When to start insulin - A1C level?

[Red_Fox22]

Currently non-insulin dependent LADA two years after diagnosis.

Latest A1C was 57 which is down from 63 six weeks ago. My score of 63 was a blip, it was 48 three months prior.

So I am pleased with a fall but its been tough over the last 6 weeks, I have been very low carbing. Not sure how sustainable that is.

When do people think it is time to accept the A1C is too high and move on to insulin (or possibly other meds)? Currently on 1500 mg of metformin per day.

Ta

 

[KK123]

Currently non-insulin dependent LADA two years after diagnosis.

Latest A1C was 57 which is down from 63 six weeks ago. My score of 63 was a blip, it was 48 three months prior.

So I am pleased with a fall but its been tough over the last 6 weeks, I have been very low carbing. Not sure how sustainable that is.

When do people think it is time to accept the A1C is too high and move on to insulin (or possibly other meds)? Currently on 1500 mg of metformin per day.

Ta

Hi Red Fox, that's impossible to answer because everybody is different obviously. You presumably had the proper tests two years ago in order to diagnose lada? I am 57 years old and was diagnosed with type 1 two years ago (positive gad test seemed to decide it for them) but they sometimes referred to it as lada/type 1 depending on who I saw. Either way I went onto insulin on very low doses for the first 3 months, I kept going low so they said stop the insulin, I did this for the next 3 months but my levels went up to an A1c of 50, then they said go back on the insulin. I was low carbish throughout this time (aprox 60 per day). I use 1 unit of insulin for some meals and take long acting of 8 units once a day. This keeps me level and enables me to have far more choice when eating carbs. They did say this would also help my remaining beta cells by giving them a rest but I think the jury is out on that one. Personally, I am happier having insulin to use as and when I need it.

 

[Antje77]

I went on insulin because I didn't want to see double digits on my meter and I didn't want to go extremely low carb either. I like the freedom of insulin.

 

[SB.25]

I’m still awaiting formal diagnosis of my type, but was advised to go on insulin 2 months after being diagnosed as ‘diabetic’ (initial hba1c was 103).

At first I refused the insulin but after a difficult Christmas with levels all over the place. I went on slow acting (started at 6 units now on 14). I also as of this week started quick acting and my numbers have been amazing. I now have much more freedom when I eat and don’t always feel deflated when I check my blood sugars.

 

[Daibell]

NICE suggests a level of 7.5% in old money to consider starting insulin. Normally you would be on a further tablet such as Gliclazide for while which is what I did but insulin is preferable if you don't mind starting it.

 

[cz_dave]

My HbA1c was 40 and my endo put me on insulin (very low doses initially) immediately after I was diagnosed as LADA. Well, technically Type 1 as LADA is not an official diagnosis where I live.

If I was you, I would probably start insulin earlier than later.

 

[Ian DP]

Two years after Lada diagnosis I started on small amounts of insulin when my hba1c hit 40. My hba1c is now 36. In my opinion, best to start early. The earlier you start the longer the honeymoon period will last, if hba1c is kept low. Now nearly 6 years since diagnosis and still in the honeymoon period. I find taking insulin much easier and less obtrusive than testing. BG testing is a pain and sometimes very difficult, especially when traveling and eating in restaurants using public toilets. Taking insulin is much more straightforward, most of the time i can discretely do it at the restaurant table. Often I inject 3 units at the restaurant table as the meal is served, without testing. I am low carb high fat.

 

[Diakat]

Injecting without testing is not to be recommended.