin for too long as my stupid diabetes GP did for me. When your HBA1C in old money goes above 7% then look for insulin. Your numbers currently look very good so you may have a few years even before insulin, but it's a lottery.

I should have been in insulin earlier as well. They put me on amaryl until that destroyed the beta cells I had left. On to insulin. It really isn't nearly as bad as I thought. The finger sticks hurt worse. The tummy rarely does. I still eat vlc as it's the only way I can get my insulin there at the same time as my food but that's my choice. I prefer fat over carbs so it works out well. Insulin sure beats walking in freezing or rainy weather which I used to do to bring down spikes!

Boozon said:

Thanks @DaftThoughts and @Daibell. Just to give you an idea of my levels.
Fasting 6am - 6.4
Got home from work about 1645 - 5.6
Had piri piri chicken a few chips and peas (then stupidly had one After eight!)
Tested 2 hrs later 9.0......was expecting it to be worse.
Not sure whether I'm worrying too much which makes things worse but don't want to get to a point where I'm in hospital.
Dr said something interesting to me a few months ago 'we'll know something has changed before you do'....not sure if he meant that due to the fact he's told me I shouldn't be testing.

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Those values look pretty good to me. Some people consider 9.0 on the high side, but this is also a very individual thing. 9 for me is my preferred max, as I used to go up to 13 after meals even with gliclazide, metformin and basal insulin.

Do you feel okay when your value is around 9? Some people feel horrible when they're 'that high' while others feel perfectly fine. Use how you feel as your main guideline for this, especially considering you're so frequently around lower values.

Worrying will also mess with your levels. Remember that DKA only happens when your body doesn't produce enough insulin anymore, something that isn't the case for you at this time. You will notice an increase of thirst, urinating and persistent high levels (typically 15+, sometimes up in the 20's for prolonged periods of time). Then you'll feel tired, nauseated and struggle to focus. Considering how diligent you appear to be about your health, I'm assuming you'll catch the early onset of these symptoms very easily and can take action immediately without any damage to yourself. Hospitalization generally only happens when symptoms are ignored and people refuse to see a doctor.

I recommend you keep testing frequently, maybe even get a ketone testing kit to test once a week, and if you notice a gradual increase in your values and symptoms, ask to be put on insulin immediately. If your GP refuses, get a second opinion from a specialist. I honestly wouldn't worry if you're taking these steps!

Not sure what your GP meant with that comment, but if we pay attention we catch things way before they do.

Boozon said:

As much as I'd prefer not to inject (as everyone would!)

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Kristin251 said:

It really isn't nearly as bad as I thought. The finger sticks hurt worse.

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I'm with Kristin on this. Everyone thinks, oh, injections, that must be so painful then I show them a 4mm needle which is so small that they have to screw up their eyes to see it and they say is that all? People have maybe got preconceptions from nurses attacking them with inch long heavy gauge needles (those do actually freak me out) but it's totally different with a 4mm - there is no pain.

Mind you, I still remember my first self administered shot in hospital after dx when the needles were bigger. My dad was there doing the paternal support bit, and said, "well done, son" and then gave me a hearty slap on the back while the needle was still in my leg. I could've decked him.

Scott-C said:

I'm with Kristin on this. Everyone thinks, oh, injections, that must be so painful then I show them a 4mm needle which is so small that they have to screw up their eyes to see it and they say is that all? People have maybe got preconceptions from nurses attacking them with inch long heavy gauge needles (those do actually freak me out) but it's totally different with a 4mm - there is no pain.

Mind you, I still remember my first self administered shot in hospital after dx when the needles were bigger. My dad was there doing the paternal support bit, and said, "well done, son" and then gave me a hearty slap on the back while the needle was still in my leg. I could've decked him.

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OMG and here I thought my cats trying to jump into my lap while taking the shot was bad!!

I can confirm that though, the shots themselves are easy and mostly painless. There aren't many nerve endings in the belly and thighs. 2 out of 10 shots sting a bit, but that's half second and then I don't feel anything anymore. The worst part about starting insulin is the way you amp yourself up for the first shot. I had massive anxiety and panic attacks for 2 days before my brain finally realized it's no big deal.

If you insert the needle fast and inject the insulin slow, you'll wish that's all you had to do to treat your diabetes it's that easy.

When I first started I had the syringe and via that was not fun. The pen is fabulous !!

I wish my highs were only 9. I I am currently being treated as a type 2. I am currently taking 2000mg metformin, 4mg glimpiride, 2 weeks ago I started injecting lantus, am taking 18 units of lantus. I am also eating moderate carbs of between 75-150g. My fasting bg is between 15 and 19, and going up to as much as 29 during the day.

Fi2000 said:

I wish my highs were only 9. I I am currently being treated as a type 2. I am currently taking 2000mg metformin, 4mg glimpiride, 2 weeks ago I started injecting lantus, am taking 18 units of lantus. I am also eating moderate carbs of between 75-150g. My fasting bg is between 15 and 19, and going up to as much as 29 during the day.

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Oh wow! That is way high especially while on that medication. Are there any plans to switch you over to bolus insulin and take you off the glimepiride?

So the plan is to keep increasing the lantus until my fasting bg is 7 or less.
At the mo I am just so fed up feeling rotten because my bg levels are so high. I am fed up with my diabetes nurse as I feel that my high bg levels could be treated faster.

Fi2000 said:

So the plan is to keep increasing the lantus until my fasting bg is 7 or less.
At the mo I am just so fed up feeling rotten because my bg levels are so high. I am fed up with my diabetes nurse as I feel that my high bg levels could be treated faster.

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I'm immediately questioning your DNS' approach. Your values are ridiculously high, in a very dangerous zone, and I highly doubt that bumping your Lantus dose up until you're in an okay range is the right approach here.

I would request a C-peptide test if I were you, it sounds like your insulin production is nearly non-existent. In that case you need to go on an immediate bolus/basal regime and drop the glimepiride.

I'm actually very upset about this because you could be facing DKA at this rate, and your nurse seems horrifically lax in their approach. Get a second opinion ASAP if you can't get this sorted before the damage is done.

Thank you for ur support. I've a fon appt with my diabetes nurse on wed, I think I will dig my heels in and push for something to be done sooner rather than later.