LADA/1.5 question - insulin

[Mileana]

Hi all, and you LADAs especially.

I've been having very good control on minimal insulin and low ish (-50g) carb for a while now.

Suddenly, however, that is not the case - my fasting blood sugars are creeping up over 6 again and I struggle to get my bolus right.

I am guessing I need to adjust my basal then - the 4 hour fasting tests see a rise in bg by about 1-2 mmol over a 4-5 hour period.

I suppose I can translate that to I need to up my basal by about 5-10 percent.

I don't really know what my question is, lol - I think it is: Is this a sensible thing to do, and Is this normal for things to go this fast over just a week or two for us LADA people?

I'm still trying to get my head around this autoimmune thing and sometimes I suppose I try to predict what it will do - which probably isn't possible, so I need to look at the results and adjust that way around - is slightly frustrating as you peeps will probably understand, as I had just found some balance that seemed to work, lol.

-M

 

[Sanober]

Hey Mileana. Talking of LADA progression my insulin requirements changed 4 months since I started it.

If you feel that the basal's pulling your blood sugars into hypo territory then 1 unit adjustment should be attempted. The Using Insulin book (which I totally recommend) suggests that the sugar lows and basal should be the one to adjust first. The best means to asses the basal's efficiency is to test 2-3am for a couple of night's as long as you go to bed with decent reading and no other external factors are present to affect things e.g booze, exercise etc. If the basal's set correct it should only drop down by 0.7-1.8 at the most by dawn.

 

[Sanober]

The book suggests that the correct basal should allow you to skip a meal without going hypo. I'm on 14 units Lantus in the morning, following my frustrations with the dawn phenomenon I adjusted to 15 and I woke up in the 5-6s but I was dropping below 4s for the rest of the day and I exercise now 5 times a week minimum. My 14 units are steady to 2-3am but drop by about 1-1.5 by dawn but then if I don't take my Lantus by 6.45am...my liver dumping pushes me higher by 8am onwards ho hum. I wake up in the 7s if I take my Lantus on time. Wish there was a half unit Lantus.

 

[Mileana]

I can skip a meal 'a bit too well' without going hypo and I wake up just around +1 from where I went to bed, maybe +2 sometimes.

When I had my Levemir too high, I used to hypo a lot when moving my pinky finger, heh, but now it's a bit the other way around - I guess I will add a unit to it.

My Levemir is split dose - currently 8+8 - but then I am a big woman still, heh.

Will see tomorrow whether the same is still the case and if it is, I'll adjust. Been on an 8 mile walk today so will not do it just today. An 8 mile walk would normally see me needing a little bit of carb - perhaps 10g to stay above 4 mmol. That is where I would like it to be - steady when not over-doing it, dropping slowly but steadily when I am, and not going up loads from a low carb meal. However today on that walk, I couldn't push it below 6, so that's a bit of a bummer, heh.

I checked my overnight stuff a couple or weeks ago when I had good control in the day time, and at that time it was fine, steady drop from 6 to 5 ish over night, so I'm not suspecting a night time hypo when it looks to be working less well during the day.

 

[Mileana]

Btw, have you considered your lantus in split dose?

 

[smidge]

Hi Mileana!

LADA is tricky sometimes - you're right in that it is very difficult to predict, so I usually end up reacting instead. I get exactly the same situation as you have described - everything settled and working for a couple of months and then BAM off we go again :roll: I usually keep my basal low and adjust the rapid-acting (Apidra). The trouble is, you don't know what your own basal is doing, so it's difficult to get your basal dose right. I think splitting the basal into two small doses helps. I use Insuman basal (which is an intermediate acting, so a bit different from your Levimir). I used to take it 10.00pm to keep the BG steady overnight. That worked brilliantly for fasting and breakfast, but I was finding that my BG was rising in the evening 3 or 4 hours after food even though the Apidra got the 2 hour reading perfect. So I changed to splitting the dose 3 units 6.30am and 4 units 6.30pm. This gives me a much better coverage, but now my fasting levels are not so good sometimes.

Before changing the basal dose, I'd consider what time you are taking your basal and whether it's lasting long enough i.e. is it covering the whole day? I see you're already on a split dose, but as Levemir lasts about 18 hours for many people, you will sometimes have two lots and sometimes 1 lot active - I'd work out which times of the day you have the double dose and which you have the single dose - you might need to adjust your rapid-acting ratio to take account of that. I know that Insuman has a peak at 4 -6 hours, so I have to adjust my Apidra ratio down if it's peak is going to coincide with the Insuman peak. If you're sure your coverage is right, then you are on the right track changing the basal dose. However, be prepared to back-track quickly! I usually find that I have a couple of weeks where my readings are a bit high and then they fall again and I find myself chasing slight lows. For example, my breakfast is 15g carbs and usually requires 1.5 units Apidra. Over the course of a couple of weeks though I can find I need to take 2.5 units for the same meal, then suddenly it returns to 1.5 units. That's why although I sometimes know it's the basal that needs tweaking, it's usually easier to tweak the Apidra - if you see what i mean.

Could you be reacting to your menstrual cycle? I do find that I get a bit of insulin resistance leading up to my period and this disappears very suddently as soon as the period starts.

It's all a bit trial and error I'm afraid. An art rather than a science :lol:

I hope you get it sorted soon as you are doing very well.

Smidge

 

[Mileana]

I'm trying at least, thank you lol.

I'll try and do that maths and see if there's any pattern - there might actually be.

I don't know to be honest when my time of month is as I don't have those parts apart from 1 ovary - may be I am getting to that age... Early I know, but was warned about that when I had surgery.

Will do a bit of thinking.

Thank you for the input.

-M

 

[Mileana]

Okay.

I have put some lines on some paper - I R good, lol.

Now what seems to be the best thing to do is to do a triple split Levemir. 9 am, 6pm and 1am. (I get up a bit late, heh).

Am I raving mad for considering that?

That would leave my insulin resistant mornings 'triple covered' and the rest of the day there would be two active injections if we go by the 18 hour profile?

With the current dual injection, all the early afternoon and all the early am's are only covered by one injection...

The extra injection before bed I wouldn't mind... I'm over that part, lol, I just want control, lol. (Wish I had a pump, heh).

 

[Sanober]

Triple filtered basal....hmmm now there's a thought haha

I think Lantus has a long profile compared to other basal's but I will surely look into splitting it, I will speak to my DN. If I can have some overlap for my own insulin resistent mornings then that may be the way to go. For now I get up early to put in single shot of Lantus. If I'm late with the Lantus and going high, I will correct and delay breakfast or get on the bike.

Diabetes does keep us on our toes doesn't it. Ho hum.

 

[smidge]

Hi Mileana!

No, that's not daft, there are other forum members who split their Levemir into three doses. Having said that, if there is a specific time of the day you are struggling with, then maybe an intermediate acting basal like Insuman or Humalin I would be a better basal for you; these have a definite peak at 4 - 6 hours rather than the flat profile that Levemir and Lantus have. They are supposed to last for 16 hours, but I find that my Insuman is spent by around 11 or 12 hours - hence the split dose. They are not supposed to be as good as Lantus or Levemir for type 1 as they don't mimic the flat action of natural basal insulin, so they are used more frequently for type 2s who need something to supplement their own insulin. However, with LADA, you will probably be producing some of your own basal insulin, so you might find they work better for you.

Good luck

Smidge

 

[Mileana]

I think I have a relatively normal pattern in that my mornings I am more insulin resistant - my Carb Ratio is about half of what it would be in the pm's. I can sort of live with that.

I tried shorter acting 'basals', but they drove me up the wall because I would have to be careful to not exercise around the time when they peaked, and I need the flexibility.

I think I have some insulin of my own - I must have, I guess. It just seems very stable. And I can be sure that if I skip any insulin at all on a moderate carb diet, I see 20's and 30's, so there's no chance that I would keep up without a proper basal. On a low carb diet I still have to have active insulin kicking around or I'd spike to the teens. I can skip the Rapid if I stay under 10g per meal, but it seems to work best if I do 1 unit and 15-20g, so I don't think I would be up for a less stable basal at this point. I can force my body to use all the sugar, but only if I have insulin around. I reduce my basal for long walks, but if I even think about omiting them or more than half of my morning dose, I'll have teen readings again.

Sometimes I wish I knew exactly what my own insulin does, though - I've caught myself these past days thinking 'can't wait till it gives up so I know what I got' - that's of course not the best wish to come up with, but it's just somehow a bit frustrating knowing your body is eating your pancreas, but not quite how fast and when and all that...

I think I may have found part of the error though in that one of my pens is taking in air somehow when it shouldn't - I suspect it may have had a bump somewhere in the process, and as it's my last, I will have to have a new set tomorrow. If that doesn't do it, I'll go triple I think, and see if that helps.

 

[Sanober]

Sometimes I wish I knew exactly what my own insulin does, though - I've caught myself these past days thinking 'can't wait till it gives up so I know what I got' - that's of course not the best wish to come up with, but it's just somehow a bit frustrating knowing your body is eating your pancreas, but not quite how fast and when and all that...

Oh I know THAT thought, I feel like that sometimes, so you're definitely not on your own there. :yawn:

 

[Mileana]

:roll: And I was beginning to think sometimes it was me who was mad. :lol:

But yes, it is sometimes a tad tricky. Glad somehow that I'm not the only one...